The Covid-19 outbreak is a reminder


  • Letters
  • Wednesday, 12 Feb 2020

I HATE being sick. As a mother, I hate it more when my kids are sick. Regardless of whether it is the burning fevers, the annoying sniffles, the sore throats, the chesty coughs, the aches and pains, or the general simply-cannot-get-out-of-bed feeling, being sick is not only uncomfortable for the ill and their carers, but it is a real moment we are reminded that we are all mere mortals, that mortality knocks quietly at the door.

However, when that relief of fever-breaking sweats washes over, whence the desire to eat and do anything again returns, amazingly the fear and fever quickly become a distant memory. Almost like it never happened.

The same can be said of infectious diseases in general.

Thanks to scientific progress, we have advanced modern medicine and increased general quality of life. Viral, bacterial, and the more rare fungal diseases that used to kill many in the cartloads, can now be managed with some bed rest and fluids, or perhaps depending on severity, a course of antivirals, antibiotics, or antifungals, respectively.

For some of these diseases, such as the terrifying smallpox and paralytic polio, we no longer need to worry about catching at all, because they have been eliminated to but a few locations, or completely eradicated from the entire planet – thanks to aggressive campaigns coordinated by public health agencies like the World Health Organisation (WHO).

The thought of dying from such infectious diseases is no longer one that plagues our mind, the way it did centuries before. Infectious diseases seemingly became a problem of the past.

Many of these dangerous microscopic bugs that still remain, like the rotavirus or measles virus, which causes diarrhoea and pneumonia and often kills young children, or mycobacterium tuberculosis, the bacteria that causes tuberculosis (TB) which kills millions of adults, especially those imprisoned or living with human immunodeficiency virus, are more common in areas with poverty and limited access to healthcare.

Infectious disease became a problem of the poor and the marginalised.

With these advances and victories, came the problem of complacency and indifference to the ever-present threat of these invisible, yet dangerous and deadly bugs.

And even worse, inappropriate and overusage of antibiotics have created resistant bugs that can survive and spread even after the course of treatment is completed. These resistant infections often become deadly.

Measles, rotavirus and TB are vaccine-preventable diseases (VPDs). Like many VPDs, vaccination can provide either complete or reasonable protection from severe disease.

Some of these vaccines are given through injecting the arm or thigh; some are injected just beneath the skin; some are given as oral drops, and some as a nasal spray.

There may be discomfort from the injection, and occasionally a vaccinated person might even develop a few symptoms similar to the disease the vaccine is supposed to protect against.

This is because vaccines are basically either weakened versions of the bug, or bits and pieces of the bug, given to our bodies to wake our immune system up, to prepare and train our defences to remember and defeat the real bug should it ever invade.

Rarely though, and often because of human error, contamination or underlying disease in a vaccinated person, some vaccinations can cause more serious problems, even fatalities.

But risk of this is extremely low. In Malaysia, in 2018,983 adverse events from vaccinations were reported, compared to a whopping 26,000 adverse drug reactions.

The claim that vaccines caused autism was based on one fraudulent study that has been debunked by several subsequent studies. Religious authorities have also countered claims that vaccines contain haram or non-permissible ingredients.

Yet, these are the very claims that persist and cause many of these VPDs to remain real threats to human health until today.

As someone who was trained in VPD epidemiology (the study of diseases in populations) and biomedical research, I still remember the day I had to bring in my firstborn baby for vaccination.

The minute risk of an adverse event suddenly did not seem so minute because he was my baby. But it was a risk I had to take because I believed that the duty to protect him against future disease was greater than my fear.

After the vaccination, we drove back in a terrible thunderstorm and I realised that if I could vaccinate him from traffic accidents, I would. (Luckily we sort of did, and it’s called “using the car seat”).

After faithfully following rounds of compulsory injections and recommended optional vaccines for both my kids, with the privilege of being able to provide them with a general healthy living environment, my children have grown relatively robust and healthy.

I am now more convinced that being vaccinated with a good and safe vaccine is a child’s right to health.

However, my maternal guilt quickly crept up recently, because for a while, since my children have grown and become less frequently sick, I have become lax with keeping up with seasonal flu vaccinations.

With the recent waves of flu outbreak, and now of course the 2019 novel coronavirus or Covid-19, the thought of contracting and potentially being severely ill from an infectious disease lingers in my mind.

While “older” coronaviruses like Middle-East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS) viruses appeared to kill more of the people they infected, Covid-19 incites anxiety because the way it is passed between people is still not fully understood, and thanks to global travel and constant population movement, it has quickly reached many shores including ours and neighbouring countries.

But we have been fortunate that the Health Ministry and public health agencies have been agile, learning from past experience, putting in place appropriate monitoring and quarantine measures. Otherwise, the spread may have been worse.

What we have failed to learn, however, is that contracting infectious disease is not a crime, and the ill should not be viewed or treated as suspects or criminals.

Pandemics like Covid-19 occur and will continue to occur because although our immune system may have good memory, sufficient to fight off infections as long as we give them “training” through vaccination, our memory as human societies is less reliable.

Covid-19 is merely a wake-up call. We have grown complacent in the quest to control infectious disease. Armies have been brought down at times not by enemy forces, but by outbreaks of flu, cholera or typhoid fever. The world scraped through a modern-time H1N1 flu pandemic only a decade ago, and 284,500 lives were lost.

Yet, some of us still refuse vaccines, overuse antibiotics, practise lifestyles that enable the spread of animal-human disease transmission, and take for granted many of the victories that centuries of research and investments have brought into our modern lifestyles.

We have invested less in fundamental research, drugs, diagnostics and vaccines for infectious disease, because we thought they are problems of the poor and of the past, and they are not as profitable as developing solutions for “modern day” problems and demands.

Covid-19 is a reminder that infectious disease is not a problem of the past or the poor. As long as we are complacent, it will be a present and continuing problem of the global public.

The writer is senior lecturer in Medical Microbiology at Universiti Sains Malaysia, and is active in science communication and infectious disease biomedical research. She was the first female Asian champion of FameLab, the world’s longest running science communication competition, in 2018.

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