Moving forward with managing the pandemic

IT is time to take stock of the situation, learn from past failures and move forward in managing the pandemic to sustain economic reopening.

First of all, we need to maintain high levels of vaccination readiness, so we shouldn’t be quick to reduce the involvement of general practitioners (GPs).

If anything, they are an important part of future pandemic management strategy.

Chances are we will have a prolonged (if not continuous) need for vaccination drives nationwide, given a “double whammy” of potentially waning immunity, and immune evasion of variants.

The potential need for updated vaccines, heterologous boosters i.e., mix-and-match strategy with different vaccines, and increasing trend of children vaccination are possible vaccination trajectories for Malaysia and we will need vaccine administration outlets to be on ready-mode.

Moving forward, the COVID-19 Immunisation Task Force (CITF) should consider registering GPs nationwide as “mini” vaccination centres (PPVs) and assign people’s vaccination appointments according to locations (prioritised according to risk profiles) through MySejahtera for future vaccinations drives.

One thing we all can agree on is the need to boost healthcare capacity, particularly in increasing the number of beds, intensive care unit (ICU) capacities, equipment (ventilators, oxygen etc.), drugs and reagents, personal protective gears and many other needs.

Additionally, the healthcare system requires a stockpile of existing and emerging therapies as prophylaxes (prevention of disease progression) and drugs to manage late-stage diseases.

This includes promising high-end therapies such as monoclonal antibodies and anti-viral drugs for early-stage disease treatments.

This has to be reflected in emergency health expenses as well as future budget allocations.

Related to expanding healthcare budget, healthy living should be incentivised, while unhealthy choices such as the purchase of alcohol and cigarettes should be subjected to larger sin taxes to fund a special budget under the Health Ministry for lifestyle and non-communicable diseases.

It’s also clear that we cannot monitor all shop owners to be strict in accepting only fully-vaccinated people and ensure all shop-goers to practice strict standard operating procedures (SOPs) and personal hygiene.

Sustainable reopening of the economy ultimately boils down to self-discipline.

Health director-general Tan Sri Dr Noor Hisham Abdullah previously pointed to several studies indicating high virus loads in the noses of both vaccinated and unvaccinated people.

The mucosal surfaces (in our nose and lungs) acts as a reservoir for continued infection and transmission which increase chance of mutations and further antigenic drift , i.e. changes in the structure of antibody targets such as parts of the virus spike.

Over time, mutations may cause further vaccine breakthroughs, calling the need for continuously updated vaccines.

Governments worldwide should demand for next-generation vaccines that address this unsustainable “cat-and-mouse” game and increase the voice calling for vaccine equitable access.

While waiting for next-gen vaccines, we have no other way but to strictly enforce SOPs such as indoor double-masking (ideally with face shields) and physical distancing, adopt best hygiene practices, control crowd density, and ensure sufficient air circulation and purification.

Aligned with the narrative on personal responsibilities, this is the time where health authorities should emphasise the importance of maintaining good physical and mental health through proper diet, exercise, rest, management of stress and other holistic preventative health approaches.

With vast data collected by MySejahtera over the past year, efforts should be put into reviving the Hotspot Identification by Dynamic Engagement (HIDE) early-warning predictive system to identify a potential super-spreading hotspot before it emerges.

Additionally, as soon as the study on price of COVID-19 self-test kit is done, these kits should be made widely available for self-management (testing and isolation) and paired with enhanced contact tracing technology.

It is also crucial to conduct immunological and viral genomic studies in fighting the pandemic.

When authorities combine this with on-going global research on the correlation between demographic profiles, vaccine types, antibody levels and protection against different variants, it can help provide a better ‘feel’ of the immunological status of the nation and guide the decision regarding if and when boosters and children vaccination may be needed.

Additionally, we should start to monitor other virus transmission reservoirs such as those in animals and also conduct genome sequencing to monitor potential cross-over to humans.

Last but not least, there is a need to scale-up clinical trials on potential drugs and therapies.

For example, while waiting for next-gen vaccines, why not consider promising nasal sprays for local trials?

An investigation on the clinical efficacy of nitric oxide nasal spray for the treatment of mild COVID-19 infection reported a fast and significant drop (95%) in viral load within 24 hours, and 99% reduction within 72 hours.

If those tested positive can have access to cheap early-stage treatments to reduce viral loads in upper respiratory tracts before the virus can spread deeper into the lower respiratory system, it could be a game changer in stifling infection, transmission and disease progression.

Let’s explore all options.

Past failures of premature reopening of high-risk areas and schools, low monitoring and enforcement of SOPs (particularly in high-risk clusters), half-hearted restrictions and inconsistent policies must not be repeated.

The time for proactive, consistent, clearly-communicated, data-driven policy-making is now or never. – Aug 26, 2021

 

Ameen Kamal is the Head of Science & Technology at EMIR Research, an independent think tank focused on strategic policy recommendations based on rigorous research.

The views expressed are solely of the author and do not necessarily reflect those of Focus Malaysia.

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