OT&P COVID-19 Update and Podcast
In response to the feedback from our first podcast in December, we have produced a follow-up interview with Professor Ben Cowling, the division head of the department of epidemiology and biostatistics in the School of Public Health at the University of Hong Kong. In this podcast, we discuss the expectations of the fourth wave in Hong Kong, the evolving new viral mutations and the outlook for immunization. Professor Cowling expressed his concerns about the early reports of the effectiveness of one of the vaccines currently proposed for Hong Kong. The podcast can be accessed directly from our website or you can subscribe for this and future podcasts directly via the following links on Spotify or iTunes.
Information about COVID-19 continues to accumulate at an extraordinary rate. We are now able to establish the gene sequencing of individual viral clusters. This allows a greater understanding of variations in the epidemic both geographically and over time. All viruses have a tendency to evolve. Random change in genetic structure is the basis of evolution. COVID-19 is caused by an RNA virus. RNA viruses have a tendency to evolve rapidly. The SARS-COV-2 virus has already undergone many thousands of such mutations, indeed almost every single infection in Hong Kong has its own ‘genetic fingerprint’. It is possible that by chance, as any virus changes, it may acquire the ability to spread more easily. It is also possible that a viral mutation can lead to more serious disease, although statistically it is more likely that antigenic drift leads to attenuation. That is to say that the natural order of evolution more typically makes new viruses less severe over time. There is no evidence currently to suggest that the new mutations are causing a worsening of disease. Further information on the evolving COVID-19 mutations is available in an article on our website.
We have previously explained the important distinction between the severity of a disease and the severity of an epidemic. Although in the majority of cases COVID-19 is not a severe disease, characteristics of the virus, in particular it’s infectivity and ability to spread via asymptomatic cases, make it a serious epidemic. COVID-19 has the potential to overwhelm health systems because of the rapid increase in numbers. The graph below demonstrates this issue. It compares a disease which is 50% more severe, continuing with slightly higher fatality rates, versus a disease which is 50% more infectious, producing a significant increase in mortality due to the rapid increase in the number of infected cases.
This is the reason that public-health doctors continue to advocate continued caution. Fortunately, we have very good evidence that public health measures in Hong Kong, in particular test, trace, isolate in association with social distancing and masks are highly effective and there is no reason to believe that they will not continue to be so.
COVID-19 Vaccination
Population immunisation represents the best chance to escape the current public health restrictions. Vaccinations will not work on their own and at least in the first instance some degree of public health controls will be necessary until adequate population immunity can be achieved. It will be necessary to manage equitable distribution of vaccinations in a way that is maximally effective for population health. This means establishing immunity in the most vulnerable members of the population in the first instance. Apart from the logistical challenges of procurement, delivery, storage and injection, it will also be necessary to manage vaccine hesitancy within the community. A recent study reported in Hong Kong has suggested low levels of confidence in COVID-19 vaccination. The vaccine rollout will likely be associated with increasing misinformation and disinformation. In order to better understand the factors in our own population, we are undertaking a simple survey of current perceptions. We would be grateful if you could complete this questionnaire. It will be anonymized and all primary data will be destroyed. It should take less than two minutes to complete. We will produce and circulate a summary of the results. Click here to participate.
Vaccinations are due to be rolled out in Hong Kong in the next few weeks. The logistics of this program are still being worked out but the initial wave of vaccinations is likely to take place in government vaccination centres. We have produced a summary of the vaccinations which are planned for Hong Kong and will keep this page updated, including our role in the vaccination program, as information and evidence evolve.
Very early in this process we described the competing epidemics. The epidemic of disease and the epidemic of anxiety. As of today, 0.13% of the Hong Kong population have had a confirmed case of COVID-19. To reframe this data, 99.87% of the population have not been infected. Indeed the combined population mortality from COVID-19 and Influenza was lower in Hong Kong in 2020 than in 2018 and 2019 due to the lower death rate last year from influenza. This statement is not in any way intended to belittle the importance of this serious epidemic. Data from other countries shows what happens when health systems are overwhelmed. However, whilst 99.87% of us have not been impacted directly by the disease 100% of our population have been impacted by the psychological and social fallout of the public health measures used to control the disease. As an example of this process our MindWorX team have produced a number of resources including the following articles on the challenges of online learning and the impact of school closures on social development in children.
Lack of control and uncertainty are key factors in stress, anxiety and depression. This can lead to negative thoughts and a tendency to ‘look at the glass as half empty’. There is no doubt that the anxiety epidemic and the psychological impact of COVID-19 has been aggravated by the ‘infodemic’. Education and information are the key factors in managing epidemics of infectious disease but in a ‘post-truth world’ philosophical arguments around the arbitrators of truth and fakery abound. We continue to advise our patients to critically analyse all information, including ours, and ask if it is rational and logical. It is one year since OT&P’s first COVID-19 newsletter and in that time our COVID public health content has received almost 1 million views. We have placed all our previous newsletters, blogs and opinions on our website as a timeline and historical record and we will continue to modify our opinions and advice as evidence accumulates.
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