Photo: — FAIHAN GHANI/The Star
COVID-19 has become entrenched in our communities as can be seen by the higher rates of community transmission (ie, unlinked or sporadic cases). Approximately seven out of 10 cases in the last month were unlinked cases. Covid-19 will be here for the next many years.
Daily reported cases are not a good indicator in the long term to evaluate SOP calibration. And the actual effect of vaccination on long term incidence is uncertain. It is tough to achieve herd immunity against the virus due to the increasing variants.
Vaccination will have the short-term impact of drastically reducing transmission, but that is likely to wane with time and newer strains. Newer strains that escape the current vaccines will likely predominate future infections. Vaccination is still essential but in the sense that it dramatically reduces the severity of cases. Following immunisation, much fewer Covid-19 cases will have complications and require hospitalisation. As a result, the daily reported cases lose their significance as an indicator of disease morbidity.
Preventive public healthcare services are one of the most sustainable interventions during a pandemic. As we may have to weather this pandemic through the coming years, there is an urgent need to increase the capacity for preventive public healthcare services.
A better-equipped public healthcare workforce will decrease the likelihood of future lockdowns. The government should consider the secondment of civil servants from other ministries to the Health Ministry to help public healthcare services during this crisis.
Movement restrictions have been in place for the past 17 months. Their effectiveness is highly dependent on the rate of community transmission. Intense restriction during the first movement control order in March 2020 for a prolonged period was very effective because community transmission of Covid-19 was rare. This latest lockdown, MCO 3.0, has not been as effective partly due to the decreased intensity that allows more movement by the working population to lessen financial and economic impacts. Due to its reduced effectiveness, MCO 3.0, extended under the National Recovery Plan Phase One, will probably require a more extended period to bring the number of cases down.
In addition, the impact of these latest movement restrictions is likely transient due to the high community transmission; cases are likely to increase with its lifting. Thus, movement restriction is now an inferior intervention due to its decreased effectiveness, temporary effect, and high cost. We should use it rarely, as a form of total lockdown (think MCO 1.0) in times of emergency only.
The community is the most critical element in fighting this pandemic. Unfortunately, the constant high intensity of interventions thus far has created pandemic fatigue among the people. Pandemic management that is authoritative and top-down will not get the necessary buy-in from the community for the long term. Emphasis on policing, enforcement and unreasonably high penalties rather than compassionate health-promoting approaches reinforce this disconnect. Ultimately, this may lead to a loss of trust that results in poor compliance by the community.
We have to learn to live with this virus. A big issue has been the perceived severity of this disease. The infection fatality rate is very low among those aged 50 and below. Therefore, we should consider relaxing SOPs on completing Phase Two of the National Covid-19 Immunisation Programme. High-risk groups, including senior citizens, those with comorbidities and people with disabilities, would have been vaccinated, resulting in a lower need for hospitalisation.
Globally, many countries are facing prolonged psychological, social, financial and economic problems due to the maladaptation of their society to the virus for the long term. Effective and efficient public healthcare services, completion of the immunisation programme, and evidence-based time-varying SOPs will likely help us better adapt to a future with Covid-19. The faster our nation adapts to the virus, the better our overall outlook for the long term.
DR SANJAY RAMPAL , Professor of Epidemiology & Public Health Medicine specialist Universiti Malaya
