COVID-19 Now and Later
Remember that good health is a precious asset that requires proper maintenance. The Covid-19 pandemic has shown that although health may not be everything, without health everything is nothing.
Kompas daily on Saturday, 6 May 2023, published an article titled "Covid-19 Emergency Phase Ends". According to the World Health Organization director general Tedros Adhanom Ghebreyesus, the number of Covid-19 cases and deaths is decreasing. The pressure on the healthcare system has also greatly decreased, while population immunity had also increased from vaccination and infection.
Many countries around the world have resumed activities as they were before the Covid-19 pandemic. These various considerations have led the WHO to declare that Covid-19 is no longer a Public Health Emergency of International Concern (PHEIC), or the Indonesian term that I introduced when serving as the Health Ministry director general, Kedaruratan Kesehatan Masyarakat yang Meresahkan Dunia (KKMMD). It is also important to know the true meaning of PHEIC/KKMMD.
If we examine the WHO statement in depth, it can guide us in determining what national policies need to be taken. Let us look at our experiences so far.
Covid-19 Emergency Phase Ends
The pandemic before Covid-19 was the H1N1 influenza, declared a pandemic by WHO director general at the time, Margaret Chan, on 11 June 2009. A year later, on 10 Aug. 2010, the WHO declared the world to have entered the post-pandemic period. This means that it was clearly stated that the H1N1 influenza pandemic had ended.
On the other hand, for Covid-19, it was declared a PHEIC on 30 Jan. 2020. It was only declared a pandemic one and a half months later, on 11 March 2020.
Three years after that, on 5 May 2023, the WHO declared that the PHEIC had ended. It did not mention whether the pandemic had ended or not, so it is clearly different from the situation when the H1N1 pandemic ended more than 10 years ago.
Also read:
> Handling of the Pandemic Continues
> Remember, Covid-19 is Still Here
Therefore, there are three possible analyses. The first analysis, it is possible that in the coming months, the WHO will issue an official statement declaring that the Covid-19 pandemic has ended, as they did with the H1N1 pandemic.
The second analyses, during the H1N1 influenza pandemic, the term used was that the world had entered the post-pandemic period, and we will wait to see what term the WHO will use if it declares that the Covid-19 pandemic has ended.
The third analysis is that although the Covid-19 situation is now under control, there are still some factors that need to be watched out for, including the possibility of new variants. This may be one of the reasons why the WHO has not yet clearly stated that the Covid-19 pandemic has ended.
Instead, the WHO emphasized that Covid-19 as a global health threat has not ended. Therefore, caution is still needed to prevent the spread of Covid-19, which may still occur in the community.
To demonstrate the seriousness facing the future, the WHO is now preparing a strategic preparedness and response plan (SPRP) for Covid-19 management for 2023-2025, something that seems necessary for us to prepare for as a nation to continue protecting our people.
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According to the definition in the International Health Regulations (IHR) 2005, PHEIC/KKMMD is an extraordinary event (outbreak) that threatens the public health of other countries through the global spread, and its control requires a coordinated international response. This means that if there is an extraordinary event in one country, but it does not threaten the spread to other countries, it is not a PHEIC/KKMMD. It is just an outbreak or epidemic in that country only.
So, the PHEIC/KKMMD refers to the possibility of the global spread between countries. This condition was declared as over for Covid-19 on 5 May. It is not the disease that disappeared.
In this regard, let us examine an article in the media on 6 May titled "WHO Announces the End of the Covid-19 Emergency as Cases in Indonesia Are on the Rise." It is true that our current cases are still increasing, from less than 200 people and less than five deaths to more than 2,000 cases and unfortunately more than 20 deaths. On 5 March, we had 165 new cases and two deaths. This number then increased to 665 new cases and four deaths on 5 April.
Stay vigilant
When Covid-19 was declared no longer a global health emergency on 5 May, our cases were still soaring, with 2,122 new cases and 20 deaths in a single day. Therefore, on one hand, we should be relieved that Covid-19 is no longer a global health emergency. However, on the other hand, we still need to be cautious, at least in the following five aspects.
Firstly, although Covid-19 is no longer a global health emergency, the virus still exists, the disease still exists, patients still exist and even deaths due to Covid-19 – both in Indonesia and the world – will still occur. The difference is that the numbers will be fewer and the health situation will be under control.
If we learn from the experience of the H1N1 influenza pandemic that was declared to have ended in 2010, the virus still exists to this day, 13 years after the pandemic was declared over. This means that the SARS-CoV-2 virus, the cause of Covid-19, will still be with us in the coming years and public must still be on alert.
Secondly, science still needs to continue to develop in the field of Covid-19, especially since the disease is still relatively new, having been only three years since it was first reported in December 2019. Compare this to other diseases that are decades and even hundreds of years old, where the science community already has long experience and very complete scientific evidence.
Domestic and foreign scientific experts still need to continue to explore Covid-19 about many things. For example, how likely are new variants, how to deal with the long-term effects of the virus, how long a gap is needed before vaccines need to be repeated, or how to encourage vaccines with more scientific data so that they no longer require special emergency use permits as they do now.
The cause of Covid-19, will still be with us in the coming years and public must still be on alert.
Controlling infectious diseases
Thirdly, we all certainly still need to be cautious in facing any infectious diseases, including COVID-19. Government control efforts must still be implemented, as with the control of various other infectious diseases.
The control of any infectious disease begins with health education and community participation, prevention, case surveillance and detection, epidemiological investigation and response to outbreaks. Next is the handling of acute cases in healthcare facilities and in the community, handling of chronic impacts (including long Covid), and palliative activities. All of this requires sustainable health research and development.
Fourthly, we know for sure that there will be another pandemic in the future. We just do not know when it will happen and what disease will cause it. Therefore, prevention and preparedness programs still need to be implemented so that if there is another pandemic, it will not be as severe as Covid-19.
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> An Evaluation of the Covid-19 Situation
According to the WHO, the official report on the three-year Covid-19 pandemic shows that almost 7 million deaths have been reported, with the actual number likely much higher. There have been at least 20 million deaths worldwide.
So far, experts have mentioned three diseases that could become the next "candidates" for a pandemic: diseases originating from animals (zoonoses), the possibility of recurring pandemic influenza with different strains/variants and, thirdly, the possibility of a completely new disease. This is what is called "Disease X".
Lastly, we urge the public to keep up a healthy lifestyle and prioritize health in their daily routine. We recommend following the CERDIK approach: regularly checking your health, avoiding cigarette smoke and air pollution, staying physically active, maintaining a balanced and nutritious diet, getting enough rest and managing stress.
Remember that good health is a precious asset that requires proper maintenance. The Covid-19 pandemic has shown that although health may not be everything, without health everything isnothing.
TJANDRA YOGA ADITAMA
Tjandra Yoga Aditama,Postgraduate director at YARSI University, professor of pulmonology and respiratory medicine at the University of Indonesia, and former director of communicable diseases of Southeast Asia World Health Organization
This article was translated by Tenggara Strategics.
