The post-pandemic world is one where we will coexist with COVID-19 diseases and incorporate them into our daily risk calculations.
People line up to get covid-19 vaccinations at Hampton Park, Scotland, Uk.
Recently, the university medical school where Liu Shanxuan, a virologist working in the United States, informed everyone that the hospital has ushered in the highest number of hospitalizations since the new crown epidemic, coupled with the shortage of manpower caused by the infection of medical staff, all non-urgent surgeries must now be suspended or postponed.
Liu is the director of the Virus and Neoplasms Research Program at Ohio State University, and the scientists and doctors he works with, as well as colleagues and staff in the labs around him, have all been infected with the New Coronavirus Omiljung variant. A Chinese American described it this way: If you have not heard of any friend infected, then it can only mean that you have no friends in the United States.
With the blessing of the Christmas and New Year's Double Festival, after more than a month of transmission, the proportion of the Aumechjong variant among new infections in the United States has soared from 1% to 95.4%, effortlessly replacing Delta, which has been popular for more than half a year. On January 3, the United States saw more than 1 million new infections on that day, the highest daily statistic for all countries in the world since the COVID-19 pandemic.
Not only in the United States, but also in the United Kingdom, France, Italy, Australia and many other countries, the impact of Omi kerong has made them face the worst pandemic since the new crown epidemic, and the number of new cases has increased exponentially. As of January 7, Omi kerong has been detected in 138 countries and territories around the world.
WHO Director-General Tedros Adhanom Ghebreyesus said that the cases of COVID-19 infection caused by the Omikejong variant have become a "tsunami", and the more contagious Omilon and Delta spread at the same time, will continue to put great pressure on exhausted health workers and health systems on the brink of collapse, and once again disrupt people's lives and livelihoods.
With this strong posture, the new crown virus began to enter the third year of its pandemic. People don't see any signs of the outbreak getting better, but this time, there are some opinions that Omi kerong is the booster of the end of the pandemic, but is the situation really so optimistic?
Crises at the group level outweigh individual health risks
A Chinese living in Paris wrote, "During my infection [of Omikron], I did not have two typical COVID-19 symptoms: fever or loss of taste and smell. Instead, it was like I had a long cold, headache, fatigue, cough, sore limbs, nasal congestion, dizziness. And the friend who was infected with me, because of the strengthening injection, the time of symptoms was shorter than mine, but after coughing for three or four days, it was completely fine."
Whether it is because of the characteristics of the virus itself or the effect of the vaccine, The symptoms of Omi kerong are mild and the rate of severe illness is low, which is also widely felt by clinicians. In New York, one of the "epicenters" of the U.S. outbreak, Rahul Sharma, chief physician of the emergency department at Presbyterian Hospital, said the number of hospitalizations was increasing, but the number of patients entering the intensive care unit or needing intubation was far less than during previous outbreaks, and most of the infected people who came to the emergency room were quickly discharged.
The number of COVID-19 hospitalizations in the United States has exceeded the record. On January 10, 132646 people in the United States were hospitalized for the new crown virus, exceeding the peak of 132051 in January last year.
In many countries and regions, the surge in the number of people living with COVID-19 has not led to a significant increase in hospitalization rates and death rates in the same proportion. At the end of 2021, the number of new cases in a single day in London was almost double the peak at the beginning of the same year, but the number of hospital admissions and ventilators was only 50% and 20% at that time, and these two indicators have remained stable since August 2021. Currently, the UK has a COVID-19 vaccination rate of 80% and a three-shot vaccination rate of more than 50%.
Japanese geisha wear masks and paint makeup in Kyoto, Japan, January 7, waiting for the first working day of the New Year to begin.
However, even if the symptoms of healthy people after infection with Omicron are mild or asymptomatic, the virus can still be transmitted to more vulnerable people, including the elderly, people with underlying diseases or immunodeficiency, etc., and should not be taken lightly. It's a simple math problem, and epidemiologists have pointed out that assuming that Omilon's ability to spread is four times that of Delta, but half the pathogenicity of Delta, the number of hospitalizations will still double.
The number of infections caused by Omikejon is too large, far more than the previous waves of outbreaks. The Institute for Health Statistical Evaluation (IHME) at the University of Washington has modeled the epidemiological characteristics of Omilon to predict that from January 1 to March 1, 2022, 140 million new infections may occur in the United States, with a peak of late January and a peak of 2.8 million new infections per day. This figure means that the number of infections in the next three months is comparable to the total number of infections in the United States in the past two years.
