With countries one by one slowly opening up after vaccinated majority of their population despite the Covid-19 pandemic still ongoing, in particular with the B1617, Delta variant, is the ligth at the end of the tunnel for Covid-19 ?
Singapore is one of those countries that starting to opening up after vaccinated majority of the population. As of 21st Aug 2021, according to MOH statistic, 78% of the population has completed the full regimen of vaccination. This makes Singapore embarking on the so-called endmeic route with Covid-19 when its decided to raise the white flag against the zero Covid-19 policy. Endemic ???
Endemic
It was told that the nation shall treat Covid-19 as an endemic just like the common flu. Is there an endemic with common flu ? One of the common flu strain that circluting around the population causing people infected with flu during the flu season is the Influenza A/H1N1 strain, the exact strain of the 1918 Spanish Flu pandemic. If looking at past history after the 1918 Spanish Flu pandemic, the 1977 Russian Flu and the 2009 Swine Flu were both pandemic that involved exactly the same strain as the Spanish Flu, Influenza A/H1N1. If widens the scope a bit, instead of Influenza A/H1N1, focus on the Influenza A (one of the 4 types, A, B, C, D) as the other 3 types are known to be less severe. After the 1918 Spanish Flu, there were the Asian Flu, A/H2N2 in 1957, the Hong Kong Flu, A/H3N2 in 1968, the Russian Flu, A/H1N1 in 1977 and Swine Flu, A/H1N1 in 2009. A total of 4 notable pandemics involving the Influzena A virus in the past 100 years. Moreover, we cannot guarantee going forward, the world won't be hit by another Influenza A pandemic as there is in theory a possible 198 combinations for this virus to mutate into but scientists thus far only managed to identify 131 subtypes. So, is Influenza A virus still an endemic ?
The same is for Covid-19, the same family class of coronavirus as the 2003 SARS and 2012 MERS. None of the coronavirus since 2003 SARS has been totally eradicated and within a 2 decades time frame, the world has been hit with the same family class of coronavirus 3 times. So, is it really an endemic ? Probably, the closet is co-living with the virus and be prepared for potential future pandemic with the same family class of coronavirus again. Endemic, the word is nice to the ear to say it but scientifically afraid is incorrect ! So when political leaders, doctors, journalists or whoever tell you "endemic with Covid-19", better think twice !
Narrative
The narrative for Covid-19 has changed several times since the breakout last year, in particular after we have the vaccine.
1. Vaccine Function
There was so much promise and optimism about the vaccine when it was first developed as political leaders, doctors, experts, specialists and scientists believed this is the one to end the pandemic.
Above were 2 screenshots from US CDC and Singapore Gov.sg message on the vaccine when the vaccine was first rolled out. The keyword is "Protect You (Yourself), your family (loved ones)". Whoever read that message will definitely interpret as the vaccine is able to prevent severity, infection and transmission. Unfortunately, now the scenario is apart from prevention of severity, reducting death rate, the vaccine fails to prevent infection and transmission. Around the world, fully vaccinated person still get infected and still able to transmit to others including family, loved ones, coworker and the community. The only truth still remain intact is prevention of severity and reduction in death rate (as of now).
2. Vaccine Effectiveness / Efficacy
When the vaccine was first developed, vaccine makers talked about effectiveness. The mRNA technology vaccine was trial with an effectiveness of around 95% while the conventional inactivated vaccine was between the 75% to 80%. As the Delta variant striked few months ago with fully vaccinated person can also get infected and transmit to others (Israel, UK, US, Singapore and other parts of the world all happening), the narrative changed to efficacy instead as it is still able to prevent severity (as of now). The studies from Israel and UK (refer The Number Game Of Covid-19 dated 25th July 2021) and many others more all came to a conclusion that the vaccine effectiveness faded to almost just 40% against the Delta variant after 6 months. Now, booster shot is being called upon for those immunity has been waned due to time lapse. Booster shot is just to increase the quantity of the antibodies against the virus but not the quality of the vaccine against the virus. Hence, after certain time periods, we will be back to sqaure one about the waning of vaccine effectivness. The initial promise of the vaccine was never met thus narrative changes.
