Five future strategies for fighting COVID-19




Syafiq Basri Assegaff (The Jakarta Post)

Jakarta Wed, June 2, 2021

It seems we may have to reconsider our optimism, which blossomed thanks to the mass vaccination program, following the recent Idul Fitri holiday in mid-May. The likelihood of achieving herd immunity against SARS-CoV-2 has remained low due to two important factors: not all individuals in Indonesia (and elsewhere) have access to vaccines, and many eligible individuals are refusing vaccination.


This article was published in thejakartapost.com with the title “Five future strategies for fighting COVID-19”. Click to read: https://www.thejakartapost.com/paper/2021/06/01/five-future-strategies-for-fighting-covid-19.html.

It seems we may have to reconsider our optimism, which blossomed thanks to the mass vaccination program, following the recent Idul Fitri holiday in mid-May. The likelihood of achieving herd immunity against SARS-CoV-2 has remained low due to two important factors: not all individuals in Indonesia (and elsewhere) have access to vaccines, and many eligible individuals are refusing vaccination.

Green coronavirus with a vaccine. Covid-19. Funny cartoon character with emotion. Sadness, tears, chagrin.

Worse, the vaccines do not provide full immunity against infection and some available vaccines are less effective against the new B.1.351 (Beta) variant first detected in South Africa, and possibly other variants as well. Accordingly, public health systems need to plan for the possibility that COVID-19 will be her to stay as a recurrent seasonal disease.

Yet, we may be content with the anticipatory measures of local administrations like Jakarta’s. The capital city has intensified its contact tracing and treatment efforts, following its mudik (exodus) restrictions and as 1.5 million mudik travelers return to Greater Jakarta after celebrating Idul Fitri in their hometowns. The Jakarta Health Agency has prepared health facilities and increased the bed capacity of isolation and intensive care units. More than 6,600 hospital beds have been allocated for the treatment of COVID-19 patients (The Jakarta Post, May 22, 2021).

Furthermore, the city has cut the operational hours of the MRT Jakarta and the Commuter Line services. It is also monitoring returning Idul Fitri travelers, has implemented “micro” (localized) lockdowns in certain neighborhoods to anticipate “Idul Fitri clusters” and has enhanced border checks at 14 posts. A week after Idul Fitri on May 13-14, apart from increasing its testing rate, Jakarta has also managed to cut its single-day positivity rate from 13.8 percent on May 13 to 6.6 percent on May 21 and has generally maintained this rate.

Despite these achievements, the fight against COVID-19 is still far from over. A pulmonologist at a city-owned hospital said that, apart from anxiety and mental health issues, many patients were suffering from social stigma. This confirms a study I and my colleagues conducted in September 2020, which found that 74 percent of doctors encountered individuals who had concealed their health condition for fear of stigmatization by friends and family.

People who do so could exacerbate the country’s struggle to contain the virus through testing and tracing. At the national level, however, we have yet to flatten the curve. Instead, the latest figures show a distressing increase in infection. The official tally of the Covid-19 task force on May 15 (two days after Idul Fitri) showed 2,685 confirmed cases, which increased to 4,185 cases on May 18 and then to 5,797 cases on May 20.

The chance to achieve herd immunity against SARS-CoV-2 could narrow, particularly due to vaccine hesitancy. As Christopher Murray and Peter Piot wrote in a March issue of The Journal of the American Medical Association (JAMA), the currently available vaccines were possibly less effective against new coronavirus variants like the B.1.351 (P.1) first detected in Brazil. As such, public health systems needed to plan for the possibility that COVID-19 could persist to become a recurrent seasonal disease.

As health experts have suggested, it is our duty to achieve herd immunity in the presence of new and more contagious variants by requiring 70 percent to 80 percent of the population to be vaccinated. This is a huge challenge. Murray and Piot also suggested that vaccines would have reduced efficacy in preventing infection by certain variants. While some vaccines have an overall effectiveness of around 95 percent for against symptomatic disease from wild variants, but other vaccines have lower effectiveness.

If new variants continue to appear, infection surges could become the norm. This potential needs serious advance planning and consideration of five strategies to mitigate the consequences for our communities and health systems in the coming months. First, intensify nationwide vaccination. As Murray and Piot suggested, new variants could emerge anywhere, but wider vaccination coverage could help reduce the risk of recurrent COVID-19 as well as the frequency at which new variants might emerge.

Second, invest in broader surveillance, including genome sequencing, to facilitate early detection of variants and to track local trends. If new variants continue to emerge, it is possible we might need annual vaccination. Third, manage and finance possible surges in hospital patients, like the Jakarta administration has done.

Fourth, reduce transmission during peak seasons, particularly after long holidays like Idul Fitri or Christmas, through measures imposed at workplaces and educational institutions. Although it is unlikely that the government will mandate year-round social distancing, employers and schools could adopt certain measures like mandatory vaccination and virtual meetings and classes. Finally, modify the behavior of at-risk individuals. This is not an easy task, but people will become motivated if they understand that the risk could be fatal. Apart from wearing masks, which can prevent infection by 30 percent, individuals at higher risk, like seniors above 65 or people with preexisting comorbidities, can modify their behavior by avoiding large gatherings, among others.

Although the prospect of persistent and seasonal COVID-19 appears to be real, we cannot confirm this at present. There is huge uncertainty about the probability and frequency of the occurrence of new variants and the potential for reduced vaccine efficacy against each variant, as well as the critical issue of cross-variant immunity and the consistency of safe human behavior. We need to learn about them all in the coming months and prepare for such scenarios by aligning surveillance, public health response and, of course, relief programs.

The author is a medical doctor and lecturer at the LSPR Communication & Business Institute in Jakarta. The views expressed are personal.


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