Zhang Fengfeng, a senior professor of epidemiology at the University of California, Los Angeles, reminded on social media that Omilon may be mild in young people, and in the elderly, frail, and high-risk groups, it is a serious disease, and such people should be quickly vaccinated with reinforcing injections.
A common concern is that the threat posed by Omikeron may be more at the group level. Because the Delta outbreak has affected many countries, most countries have reached the limit of their health care systems, health care workers are exhausted, and the ultra-high transmission of Omi kerong is enough to seriously impact the health care system.
Liu Jigao is president of the American Association of Asian American Physicians and a physician at a private clinic in New York City. According to what he learned, although the intensive care units in some local hospitals are not as full as in the early days of the epidemic, the number of patients in general wards is increasing, and the bed utilization rate has risen from about 70% to 90% to 95%. More importantly, because the infection rate is too high now, 10% to 15% of medical staff are isolated because of infection, the hospital cannot operate fully, and the hospital may burst at any time.
In response to the surge in patients, the UK's National Health Service (NHS) has declared itself in a "wartime state" on 30 December 2021 and plans to reopen the Nightingale Temporary Hospital to cope with a possible future outbreak of Admissions to Omicron. The NHS also plans to convert fitness institutions, education centres and other facilities in multiple locations across the country into temporary treatment sites, providing a total of about 4,000 temporary beds. The UK Ministry of Defence said on January 7 that 200 armed forces personnel had been provided to support the NHS over the next three weeks.
Allowing the seemingly "moderate" Omicron to spread in human society has brought chaos far beyond the medical system. In countries with high infection rates, the impact of Omeikron is being felt in all walks of life. In the aviation industry, for example, 2,300 flights in the United States were cancelled on January 7 alone due to employee infection and understaffing; on the same day, WestJet Airlines of Canada announced that 15% of flights would be cancelled by January 31 due to the reduction in passengers and absenteeism caused by epidemic prevention requirements.
On January 2, the British government said in a statement that it expects businesses and public services to face disruptions in the coming weeks as the number of infections per day hits a record high and people who test positive need to self-isolate for at least seven days. The damage to the public health sector has so far been contained in most of the region, but public sector leaders have been asked to plan for a worst-case scenario of 10 percent, 20 percent and 25 percent of labor absenteeism, the statement said.
Children are vaccinated against COVID-19 at the Antwerp Zoo in Belgium on Jan. 12.
Re-moderate tightening
In order to alleviate the various impacts on social life of Aumechjon, most developed countries have adopted different degrees of epidemic prevention measures. What they all have in common is that the appropriate level of public health measures is used to reduce the spread of Omi kerong, delay the run on the health care system, and buy time to understand the characteristics of the virus and increase the vaccination rate.
But on closer inspection, the measures of each country are different. If the degree of control is regarded as a spectral map from loose to tight, what determines where a country is located is a combination of its vaccination rate, the ability of the health care system to bear pressure, the political system, the social culture and other factors.
After Christmas, Germany began to introduce some tightening policies, from December 28, 2021, vaccinated or recovered infected people, private gatherings are limited to a maximum of 10 people, for the unvaccinated, each family is allowed to receive up to two visitors. On 7 January, the measures were escalated again, and entry into restaurants and bars required proof of vaccination with booster needles, or a basic vaccination + negative nucleic acid report.
Lu Mengji, a German-American virologist and professor at the University of Essen, explained that the vaccination rate in Germany has not yet reached expectations, with almost 71% of the population completing two doses and 38% of the population receiving booster injections. In Europe, vaccination rates are the most important basis for degree of control, compared to countries such as the United Kingdom, Spain, Portugal, and France, which are now more likely to be vaccinated.
France currently has the highest number of new cases in Europe. After the number of new cases in France exceeded 100,000 on Christmas Day, it reached a new high on January 8, approaching 300,000. In light of this, France announced a series of measures on December 27, 2021, but did not impose a curfew on the cross-Chinese New Year's Eve, followed by the return of French students to school as usual on the first day of school on January 3. The government's confidence comes from the fact that 90% of the country's eligible population has been vaccinated, and the French are now the "best protected in the world".
The Netherlands was the first country in Europe to adopt a total lockdown. On 18 December 2021, the government announced that the measures already in place are not sufficient to ensure that the pressure on the healthcare system remains manageable, so the Netherlands will enter lockdown from 19 December, at least until 14 January 2022, with measures including people staying at home as much as possible, with no more than two daily household visitors, educational institutions closed until 9 January, and so on.
