After more than two years of living with the Covid-19 pandemic, the world and Malaysia are fatigued.
We want the pandemic to end and for all of us to get on with our lives. But is the end in sight?
Just wishing for it to happen will not make it so. Fortunately, vaccines have significantly improved outcomes, but this has only limited success and we will have to contend with future variants.
We want to restore our jobs, revitalise the economy, get our children back to school, and allow our health care services to focus on the many outstanding health needs.
But to make these important changes, we must not lose sight of the threat that Covid-19 still poses to the community, and keep in place vital measures.
What Endemic Is Not
The constant talk about ‘endemic’ has sadly begun to lull many in the world and Malaysians as well into complacency. As experts from the World Health Organization (WHO) clearly express, endemic is not the same as ‘good’ or ‘better’, and that endemic does not imply mild or milder.
Dr Maria Van Kerkhove, an infectious disease epidemiologist and technical lead for the WHO said in February 2022: “The next variant of concern will most likely be more transmissible as compared to Omicron, because it will have to overtake the strains that are currently circulating. Future variants may also have a greater ability for immune escape (vaccines will not be as effective against them).”
It is extremely difficult to predict what will happen in the immediate future, as the situation is dependent on many factors, which include new vaccine-resistant variants of concern emerging, waning immunity from current vaccinations, better vaccines, new therapeutics, what level of burden that disease and disruption have on the health care capacity that we are willing to accept, and what long-term meaningful social behaviours and changes the public will make.
The reality about Covid-19 is that it is here to stay for a long time, and it will continue to impact society in various ways.
We Must Appreciate The Full Impact Of Covid-19
As we discuss the move to a more ‘open’ and ‘relaxed’ stance, we must remember that there are three main effects of Covid-19 infection.
Firstly, the immediate hospital admission, organ damage, and death risk. This is dramatically reduced by vaccination.
However, from good data acquired locally and overseas, we know that the elderly and vulnerable (those with chronic diseases, and those who are immunocompromised or disabled) still have a significant risk of hospitalisation and severe illness if they do not get a booster.
In addition, not all vaccines are the same. A recent study from Hong Kong (released March 2022) showed that the two-dose vaccine effectiveness against severe disease and death for Pfizer was 88.2 per cent (95 per cent CI: 84.4 per cent, 91.1 per cent) and for Sinovac 74.1 per cent (95% CI: 67.8 per cent, 79.2 per cent).
This means that there would be 12 to 17 per cent less deaths if two doses of Pfizer were used, compared to two doses of Sinovac for those aged over 60.
Three-dose protection (booster) for both vaccines was good at 98.1 per cent (95%per cent CI: 97.1 per cent, 98.8 per cent). Hence, it is worrying to see booster rates of only 61 to 72 per cent among those aged 60 and older, especially if they had the Sinovac vaccine as their primary vaccination.
Remember that young adults with comorbidities or disabilities also need boosters.
Secondly, the intermediate risk of long Covid, even for those who had mild infection. Adult long Covid rates are in the range of 20 to 30 per cent. Data from the United Kingdom’s Office for National Statistics on Long Covid in children showed that 1.0 per cent of all primary school and 2.7 per cent of secondary school students have experienced long Covid, lasting up to a year for 15 per cent.
Recent data pooled from 21 studies from Europe, Asia, Australia, and South America showed that up to 25 per cent of children infected developed long Covid.
Hence, our poor vaccination rate for children aged 5 to 11 (37 per cent first dose rates) is of serious concern. Vaccination can reduce the risk of long Covid by up to 50 per cent.
But note that you still have a 9.5 to 14 per cent risk of developing long Covid if you have a breakthrough infection after two-dose vaccination. This should be a good reason to take precautions to avoid getting infected.
Thirdly, the still poorly understood long-term effects of Covid-19 on the brain and other organs (heart, lungs, endocrine organs, etc.), which may lead to chronic ill-health or even disability years from now.
Preliminary studies suggest that these long-term effects do not always appear to be related to the severity of the infection, and can occur even in those who had asymptomatic infection.
We must count the cost of the long-term disability risk of this pandemic. We also have a mental health pandemic that has risen in tandem with the Covid-19 pandemic.
Vital Measures Needed In Society In The Coming Months
As a society, we need to make significant long-term changes — a new way of life for now and in the post-Covid era that will enable us to live better, deal with potential new challenges Covid-19 throws at us, and face the next possible pandemic. This is a summary of the essentials:
1. Get Your Boosters Yesterday
Those aged 60 years and older and young adults with comorbidities, disabilities, or are immunocompromised need boosters before the next wave (possibly a BA.2 wave in April 2022).
2. Please Vaccinate Your Children Now
Note that 63 childhood deaths due to Covid-19 occurred in the past 24 weeks; two-thirds in the past three months, and mostly in children under 12. Please vaccinate all children aged between 5 and 11 before they get infected. We hope to have the data that supports vaccination of younger children soon.
3. Use A Good Mask, Always
We must improve the mask quality in our community. Good cloth and surgical masks are only 60 to 75 per cent effective. We need to use FFP2 or KF94 masks. Make sure they are reliable because many masks sold online may be fake. These masks have a better fit and filtration, and are especially useful indoors.
4. We Have Failed To Improve Indoor Ventilation
It is sad that despite the good data, we have yet to make mandatory changes to optimise ventilation in all buildings and rooms. Suggestions will be not be enough — we need mandated changes that include monitoring. Only then can we keep our children in schools and staff in offices safer.
5. Not All Outdoor Locations Are The Same
While some nations have removed mask mandates outdoors, we must remember that not all outdoor locations are the same. A crowded pasar malam, Ramadhan bazaar, and outdoor shopping area pose greater risk than jogging in the neighbourhood or walking in an urban park. Keep your mask on in crowded locations with limited spacing and prolonged exposure.
6. Support Employees
We need to change our work ethics and behaviours to allow routine work-from-home arrangements, offer paid leave for unwell staff members, and move more meetings and conferences online.
7. Time To End the Fake News Pandemic and ‘Covid Wars’
Currently, measures to fight Covid-19 are hampered by a continuing fake news pandemic. We must work collectively to stop this. In addition, we have what I call ‘Covid wars’ among medical personnel. We need to be data and science-based and present the full picture to minimise confusion among the public.
8. Invest in Our Health Care System
Our national health care system has been deteriorating. We have failed to deal with social determinants of health, have grossly underspent on health care, have not supported health care workers adequately, and focused too much on curative medicine and hospitals, while neglecting prevention and public health. We must reverse these trends to make our national health care system more robust to deal with pandemics like Covid-19.
We may be making a move to an endemic state, but the virus may not have got the memo. Many nations that have good vaccination rates and have lifted restrictions have suffered new waves, showing us how fragile we still are in the face of Covid-19.
The Covid-19 virus and its new variants will exploit any and all weaknesses. Continuing vigilance is required both by the authorities as well as the public. We can only succeed if we are together.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.