How much longer until we get back to normal? – Manila Bulletin

We hope to ask this question.

CLINICAL MATTERS

As the first Covid-19 vaccines are released, pandemic fatigue becomes more acute, especially during this Christmas season. Everyone asks, “How much longer?” The last nine months have been strange and surreal. Children and older people who do not work have been locked up in their homes for an unimaginable amount of time. Mental stress is affecting everyone, whether you’ve contracted Covid-19 or not. The covid brain is not just the effect of the virus on the brain that leads to fuzzy thoughts. There is also a Covid brain for people who were never infected. The most unlikely people have developed a bad temper. Depression abounds. Irrational thoughts and actions arise unexpectedly. The spells of staring into space and forgetting what was said a couple of seconds ago happen daily. These are all manifestations of the uncertainty that bothers people. On social media, innocent comments get misinterpreted and trigger all-out wars.

Everyone is exhausted. Yes, the vaccines are coming and there is light at the end of the tunnel. However, the vaccination of billions of people does not happen overnight or even in a matter of weeks. It may take months or years before a semblance of herd immunity to this virus is achieved. This without considering the policies surrounding the acquisition at the national level of a currently scarce resource. Do people have to stay hidden and take refuge until herd immunity is achieved?

Fortunately, the answer is no. While wearing masks and face shields and physical distancing are here to stay for the near future, things will slowly start to change once the vaccines arrive.

First impact

The most important early impact of vaccines will be to lower the risk of death among the most vulnerable. The Moderna vaccine was recently reported to be 100 percent effective in preventing serious disease. If this is confirmed during launch, then we have the means to bring Covid-19 down to the level of the common cold. People who are vaccinated can still get it, but they won’t die or develop complications. This is the rationale for targeting the elderly and people with chronic diseases as the first recipients of the vaccine.

The other important population that should receive vaccinations before the general population are those on the front lines. These include medical personnel and non-medical personnel who are at high risk of contracting Covid-19 due to the nature of their jobs. These people are also the most likely to pass Covid-19 to other people they interact with. Vaccinating them first will not only protect them while they perform their essential work, but it will also protect many others later.

The vaccination of these two groups will have a significant impact on the risk of transmission and the risk of dying from Covid-19. Even before herd immunity is achieved, those most at risk will be protected. This goes a long way toward reducing the impact of SARS-CoV-2.

Increasing vaccination coverage will also increase the effectiveness of our minimum health standards. Masks and social distancing will have a greater impact on mitigation. These effects will be evident in the first months of vaccination of vulnerable and first-line populations. This will allow the economy to open further due to decreased disruption of essential services. There will be less pressure on the healthcare system as there will be fewer critically ill patients and fewer healthcare workers getting sick themselves.

International travel and business restart

Shortly after the announcement that the vaccines were working, an airline stated that it would only allow international travelers who had been vaccinated against Covid-19 to fly on its planes. Other airlines may soon follow this policy.

Covid-19 vaccination increases confidence in travel safety. Spending long hours in a closed environment during a pandemic is stressful for travelers. Airlines are also stressed because less profit is made on each flight due to fewer passengers buying tickets and seats are blocked to meet physical distance requirements. Vaccinating travelers will give them peace of mind and allow countries to relax restrictions on testing and quarantine of incoming passengers. It will allow business travelers to resume their activities and accelerate the return of tourism, which will boost economic activity.

Group immunity

To achieve herd immunity through vaccines, we need a vaccine that blocks transmission. The vaccine most likely to block transmission is the Astra vaccine. Assuming a 100 percent effective vaccine, vaccination of 60 percent of the population is needed to achieve herd immunity. Herd immunity means that there are enough immune people in the population so that the disease is not transmitted. Sixty percent is the estimate for Covid-19. If it only works about 90 percent of the time as the Astra vaccine does under the best conditions, about 70 percent of the population would need to be inoculated to achieve herd immunity. For a population of 110 million, that would mean that 70 million people would each receive two doses of the vaccine. That will take a lot of time and money to do. However, not all places in the Philippines are Covid-19 hot spots. Efforts should initially focus on places like Manila, Cebu and Davao, where cases are rife and the risk of transmission is greatest. The impact on transmission will be greater in these places. Even before reaching the goal of vaccinating 70 percent of the population, there will be a decrease in overall risk because there are fewer hosts for the virus. As more people are vaccinated, the increased immunity of the subgroup will have a greater effect, but will still need to be supplemented with continued public health measures to prevent further outbreaks.

More vaccines on the way

The current deadline for the launch of the vaccine in the Philippines is the second quarter of 2021. However, there may be limited availability from January 2021. Pharmaceutical companies are increasing production and adjusting supply chains. If more vaccines are shown to work, this time frame will be shorter. Some vaccine producers have invested in pre-production stocks, ready for release in bulk. Countries with controlled outbreaks, such as China, Australia and New Zealand, may choose to share their allocated supplies with countries with surges.

Meanwhile, cautious optimism is the order of the day. Covid-19 has shown the ease with which it can spiral out of control when surveillance is relaxed. It will take a while to get back to normal, but things will definitely get better once the vaccines start rolling out. There will be a lower risk of dying for vulnerable populations. There will be more travel for business and tourism. Some of the treatments in clinical trials are getting evidence of efficacy, so even if someone does get Covid-19, a better outcome is expected.

The lessons learned during this pandemic must not be forgotten. It is time to address the underlying problems, such as the increasing human encroachment into areas where new diseases can emerge. Concern for the environment must be translated into the recognition of excessive and unnecessary personal consumption habits. Alternative strategies that can decrease environmental impact, such as physical and online hybrid workplaces, should be considered. The world is interconnected, and the pandemic has shown how disastrous modern habits have been for the environment. In turn, the disaster for the environment has meant a disaster for people. Another valuable lesson is that refusal to believe in science can lead to hundreds of thousands of unnecessary deaths. When this year is over, perhaps the lessons will remain and we will have a new and better normal.