According to the analysis of Independent Media in Europe, the Netherlands is not willing to wear masks like Spain, does not have the abundant number of ventilators in Belgium, does not have a strong virus detection and surveillance system in Denmark, does not have Anitasilis' voluntary immunization program, and does not have small class classrooms in Finnish schools... So, only a strict blockade. The booster vaccination rate is also 31 per cent, which is only moderate in Europe.
Liu Jigao recalled that at Christmas, on the lively 42nd Street in Manhattan, New York, the crowds were rubbing shoulders and had no intention of maintaining social distancing. While the United States continues to open up, Canada, which is also in North America, is moving towards blockade. In Ontario, Canada, restaurants, concert halls and gyms have been closed, schools have been switched to distance learning, non-emergency surgeries have been stopped; Quebec has imposed a 10 p.m. curfew and banned people from attending churches; British Columbia has called off indoor wedding and funeral receptions...
The different attitudes towards Aumechjong stem from the differences between the United States and Canada in terms of medical resources and treatment systems. In the case of Ontario, Canada's most populous federal province, the latest official figures show that the province has only one ICU or acute care bed for every 800 residents, compared with 420:1 in New York.
Some senior Canadian health officials also stressed that in terms of social psychology, Canadians have more trust in the government and have a lower tolerance for death and severe illness caused by the new crown virus than in the United States. David Neller, former president of the University of Toronto in Canada and who once commanded the SARS epidemic prevention in Canada, did not understand that with the strong scientific and medical strength of the United States, the performance of the United States on the new crown epidemic could not be said at all in protecting citizens from infection and death.
Continuous liberalization is mainstream
A biomedical industry employee working in Maryland, usa, shared that some time ago, the company basically reported positive for the new crown every day, at the beginning, everyone was very nervous, and they all did deep disinfection and cleaning and isolation. Now that there are more positive employees, it is impossible to stay like this forever, otherwise the company will have to close for months. "Now the countermeasure is that if you are positive, you will go home to rest, and the other employees will go to work as usual." Now there are positive employees who have recovered and returned to work, basically mild diseases, and everyone does not care and is not afraid, only when the live virus is used as a vaccine reinforcement needle. ”
Whether it is due to its serious interference with the operation of society or the weakness and abandonment of people's psychological level, it has impacted the previous set of standardized public health measures such as circulation tracking, isolation, and testing. Not only a business, at the policy level, for pragmatic considerations, in many European and American countries, such efforts to maximize the control of infection are gradually being abandoned.
In the penultimate week of December 2021, the U.S. Centers for Disease Control and Prevention (CDC) updated its guidelines to recommend that after diagnosing COVID-19, the isolation period can be reduced to 5 days instead of the original 10 to 14 days. If there are no symptoms, or if the symptoms improve or disappear significantly after 5 days, the patient can lift the isolation on their own without having to repeat the nucleic acid test, but should still wear a mask when exposed to others.
People gather in Brooklyn to receive COVID-19 kits in New York, USA, December 24, 2021.
At least Israel, Canada, the United Kingdom, Italy, Australia, Portugal and other countries have recently announced that they will reduce the scope of close contact tracking and shorten the quarantine period for infected people to 5 to 7 days. This abrupt change in policy has provoked some outrage, some of which argue that it is putting business and political considerations above public health.
In this regard, ROCHELLE Valensky, director of the US CDC, explained that based on the past understanding of respiratory infectious diseases and the new crown virus, 85% to 90% of the transmission occurs in the first 5 days after infection with the virus, and the risk of transmission after that is greatly reduced. People may be able to test positive for up to 12 weeks after infection, but the infectivity has dropped significantly later, so nucleic acid retesting is of little significance.
This rule allows many people who are isolated because of infection, especially public service personnel, such as health workers, to return to work as soon as possible to maintain the normal functioning of society. Of course, this is not the most secure policy. Liu Jigao said that some people stay at home for a few days and go to work, and they may not meet the time requirements, nor can they know whether they still carry the virus after contact isolation. But this is not only a medical decision, but also more of a balance between the economy, employment and other social conditions.
In line with the goal of shortening the quarantine period, the UK stipulates that from January 11, people who have rapidly tested positive for COVID-19 using LFT (Flow Antigen Test) but no symptoms will begin to self-isolate without further PCR nucleic acid test confirmation. This decision will greatly save time waiting for test results, and also shorten the isolation time of infected people to a certain extent. The sensitive period of the LFT test is the period when the viral load is high and contagious, which means that the government no longer looks for asymptomatic carriers who are less contagious during the incubation period or late in infection.
