Number, figure or digit itself is meaningless. It is only with one's perspective that gives it a meaning.
Too chim to understand the above ? Now try this. "A glass with water at 1/2 of its capacity". If asking around, if not all, many will tell you the glass half-filled. How many will tell you the glass is half-emptied ? If nobody said half-emptied does that mean it is incorrect ? Answer is no, both descriptions are valid, just describe the psychological behavior of how one's view certain thing only. Now read carefully the description I mentioned about the glass and water, none of the word filled or emptied was mentioned as I know both perspectives are not wrong. This is exactly the case of number, figure or digit itself is meaningless and only with one's perspective that gives it a meaning. So what's to do with Covid-19 ? Like it or not, since the outbreak of Covid-19 in January 2020, the whole world is focus on the number game especially after vaccines were produced.
Let recap the previous post before proceeding on the number game of Covid-19. In the post Herd Immunity Through Vaccination ? dated 5th Jun 2021 I mentioned the scenario of "What if multiple variants among the 4 enter the body ?". At that moment when most read that will say impossible to happen or even if possible it will just be a rare occurrence. Rare occurrence maybe but impossible is definitely ruled out as there was a Belgian elderly aged 90 died with double variant infection in March 2021 but somehow the report only published in July 2021 (refer here). Well at the time of my post in Jun 2021, honestly speaking I have not picked up that news yet. The elderly was not vaccinated so if that can happen to her, can it happen to one who is fully vaccinated ? Scientifically, yes it can happen barring the rare occurrence explanation as vaccination is not some kind of "force shield" that when virus in contact will repel away. Once the virus in contact, regardless one's vaccination status it will just enter the body. Next, I also mentioned vaccination becomiing a double-edged sword in which the good is its prevent severity but at the same time increase the platform for further mutation in this rapid mutation rate pandemic. Now, think again, is that impossible to happen ? It might not have happened so far in history or it does but the outcome is not damaging enough to let the world notice. Nevertheless, yet to come across any scientific proof that it cannot happen. So, what's this got to do with the number game of Covid-19 ? Well, will slowly bring in this in the following.
Before vaccines were developed for Covid-19, we were focus on the number game of how many people infected, how many hospitalized, how many in critical conditions, how many died and how many recovered. There is nothing wrong there as if we don't focus on these number, the whole world will be out of control. The number game problem started to come in after vaccines were developed. First we talked about effectiveness (95%, 94%, 78%, etc) and now the narrative changes to efficacy but still stuck in the number game. Next, we talked about achieving herd immunity via vaccination. Initially, was said 70% but now bar has risen to 80% or even higher, again stuck in the number game. Why and how stuck in the number game ?
What's the difference between Effectiveness and Efficacy of a vaccine and why initially we talked about effectiveness and now becoming efficacy ? You can refer to this WHO explanation of the difference (refer here). Given effectiveness is a measure how the well the vaccine will work in the actual population, the real world while efficacy is a number derived in a controlled clinic trial environment, shouldn't the number of effectiveness is more important than efficacy as Covid-19 is happening around the world and not in a clinical trial laboratory ? Well that what's the number game is about. Human being will change their perspective when things don't go according to script. Again, the initial concept of herd immunity percentage (calculated from a formula) was 70% and now that figure has risen. Why ? Number game again, situation didn't go as scripted so perspective changes.
The world has seen reports from UK and Israel these few months about the efficacy of in particular the Pfizer-BioNTech mRNA vaccine when the B1617 variant has been upgraded to Variant of Concern by WHO and infected most part of the world now following the outbreak of this variant in India in April. The figure showed a drop in effectiveness in preventing infection of the B1617 variant. UK reported a drop to 88% while Israel latest figure showed 39%. So which is the correct one ? This article might explain the difference (refer here). Depsite the contrast difference, one thing both reports agreed on was the effectiveness against severity still on the higher percentage above the 85% level. Now, this is where the number game comes in again. Most will focus on the figure on prevention of severity and perhaps largely ignore or don't take it more seriously of the lower value of the effectiveness in preventing infection. If you have been monitoring social network like forum, comment section of the SPH Facebook page and experts or specialists or even ministry statements you will see the focus are very much on the prevention of severity.
Now, let brings in the case of the vaccine being a double-edged sword scenario in my earlier post. Despite the drop in infection prevention, it's still largely able to prevent severity just as the same as the good side of the double-edged sword. The drop in infection prevention (in fact the recent Jurong Fishery Port cluster, 3/4 of the infected are vaccinated) meaning the virus is able to stay in the expanded asymptomic state of the vaccinated person without being detected and destroyed by the antibody before moving to the symptomic state and manifest into infection. This is the worrying part and also the bad part of the double-edged sword. The failure to detect and destroy in the expanded asymptomic state will give the virus sufficient time to potentially mutate into another variant either more contagious or even deadly that has the ability to break the protection of vaccine. You might think that is impossible. Referring to the part on WHO's narrative of vaccine protection (refer here) :-
"Vaccines are likely staying effective against variants because of the broad immune response they cause, which means that virus changes or mutations are unlikely to make vaccines completely ineffective."
Take note the two key words, highlighted in red -- likely, unlikely. If it is scentifically impossible for a virus to mutate into another variant in a vaccinated person, the above statement would be written in a very affirmative way, using the word "will, will not" and not "likely, unlikely". Until it is scentifically proven is impossible, even if it is a rare occurrence it can still happen. As the effectiveness in infection prevention keeps dropping or getting to the lower side, the odd of that happening will increase.
