Predicting the Future of COVID-19

The Singaporean government has publicly stated that it will treat the SARS-CoV-2 and COVID-19 viruses as endemic diseases that cannot go away, but will not cause too much trouble.

It has acted very rationally, taking into account all the developments in the last 18 months. Of course, it has grounds to justify the decision.

In contrast to Singapore, we may not yet have those grounds, so for us, we need more effort to reach the same point.

Indeed, there are still other options for predicting the future of COVID-19. The best option is that the disease can be eliminated and the SARS-CoV-2 virus does not return.

Also read:

> Together We Obey ‘PPKM Darurat’

> Mutual Discipline to Prevent Worst-Case Scenario

We have experience with smallpox and rinderpest in livestock. Unfortunately, several things distinguish COVID-19 from the two diseases.

What was able to eliminate smallpox was a strong vaccine. The smallpox virus has no other host, and no smallpox case is asymptomatic. These three things cannot be matched by COVID-19. With all the current facts, it would be very difficult to expect the SARS-CoV-2 virus to be wiped out forever.

Middle option

The worst-case scenario is a prolonged pandemic with millions of people continuing to become victims. Currently, there is clearly a gaping discrepancy between developed and developing countries.

This discrepancy has potentially made people in poor and middle-economic countries unable to escape the snare of COVID-19. The availability of vaccines is very limited, both because of funds and supplies. The number of tests is also very limited, and the facilities for handling patients are far behind those from developed countries in terms of quantity and distribution. We hope this worst-case scenario doesn\'t happen.

The World Health Organization’s COVAX facility, which balances the distribution of vaccines, the increasing number of diagnostic tests for COVID-19 and the improved quality and quantity of health services, especially in remote areas, are part of efforts to avoid the worst-case condition.

The most realistic scenario is as stated by the ministers of Singapore: a compromise solution, which has been one of the options from the start.

REUTERS/EDGAR SU

A youth takes photos at Merlion Park, amid the coronavirus disease (COVID-19) outbreak, in Singapore July 14, 2020.

The slogan “Make peace with COVID”, or the new normal, essentially accommodates this middle option. There must be several reasons behind this option.

First, the coronavirus has been around for a long time. Around a quarter of patients with fever, coughing and flu complaints actually have the coronavirus, but definitely not SARS-CoV-2. These patients can experience repeated symptoms in the same year, which indicates immunity will not last long. It also seems impossible that this relatively old world-dwelling virus would suddenly disappear.

Second, it is very clear that the virus can mutate. The detection of the Alpha, Beta, Gamma, Delta, Kappa and Lambda variants proves this. Mutations make viruses more adaptable, stronger and harder to beat. This is basic to all living things.

Defeating the currently dominant variant does not automatically mean defeating it forever. The bitter experience with the current Delta variant should be one of the valuable lessons learned.

Even with such a mutation ability, the virus can escape vaccines and monoclonal antibodies.

Fortunately, the SARS-CoV-2 mutation’s ability is only one-10th of influenza and one-100th of the HIV virus. Even with such a mutation ability, the virus can escape vaccines and monoclonal antibodies.

Third, the current vaccines cannot completely kill the virus. Indeed, vaccination gives us strong protection, especially from serious illness and death, but it is unable to completely stop virus transmission.

Fourth, until July, no really effective SARS-CoV-2 antiviral has been found. As a comparison, the world\'s most effective antiviral is ARV for HIV. The antivirus for COVID-19 has not been able to match the power of ARV. However, currently, there are at least a few high-strength SARS-CoV-2 antiviral candidates that are still undergoing clinical trials.

Also read:

> Task Force Tracking Violators of PPKM Darurat

> Hopefully, We Are Not Mentally Ill

Hopefully, this antivirus medicine can successfully pass clinical trials and be available for use soon. The desire to turn to old medication as a therapeutic modality, as in the successful case of artemisinin for malaria, seems unable to be fulfilled. Many drugs only look to be promising on social media but not in the scientific realm of medicine and pharmacy. New invented drugs are now more of a focus.

