The Year Ahead Against Covid-19

AS Malaysia’s Covid-19 vaccination programme moves towards the booster stage, there is hope that next year may see some respite from the long pandemic. However, we cannot let our guard down and must remain vigilant amidst the emergence of more dangerous strains like the Delta, and new variants of concern like the Omicron.

While Malaysia’s vaccination rate is in a good place with 78% of Malaysia’s total population fully vaccinated (according to the covidnow.moh.gov.my website updated yesterday), the low uptake of boosters is a red flag for local healthcare specialists. To counter waning immunity, the public needs to embrace boosters, they say.

Vaccines currently being used in Malaysia are Pfizer-BioNTech (55.0%), Sinovac (37.1%), Astrazeneca (7.5%) and Cansino (0.4%). While the Moderna and Johnson & Johnson vaccines have been approved, they have yet to be used here. Some vaccines’ effectiveness decreases faster than others’ over time, and Sinovac’s efficacy wanes sooner compared with the rest.

Currently, 97.2% of adults and 86.9% of teens have completed their primary doses and are considered fully vaccinated. However, the total number of boosters given out so far is only at about 3.5 million doses for Malaysia’s 32.7 million people. Earlier this month, Health Minister Khairy Jamaluddin revealed that some 40% of those given booster appointments did not show up for their shots.

Boosters aside, some Malaysians seem to be suffering from Covid-19 fatigue and are reducing adherence to SOPs, exposing themselves and others to risk. So how can we prepare ourselves to continue battling Covid-19 next year?

Keep practicing SOPs

We are not fully out of the woods yet with Covid-19, and respiratory physician Dr Helmy Haja Mydin says that preventive measures such as wearing masks, avoiding closed and poorly-ventilated areas, working from home where applicable, and so on should continue.

At the moment, it is too early to tell how Omicron will affect us, says Dr Helmy, who is the department head of a local hospital’s lung centre. With any new variant, we will need time and data to give us an idea of what extra measures are required, he explains.

As the fight against Covid-19 is far from over, preventive measures such as wearing masks, avoiding closed and poorly-ventilated areas and working from home where applicable should continue. — AZHAR MAHFOF/The StarAs the fight against Covid-19 is far from over, preventive measures such as wearing masks, avoiding closed and poorly-ventilated areas and working from home where applicable should continue. — AZHAR MAHFOF/The Star

“While we keep talking about new norms, there seems to be a tendency or expectation that things will return to normal – this, alongside a degree of complacency, may be disastrous.

“As with all viruses, SARS-CoV-2 will continue to mutate and change over time,” he says, adding that we can reduce the probability of this happening by improving booster vaccinations and adhering to other public health measures.

Dr Helmy cautions that we will need to prepare for the day when we face a variant that is not addressed by vaccines, in which case there will likely be a global race once again for access to an updated vaccine.

Planning healthcare facilities

Dr Helmy is hopeful that we will not see the same degree of capacity strain in terms of hospital usage and medical practitioners as we did last year.

He says that there is more effort being put into scenario planning, and there is more awareness and acceptance of the need to prepare for intermittent surges or even waves of infection.

Nevertheless, he warns that we have to be mindful of physical and mental fatigue as those on the frontlines may feel like they’re facing a war with no end. We also have to do more to ensure that non-Covid-19 diseases are not neglected.

Long Covid

Thankfully, the majority of individuals who get Covid-19 will not have to deal with long-term consequences. However, those who are troubled by long Covid syndrome must be identified and provided with the necessary medical and socioeconomic support, says Dr Helmy.

“It will be tricky, and we will need to have a low threshold for support, as some of these symptoms, like fatigue, are not easily quantifiable or demonstrable,” he explains.

Post-Covid-19 syndrome, also known as long Covid, refers to the persistent state of ill health experienced by some Covid-19 survivors, who, although no longer infectious to others, experience a range of symptoms that continue for weeks or months beyond the initial illness. The latest data shows that nearly 20,000 people in Malaysia have experienced or are experiencing long Covid.

“We will also need to be prepared for younger patients who have such symptoms, including those of school-going age. As school reopens and numbers continue to rise, we foresee more patients requiring care and attention,” says Dr Helmy.