Next, is the herd immunity via vaccination concept. As more and more people are vaccinated, the number of vaccinated people being infected will increase given vaccine is not 100% infection prevention. This is just pure logic, 10% of 1000 is definitely a much higer number than 10% of 100. If the virus mutation in a vaccinated person cannot be proven to be scientifically impossible, the more people are being vaccinated, this will increase the plaform for such mutation to take place. Increasing number of people vaccianted to achieve herd immunity and at the same time effectiveness in infection prevention drops in vaccine, the number of platform and odd for another mutation will just increase. To make matter worse, should multiple variants infect a vaccinated person, that will further increase the possibility of further mutation. There is thought of the world has to live with Covid-19 and treat it as an endemic. Can we really treat it as endemic just like common flu ? Common flu and Covid-19 are different family of virus, the way they attack the body and did the damage also different. Even within the same family, Covid-19 and SARS, both behave not 100% identifical either. SARS didn't cause infected person to lose sense of smell, SARS has a much higher fatality rate and SARS recovered patients didn't have the so-called Long-Covid. So, can Covid-19 be treated as endemic just like the common flu ? I don't think any infectious disease experts or specialists can 100% positive about it from scientific perspective. If we continue to stuck in the number game by just focusing on the severity prevention, the world could miss or overlook another perspective and the whole pandemic will start all over again with further mutation. This mutation might not happen in this nation but it will just take one successful mutation in other part of the world and the job is done.
So if vaccine were to be a double-edged sword, are we going to get vaccinated ? Barring the debate of the still largely unknown long term side effects, let not be the extreme of pro-vax or anti-vax and be rationale about it. Without a cure for Covid-19, vaccination is the second best treatment already. However, vaccination is not the one and only one solution to get out of the pandemic. Vaccine is just part of a system to adopt to end the pandemic. Look at past pandemics in mankind history, did we have vaccine to get us out of those ? Just look at 2003 SARS with a fatality rate of 10%, we didn't have vaccine then and with a good pandemic system which involved aggressive testing, quarantine, isolating and treatment, Singapore itself was able to get out of the pandemic in less than 6 months. To get vaccination to be mandatory might not be the best solution given the possibility of being turned into a double-edged sword in this rapid mutation rate pandemic. The best is to educate the importance of the vaccine and at the same time make known of the possible downside risks from long term side effects to the possibility of being a double-edged sword. Let the people to decide and be responsible for themselves of the action they have taken. No discrimination of vaccination status as that practically did nothing helpful to end the pandemic. At the same time don't simply just raise the white flag to achieve a 0 case situation and hastely declare endemic. 0 case situation is not impossible as some of the nations manage to get it for several months without even having high vaccination rate. The world is so stuck and suck into the number game of vaccine that we forget the very basic of how to fight the pandemic like what we did in 2003 SARS.
As such, who can stop the number game and lead the world out of this pandemic (not just via endemic route) ? Definitely not political leader or politicians. These group of people only know how to script a narrative that suit their political agenda. If they see the glass is half-emptied, they will just script it as forever half emptied and they could even coin out a "political prawn" strategy on the people just to achieve their narrative. Look at the forum, the comment section of SPH Facebook, look at what was written by journalists and look like the spamming of Facebook posts by those people with certain influence. This is why the statement "politics is dirty" is never wrong. In fact, look closely some of the politicans already have the "dirty" word written on their face on the first glance, be it in other part of the world or in Singapore.
Thus, who is or who are the group of people ? Answer is Doctor. Not because they can treat infected person but because they are both medical and scientific trained. Scientific trained allow them to see the both perpsectives of the half-filled or half-emeptied glass. In fact, as long as you are scientific and/or analytical trained, it is not difficult in not seeing both these perspectives. The differentiation is the medical trained part. With their medical knowledge and experience, they should be able to detect the early warning signals of the other perspective, the early signals of vaccination eventually becoming a double-edged sword and further mutation coming along the way. They might not have the solution to stop it but should be able to sound out the danger before it could happen to minimize the damage. To be exact, it is not just Doctor but GOOD Doctor, not a doctor that tells off ordinary people being irresponsible, not a doctor that openly scolding people, not a doctor with a questionable conduct and enthic that dig into the SMC registary to find out who the other doctor is in order to rebut him and if couldn't find it joke around with others in social media and last but not least not a doctor that act on political reason.
So, regardless whether you are a doctor advisory to WHO or a professor in a medical school or an experience specialists or a director of a health center or organization, just be a GOOD DOCTOR and do the part to stop the number game and take not just Singapore but the world out of this pandemic.
Added 27th Jul 2021
Came across a video from a Soth Korean Infectious Disease expert talking about Covid-19 and how the world should approach it. Even mentioned abouth countries including Singapore for rushing into endemic. Last but not least the part of politicians and scientists role in battling this pandemic. Very much like mentioned above we need GOOD DOCTOR as they are both medicially and scientific trained to get of out the number game and help the world out of this pandemic.
Singapore Covid-19
主将无能垮三军
左士缺策只砸钱
右士辱人自被辱
左象无计只会泣
右象理人理出祸
左马略识色不分
右马讲据终慢拍
小卒仗权乱闹事
大敌当前夸本领
火烧眉头方才悟
城门紧闭称闭窗
高傲自大多借口
知错不认真懦夫
领导者最佳战友
为何小红点缺乏
是否无勇气拥有
是否缺远见拥有
是否不知怎拥有
还是不想去拥有