Long-term compromise zone

We have to prepare several things to get to the long-term compromise zone. Broadly speaking, we need to follow several steps taken by developed countries, including Singapore, but on a different scale considering the vast territory and large population of Indonesia.

AP PHOTO/RAJESH KUMAR SINGH

A health worker administers a dose of the Covishied vaccine for COVID-19 at Railway hospital in Prayagraj, India. Saturday, June 26, 2021.

First, we need high immunization coverage. The minimum is 70 percent, but if it can reach 80-90 percent, success will be more measurable. Surely, efforts in our country are more challenging than in our neighboring countries. Rejection or cynicism toward vaccines, as well as the lingering politically motivated opposition provide, extra barriers to the efforts.

The government has submitted a plan to make proof of vaccination one of the administrative requirements in daily life, which is believed to be effective. However, the potential for resistance from the community, such as what happened at the Suramadu Bridge, must be anticipated.

Second, the quality of the vaccine will basically come into play. With the power of vaccines clearly under mRNA vaccines or adenovirus-based vaccines, we need booster or vaccine repetition, which will definitely cost money, time and energy. Improving the quality of vaccines deserves consideration if the global distribution runs more smoothly.

Third, the capacity to carry out diagnostic tests deserves attention. Our abilities have so far been low. What also becomes a concern is that the high and low positive cases become a political barometer.

It’s no wonder that many regions deliberately refrain from doing tests. A developed countries with low number of tests today must receive a barrage of criticism, so like it or not, the ratio of the number of tests per population is one of the benchmarks that deserves attention.

International publications and broader external validation are possible examples.

The PCR test, which is the highest standard swab tests, will not be carried out massively given the technical difficulties of implementation and high cost. Simpler tests, such as antigens, are more feasibly considered. The GeNose test or similar test analyses being researched (based on mouth and sweat) requires a lot of effort to win the trust of domestic experts. International publications and broader external validation are possible examples.

Fourth, because cases will not go away, the ability to treat needs to be improved. We are waiting for a more potent antiviral drug, in addition to a stronger vaccine. If cases are not at their peak, there will be sufficient treatment rooms throughout the country.

The number of doctors and nurses may be relatively fixed, but with better management, patient care will be more satisfying.

KOMPAS/AGUS SUSANTO

Motorcycle riders cross a mural calling for them to wear masks at Pancoran, South Jakarta, Thursday (17/6/2021).

Fifth, the most difficult part is to make adjustments to social life. The habit of wearing masks will still be carried out in some activities. I don\'t think we\'re going to enter the 100 percent mask-free zone. However, as it is well known, in many community groups this is very difficult to do consistently — not to mention washing hands, keeping a distance and avoiding eating together.

The Indonesian people have a sociable culture, so chatting and eating together is a habit impossible to be wiped out. In fact, this activity is a major source for the spread of SARS-CoV-2. In the context of sociability, if the endemic stage is reached, mass activities such as weddings or religious activities will be able to be carried out.

Of course, with the support of immunization coverage, health protocols, adequate testing and improved management as mentioned above, indeed, many people hope that we can reach the level of the US or other developed countries that have already freed their citizens from wearing masks.

Also read:

> Health Facilities Limited, Self-Mitigation During Isolation Increasingly Important

> Implementation of ‘PPKM Darurat’

Who knows, we can reach that level too. However, passionate desire should not overpower common sense. People may be jealous of the progress made by several countries but reluctant to learn how those countries have strived hard for months and are now reaping the fruits.

If we are not willing to work hard and only expect instant results, then what we will receive is merely delusion.

ARSIP PRIBADI

Dominicus Husada

The effect is that the number of cases cannot decrease with the death toll continuing to rise. Official administrative data may show minimal cases, but in the field, the victims continue to fall. Instead of making it endemic, we will remain to be plagued by the COVID-19 outbreak and will automatically be shunned away by many other countries. Hopefully, we can continue to improve ourselves.

Dominicus Husada, Head of the Division of Infection and Child Tropics, Department of Pediatrics, Medical School of Airlangga University/Dr Soetomo General Hospital Surabaya; Member of Airlangga\'s Merah Putih Vaccine Team

(This article was translated by Musthofid).