Living with COVID-19 for 20 months, how safe are we now?

Granted, no two pandemics are the same. COVID and the ‘Spanish Flu' belong to different eras. Science was not as advanced 100 years ago as it is today. The world population at 7.8 billion today is much bigger today. Still, the sheer numbers are instructive.

When the “Spanish Flu” pandemic hit, it had infected an estimated 500 million people between1918-1920, and killed up to 50 million — a 10% fatality rate — during a period when the planet's inhabitants were still less than 2 billion.

What is the Spanish Flu pandemic were to hit today? Any answer would be purely hypothetical. One thing that’s absent then: transcontinental flights. The world today is truly more “global”, with both its upsides and downsides. This makes COVID truly a pandemic (“all people” in Greek). One cannot unmake air travel. But this has a potentially dangerous downside: In the case of smaller island nations, their very existence is at risk, warned WHO. 

Given the highly transmissible variants, COVID has so far infected 203 million, with 4.29 millions deaths (as of August 8, 2021) — a 2.1% case fatality rate. Due to the unknown number of “asymptomatic” cases, and deficiencies in RT-PCR testing in less developed countries, the fatality rate would be even lower, say experts.

(2) Rapid vaccine development:

Get this: there are at least 21 COVID-19 vaccines approved today. Vaccines were developed in record time — using at least three platforms. The WHO has so far approved 7 vaccines. Experts estimate that if 30.2 million vaccines are produced daily — a run rate of 349 vaccines per second — that number would enable the world to achieve “herd immunity” in the next 12 months.

Double the number — but also address vaccine hesitancy — and COVID will be history sooner, instead of later, some experts argue. But it's easier said than done. Vaccines took years, even decades, to develop and test before enough evidence was gathered to show their efficacy and safety. Inadequate funding, lack of scientific resources, unavailability of clinical trial volunteers slowed down development. Only a few companies and researchers madd the jabs then.

This time, vaccine development was accelerated — but not rushed. The rigours of science were not compromised. They both use the tried-and-test vaccine types (such as attenuated and inactivate-virus platforms), as well as the mRNA, which been under development for at least 30 years.

The urgency of the situation, government support and the sheer number of companies/scientists engaged in vaccine development (404 vaccine trials of 138 candidate vaccines in 59 countries), have worked together to make this happen. The result: today, 21 vaccines are approved in at least one country, and 7 approved by the WHO.

(3) Vaccinations work:

Vaccinations (not just vaccines) work. Study after study confirms one thing: The current batch of approved vaccines are highly effective at preventing severe cases. The vaccines are less effective at preventing mild cases of delta. Recent research published in NEJM compared and tested neutralisation activity of sera from individuals who recovered from COVID naturally and sera from individuals who had been fully vaccinated with Moderna or Pfizer vaccines against the infectious B.1.617.2 variant.

It shows that, on average, the Delta variant was 2.9 times less susceptible to neutralisation than the original Wuhan strain. However, most convalescent serum samples and all vaccination serum samples showed detectable neutralisation activity — which indicates vaccine efficacy against the viral strain. Their conclusion: immunity conferred by mRNA vaccines is likely to be retained against the Delta variant. This offers hope. But there's a huge, influential segment of the population that denies science.

A US judge aptly puts it: “At this point, if you’re unvaccinated by choice, you’re complicit in this crisis.” Israeli Prime Minister Naftali Bennett even compared not getting vaccinated against COVID-19: “It’s as if you’re walking around with a machine gun firing Delta variants at people.” Needless to say, the world needs bold collective leadership to pull off a death blow against COVID — scale up vaccine production, reach as many people are possible, as soon as possible.

What drives super-spreading strains? The data is out. Experts now know that extensive PCR tests show that fully-vaccinated people had lower "viral loads" (quantity of virus cells detected) than un- or partially-vaccinated. This supports the thesis that viral transmission of variants — including the highly transmissible Delta — significantly decreases with vaccination, according a new study published in The Lancet on August 2, 2021.

In the study, Dr Paul Chen, a professor at the University of Toronto, and his colleagues in Canada and the Netherlands, characterised the transmissibility of infectious diseases. The biggest challenge, they said, is not vaccines — but vaccinations. As most of the world have yet to get even their first dose, they called upon world leaders to make a greater effort to boost COVID vaccine production, distribution and inoculation. Needless to say, the world needs bold leadership to pull off a death blow against COVID. The leaders of the developed world, notably the G8, have to truly put their acts together sooner, instead of later, if they are to truly lead.

(4) Treatments for COVID, other than vaccines, are proven to work:

The SARS-CoV-2 is a virus like no other, and is considered now an efficient at transmission. Scientists refer to the “Pareto 80-20” rule for "over-dispersion: of infections and found that SARS-CoV-2 is indeed prone to super-spreading, compared to other pathogens. But though it’s “new,” old drugs had been proven to work against COVID — from antivirals and corticosteriods to plasma and monoclonal antibodies.

These are useful tools, but they require that the healthcare infrastructure is robust enough to deliver them when and where they’re needed.

(5) Open Science

Science benefits mankind. In this pandemic, keeping science open helps save lives. As research findings are being translated into practice even more rapidly, open science encourages a broader endorsement of the principle that science should always be a rigorous process, reliable and transparent. There are some glitches (cited below), but in general, the world has seen an unprecedentedly pace of research in the midst of COVID. Rapid sharing and review of research data have greatly improved understanding of the pandemic, which has led to reduced mortality. Remember the outbreaks in Italy and Latin America and images of mass graves there? More deaths had been curbed today, thanks to sharing of clinical research data.

A sipmle evidence of open science: as of June 2021, over 80,000 preprints and peer-reviewed articles on COVID-19 or SARS-CoV-2 came out the new virus first emerged in late 2019. Also, the principles of open science had been more broadly adopted.

