Beware the 5th Covid-19 wave

On May 8, I wrote about preventing a Covid-19 disaster in Malaysia. The toll in deaths and livelihoods has been and continues to be significant.

I am now writing about an impending, massive fifth wave. This may be so big that it’ll make the current one pale in comparison. We have, in the fourth wave, experienced what Italy did last year. Now the fear is that we may experience what India, Peru and some other countries in South America are experiencing.

Some of our leaders seem to be living in denial of the reality; one even saying that the pandemic in Malaysia is under control. Others have set a value of “4,000 cases” as a benchmark to use, but in the face of a high positivity rate and limited testing, this is fraught with problems. A look at the data and trends suggest that the worst may be yet to come.

When will a 5th wave potentially hit us?

The figure below shows the growth of the Covid-19 outbreak in relation to the population (seven-day averaged data to offer a more accurate picture).chart© Provided by Free Malaysia Today

You can see that the fourth wave came very quickly, as fast as four weeks after the third wave. Some may argue that the fourth wave was due to movement of people during the puasa and Hari Raya periods; that this encouraged the virus to spread.

But the real issue is that, even now, we fail to understand that there is no safe number. All social interactions – work, education, religious or otherwise – are easily exploited by this virus. The current high baseline community infections, predominantly unlinked, makes another surge very likely.

Why will a 5th wave come?

The fifth wave will come for a number of reasons.

First, we cannot continue lockdowns indefinitely; the suffering of the poor and middle class is enormous. It has been estimated that an additional 2-3 million Malaysians have been pushed below the poverty line during the Covid-19 crisis thus far.

The Small and Medium Enterprises Association of Malaysia is quoted as saying that some 100,000 companies have ceased operations since the first MCO and an additional 50,000 may lose their business with any extended lockdown.

So we will have to reopen the economy or face worsening poverty, malnutrition of children, rising suicide rates, etc.

Second, we have yet to make significant changes to our work, business and education environments to reduce Covid-19 spread. We have continued to focus on surface decontamination instead of the more important ventilation to reduce airborne transmission. The lack of a national directive to do this hampers local initiatives.

Third, our social responsibility remains limited. This applies to the leaders as much as to the people. Blaming the people without stern action against errant leaders and the rich does not promote collective responsibility in addressing this pandemic.

Finally, and perhaps a critical reason, is the Delta variant.

Dr Mike Ryan, executive director of the World Health Organization (WHO), said the Delta variant has the potential “to be more lethal because it’s more efficient in the way it transmits between humans and it will eventually find those vulnerable individuals who will become severely ill, have to be hospitalised and potentially die”.

The Delta variant appears to be more contagious and vaccines seem to be less effective against it. The limited genome testing done locally shows that the variant is present in many states but we need more data to track its spread.

Data from some nations shows that the variant rapidly becomes the dominant infective strain and reverses some of the progress that has already been made to fight the disease.

Won’t our Covid-19 vaccination programme save us?

Many hope our vaccination programme will save us, but we still require about three months to get 50% of our population vaccinated with two doses. There is also an unacceptable disparity in vaccination rates in various states, which may leave some regions less protected.

Note also that many vulnerable people have yet to be vaccinated. As at June 20, we have 937,078 registered senior citizens who are still waiting for their vaccination appointments. Only 19,000 (6.8%) out of 280,000 adults with disabilities who registered have received their first dose.

We have no idea on vaccination rates among adults with comorbidities like diabetes, hypertension and heart disease, who comprise about 30% of the adult population and many of whom are under 60 years of age. There are many more of these three vulnerable groups who are either not able to register for vaccination or are hesitant. They will be the ones hard hit by a fifth wave.

Even nations with high vaccination rates are beginning to see a rise in cases and hospitalisations due to the Delta variant.