A few months ago, like Singapore, Vietnam, South Korea, New Zealand and other countries, Australia is also a country that aims to achieve the goal of "zero infection", that is, to keep daily new cases at a very low level through quarantine of people entering the country and large-scale nucleic acid testing.
In August 2021, Australia released the National Plan for Transforming the COVID-19 Response, which officially shifted the focus of epidemic prevention and control from inhibiting community transmission to preventing hospitalization, severe illness and death, and from a "pre-vaccine" environment to a "post-vaccine" environment. Since then, Australia has been in a hurry to get vaccinated, and by the end of December, the full vaccination rate has reached 79%.
In response to Omilon, Australia's strategy has been tightened, re-requiring indoor masks, accelerating vaccination, etc., but only one week later, that is, on December 30, 2021, the government announced that it will reduce the importance of public health means such as testing, tracking and isolation, no longer carry out detailed circulation, only trace the family of infected people, and at the same time, regardless of vaccination status, it is recommended to isolate for 7 days until the test result is negative on the 6th day. This is because, according to the country's ministry of health, "in a highly contagious environment, these measures are no longer effective, the public health response at the government level will focus on the highest risks, and day-to-day management will be more dependent on individual participation".
From 26 December 2021, singapore's Ministry of Health has also adjusted its response to Opmi Kerong, significantly relaxing some measures to coexist with the virus in the outbreak.
"Singapore is a very small country that needs to keep people and goods flowing outside its borders, and border closures are unrealistic here." Gu Alie, associate dean and associate professor at the National University of Singapore's Suriver School of Public Health, wrote in an email to China NewsWeek. He explained that with Singapore's very high vaccination rates and expanding enhanced needle coverage, the risk of contracting COVID-19 and causing serious illness has now fallen to a lower level, closer to influenza than COVID-19 in 2020, so it doesn't make sense to implement strict measures that are devastating to the economy and society.
Singapore's consideration is also the reason why many countries have adjusted their epidemic prevention strategies. On 5 January, in France, where the epidemic in Europe is most severe, a new rule was enacted that allows infected healthcare workers who are asymptomatic or mildly infected to remain on duty without any self-isolation. Two days later, Germany also finally decided that it would no longer strictly comply with WHO regulations, and close contacts of COVID-19 infected people would no longer need to be isolated if they had received booster injections, or had been fully vaccinated or recovered in the past 3 months. Everyone else can end isolation after 10 days if they have no symptoms or have remissioned, or to 7 days if the test results are negative.
"In the future, positive cases, as long as they are not sick, they will continue to work and do not have to isolate." Otherwise, entire government agencies, even as small as urban garbage removal personnel, will be paralyzed by the sheer number of infections. Lu Mengji said that the epidemic has forced the whole society to move towards a more open model, and should not stubbornly stick to the outdated strategy.
More radical in this regard is South Africa. The country that first reported on Omikejong announced on 24 December 2021 that it would no longer track and isolate people infected with Omiljun who tested positive but were asymptomatic, as long as they wore masks and maintained social distancing. Without adjusting the policy, many people are required to stay home without symptoms, without income, and children in contact with covid-19 people lose valuable learning opportunities, the government says. As a result, the South African Committee of Experts has focused its public health policy on immunization programmes rather than tracing and isolation measures.
On 30 December 2021, South Africa announced that it had passed the peak of the fourth wave of the epidemic brought by Omi kerong, with no significant increase in the death toll, and on the same day, it was announced that the curfew would be lifted and the limit on the number of people moving indoors and outdoors would be relaxed, but masks would still be required indoors.
On 7 January, the Hong Kong SAR government tightened its epidemic prevention measures in response to the epidemic, and restaurants banned dine-in at night. On the evening of the same day, some citizens bought takeaway food to eat in the park.
Conditionally "coexisting with the virus"
Human expectations for the end of the epidemic have been repeatedly postponed. In the spring of 2021, there was a mood of optimism. At the time, a large wave of COVID-19 vaccines was approved for use, and two of them had high hopes for their protection by up to 90%. It is hoped that when 70 to 90 percent of the world's population is vaccinated, a barrier to herd immunity can be established to end the outbreak.
But the evolution of the virus, the uneven distribution of vaccines around the world, and the weakening immunity of vaccinated populations have dashed this hope. A new consensus is that the virus may still maintain a certain level of transmission after a full third dose of vaccination in the future.
Even among highly vaccinated populations, as in Singapore, Guallie said, there will still be a large number of communities spreading once it reopens. Therefore, this can be learned from the experience that countries with low or zero transmission of the new crown virus in the past need to be cautious when communicating with the public to avoid false public expectations.
