The rapid spread of the Delta variant is providing a clear illustration of the different challenges being faced by countries based on their adopted Covid-mitigation strategies and their access to vaccine supply. Only 1% of people in low-income countries have received a single vaccination. Vaccine inequity remains a global challenge that increases the threat to all due to the increased risk of mutation with an increasing global viral load. In countries with inadequate vaccine supply, we will unfortunately see an aggressive burn with overloading of health systems. This was the case in India and we are beginning to see a similar process in Indonesia. In countries with high vaccine coverage, especially those, such as the UK, that have adopted a policy of immunising the vulnerable first, the Delta variant is burning through the younger, less vulnerable members of the population. In this context, the combination of vaccination and natural infection is likely to lead to herd immunity over the next few weeks. The UK recently announced a date for the end of social distancing restrictions and, barring any new variants that escape the current vaccines, it is likely that COVID-19 will no longer be a significant public health threat within the UK after another 4 to 6 weeks. Europe and the US are likely to follow 1 to 2 months behind. That does not mean that cases of Covid will no longer occur, they will, however Covid will effectively become an endemic and episodic disease, predominantly of the non-vaccinated. This is already the case in Europe and the US where 99% of Covid deaths are now occurring in non-vaccinated individuals.
We have explained in a previous article the limits of Zero Covid as a long-term strategy. One of the impacts of the Delta variant is that it is extremely unlikely that Hong Kong will be able to achieve herd immunity by vaccination alone. The same applies to other countries which have pursued an elimination strategy. In another article, we explain the reasons for this, but also that reaching an absolute threshold of herd immunity is not essential. There is a common misunderstanding that herd immunity is an all or nothing line in the sand. This is not the case. Risks of population infection decrease as the number of immune people in the population increases. The herd immunity threshold gets further away as a result of vaccine hesitancy, variants becoming more infectious, populations becoming more densely crowded (reduced social distancing) and vaccinations becoming less effective. It is a question of risk mitigation. The idea of completely eliminating risk is an illusion. Singapore has already begun to plan for a post Zero Covid strategy. It is inevitable that Hong Kong will need to do the same at some point. The question is at what level of vaccine uptake and to what degree Hong Kong is prepared to shift to mitigation based on risk rather than a continuation of elimination. Vaccination rates have ticked up in Hong Kong over the last few weeks. However, uptake in the elderly and vulnerable remains a challenge. Currently only 5% of residents in elderly care homes are fully vaccinated.
OT&P have provided public health information since the beginning of the COVID-19 Pandemic. In addition to our newsletters and podcasts, we have given public health talks and webinars, in both English and Chinese, to chambers of commerce, businesses, schools, clubs and public forums. Over the last few months we have seen a significant increase in the number of people reading OT&P blogs in Chinese. Our articles on Covid vaccines have received more than 120,000 Chinese language views in the last month alone. We have increased this focus in an attempt to challenge vaccine hesitancy. Below is a sample of our more popular Chinese blog articles. Our patients are welcome to share any of our Covid resources within their own organisations. Our other blogs are also available in English and Chinese by clicking on the language tag at the top of the articles on our website.
Covid has already demonstrated the importance of honest and open recognition of uncertainty, particularly when coupled with the dilemma of predictions in evolving epidemics. Notwithstanding the potential for further viral mutation, Europe and North America will most likely be fully operational and without restrictions by the Autumn. The economic pressure for other countries to open up will increase. The benefits of Covid vaccination are now unquestionable. Combinations of vaccines and natural infections will likely occur to different degrees in all countries. The challenge for the countries that have pursued elimination strategies will be to vaccinate as a high a proportion of the vulnerable with as effective a vaccination as possible, such that the inevitable natural infections do the minimal harm and specifically do not overload health systems. Navigating this journey will likely need some intermittent social distancing restrictions. It will require clear and consistent explanations of the evolving public health strategy.
We wish all of our patients a pleasant and healthy summer, wherever you may be.
Sincerely,
OT&P Healthcare
