How much longer until we get back to normal?

Published December 9, 2020, 8:19 AM

by Dr. Edsel Salvana

We are hopeful enough to ask this question

CLINICAL MATTERS

Dr. Edsel Maurice T. Salvana

As the first Covid-19 vaccines roll out, pandemic fatigue is becoming more acute, especially during this Christmas season. Everyone is asking, “How much longer?” The last nine months have been strange and surreal. Children and non-working senior citizens have been cooped up in their homes for an unimaginable amount of time. The mental stress is affecting everyone, whether you did get Covid-19 or not. Covid brain isn’t just the effect of the virus on the brain leading to foggy thinking. There’s Covid brain for the never-infected people, too. The most unlikely people have developed short tempers. Depression abounds. Irrational thoughts and actions come unexpectedly. Spells of staring off into space and forgetting what was said a couple of seconds ago happen on a daily basis. These are all manifestations of the uncertainty bothering people. On social media, innocent comments are misconstrued and trigger all-out wars.

Everyone is exhausted. Yes, the vaccines are coming and there is light at the end of the tunnel. Vaccinating billions of people, however, does not happen overnight or even in a matter of weeks. It may take months to years before a semblance of herd immunity to this virus is achieved. This is without considering the politics surrounding country-level procurement of a currently scarce resource. Do people have to lie low and shelter till herd immunity is achieved?

Thankfully, the answer is no. While mask and face shield use and physical distancing are here to stay for the near future, things will slowly start to change once the vaccines arrive.

First impact

A vial of the COVID-19 vaccination of BioNTech and Pfizer is displayed in this undated handout photo. Britain authorized a COVID-19 vaccine for use Dec. 2, greenlighting the first shot backed up by rigorous scientific review. (CNS photo/BioNTech SE 2020 handout via Reuters)

The most important early impact of the vaccines will be to decrease the risk of death among the most vulnerable. The Moderna vaccine was recently reported to be 100 percent effective in preventing severe disease. If this bears out during the rollout, then we have the means of reducing Covid-19 to the level of the common cold. People who are vaccinated may still get it, but they will not die or develop complications. This is the rationale for targeting the elderly and people with chronic illnesses as the first recipients of the vaccine.

The other important population that should be given vaccines ahead of the general population are the frontliners. These include medical staff and non-medical personnel who have a high risk of contracting Covid-19 due to the nature of their jobs. These individuals are also the most likely to transmit Covid-19 to others whom they interact with. Vaccinating them first will not only protect them while they engage in their essential work, but also protect many others downstream.

Vaccinating these two groups will significantly impact the risk of transmission and the risk of dying from Covid-19. Even before herd immunity is achieved, the people at highest risk will have protection. 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 apparent within the first few months of vaccinating frontliners and vulnerable populations. This will enable the economy to open up further because of decreased disruption of essential services. There will be less pressure on the healthcare system because of fewer critically ill patients, and fewer health care workers who get sick themselves.

Restart of travel and international business

Shortly after the announcement that vaccines worked, one airline declared that it would only allow international travelers who had been vaccinated against Covid-19 to fly on its airplanes. Other airlines may soon follow this policy.

Covid-19 vaccination boosts confidence in the safety of travel. Spending many hours in an enclosed environment during a pandemic is nerve-wracking on the part of travelers. Airline companies are also stressed because less profit is made on each flight due to fewer passengers purchasing tickets, and seats being blocked off to comply with physical distancing requirements. Vaccination of travelers will give them peace of mind and will allow countries to relax restrictions on testing and quarantine on incoming passengers. It will allow business travelers to resume their activities, and it will hasten the return of tourism, which will drive economic activity.

Herd immunity

To achieve herd immunity through vaccines, we need a transmission-blocking vaccine. The most likely vaccine that can block transmission is the vaccine from Astra. Assuming a 100 percent effective vaccine, vaccination of 60 percent of the population is needed to achieve herd immunity. Herd immunity means 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 in 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 70 million people each receiving two doses of the vaccine. That will take a lot of time and money to procure. Not all places in the Philippines, however, are Covid-19 hotspots. Efforts should be initially concentrated on places like Manila, Cebu, and Davao where cases abound and the risk of transmission is highest. The impact on transmission will be greatest in these places. Even before reaching the goal of vaccination of 70 percent of the population, there will be decreased overall risk because of fewer hosts for the virus. As more people are vaccinated, increasing sub-herd immunity will have a bigger effect, but will still need to be supplemented with continued public health measures to prevent further outbreaks.

More vaccines on the way

The current time frame for vaccine rollout in the Philippines is the second quarter of 2021. There may be limited availability, however, from as early as January 2021.Pharmaceutical companies are ramping up production and tweaking supply chains. If more vaccines are proven to work, this timeline will be shorter.  Some vaccine producers have invested in preproduction stockpiles, ready for release in large quantities. Countries with controlled outbreaks such as China, Australia, and New Zealand may opt to share their allocated supplies to countries with ongoing surges.

In the meantime, cautious optimism is the order of the day. Covid-19 has shown how easily it can get out of control when vigilance is relaxed. It will take a while to get back to normal, but things are definitely going to get better once the vaccines start rolling out. There will be a decreased risk of dying for vulnerable populations. There will be more travel for business and tourism. Some of the treatments in clinical trials are gaining proof of efficacy, so even if someone does get Covid-19, a better outcome is expected.

Lessons learned during this pandemic should not be forgotten. It is time to address underlying issues, such as increasing human encroachment in areas where new diseases can emerge. Concern for the environment should translate to recognition of excessive and unnecessary personal consumption habits. Alternative strategies that can decrease environmental impact, such as hybrid physical and online workplaces, should be considered. The world is interconnected, and the pandemic has demonstrated how truly disastrous modern-day habits have been for the environment. In turn, disaster for the environment has meant disaster to 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.

 
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