The sudden increase in Covid-19 cases in Singapore two weeks ago gave rise to the usual over-the-top reactions in social media. This was further fueled by a subsequent modest uptick in the number of local Covid-19 cases, albeit mostly mild. Panicked and hysterical posts were once again all over the internet. Are we going to lock down? Will masks be mandatory anew? Are hospitals going to get overrun? This was followed by a barrage of recycled fake news about certain hospitals being full and overwhelmed. Thankfully, the madness was short-lived when the Department of Health unequivocally declared that all provinces were low risk and healthcare utilization remains below 20 percent.
I suppose it is hard to blame people for overreacting since many of us, especially healthcare workers, are still dealing with the PTSD (post-traumatic stress disorder) from the pandemic years. It was such an uncertain time and people we knew were dying left and right that those terrible experiences continue to affect us to this day. When the first vaccines trickled in, those of us who were fortunate to be among the first batch of recipients literally cried with relief. Those emotions were certainly not misplaced as mass vaccination proved to be the turning point that eventually led to the lifting of the pandemic emergency. It used to be that every cough or sniffle was so scary and people dreaded getting tested and were on tenterhooks while they waited for their test results.
While the rise in cases in Singapore is concerning, only a small proportion of these were severe. Hospitals were able to deal with the slight uptick in cases needing hospitalization and most patients got better. The majority of cases were managed as outpatients, and even those in the vulnerable population who needed antivirals like Paxlovid and molnupiravir got proper treatment and recovered nicely. In the Philippines, local Covid-19 cases have also risen but not as large as that of Singapore. There have been some outbreaks among healthcare workers who presumably got it from patients or their co-workers since they are no longer required to wear masks in hospitals.
We still see a small number of deaths in very sick patients, although in most cases Covid-19 among these is an incidental finding (they tested positive due to screening in the hospital) and some other comorbidity was the actual underlying cause of death. Patients who come into the emergency room who end up testing positive for Covid-19 are now quickly triaged to either outpatient or inpatient care and are efficiently treated depending on their symptoms and severity of disease. Covid-19 has become just another disease we commonly deal with.
The end of the emergency phase of the pandemic was declared last year in May 2023 and since then, most countries including ours have scaled down surveillance, monitoring, and interventions.
Removal of mask mandates predictably caused a rise in cases not just of Covid-19 but of other respiratory infections such as influenza and RSV (respiratory syncytial viruses). Waning immunity to respiratory viruses due to SARS-CoV-2 supplanting their usual seasonal infections also contributed to higher than usual caseloads, sometimes with mixed infections. Fortunately, as with most respiratory virus outbreaks, these eventually peaked and died down.
Some new Covid-19 variants, most notably JN.1, have since become dominant and have been designated as variants of interest. Fortunately, none of these cause disease that are more severe than the previous variants. The vaccines continue to protect against severe disease albeit there is less protection against infection due to the variant mutations. The latest variants that are emerging include KP.2, a sublineage of JN.1 and is one of the variants unofficially referred to as FLiRT. FLiRT is just a nerdy wordplay on specific amino acid mutations found in these variants that may potentially increase their ability to evade antibodies. These mutations are F456L (a substitution at position 456 on the gene from phenylalanine (F) to leucine (L)) plus the mutation R346T (a substitution of arginine (R) to threonine (T) at position 346). These are technical terms that have little bearing on the overall public health response other than serving as media fodder.
If there is anything that these up and down case numbers of Covid-19 are telling us, it is that SARS-CoV-2 is following the pattern of other endemic respiratory viruses. The same way there is a “flu season,” Covid-19 will find its niche among the different seasonal respiratory viruses and come up with its own “Covid-19” season. It will probably be a few years before a particular pattern stabilizes and emerges, but what we are seeing now is part of that process. As long as there are no unexpected increases in hospitalization, severe cases or deaths, there is no reason for alarm.
If we do eventually end up with a defined Covid-19 season, how should we prepare for this in the future? We can take cues from how we prepare for the flu. As with any respiratory virus, it is important to protect the most vulnerable. Updated vaccines for the flu are available every season and it is likely that this will become established for Covid-19, at least for the most at-risk populations. So far, we have seen one updated bivalent booster back in 2022 and one updated monovalent booster based on XBB.1.5 in 2023. Plans for an updated monovalent SARS-CoV-2 booster based on JN.1 for 2024 are in the works and are expected to be available in the United States around September this year.
In the Philippines, only the bivalent booster has been rolled out, and only for select populations. While cases remain mild in the interim even as the bivalent vaccine effect wanes, there needs to be concrete steps taken to ensure the availability of updated vaccines for the elderly and healthcare workers in the near future. In the meantime, it is important to break out the tools that saved so many lives during the height of the pandemic if we want the best protection possible. Good quality masks should be used when cases are high, especially in hospitals and among the vulnerable populations. Updated vaccinations for other respiratory illnesses like influenza, RSV and pneumonia will help. Good ventilation and proper hygienic practices can also keep cases under control. Using these interventions should be automatic when respiratory illnesses are on the rise and not just for Covid-19. There is no utility in travel bans or strict quarantines unless the healthcare capacity threatens to be overwhelmed. We now know that Covid-19 is here to stay. How we can safely live with it is up to each one of us.