Backwards and forwards …

I wish this article could be all about Christmas and New Year, but we cannot escape reality. Sadly, tradition is on the back burner for the time being.

It has not been easy to attain a progressive, controlled, positive, steady evolution of the Covid-19 pandemic. When it looks like we are getting there, it goes backwards.

Cases have been sweeping Europe and concerns over the Omicron new variant, detected in South Africa, have forced many European countries to reintroduce tighter pandemic restrictions. Omicron is undoubtedly a new crisis phase in the long pandemic. It is easy, and even forgivable, for anyone to take a passive approach when faced with yet another negative surprise.

As Covid-19 cases surge in Europe, there has been more focus on convincing the unvaccinated to get the jab, as measures have gone from Covid passes to lockdowns to targeting those without the vaccine.

Presently, several countries are considering mandatory vaccination. Although many vaccines are mandatory for children in many countries, it looks more difficult to convince adults of the absolutely proved need to do it.

Portugal has a high vaccination rate with around 86% of its population fully vaccinated against the virus but, even so, we need more!

Preventing harm to others
There are many instances where governments restrict people’s freedoms. You cannot drive without a licence or drunk drive, and you cannot carry a gun in many places in the world – many more examples could be given.

Governments often must restrict our freedoms to protect others from risk, and restrictions on the unvaccinated are similar, in many ways, to these existing restrictions.

Simon Rippon, an associate professor of philosophy at the Central European University in Austria, said: “We don’t want the government to judge for us what the best way of life is, we don’t want it to impose one particular view about the right way to live. But in this case, there are scientific facts which are well established. What’s happening is that governments are taking measures to restrict some people from imposing physical risks on others because they choose not to take a precaution that’s scientifically well-supported. It’s very clear that even strong measures like widespread testing and green passes are not strong enough in the situation that we’re in.”

A renowned British philosopher, John Stuart Mill, argued in his essay On Liberty that “the only purpose for which power can be rightfully exercised over any member of a civilised community, against his will, is to prevent harm to others”.

It has been confirmed that there is a much higher incidence rate of Covid 19 cases in the population of the unvaccinated, with more severe presentation of the disease.

“We do know that vaccination obviously prevents some infection and is better at preventing hospitalisation and deaths, although that still does occur,” explains Rowland Kao, epidemiologist at the University of Edinburgh.

Kao explained that the expectation is that while vaccinated people do transmit the virus, the vaccine does block infection and thus has an effect on transmission.

The Omicron variant is here!
Clarity on the implications of Omicron will not arrive for a few weeks and, until then, uncertain risks make the situation more difficult to manage. As the world waits for studies that give a clear picture of the Omicron variant, early clinical data emerging from South Africa hint at a virus that may cause less severe cases of Covid-19.

Even if Omicron outcompetes Delta on transmissibility and becomes dominant globally, there is hope that it may have no worse effects than earlier variants. If this proves true, Omicron’s lasting impact on the pandemic could be unexpectedly positive.

It might show the need to push through to higher vaccination levels, reducing hesitancy and inspiring greater public support for containment measures like masking and distancing, which are needed until vaccination reaches the required critical mass.

Even in the developing world, vaccine hesitancy is emerging as a more potent barrier to better outcomes than lack of vaccines.

Portuguese virologist Pedro Simas says the population of Portugal has a very good protective immunity and the most important thing to do now is to focus on giving the third dose.

From pandemic to epidemic
It is highly unlikely that the world will be able to eliminate the coronavirus that causes Covid-19.

But a day will come when it is no longer a pandemic, when cases are no longer out of control and hospitals are not at great risk of overflowing with patients.

Many experts predict the spread of coronavirus will look and feel more like seasonal influenza, but how and when that will happen is less clear.

The good news is the power of vaccines, as our vaccines are much more effective than what we were used to seeing.

The bad news comes with the power of the virus to change and evolve, as no one can predict what the future of Covid-19 may look like, considering the unexpected changes in transmission patterns due to the emergence of coronavirus variants.

There is now much more uniform, extensive global transmission and spread, making it more difficult to declare the end of the pandemic.

In early 2020, as the pandemic was ramping up, officials at the World Health Organisation predicted that the novel coronavirus could become another endemic virus in our communities and never go away.

Endemic means that a disease has a constant presence in a population, but it is not affecting an alarmingly large number of people as is seen in a pandemic.

“What we hope to get it at is such a low level that even though it isn’t completely eliminated, it doesn’t have a major impact on public health or on the way we run our lives,” Fauci said. “So, if we get more people vaccinated globally and more people vaccinated now, hopefully within a reasonable period of time, we will get to that point where it might occasionally be up and down in the background, but it will not dominate us the way it is doing right now.”

There is still much to be done!
To achieve transition from pandemic to endemic, the world must build up enough immunity to the coronavirus, which means many more people need to get vaccinated.
With people still refusing to get their Covid-19 shots and some refusing to wear masks, it is easier for new variants to appear, thus the transition could take longer.

With winter settling in, it is important to continue practising all the prevention measures that we know really work, like vaccinating, wearing a mask in public and indoor settings, staying home when you are sick and washing hands frequently.

The battle to keep coronavirus under control, every year, may look very much like the annual fight against the flu. Even flu is unpredictable!

We certainly have trustworthy weapons to help us fight this war, so they must be used.

I regret that I am repeating myself over and over again, but the last movement of the pandemic was unfortunately “backwards”. We can only hope the next move will be a sustained, strong “forwards” … with no turning back! It depends on us, Humans.

Dr Maria Alice
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Dr Maria Alice is a consultant in General and Family Medicine. General Manager/Medical Director – Luzdoc International Medical Service. Medical Director – Grupo Hospital Particular do Algarve/ Hospital S. Gonçalo de Lagos