3. Herd Immunity Through Vaccination
To get herd immunity, the population must be vaccinated. That the initial notion to end the pandemic. As such, countries were campaigning to get their population vaccinated as much as possible. Israel, UK and US were few of those countries with at least 50% of its population fully vaccinated and decided to ease restriction and opened up. However, that kind of vaccination rate still unable to provide the needed herd immunity against the Delta variant. The herd immunity is derived from the mathematical formula (1 - 1/R0) whereby R0 represents how many others are infected by one. The Delta variant according to UK study found to have R0 between 6 to 8. This will translate into a herd immunity requirement of at least 84% against the Delta variant. The population must have at least 84% being vaccinated or gained the naturalized immunity after recovered from earlier Covid-19 infection. With that, countries for the past few months were aggressively getting their population to be vaccinated in hoping to reach the high herd immunity rate. However, lately, experts and scientists were slowly one by one coming out to claim the impossible to achieve herd immunity in particular against the Delta variant. The followings are some of those reports :-
-- Has the Delta variant of SARS-CoV-2 made herd immunity impossible ?
-- The word may never reach herd immunity against Covid-19
-- Scientists now say herd immunity impossible against Covid-19 due to Delta variant
-- Here's why herd immunity from Covid is 'mythical' with the delta variant
Just days ago, even Singapore government through the multi-task force against Covid-19 admitted to that, Singapore won't reach COVID herd immunity: Lawrence Wong. This is not something new to me as in the post The Many Questions About Covid-19 Vaccine dated 14th May 2021 already questioned about herd immunity through vaccine.
Another aspect is herd immunity is calculated from a mathematical formula, a theoretical model. Theoretical model will have lot of assumptions being made so that the formula could model to the situation. The formula only has 1 variable, R0, suggesting there are lot of real life conditions not being factored in. Vaccine effectiveness which wane over period of times, rapid mutation rate of virus and fixation of population couldn't be vaccinated due to age inegiblity or underlying health conditions, etc are definitely some of the conditions didn't factor into the formula. Another doubt is whether the formula is assuming the ideal case that vaccinated person will not get infected and transmit the virus to others. This however is untrue in real life. The situation doesn't improve when decision makers fail to analyze comprehensively those practical impacts before makeing the decision on herd immunity. Again, narrative changes.
4. Vaccine Side Effects (Short and Long Term)
Minus the general known side effects from any vaccination like fever, sore or pain at injection site, chills, headache and fatigue found during the trial phase, others more severe effects were not known until the mass population was vaccinated. These severe side effects include blood clots, anaphylaxis, myocarditis and pericarditis. Though it is found to be rare, there are still quite a number of vaccinated person suffer either injury or die from it globally. Lately, EU is looking into new possible side-effects of skin rash and kidney disorders (refer here). Apart from that, US CDC also recently looking into potential side effects that could affect female (refer here). While there isn't any conclusion from the above two recent investigations, there is still a big unknown of the potential long term side effects of the Covid-19 vaccine. Vaccine makers, scientists, experts or even politicians unforuntately don't have a time machine for them to leap forward 10 to 20 years into the future to affirm it. What they claim now is purely based on the data as of now. Can you just use present data to extrapolate into the future ? From the initial of the vaccine is very safe to discovering of rare side effects in which people has been injuried or died from it to investigating into new side effects and a big unknown of potential one into the future, the narrative defintiely has changed. Nevermind the statement globally used "benefits outweigh the risks" as scientifically how is it allow to compare a countable number to a big question mark ?
