Living with the virus


PETALING JAYA: Dining out with your friends, enjoying family gatherings, going back to the office or school, facing those daily traffic jams, interstate travel, outings at the theatre or just walking in the park – all these normal slices of life look set to be served up again as Malaysia edges closer to the endemic phase of Covid-19.

However, Covid-19 remains a scourge and should be treated cautiously, public health experts warned.

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They recommend that a Covid-19 surveillance system be put in place and for standard operating procedure to remain due to the threat of new variants.

Universiti Malaya epidemiologist Prof Datuk Dr Awang Bulgiba Awang Mahmud said that in the endemic phase, people would need to live with Covid-19 inoculation from several types and brands of vaccines, as well as some form of non-pharmaceutical intervention, for some time.

This would help ensure that the country reaches some degree of population-level immunity before newer variants emerge to reduce the effectiveness of current vaccines, he added.

“When we have reached a certain degree of population-level immunity, which needs to be demonstrated, we should see an equilibrium emerging between the virus and the population’s ability to fight the virus.

“As the majority of the population becomes resistant to the virus, breakthrough infections will become less and less common, and subsequent variants will be less and less virulent.

“It is likely that booster doses will be required for the immunocompromised segments of the population, but if the B- and T-cell immunity of the rest of the population remains strong, then the need for repeated boosters may be obviated,” Dr Awang Bulgiba said.

The government had previously announced that the country would begin transitioning to the endemic phase by the end of October.

On Sept 4, Health Minister Khairy Jamaluddin said the mandatory use of face masks would still be in place, as would other vital SOP.

Dr Awang Bulgiba also said there would be a more enhanced level of contact tracing and a concise policy on Covid-19 testing.

He added that the transition to an endemic stage was “inevitable”.

“I do not see how we can get out of this situation anytime soon,” he said, citing the similarities between Covid-19 and dengue in the country.

He added that Malaysia’s pandemic management must also transition to endemic management.

Dr Awang Bulgiba said this necessitates intersectoral collaboration, adding that expertise gaps within the government need to be plugged with experts from outside the government.

The government also needs to be consistently transparent with its data and make known its analysis of the situation, he said.

“It needs to institute syndromic surveillance, better real-time data analysis, more genomic surveillance, use big data effectively and introduce additional indicators by locality – like doubling or halving time, vaccine effectiveness, spatio-temporal correlation values, and virus genotype.

“If these are not in place, then there is a real danger of a surge in infections without people realising it until it is too late.

“In an endemic stage, we need to be wary of new waves and new variants, so this kind of surveillance system needs to be in place,” he said.

Dr Awang Bulgiba also said that the country needed real long-term investment in its own vaccine technology research and development, noting that Malaysia was the only major Asean nation that did not have the capability to design and make its own vaccines.

Malaysia also needs to restructure its economy and civil service as it has been shown that it is “not very pandemic-resilient”.

He added that there should be greater use of advanced technology and robotics, which would reduce the reliance on migrant workers.

Dr Awang Bulgiba said people should be able to work remotely, the living conditions for workers need to be improved, and research into zoonotic diseases should be increased.

“As part of endemic management, it is imperative that we have our own data. This is why the Independent Covid-19 Vaccination Advisory Committee (ICVAC), which I head, recommended the government establish a Voluntary Covid-19 Vaccination Registry.

“Monitoring of the population’s immunity should include testing for neutralising antibodies as well as B-cells and T-cells.

“Although the government has announced that serosurveillance will be instituted, I am not sure how far this goes.”

Serosurveillance involves monitoring antibody levels to measure population-level immunity.

Health economics, hospital and health management expert Prof Dr Sharifa Ezat Wan Puteh from Universiti Kebangsaan Malaysia said the country could only be considered to have reached the endemic stage if a high vaccination rate was recorded in all the states and not just a few.

She said in areas where everyone was fully vaccinated, wearing a face mask would not even be necessary, adding that other SOP could be relaxed.

“People will be encouraged to work as usual, a lot of social sectors will open up, and hopefully for the education sector – once adolescents and children are fully vaccinated – it will be fully reopened, too.

“We will all be carrying out our work as per normal,” she said.

Prof Sharifa Ezat, however, said that if certain parts of the community were still not vaccinated, then the current SOP needed to be maintained even in the endemic phase, or if there is an outbreak of a new variant.

“If the Delta variant is a big problem in the country, we still have to continue wearing face masks and practise the SOP even though we are fully vaccinated,” she said.

In the future, she predicted that data on daily and active cases would be considered “irrelevant”.

“Not to say that these figures are not required – we can still have them so that we know how rampant the virus is, but the more applicable indicators are the number of deaths and the brought-in-dead cases, as well as the prevalence of cases in Categories Three to Five, which are the more severe ones.

“We also need to emphasise the prevalence of variants in the country. This is important if we want to fight the virus.

“Currently, we don’t know what’s the prevalence of the Delta variant in the country. We know the daily cases, but what is the prevalence of the Delta variant as the cause of Covid-19 cases here?

“We also need to know what the breakthrough infection rate is. If these breakthrough cases really occur and they are going to be as high as we see in some other countries, then we need to know what the cause is.

“Is it because of new variants or because of vaccine effectiveness failure?” she added.

On whether there would still be a need to observe all the current SOP in the endemic phase, Malaysian Society of Infectious Diseases and Chemotherapy president Dr Zamberi Sekawi said this will depend on the situation at the time.

“If the virus is... still a threat to a particular group, then these measures would still be relevant. For example, the elderly. If there is a social event involving the elderly, then risk mitigation initiatives need to be taken.

“Otherwise, these things will no longer be practised. But it depends on the risk, the important thing is to do risk assessments. So, if there is still a risk then we still need to practise all the SOP,” he added.

On restriction to people’s movement, Dr Zamberi said it should no longer be relevant in a fully endemic phase, adding that people should be able to live their lives normally while remaining aware of those who would be at high risk of getting severe Covid-19.

He also said he believed Covid-19 testing would still be relevant but no longer a necessity.

“In the transition to the endemic phase, we still need to conduct Covid-19 testing because we still need to gauge community transmission, but in the true endemic period, this would no longer be necessary unless individuals experience symptoms and want to get tested on their own.

“If they find themselves positive, they can monitor themselves and if things deteriorate, they can go to the hospital,” he said, adding that testing could be done to treat and provide medical care just like how it is carried out for other diseases.

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