The communication war

The world will likely experience multiple cycles of lack of information and misinformation regarding the prevention and cure of Covid-19, as has been happening over the past two years. Therefore, the information vacuum will need to be filled in quickly and appropriately, and Malaysia will need to continue being proactive in dismissing fake news.

“There is also likely to be cyclical changes to our socioeconomic situation, which may be exacerbated by an unstable political landscape,” says Dr Helmy.

“Hidden behind all these permutations is the fact that many people continue to suffer both physically and mentally, and our leaders must continue to be reminded that incorrect policy decisions have real life consequences for those on the ground.”

Focus on boosters

International Islamic University Malaysia public health physician Dr Mohammad Farhan Rusli finds the low take-up of booster shots to be “a little worrying”.

Although the number of total population vaccinated is high, there is a waning of the neutralising antibodies as time passes – which is why it is imperative for all of us to get boosters, he says.

Red flag: While Malaysia’s vaccination rate is at a good place with 78% of Malaysia’s total population fully vaccinated, there is a low uptake of boosters. –AZHAR MAHFOF/The StarRed flag: While Malaysia’s vaccination rate is at a good place with 78% of Malaysia’s total population fully vaccinated, there is a low uptake of boosters. –AZHAR MAHFOF/The Star

Dr Mohammad Farhan, who is Selangor Covid-19 Task Force Operations director and also a member of the National Rapid Response Task Force, predicts that Malaysia may have a change of booster policy due to the low response.

It may be a case where a completed vaccination will mean those who have completed their boosters. As new strains and mutations are discovered, likewise we must also be prepared that vaccines for Covid-19 may be an annual affair just like influenza vaccines, he says.

Prof Dr Moy Foong Ming, of Universiti Malaya’s Faculty of Medicine, explains that the slow booster uptake is because many people are not convinced that boosters are necessary, and also because they are concerned by the “mix and match” regime for booster doses.

Next year will be spent focusing on improving these areas with better communication and outreach, says Dr Moy, whose area of specialisation is epidemiology.

“The Health Ministry is expected to continue improving vaccination rates in states like Kelantan and Sabah (currently with only 60% uptake) and Pahang and Terengganu (barely reaching 70%). In addition, the waning effect of vaccines will also mean that booster doses will be aggressively promoted to the public to prevent breakthrough infections,” she tells Sunday Star.

Furthermore, if the Omicron variant causes mass transmission and increases hospitalisation and deaths, the uptake of booster doses will increase. People are more likely to be convinced to take booster doses when they feel at risk, says Dr Moy.

More MCO?

Dr Mohammad Farhan says that it is unlikely Malaysia will ever revert back to the full movement control order.

“The full MCO is not only detrimental to the national economy, but the cost-benefits in terms of health is also not that impactful. MCOs tend to stop the issues for a while but do not serve the main purpose of actually stopping the outbreak,” he explains.

The best way to beat Covid-19 is to focus on the find, test, trace, isolate and support (FTTIS) approach, which is more holistic and comprehensive, says Dr Mohammad Farhan.

“We will learn that normal means Covid-19 will be with us always, and that we must learn to adapt so that it won’t always be a lingering threat,” he emphasises.

Dr Mohammad Farhan believes that the Omicron variant will not impact our lives much more than Delta has done, and that if we keep to SOPs we will likely be able to curb the threat and prevent the spread.

“The new variants occur because countries are not able to vaccinate their populations in time. This creates a problem because when people get infected and pass it on to one another, mutations occur.

“The main thing for us to do now is to get as many people vaccinated as possible, avoid vaccine hoarding, and help other countries. There is no point if only we recover but the rest of the world does not,” he says.

Above all else, Dr Mohammad Farhan advises everyone to take care and be mindful of our mental health and ensure that people around us who have suffered are looked after.

As we move into the new year, Dr Moy suggests a few measures that would help in combating Covid-19, such as enhancing the resilience of our healthcare systems and capacities, training more public health workers, developing capacity for behavioural scientists in pandemic responses, and updating medical and health curricula to meet the emerging public health changes.

Other measures that can be taken are having government/private sector partnerships to invest in digital healthcare technology, improving mental healthcare support, and creating an effective risk communication approach that can be applied to future pandemics.

Source: The year ahead against Covid-19 | The Star

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