For example, the practice of “preregistration” of studies through dedicated scientific servers (e.g., ClinicalTrials.gov, OSF, or AsPredicted), has become a standard. It starts with a thorough description of the study design, ethical approval, data collection methods and analyses, which help together improve the quality of such studies. Of course, there’s the “gold standard” of research — randomised, double-blind and placebo-controlled clinical trials, adhered to the trials of approved vaccines.

These publications have contributed to a huge “deposit” of knowledge that collectively informed the global community, especially health professionals and authorities. To be sure, not everything is perfect. There are low-quality studies, some of which had been cited for methodical weaknesses — or even making conclusions that could negatively affect public health. Some of these studies have already been retracted (i.e. the claim that smoking protects you from the coronavirus, which was found to be seriously mistaken, and subsequently withdrawn). 

Another benefit of open science: greater scrutiny of "informed consent". And in any drug study, adverse effects cannot be neglected. An example: ignoring the cardiotoxicity of combined dose of hydroxychloroquine and azithromycin in in the intial stages of COVID, as cited by a study published in June 2021 in BMC Medical Research Methodology.

One example of the benefits of open science: major publishers such as Elsevier and Springer Nature have made the latest COVID-19 related articles "open access", i.e. freely accessible. Researchers have also been more transparent with their work — through a systematic “pre-print" protocol, compared to previous pandemics. Extenral platforms have carried informed reviews citing weaknesses as well as benefits of such studies.

Why we’re worse off today: 7 signs

It’s been 20 months since the new coronavirus (SARS-CoV-2) first surfaced. There are plenty of vaccines, and healthcare professionals have a fair idea of the treatment protocols. That’s all good. Actually, we should feel safer now.

But, that’s not the case. The feeling of safety is conditional; it depends on several factors. Because the virus is among us; it’s still infecting people worldwide. So there’s no reason to ditch the safety protocols. We now have learned to live with the virus. There lies the danger. Because there’s an element of familiarity. Fatigue too.

A look at the worrying signs:

(1) Inadequate vaccine supply

There are 21 COVID-19 vaccines in at least one country, and they are effective against most variants in reducing the severity of infections and preventing hospitalisations.

WHO has approved WHO seven (7) COVID vaccines. More than 190 countries have approved vaccines; there are 138 vaccine candidates and 404 vaccine trials. More than 4.46 billion vaccines doses had been administered globally, according to COVID tracking site ourworldindata.org.

But there isn’t enough vaccine stock in the world. Wealthy nations that funded vaccine research have plenty of vaccine supplies while underdeveloped countries struggle to procure them.

Even a developed country like Australia doesn’t have sufficient stock, and their COVID inoculation programme is suffering. Only 1.1% of people in low-income countries have received at least one dose.

Vaccine alliances like Gavi and Covax are working to ensure that poorer countries get enough stocks of vaccines, but their efforts have been hampered by inadequate production. Vaccine manufacturers do not have plants big enough to produce enough shots for the world. This — lingering uncertainty over vaccine production, shortfalls and distribution issues — impacts herd immunity. In this interconnected world, unless every country achieves herd immunity, the COVID-19 will continue to be a pandemic.

(2) Anti-vaxxers

A country like the US has ample vaccines, but their vaccination rate hovers only around 50 per cent. Vaccine hesitancy is to blame. That’s ironic, considering that some countries cannot inoculate their population due to an inadequate supply of vaccines.

The US administration had offered several incentives, but conspiracy theories continue to dissuade people from turning up at the vaccination centres. This has resulted in a pandemic of the unvaccinated. The US Centres for Disease Prevention and Control has admitted that more than 99% of the infections and deaths in the country are among the unvaccinated. And the unvaccinated are a huge worry. They can get infected easily, and infected people can be variant factories since the virus needs hosts to replicate, and replications result in mutations.

(3) Breakthrough infections

It’s called a breakthrough infection when the coronavirus infects a fully vaccinated (both doses) person. It is rare, but it does happen. Sometimes it can be asymptomatic, and that’s more of a concern as they can be carriers spreading the disease. Since vaccination doesn’t bestow complete immunity, it’s imperative to continue following the safety protocols that include wearing masks, frequent cleaning of hands with soap or sanitiser and observing a social distance.

(4) COVID fatigue

People all over the world lived in fear for over a year. They diligently followed the safety protocols, fully aware of the danger that lurks in the form of a coronavirus. The arrival of vaccines liberated most of them from the climate of fear.

The downside was a farewell to safety protocols. And that’s immensely scary. Because vaccines are never 100 per cent effective. Breakthrough infections do occur, and reinfection too is possible for a person who has had COVID. And the biggest threat comes from asymptomatic cases. In many parts of Europe and the United States, most people don’t wear masks and keep a distance. That stems from COVID fatigue. At a time when travel has resumed, safety measures are paramount to keeping out the virus. Or else, lockdowns will return. That’s not healthy for countries’ economies and people’s minds.

(6) Education

Online learning helped when the virus was rampaging across the world. It wasn’t perfect but allowed education to continue even when schools were closed. Distance learning is never the same as classroom learning. Life on a university campus is the education of life itself. Students missed all that.

Many parents are still reluctant their children to school. It’s a major worry when schools and universities are deprived of the laughter of students. It just means the learning of students remains incomplete.

(7) The Delta variant

Most of the COVID infections worldwide now are driven by the Delta variant. It makes people sicker and transmits faster. And it catches the young too, unlike other strains. Although most vaccines are around 50 per cent effective at reducing the severity of the infection, the Delta variant is still spreading. And spreading fast. That’s a worry, especially for countries with poor vaccination rates.