Covid-19 Chronicles: Reflections two years later, and Oh-My-Corona

In November 2019, the first known group of humans fell ill due to a mysterious viral pneumonia and by December 2019, the World Health Organization was alerted to a rapidly spreading disease from a coronavirus later named SARS-CoV-2.

The disease and term Covid-19 entered our consciousness and modern life as we knew it was smacked into a jarring,almost dystopian reality.

In November 2020, the first Pfizer-BioNTech mRNA vaccine submitted request for emergency use authorization to the US FDA. By December 2020, many countries worldwide had approved the use of various Covid-19 vaccines.

Amidst concerns about how fast they were developed and despite minor setbacks from rare side effects from some vaccines, the real-world evidence accrued from mass vaccination campaigns was overwhelmingly encouraging—they were safe, people were protected from getting severely sick, and health system crises could be averted even as social distancingrules were eased, as long as enough of the population were immune.

Still, those who believed Covid-19 was a ploy for the government to control the masses and that they had a right to refuse vaccines and masks, held protests or spammed social media. Between lockdowns, anxiety in catching Covid-19 and/or being isolated, depressing headlines, and juggling work and home schooling—2021 felt at times like a long, weird, and uncomfortable dream.

But then in November 2021, despite battling vaccine hesitancy, supply, and distribution issues, we rejoiced successful target vaccination rates with some reaching as high as 90% ofthe eligible population within months.

We came out of (another) lockdown, the devastation of the Delta variant epidemic wave was ending, and the promise of international travel became a reality again. Friends were looking at flights to come on holiday, I was booking flights to visit home—anxious, but hopeful that the worst of the pandemic was likely over.

That glimmering thread of light on the horizon that I would take solace in seeing when running at dawn seemed to shine brighter. It felt like the world could make plans again.

I remember the day I nervously mentioned to my supervisor that I had plans to visit family in Malaysia, and I wondered whether he thought there might be any risk of Australia closing borders again.

Ever kind, he was careful to dash my hopes down gently. He said, “Kye, if you asked me two days ago, I would have said the borders will be fine. But yesterday they announced a new variant circulating in South Africa. It sounds horrible.”

I quickly read up on the new variant, now ominously named Omicron, and realized I had to cancel my flights. Fighting back tears, I walked into the lab and announced to my colleague;"There’s a new variant spreading. I’m not going home after all.” To which she sighed in frustration, “But I just finished testing all the Delta samples.”

By December 2021, it was clear that canceling flights may just be the beginning. While most people are doubtful lockdowns would happen again after so many people are immunized against Covid-19, the fact is Omicron is so different from its predecessors we do not knowhow effective the vaccines will be against this variant.

Available data confirms that a third dose is necessary to have any protection, and this is while many parts of the world are struggling to deliver people their first dose. Graphs are showing sudden steep spikes in cases, which include people who have recovered from Covid-19 or have had their booster shots.

Genomic sequencing data confirms fears that it is due to Omicron. In Australia for example, between 15-29 November 99% of cases with genomic sequencing were shown to be of Deltavariant, and less than 1% was Omicron.

By December 27, 73% of cases with genomic sequencing were Omicron—surpassing Delta as the dominant variant, in a highly vaccinated population, in less than a month. Malaysia’s sequencing data is too sparse to make conclusions, but our experience with Delta tells us it is a matter of time.

The spike in cases tells us that the immune systems of people who have been trained through natural infection or vaccines designed based on the original SARS-CoV-2 no longer recognizes the Omicron spike protein (of which there are 36 mutations and corresponding differences in its appearance) in a way that allows them to respond as rapidly and efficientlyas we would expect.

More concerning is the fact that most of the recently hailed treatments against Covid-19 are also now shown to be less effective against this variant. At this stage, fighting Covid-19 feels like playing a never-ending football match where the goalpost is not only constantly shifting, but against a team that is constantly substituting with an endless supply of new and more threatening players.

There are reports that despite higher contagiousness, Omicron manifests more mildly and associated with lower risk of hospitalization. The best-case scenario is that Omicron takes over as the dominant variant worldwide as a much milder version and we can start treatingCovid-19 as we have done with viruses of the common cold.

However, we do not have enough information to justify letting our guard down and we ignore the threat of Omicron at our own peril. If living with Covid-19 for the past two years has taught us anything, it should be that acting on the best scenario effectively leads us down the path of worse case scenarios.

That said, many attempts for public health scenario planning based on epidemiological modeling have held true to a large extent. We have been warned and warned again thatCovid-19 would not soon be over, especially while we have done little to narrow the gap in global health equity. All countries for themselves will only mean Covid-19 will find somenook that is less protected and restart the game all over again.

So as governments everywhere appear to be losing the political will to prioritize public health, we need to remember that the health of the public is our collective individual health.

Ultimately, each person is responsible for their health, and must extend that responsibility in view of the frontliners and their families, who have been dealing with Covid-19 tirelessly for the past two years. The recent floods have shown that communities have what it takes to rally and rise when disaster strikes.

As one of many Malaysians currently living overseas, the horror of knowing compatriots facing devastating floods across the country in the midst of a terrible year with Covid-19 is only eased by the knowledge that the Rakyat are resilient, compassionate, and united in caring for each other.

The challenge now is to maintain the resilience, responsibility, and discipline in playing our role for this battered and bruised team, because we have no choice but to keep fighting.

So how will we welcome 2022? What waits for us next November and December?

In reflecting on these past two years, I hope we all remember that there is no ‘I’ in team (unless that I is to ‘isolate’ when necessary), that each person plays a part in both ending and sustaining this pandemic.

Let’s mask up when indoors and in the company of others, keep our distance when we can, get tested and isolate when we need to, protect our health by vaccination, exercise, healthy habits and supporting each other in these efforts.

Although we are far from winning our battle against Covid-19, all is not yet lost either.

May we be blessed with a happy and more healthy year ahead.