Current data from Scotland (see figure below) from Public Health England regional director Dr Gabriel Scally (@GabrielScally) shows that despite 48% of the population fully vaccinated, the Delta variant has caused a rise in cases and hospital admissions. While the majority who get infected are not yet vaccinated (showing good vaccine benefit), some vaccinated individuals also do get infected.chart, histogram© Provided by Free Malaysia Today

So vaccinations will help but they need to reach a large segment of the population before outbreaks can be reduced.

Why will a 5th wave be more severe?

If we have a fifth wave very soon after the fourth one we may not be able to handle it as well compared to before. Our intensive care units (ICUs) are overstretched and still struggling with Covid-19 cases, with some having adults who have been dependent on ventilators for a long time. If we have a fresh surge due to the Delta variant, the system has little reserve to cope with the situation.

How can we work together to prevent the 5th wave?

Covid-19 has been dubbed the “unforgiving virus”. Any failure on our part will be exploited to infect us or spread the disease. The key is to avoid getting infected. This requires a shared responsibility that is built on trust and discipline (routines) between everyone – especially if you are working or studying outside the home; what we like to call “Trust Bubbles”. As always remember to improve the quality and fit of your mask.

We need to follow the data and science when working to minimise the spread of Covid-19. Sharing all our Covid-19 data will help the public make better informed decisions. Some suggestions to help prevent a fifth wave include:

1. The only good vaccine is the one in the arm of a person

We need to administer all our vaccine supply to the public as quickly as possible. The second dose should be given at the minimum duration possible (shortest data-based interval possible). Ramping up daily vaccinations is critical; 300-400,000 doses a day are necessary.

2. Speed up the vaccination of the vulnerable

In the next four weeks we should focus on completing the vaccination for all registered senior citizens, adults with disabilities and adults with comorbidities.

We should also proactively search for these vulnerable groups who have not been able to register or are hesitant and offer them vaccination appointments.

Parents of children with disabilities should also be prioritised for vaccination to protect their vulnerable children; as should all those involved in childcare and preschool services.

3. Test, test, test

We need to test widely and not allow 60%-80% of cases to be unlinked. We have to test asymptomatic contacts of identified cases, and not just those who present signs of an infection.

Using reliable antigen rapid test kits (RTK-Ag) for community testing and polymerase chain reaction (PCR) tests for admissions will be the best utilisation of resources and offer quicker results. Some 200-300,000 tests a day should be our minimum.

We need an effective contact tracing and isolation mechanism. Digital contact tracing and alerts must occur in real time for this to happen.

If possible we should offer cheap, weekly RTK-Ag tests for all those going to work in any sector to prevent clusters from developing. We need to work towards developing and maintaining work safety bubbles.

4. Home safety bubbles, even for the vaccinated

For all of us, we need to limit all unnecessary contact with others to maintain a home safety bubble. Don’t visit your extended family or grandparents and don’t stop to talk to your neighbours when doing your morning walk – speak to them via video or phone call.

Stop all family and religious gatherings, even in small groups – there is no safe number.

Those who are vaccinated should continue to maintain the Covid-19 prevention measures like everyone else. It is important not to relax our vigilance at this time.

5. National ventilation mandate and streamline SOPs

We now know that the Covid-19 virus is primarily spread through airborne mechanisms, especially indoors. Keeping a 1-2m distance in a room is of little value unless you improve ventilation.

We need a national initiative to improve ventilation in all buildings and maximise the intake of outdoor air. This means encouraging fresh air to come in all the time and stopping recirculation of air by air-conditioning units.

Current SOPs are not all science-based. Many are burdensome to the public. Even temperature scanning has little value and should be stopped. Time to revise all the SOPs, remove many and streamline them to include only the meaningful ones. This will improve compliance and effectiveness.

We must not be complacent about the threat of the fifth wave in Malaysia, especially due to the Delta variant. The pandemic is barely under any control despite four weeks of the lockdown. We need to support each other and see the nation through these next few difficult months. – FREE MALAYSIA TODAY

by Dr Amar-Singh HSS – a consultant paediatrician.

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