5. Infection
There is no question last year every countries treated every single infection very seriously to the extend of locking down the nation to contain it. However, as vaccine rolled out, except for selective few countries who still strongly believe in zero Covid-19 policy, the rest are slowly changing their reaction toward infection. Riding on the fact that the vaccine still able to prevent severity and reduce death rate (as of now), the narrative has slowly changed. Now is even though vaccinated personal can still be infected and transmit the virus to others, as long as said person displays mild symptoms could just rest at home like the normal illness to recover. In addition, government even intending to not reporting in-depth detail or totally not reporting daily infected cases. The pandemic defintiely is not over and with experts and scientists warn of potentially more contagious variant could be mutated going forward, such action put it bluntly is like throwing those vaccinated person under the bus -- get vaccinated, be mentally prepared to get inflected since the vaccine can prevent severity and reduce death rate. Now, who in the right frame of mind would want to be vaccinated, yet still get infected and not to mention transmit to others ?
6. Vaccination Is Not Mandatory
All the vaccines are approved by WHO under the EUA (Emergency Use Authorization) scheme and as such this couldn't be made mandatory. Should it become mandatory, if anything happens from the vaccine, vaccine makers and the government of the nation will be held accountable for it. However, since vaccine makers are being exempted of any legal liabilities by almost all the countries, the responsbility will have to be solely put on the government. The statement "vaccination is voluntary" still stand globally as of now but the underlying narrative definitely has changed to something totally different. Some countries are making it compulsory for those employed in selective sectors to be vaccinated (healthcare, peoeple in high risk sector, civil servants, etc). Policy makers are putting restrictions on the unvaccinated shutting them out certain activities (indoor dininig-in, access to shopping mall, air-conditional public transport, indoor facilities, etc) in the name of giving the vaccinated benefits and to protect the unvaccinated. Some even associated employment with vaccination status. Regardless of vaccinated or not, the person still can get infected and transmit to others, so how on earth scientifically it is to protect the unvaccinated. It is very easy to comestic one's true intention by words but not the psychological aspect of it. Such actions do nothing constructive except dividing the society, discriminating the unvvaccinated and at the same time putting pressure (either through the restrictions or levrage on the power of media in particular journalism or manipulating the vaccinated as a psychological prawn) on those to get vaccinated in order to achieve their own propaganda. This is exactly descibed by the famous Chinese quote "司马昭之心路人皆知“. These psychological prawns are not the average joes, carefully screening through it, these Leow, Ho, Koh, Em Lee, Meng Tat, Chieh, Gerald, Jeremy, Vincent, Salma, Adrian and the list goes on are all well educated being atttended or attending established university such as Oxford, Oxford Brookes, Yale, NUS, NTU, Johns Hokpins University Carey Business School, Longy School of Music of Bard College, etc. Perhaps due to their educational background and social network influence they are the best candidate as a psychological prawn. Ironically, the more educated you are fail to avert being used as a psychological prawn. Nevertheless the philosophical of psychology is "when thou manipulate the psychology of others to achieve thine objective, they will get back to thee eventually". This is how notorious the narrative has changed thus far.
What's Ahead ?
If you believe the narrative that vaccination is the way to end the pandemic by turning it into an "endemic", you probably can say we are seeing the light at the end of the tunnel. However, is that really so ? This is the narrative what human being want to see but not what the virus wants. The pandemic definitely not over as there are still countries in other part of the world lagging in behind in term of vaccination. A world not working in synchronization can't move forward much. Moreover, there is still lot of concerns and worries and any complacency, the world will be back to square one.
Vaccine can prevent severity and reduce death rate (as of now) but it can't 100% prevent infection and transmission to others. For every symptomatic infection occurs in a vaccinated person meaning there is a breakthrough of the virus. To achieve breakthrough, the virus must have reacted to the antibodies produced by the immune system. For a virus to react, the only way is through mutation into another variant (the basic of life science, living things react to changes to seek survival). As mutation is a random process meaning the virus won't mutate in a systematic way (A will become B, B will become C and so on), there won't guarantee the mutated variant will not be more contagious or even deadly than the original. As more and more of the population vaccinated, this will increase the platform for more breakthrough and at the same time increase the odd of mutating into either a more contagious or deadlier variant. As such, the vaccine will eventually become a double-edged sword, something that was mentioned in previous posts. This will change the whole narrative again.
