Experts question relevance of SafeEntry, TraceTogether amid endemic Covid-19

‘Infectious diseases experts have questioned the need for continued widespread enforcement of TraceTogether and SafeEntry rules as Singapore moves towards more targeted contact tracing and living with endemic Covid-19. They noted that while daily new cases continue to number in the thousands, the vast majority of the population eligible for vaccination – 94 per cent – is fully vaccinated and most will show mild or no symptoms if infected. Extensive contact tracing, as was done in the early days of the pandemic, is no longer practical or necessary, they added.’

Read here (Straits Times, Nov 22, 2021)

America has lost the plot on Covid

‘We know how this ends: The coronavirus becomes endemic, and we live with it forever. But what we don’t know—and what the U.S. seems to have no coherent plan for—is how we are supposed to get there. We’ve avoided the hard questions whose answers will determine what life looks like in the next weeks, months, and years: How do we manage the transition to endemicity? When are restrictions lifted? And what long-term measures do we keep, if any, when we reach endemicity?

‘The answers were simpler when we thought we could vaccinate our way to herd immunity. But vaccinations in the U.S. have plateaued. The Delta variant and waning immunity against transmission mean herd immunity may well be impossible even if every single American gets a shot. So when COVID-related restrictions came back with the Delta wave, we no longer had an obvious off-ramp to return to normal—are we still trying to get a certain percentage of people vaccinated? Or are we waiting until all kids are eligible? Or for hospitalizations to fall and stay steady? The path ahead is not just unclear; it’s nonexistent. We are meandering around the woods because we don’t know where to go.’

Read here (The Atlantic, Nov 1, 2021)

Singapore's Covid response overlooked a major factor: Fear

‘Mastering data is only half the battle. A major reason hospitals were getting overwhelmed is because people were scared, and the government missed an opportunity to send the right message.

‘Singapore is very proud of its reputation for technocratic excellence. In recent months, government officials have tried to tackle the country’s most pressing question — how to live with Covid-19 — by scrutinizing, modeling and projecting data, as if staring hard enough at those little gray-rimmed boxes on Excel would produce the answer.

‘The trouble with this strategy is that living with Covid is messy, and the data will never look good. Countries that have been praised for the most meticulous of approaches to the outbreak have stumbled time and again. Ultimately, treating the coronavirus as endemic will require Singapore to do something it may find unnatural: think beyond the numbers.’

Read here (Bloomberg, Sept 29, 2021)

A strong start by the Health Minister, and more is needed

The Malaysian Health Coalition (MHC) welcomes the strong start by Minister Khairy Jamaluddin, and note the recent evaluation criteria that he set for the Ministry of Health (MOH). We hope to see the entire MOH machinery, as well as inter-agency collaborations, be mobilized to achieve these goals.

We urge the following:

1. Clarify the specific policy changes for an endemic COVID

The Minister stated that Malaysia “can expect to move into an endemic COVID-19 phase” by the end of October 2021. The MOH must clearly communicate this new strategy to the public by announcing the specific policy changes to its COVID-19 responses. Controlling virus transmissibility,  routine vaccination programmes, efficient testing, and improving healthcare capacity, are among the areas that require clear policy shifts, so that we can treat COVID-19 as part of daily Malaysian life. We urge some caution in labelling COVID-19 as endemic, unless these parts of our health system are strengthened. Otherwise, we risk a complacent population or a public administration that stops focusing on COVID-19.

2. Involve expertise from outside MOH when making decisions.

We believe that it is the Minister’s right to build a team which he feels comfortable working with. Nevertheless, we recommend the Minister to get appropriate health advisors and implementation partners, especially from among health experts outside the MOH. Therefore, we urge that non-MOH health advisors and implementation partners be systematically embedded within the decision-making and implementation process, rather than be consulted on an ad hoc basis. A good working model is the Greater Klang Valley Task Force. The MHC and our member organisations are ready to assist.

3. Establish phased Key Performance Indexes (KPIs) for 30-60-90 Days

We commend the Minister’s 100 Day KPIs. However, as we are in the middle of a raging pandemic, some urgent measures must be taken earlier than the 100 days. Therefore, we suggest the Minister agrees on a phased set of KPIs to be achieved within 30, 60, and 90 days, together with MOH and non-MOH experts. This phased KPIs must be publicized for accountability, and also to unite all of Malaysia to achieve these KPIs together. These phased KPIs must be merged with the National Recovery Plan, Budget 2022 and Rancangan Malaysia ke-12, where Health must be at the forefront of all policy considerations.

We must now make up for some lost time due to the political instability of the last 18-months. Therefore, we stand behind the new Health Minister as he leads the MOH to turn the COVID-19 tide in Malaysia’s favour. We will fulfill our duties as responsible health professionals and citizens.

Read here (Malaysian Health Coalition (MHC), Sept 9, 2021)

Living with Covid-19 – Is Malaysia ready? — Dr Amar-Singh HSS

‘In recent days and weeks, there have been statements made about moving from a Covid-19 pandemic state to an endemic phase by the end of October 2021. The argument for this is that higher adult vaccination rates will be achieved nationwide by that time. So we need to ask this question: Is Malaysia ready to move to an endemic phase by the end of October 2021? I would like to describe some ‘movements’ we need to make as a nation for us to be ready to enter an endemic phase, as well as offer you a ‘report card’ of our preparedness measures.

