What is Happening While Waiting for the Covid-19 Vaccine
The Covid-19 situation gets more critical around the world as daily new confirmed cases increased from the 14 thousand of February to 290 thousand in July. As of August 7, more than 19 million people infected and 700,000 died worldwide. After six months of fighting Covid-19, notable trends are emerging.
Characteristics of the Second Wave:
The SARS-Cov-2 is a different virus from others; the patient 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 virus if he is 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 is 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 following the initial outbreak, and declared itself clear of the virus in April. However, it still faces sporadic local outbreaks since May.
The second wave phenomenon has shown that the virus is extremely sticky. WHO warns that Covid-19 is the disease of the century and likely around for a long time.
Pathogenesis of the Virus is Not Well Understood Yet:
The virus was isolated six days after the sample taken on December 30. Its genome sequence was published on January 11 with test kit available before January 20. This unprecedented speed is a landmark in science.
However, how the virus causes disease and how it transmits remain unknown in many ways. All laboratory data show that the new coronavirus is temperature sensitive and self-decomposes at high temperatures. But the summer second wave in many countries demonstrated that the hot weather is not a critical transmission-blocking factor when there are many human carriers.
On the other hand, the outbreak at Beijing and Dalian public markets in China and the explosive second wave in Australia in its winter show the virus can thrive in low ambient temperature and humid environment. Many experts have warned on a winter resurgence of Covid-19 and countries should work hard to hold down infection levels before the temperatures drop.
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 objective from elimination to containment. The less effective testing, isolation, social distancing and wearing facemasks are the policy of choice today. They 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.
Speedy vaccine development provides a bright spot amid disturbing news. Three Chinese vaccines by CanSino, Sinovac and Sinopharm, Oxford-AstraZeneca from UK, Moderna from the US and BioNTec-Pfizer of Germany-U.S. are undergoing large scale phase III 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. However, early successes do not guarantee success in the large scale phase III clinical tests involving thirty thousand test volunteers. The questions on immunization duration and protection levels remain unknown today. The ideas of Dr Zhong Nanshan and Dr Fausi, the two foremost experts on Covid-19 in China and the U.S., 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 prioritise 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.
Strengthen Public Communications:
The cardinal tenet of treating infectious respiratory disease ‘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.
The misunderstanding over negative test results accounted for many infections in the U.S. and Russia. The U.S. 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%-6% at the beginning to 2%-3%. Early testing reduced the chance of mild illness 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, 2-3% is still unacceptably high. Some countries have promoted the mortality and hospitalization reduction as an achievement and downplay 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 five million.
Learn from Best Practices and use Pooling Test:
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 them 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 is technically and operationally feasible to test hundreds of thousands people within the narrow window of Covid-19 and break the infection chain. In the pooling test, the nucleic acid sample of 5-10 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 authority because it makes tracing almost impossible to follow. The ability to conduct a rapid large scale community testing is a useful. Hong Kong is going to do community testing on all residents in two weeks, and Vietnam is studying similar methodsat Danang.
The WHO described Covid-19 as a historic medical problem. Countries should review and adopt holistic best approaches to control the disease. The advice should not be ignored!
________________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.
A similar version is published in ManilaTimes. We welcome logical feedback and possibly working together with compatible frameworks (firstname.lastname@example.org).
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