The coronavirus disease 2019 (Covid-19) situation gets more critical around the world as new daily confirmed cases increased from 14,000 in February to 290,000 in July. As of August 7, more than 19 million people were infected and 700,000 worldwide died of Covid-19. After six months of fighting the disease, notable trends are emerging.
Second wave
The SARS-Cov-2 — severe acute respiratory syndrome coronavirus 2 — is a different virus from others in that the patient who has it carries a high viral load, and he is infectious before clinical signs set in. The test is only positive around five days post-infection; test-negative persons might be carrying the virus if they were infected in the last five days.
There are asymptomatic but infectious people who can only be identified by the nucleic acid test.
Many countries in Asia and Europe saw a second wave of outbreaks in July after their April peak. Rebound in most countries was not as severe as the first wave, but countries such as Japan and the Philippines witnessed a new high.
China built an extensive monitoring and treatment system after the initial outbreak and declared itself clear of the virus in April. It, however, has faced sporadic local outbreaks since May.
The second wave phenomenon has shown that the virus is extremely sticky. The World Health Organization (WHO) warns that Covid-19 is the disease of the century and will likely be around for a long time.
Virus pathogenesis
The virus was isolated six days after a sample was taken on December 30. Its genome sequence was published on January 11, with a test kit available before January 20. This unprecedented speed is a landmark in science.
But how the virus causes disease and how it is transmitted remain unknown in many ways. All laboratory data show that the new coronavirus is temperature-sensitive and self-decomposes at high temperatures. But the second wave in the summer in many countries demonstrated that the hot weather was not a critical transmission-blocking factor when there were many human carriers.
On the other hand, the outbreaks at Beijing and Dalian public markets in China and the explosive second wave in Australia in the winter showed that the virus could thrive in low ambient temperature and humid environments. Many experts have warned of a winter resurgence of Covid-19, and countries should work hard to hold down infection levels before the temperatures drop.
Epidemic fatigue
Epidemic fatigue is evident in many countries now. Despite the resurgence of infections, few countries are using the costly but effective lockdown to slow down transmission as they did in March and April. The financial pressure forced most governments to lower virus-control objectives from elimination to containment. The less effective testing, isolation, social distancing and wearing of facemasks are the policy of choice today.
The governments are pinning hopes on early availability of effective vaccines.
Most countries have ended financial support to businesses and workers affected by the infection. They are facing very worsening economic and social dislocations if vaccines coming out are not as effective as expected or delayed.
Vaccine development
Speedy vaccine development provides a bright spot amid disturbing news. Three Chinese vaccines by CanSino, Sinovac and Sinopharm, Oxford-AstraZeneca from the United Kingdom, Moderna from the United States and BioNTec-Pfizer of Germany-US are undergoing large-scale phase 3 clinical tests now.
All six vaccines are safe and elicit both neutralizing antibody and cytotoxic T-cell response in the small-scale first and second phase clinical tests. Early successes, however, do not guarantee success in the large-scale phase 3 clinical tests involving 30,000 test volunteers. The questions on immunization duration and protection levels remain unknown today. The ideas of Dr. Zhong Nanshan and Dr. Anthony Fauci, the two foremost experts on Covid-19 in China and the US, that regular activity will likely resume only in the spring/summer of 2021 is still the best bet even with the accelerated vaccine development.
The Philippines has already reached out to the major vaccine developers for possible purchase, and China has vowed to prioritize the Philippines while Russia has also offered cooperation and supply of its vaccine developed by N.F. Gamaleya.
The world faces months of uncertainty before the vaccine appears. Two policies can help to mitigate the current situation: Strengthening public communication and adopting pooling testing.
Stronger public communications
The cardinal tenet of treating infectious respiratory disease by “early testing and effective quarantine” remains the gold-standard approach in this age of molecular medicine. In this highly urbanized era, effective quarantine calls for cooperation of the public. The adage, “No one is safe until everyone is safe” is more important than ever.
The thought that testing holds the key to solve the problem today is only half-true.
Misunderstanding over negative test results accounted for many infections in the US and Russia. The US has nearly 190,000 tests per million people, and Russia has 200,000 — both are among the most tested nations in the world — but they are also among the most infected. Some citizens became complacent after testing and forget that testing tells the story of yesterday and they must take measures to prevent infections today.
After six months of fighting Covid-19, the world has halved mortality rates from 5 to 6 percent at the beginning to 2 to 3 percent. Early testing reduced the chance of mild illness from becoming severe; regular testing and effective isolation of vulnerable groups, such as the elderly, helped to cut deaths; younger patient profiles are reducing the death risk and the hospitalization need; the extensive use of the inexpensive, effective drug, Dexamethasone, helped in reducing mortality.
Halving mortality does not mean the Covid-19 is less threatening, 2 to 3 percent is still unacceptably high. Some countries have promoted the mortality and hospitalization reduction as an achievement and downplayed the epidemic infection. Dr. Fauci lamented that many young people do not wear masks, gather in bars and go to the beach when the US infection number is hitting 5 million.
Best practices
The six-month experience proved that “early testing and effective quarantine” is the best way to deal with Covid-19. A country’s ability to put it to work marks the difference between success and failure.
China and South Korea, the first two countries in the Covid-19 outbreak, had also succeeded in controlling the second wave, providing valuable lessons to other countries.
China recently used pooling tests to control community outbreaks, showing that it was technically and operationally feasible to test hundreds of thousands of people within the narrow window of Covid-19 and break the infection chain. In the pool test, the nucleic acid sample of 5 to 10 people is mixed and tested. If negative, then all are declared free. If positive, all the individuals will be tested individually to find out who carries the virus.
Community cluster outbreak is the fear of medical authorities because it makes tracing almost impossible to follow. The ability to conduct a rapid large-scale community testing is useful. Hong Kong is going to do community testing on all residents in two weeks, and Vietnam is studying similar methods at Danang.
The WHO described Covid-19 as a historic medical problem. Countries should review and adopt holistic best approaches to control the disease. This advice should not be ignored!
Part of Series:
Covid-19 turns into an education crisis
Second wave or extension of the first?
Dr. Henry Chan is an internationally recognized development economist based in Singapore. He is also a senior visiting research fellow at the Cambodia Institute for Cooperation and Peace and adjunct research fellow at the Integrated Development Studies Institute (IDSI). His primary research interest includes global economic development, Asean-China relations and the Fourth Industrial Revolution.
New Worlds by IDSI (Integrated Development Studies Institute) aims to present frameworks based on a balance of economic theory, historical realities, ground success in real business and communities and attempt for common good, culture and spirituality. We welcome logical feedback and possibly working together with compatible frameworks (idsicenter@gmail.com).
**Also published in: https://www.manilatimes.net/2020/08/09/opinion/columnists/what-is-happening-while-waiting-for-the-covid-19-vaccine/752760/