The Beginning of the end for the Covid-19 Pandemic

The Covid-19 pandemic has been going on for a year. On 11 March last year World Health Organization (WHO) Director General Tedros Adhanom announced that the world was entering a pandemic.

The announcement was made after three months’ observation of a “new illness” emerging in Wuhan, China. This disease spread rapidly. During the three-month observation, the “new illness” infected 120,000 people, prevailing in more than 100 countries and causing over 4,000 deaths. It made sense for the WHO announce a pandemic.

Experts were then divided. Some considered the WHO’s decision premature while others deemed it too late. The public was confused and in a state of panic. The pandemic concept was not widely understood. The last pandemic known was that of influenza in 1918. The pandemic lasted 15 months, infecting 500 million people and killing 50 million others.

Also read: Vaccines for the Entire Indonesian Population

When Covid-19 was announced as a pandemic, not many people predicted its dreadful effects. This pandemic has turned out to be not just a simple epidemiologic term, it is undermining all aspects of life without exception.

Its impact is multidimensional. It is thus natural if people want to find out what the situation is like a year after the pandemic.

Bright spot

Pandemic developments can be evaluated by the use of various epidemiologic indicators. Each indicator has its own plus and minus points. Therefore, although indicators are beneficial and widely applied in evaluation work, the descriptions presented are relative rather than absolute. Moreover, Covid-19 is a multifactor disease, having so many determinants.

Among the various indicators normally used in evaluating the pandemic are the incidence of disease as shown in the number of new cases and the positive rate, as well as the mortality rate.

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The positive rate indicates the total of confirmed positive cases compared with the number of people subjected to Covid-19 tests. The figures describe the level of disease transmission. The higher the positive rate, the more extensive the transmission is. The CFR refers to the number of deaths compared with the total of confirmed positive cases. This gives an idea of the fatality of the disease. The higher the CFR, the more people die from this disease.

What is interesting and at the same time offers some hope is that at present the trend of the three indicators is beginning to decline, both at the global level and in Indonesia.

At the global level, a consistent decrease in the number of new cases per day has become apparent. Today, the total number of new cases is around 315,000 per day, far lower than the new cases in December, reaching 880,000 per day.

This declining trend also occurs in Indonesia although it is not yet solid and consistent. The number of new cases in Indonesia is now still high, around 10,000 per day. However, the figures are slightly better than those several months ago, when new cases ranged in number from 11,000 to 14,000.

Also read: Vaccination and Threat of Virus Mutation

The same phenomenon marks the positive rate. Today the positive rate in Indonesia is quite high at 27.6 percent. But the figures are lower than the peak rate in April 2020, exceeding 42 percent. Despite the argument that the total of new cases and the positive rate are not adequate indicators, their improvements at least point to the presence of a bright spot in the control of the pandemic.

Globally, there’s also a sign of decrease in the CFR. When Covid-19 cases appeared in January 2020, the global CFR was around 3.1 percent. The figures rose sharply and peaked in April at 7.2 percent. At the time, the CFR in several countries even reached 14.5 percent.

After April, the global CFR started declining and at present it’s only about 2.2 percent. It is a significant decrease. The same has happened in Indonesia. Its CFR peak in April was 9.5 percent. Now the CFR has gone down to 2.7 percent. It means that about three people die out of 100 confirmed positive cases.

Also read: Vaccines: Some Successful, Others still Awaiting Results

Of the three indicators, there are indeed positive results of pandemic control. The global fatality rate and that in Indonesia have passed the peak and begun to drop. Disease incidence also appears to be globally lessening although in Indonesia the decline is not yet solid and significant.

Covid-19 vaccination

Vaccination has been the central theme of the pandemic over the last several months. To date, 11 types of Covid-19 vaccines have been approved and used in a number of countries. Besides, 42 types are in the phase of clinical trials, ten of which have the potential for authorization within the next few months. It means that in the second half of 2021, 20 types of Covid-19 vaccines will most likely be distributed and used.

The massive vaccine production creates better prospects for pandemic control, let alone the fact that the vaccines have been widely benefited. Only within 2-3 months after approval, 215 million people have been vaccinated in some countries. It means that 70 million people are inoculated monthly. The vaccination rate is expected to increase in the coming months.