There are still some variants apart from Delta, Alpha, Beta and Gamma exist within the population. The Delta Plus (upgrade version of Delta), Lambda (first detected in Peru last year), B1621 (discovered in Colombia this year and yet to have a Geek letter assigned to it) are among those in which WHO still considered them as "Variant of Interest" but starting to get some attentions. In particular the Lambda as early study found that it is more vaccine resilience than the Delta variant. The B1612, accounting for about 88% of the infection in Peru could be (or already) spreading to other South America nations. Taiwan already reported one of its citizen being infected with it. This variant also responsible for the death of several vaccinated people in a Belgium nursing home. Should any of those fail to contain and allow to spread globally, the consequence could be even worse than Delta. This is especially so when the direction now is vaccainted people with mild symptoms shall just treat it like normal flu staying at home to recover from it. Infected with any of those, slow to response, to detect and contain will just reset the whole pandemic again. The world already have precedence with what happen in Israel, UK, US, Taiwan and now ongoing New Zealand. For Israel, UK and US, the trio riding on more than 50% of the population were vaccinated starting to ease measures and get hit by Delta variant with sharp rise of daily cases. Taiwan and New Zealand on the other hand were in a state of mask off among the population before being hit by the Delta variant. When the Delta variant strikes, sharp rise in daily cases too. That could be the same for Lambda or even worse.
The long-covid syndrome for those infected. The consequence of that unfortunately still under study and is an unknown. Who will get it, who will not, will vaccinated people get it also ? It's still an unknown. This is on top of the still largely unknown long term side effects from the vaccine, in particular the mRNA vaccine.
In previous post (The Number Game Of Covid-19 dated 25th Jul 2021) it was mentioned the world needs GOOD Doctor to step forward to take control of the pandemic. Unfortunately till now, yet to see one, not just Singapore (very likely will not see one giving the status quo now) but globally. Where are they ? Still self indulging in money counting, collecting awards, immersing in the title, the appointment and the frame, over confident of own ability or the worst case still trap inside own think box. Being trapped inside own think box is not something rare. It happens to everyone especially so frequent in politicians and veterans. Still remember last year when the pandemic first broke out, view from experts were "not worse than SARS", "healthy no need to wear mask" and "transmission is not aerosol". All these were because based on their past encounters with SARS and MERS resulting in them percepting Covid-19 virus as the same. In SARS, mask wearing was not mandatory and none of the countries entered lockdown, shut border to contain it. SARS wasn't able to aerosol either. However, all these turned out to be false for Covid-19. Another example is the mutation of variants. To them, virus mutates all the time is a norm. However, to layman like us, within such a short period of time we have Alpha, Beta, Gamma and Delta being mutated and their contagiousness is not lesser than the original strain is something different than SARS and MERS. As long as these doctors, experts, specialists or even scientists still trap in their own think box, they will not have the instinct to act differently, the world will be going round and round with the pandemic.
One thing that can be concluded so far is the virus is impossible to be eradicated. In fact in medical history so far only 2 infectious diseases (smallpox and rinderpest) have succeeded. As such, the priority for this coronvirus is to find a way to reduce the mutation rate. Vaccine should be one and not the only tools to do that. Putting all hope and bet on the vaccine to do the job might not be the wise choice. If it fails, what's next ?
Thus, with vaccine (need to stress not a cure) that can only prevent severity (at the moment) but not 100% prevent infection, really can see the light at the end of the tunnel for this pandemic ? Alternatively, are we going to have more narrative changes going forward when situation changes ? The later case which Singapore terms it as "The Art of Prata Flipping" is a specialized skills for the government of the day in case you are not awared of it.
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