• Move from looking at adult vaccination rates to total population vaccination rates
• Move away from herd immunity concepts to mitigating outbreaks
• Move from vaccinating adults to vaccinating children (before reopening schools)
• Move from SOPs to a sustainable change in lifestyle, move from external enforcement to societal checks, and move from dependence on vaccines to using all tools and mitigation measures
• Malaysia’s report card on its preparedness in entering a Covid-19 endemic phase

Three possible ‘phases’ impending

‘Finally, a note about what is to come. No one can predict what will happen with Covid-19, but after hearing international experts and looking at our situation, I would like to offer some ideas.

‘We are currently in what I call the primary protection phase, whereby we are racing against Delta and trying to complete adult vaccination. Many states outside the Klang Valley are in trouble, and we are starting to see rising cases of children hospitalised nationally.

‘We will then move to what I call a consolidation phase, where we try to increase societal protection and reduce the spread of Covid-19 by vaccinating teenagers. Meanwhile, we have to look at the data carefully for any signs of waning immunity, and if adult boosters are required.

‘We then enter a phase I call the long-term danger phase. Here is where we must not let down our guard and risk more outbreaks, especially if worse variants appear. We can do this by a change in lifestyle to address the long term Covid-19 journey. There may be a need to invest in new vaccines.’

Read here (Code Blue, Sept 6, 2021)

India may be reaching ‘endemicity’ after emerging from second COVID-19 wave

‘The number of new COVID-19 cases and deaths in India has dropped dramatically since a second wave of the virus peaked in May. First the Alpha and then the Delta variant — which was first detected in India and is now causing strife elsewhere in the world — ravaged the country. But the seven-day average of daily reported cases this week is just a tenth of the 400,000 recorded during the peak.

‘According to health authorities, more than 439,000 people in India have now died with the virus. The relatively stable numbers, which lasted throughout August, prompted the World Health Organization's chief scientist to suggest India may have reached a state of "endemicity". That is, it may be endemic or constantly present in a particular place. So how did they get there and is the worst of the pandemic over for India?’

Read here (ABC News, Sept 6, 2021)

Much more to do before reaching endemic phase, says expert

‘Malaysia is not ready to enter an endemic phase of the Covid-19 crisis, which the health ministry said the country would reach by the end of October, according to a consultant doctor. Dr Amar-Singh HSS, a consultant paediatrician, said Malaysia could only enter an endemic phase by January or February. The term refers to the presence of an infectious disease being permanently present in the population...

‘Amar said Malaysia would endure three phases in the current health crisis. The current phase was the Primary Protection Phase, with the country racing to control the Delta variant and trying to complete adult vaccination. Many states outside the Klang Valley are in trouble and a rising number of children are being hospitalised, he said.

‘Next would be the Consolidation Phase, with increased societal protection, and teenagers being vaccinated to reduce the spread of the virus. (Yesterday, health minister Khairy Jamaluddin said vaccinations of teenagers would begin in Sarawak this month.)

‘Amar said the final phase would be the Long-term Danger Phase. “Here is where we must not let down our guard and risk more outbreaks, especially if worse variants appear. We can do this by a change in lifestyle to address the long-term Covid-19 journey,” he said, adding there may be a need to invest in new vaccines.’

Read here (Free Malaysia Today, Sept 5, 2021)

When will the Covid-19 pandemic end? McKinsey & Co update August 2021

‘This article updates our perspectives on when the coronavirus pandemic will end to reflect the latest information on vaccine rollout, variants of concern, and disease progression. Among high-income countries, cases caused by the Delta variant reversed the transition toward normalcy first in the United Kingdom, during June and July of 2021, and subsequently in the United States and elsewhere. Our own analysis supports the view of others that the Delta variant has effectively moved overall herd immunity out of reach in most countries for the time being. The United Kingdom’s experience nevertheless suggests that once a country has weathered a wave of Delta-driven cases, it may be able to resume the transition toward normalcy. Beyond that, a more realistic epidemiological endpoint might arrive not when herd immunity is achieved but when COVID-19 can be managed as an endemic disease. The biggest overall risk would likely then be the emergence of a significant new variant.’

Read here (McKinsey & Co, August 23, 2021)

How the pandemic now ends: Ed Yong

‘Pandemics end. But this one is not yet over, and especially not globally. Just 16 percent of the world’s population is fully vaccinated. Many countries, where barely 1 percent of people have received a single dose, are “in for a tough year of either lockdowns or catastrophic epidemics,” Adam Kucharski, the infectious-disease modeler, told me. The U.S. and the U.K. are further along the path to endemicity, “but they’re not there yet, and that last slog is often the toughest,” he added. “I have limited sympathy for people who are arguing over small measures in rich countries when we have uncontrolled epidemics in large parts of the world.”

‘Eventually, humanity will enter into a tenuous peace with the coronavirus. COVID-19 outbreaks will be rarer and smaller, but could still occur once enough immunologically naive babies are born. Adults might need boosters once immunity wanes substantially, but based on current data, that won’t happen for at least two years. And even then, “I have a lot of faith in the immune system,” Marion Pepper, the immunologist, said. “People may get colds, but we’ll have enough redundancies that we’ll still be largely protected against severe disease.” The bigger concern is that new variants might evolve that can escape our current immune defenses—an event that becomes more likely the more the coronavirus is allowed to spread. “That’s what keeps me up at night,” Georgetown’s Shweta Bansal told me.

‘To guard against that possibility, the world needs to stay alert. Regular testing of healthy people can tell us where the virus might be surging back.’

Read here (The Atlantic, August 12, 2021)