Several countries have now even vaccinated the greater parts of their populations and achieved herd immunity. In Israel, the vaccination rate has reached 87 percent, the United Arab Emirates 57 percent, Britain 27 percent and the U.S. 19 percent. In Indonesia, around 2 million people have been vaccinated or 1 percent of its target. Such rapid and extensive vaccine treatments have never before been carried out.

Also read: Covid-19 Vaccine, Between Euphoria and Fear

More interestingly, a leading thread has begun to be identified between the efficacy of vaccines upon trials and the effectiveness of their use in society. Under trials, Covid-19 vaccines were reported to have the efficacy range of 50-93 percent. At the rates, the people vaccinated have 3-19 times lower possibility of suffering from Covid-19 than those who are not inoculated.

Now several studies in society have confirmed the efficacy levels. One of them was conducted by Macabi, a health insurance firm in Israel. This company reported that out of its around 523,000 clients vaccinated, only 544 people (0.1 percent) were infected with Covid-19, 15 people (0.003 percent) had to be hospitalized and none died.

Also read: COVID-19 in 2021

The figures were far different from those of clients without vaccination, totaling 628,000 clients, of whom 18,000 suffered from Covid-19 (2.8 percent). It means that the rate of effectiveness of the vaccines used was about 93 percent, almost equal to the rate of efficacy upon trials. The combination of massive vaccine production, the high vaccination rate, as well as the confirmed vaccine efficacy upon trials and the effectiveness of their use in society serves as a solid reason that Covid-19 vaccines will be a powerful weapon to overcome the pandemic

Collective efforts

The declining trend in the number of new cases, the positive rate and the CFR, as well as the massive and effective production and use of vaccines constitute the reason that the pandemic can cease faster than previously thought. As long as there’s no significant change in the condition, many countries are expected to succeed in controlling the pandemic in 2021, which is marked by the attainment of herd immunity in those countries. The rest still need several more years.

In order to expedite the process of pandemic control, three important things should be strived for.

First, vaccination in society should be sped up to achieve herd immunity. Today some countries have earned the status of herd immunity, such as Gibraltar, Israel and Sicily. They have vaccinated more than 70 percent of their populations. In Indonesia, the total already inoculated is only 2 million with about 50,000-60,000 people per day. Unless the vaccination rate is raised, herd immunity will only be realized after eight years.

Also read: Measuring the Efficacy of the Covid-19 Vaccines

The government and the entire public should strive hard to increase the vaccination rate at least twice the present level. In reality, many countries can vaccinate over 100,000 people daily. In Israel, the government vaccinates 120,000 people daily, Turkey 183,000 people and Bangladesh 167,000 people daily. It means that the factor of acceleration can be optimized.

Second, at the global level there should be collective efforts to achieve global herd immunity, which is the vaccination of 60-70 percent of the world population. If this level is not yet reached, the pandemic effect will not yet subside. The phrase often expressed by the WHO is that no one is safe until everyone is safe.

Vaccines are now generally still distributed in advanced and middle-class countries while developing countries are short of access. Around 60 percent of Covid-19 vaccine stocks are controlled by certain 16 percent of certain countries. There is disparity. With their purchasing capacity the advanced nations have ordered and bought up vaccines more than what they need for reasons of vaccine nationalism.

The WHO has initiated a global program to dope with this issue, which is COVAX. Through this program, a number of countries join up and allocate part of their vaccines to the developing countries. This endeavor should be more seriously and consistently supported.

Third, pending the effect of herd immunity produced by extensive vaccination, the public should continue to implement 3M (mask wearing, distancing, hand washing) and 3T (tracing, testing, treatment). These attempts have proven to contribute to the improvement of morbidity and Covid-19 mortality trends. It is indeed burdensome and boring, but there’s no other choice except compliance.

UGM.AC.ID

Iqbal Mochtar

The management of Covid-19 so far has obviously produced some positive results and vaccines will enhance the positive values, especially in reducing the rates of Covid-19 transmission and fatality. Some countries have enjoyed herd immunity but most others are still going all-out in this direction. Although it’s not easy to conclude that Covid-19 will be overcome within the next few years, the bright spot toward this end is apparent. It requires the efforts of all parties so that this bright spot will truly become a marker lamp showing that the pandemic is ending soon.

Iqbal Mochtar, Doctor and Observer of Health Affairs.

This article was translated by Aris Prawira.