"Since the outbreak of the new crown virus, its ultra-high contagiousness is doomed to not disappear like the SARS virus." Guarre said.
When Omi kerong shattered the possibility of clearing the virus, some public health experts believed that its unstoppable epidemic, if developed according to the current momentum, would be conducive to the end of the epidemic. For example, Tyra Grove Krause, chief epidemiologist at Denmark's National Serum Institute, said we may be experiencing the last wave of the pandemic because of the high levels of herd immunity associated with TheOmilon infection.
In an interview with China Newsweek, Gao Benen, a professor at the School of Public Health at the University of Hong Kong and an honorary fellow of the School of Public Health England, said in an interview with China Newsweek that most countries will consider "ending" the epidemic in 3 to 6 months: the government has decided not to count every case, and they will no longer impose any further restrictions on people's behavior. To contain the outbreak, the government will rely on effective vaccines and antiviral drugs rather than public health and social measures.
A growing number of infectious disease experts and virologists believe that the covid-19 pandemic is not ending because the spread of the virus itself is under control, but a social proclamation: stop treating it as a pandemic and accept it like other seasonal respiratory infections such as human coronaviruses.
But can vaccination alone, combined with a higher degree of herd immunity from natural infections, bring the world into a rational, balanced state of coexistence with the virus? The answer is no.
On January 3, a group of public health experts and scholars from famous universities and scientific research institutions in the United Kingdom published an open letter in the British Medical Journal. The letter points out that the immune protection brought by vaccines is not permanent, and the environment with high infection rate will accelerate the evolution and mutation of viruses. Such a strategy creates a vicious circle in which important public health measures such as testing, tracing, and isolation become inefficient or even useless because they are overwhelmed, further losing ground in the battlefield to contain the spread of the virus.
In countries where the virus has spread like wildfire, the outbreak has clearly brought about deaths, economic losses, shortages of health care workers and other consequences. At the population level, vaccines drastically reduce hospitalization and mortality, but for everyone, the livelihoods affected, disrupted school attendance plans, long-term sequelae that may be left behind by infection, and so on, are real harms.
In view of this, the above-mentioned British scholars open letter initiative, countries in epidemic prevention from "vaccine only" to "vaccine plus", specifically including advocating the use of highly protective masks, paying more attention to ventilation and ventilation systems, according to the community spread of the virus, develop quantitative standards for strengthening and relaxing control measures, and promoting global vaccine fairness.
Coincidentally, on January 6, six health advisers during the transition period of the Biden administration in the United States, including Luciana Boriot, former chief scientist of the US FDA, David Michaels, a professor at george washington university school of public health, published three articles in the Journal of the American Medical Association, calling on the United States to adopt a new national policy of epidemic and enter a "new normal" of coexistence with the virus, rather than expecting to eliminate it.
Contrary to the unconditional "coexistence with the virus" that prevailed during the Delta pandemic, Luciana Boriot and others argue that the United States needs to manage COVID-19 as a respiratory virus and define the threshold for maximum risk. Once the threshold is exceeded, policy interventions and behaviour mitigation are triggered, and health systems adjust the number of beds and staffing accordingly.
Using data on influenza and respiratory syncytial virus (RSV) in the United States from 2017 to 2018, they calculated that the tolerable risk peak in the worst week of the respiratory virus epidemic season was about 35,000 hospitalized patients and 3,000 deaths. As a yardstick, the number of hospitalizations and deaths caused by the new crown virus in the United States is far more than this figure. They made a series of recommendations, including the need to empower public health personnel at the grassroots level, build a more flexible and advanced epidemic data collection system, and build a sense of trust in public health and group action.
Zhang Wenhong, director of the Department of Infectious Diseases at Huashan Hospital affiliated to Fudan University and director of the National Center for Infectious Disease Medicine, recently pointed out when talking about Aomi Kerong that it is believed that Aomi Kerong triggers a "large flu" and lacks scientific basis, in fact, this variant strain "will bite people". A country and region need a strong immune barrier and medical resources to defend itself against the threat of Omicron.
"The post-pandemic world will not be the world before the pandemic began in 2019, but the world in which we will coexist with COVID-19 diseases and include them in our daily risk calculations." Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Safety, recently wrote. The world's divisions about the pandemic stem in part from a false dichotomy of risk: some people behave as if the pandemic didn't happen, while others are completely unable to navigate a world where there is any risk of COVID-19.
(Intern journalist Cao Yuan also contributed to this article)
Source: China News Weekly
Image source: China Press Photo Network, Visual China
Duty Editor: Wan Xiaojun