High time to take stock of Covid
As we approach the second anniversary of the first identified case of Covid-19, it is time to take stock of what we know about both the virus as well as the interventions designed to contain or alleviate its consequences, and then to make recommendations for the path forward.
Thailand, along with several Asian countries, escaped the brunt of the first year of the pandemic with fewer than 100 Covid-19 cases per million population and a mortality rate of just under 1%. These figures compare with larger case counts per million population of over 60,000 for the US, 36,280 for the UK and 1,520 for Canada and a combined mortality rate of almost 2%.
Thailand's success in the first year of the pandemic has been attributed to the imposition of strict border controls to limit new imported cases, climate, diet, and a culture of good personal hygiene, including an absence of close physical contact and a general soft-spoken disposition that helps to limit transmission.
In contrast, the response to the pandemic in the West was much less impactful. Indeed, it is now clear that lockdowns and deliberate campaigns of fear were ineffective in containing infection and transmission and had devastating economic costs in terms of unemployment, lost income, bankruptcies, and growth in public sector debt. These policies also led to a dramatic erosion in mental health, particularly among younger adults; an erosion of civil liberties; redirected health systems to Covid-19 care systems, thus crowding out elective and preventative care, and generally worsened population health. Children suffered a major and permanent loss in their learning opportunities and social interactions when schools were closed, and classes moved to less effective online platforms. In hindsight, the responses taken in the West entailed costs that were many times greater than even than the value of the erosion to health predicted by even the most ridiculous forecasts"
The second year of the pandemic (2021) started with the availability and rollout of Covid-19 vaccines that were touted as the silver bullet to end the pandemic. These pronouncements were supported by evidence from randomised clinical trials demonstrating the vaccines were "safe" and "effective". The vaccines seem to offer temporary effectiveness, but neither stop Covid-19 infections nor reduce the potential for transmission, and more importantly, the vaccines tend to suppress the body's immune system making the vaccinated more susceptible to infection. Boosters have even shorter periods of effectiveness.
Over the course of 2021, Thailand was fully exposed to Covid-19, but less so than the West. Thailand experienced 31,635 Covid-19 cases per million population, but mortality rates remained at the same level, 1%, as that recorded during the first year. These figures contrast with case counts per million population of over 105,000 for the US, over 150,000 for the UK and over 40,000 for Canada and a combined case mortality rate of 1.2%. So, while 2021 was worse than 2020 in terms of case counts, mortality rates were lower, which may be attributed to the uptake and period of vaccine effectiveness, improvements in clinical practices, and the advent of variants that were somewhat less severe.
The most recent piece of good news has been the arrival of the Omicron variant, "nature's vaccine", at the outset of the third year of the pandemic. This variant offers the world opportunities to rapidly attain herd immunity and allows for the virus to become endemic, thereby fostering a return to "normal". This variant has been shown to be much more contagious than past variants but exhibits significantly lower hospitalisation and case fatality rates. Since the start of December 2021, worldwide case fatality rates (as well as those in Thailand) have fallen to under 0.7% and are trending even lower. In regions where Omicron has become the dominant variant, such as Denmark, the case fatality rate is even lower at just under 0.1% (akin to seasonal influenza).
We need to recognise that Covid-19 will become endemic and will follow a very similar pattern as seasonal influenza. This may not bode so well for Thailand as the flu season is not clearly defined, but for regions where seasonality exists it will become important to protect vulnerable populations during that period. Actions that are effective in Covid-19 infection prevention at an individual level include enhancements to the body's immune system by eating healthy foods, avoiding harmful products, regular exercise, good sleep habits, avoiding stress, good personal hygiene, and ensuring sufficient daily intake of vitamins C, D3 and zinc.
Ventilation is also important, especially for indoor activities, and it is important to upgrade indoor air filtration systems. If infected with Covid-19, the next line of defence is through very early treatments. While some remain controversial, the evidence for their effectiveness is growing. Finally, if the disease results in significant symptoms, or where symptoms continue for more than three days, then testing and medical consultation is recommended.
Peter C Coyte is Professor of Health Economics, School of Public Health, University of Toronto, Canada. He spends time in Canada and Thailand.