Dorscon almost red, but not actually red

Today is Day One of the not-lockdown in Singapore, which is currently scheduled to end on Star Wars Day. Global infection stands at 1,347,235 with 74,767 deaths. Singapore has 1,375 infections and six deaths.

These are dark days, but I have faith that science will lead us back into the light.

Singapore’s “Disease Outbreak Response System Condition” (Dorscon) was put in place after the 2003 SARS outbreak. It was raised from Yellow to Orange earlier this year on 7 Feb, when local transmission cases started surfacing.

The last time it was raised to Orange was in May 2009 during the H1N1 outbreak, and MOH has said that if the framework was in operation during SARS, it would have been raised to Orange as well.

It has never ever been raised to Red.

In the televised press conference on 3 Apr, immediately following the announcement of “circuit breaker” measures including school closures and work-from-home orders, the Health Minister forcefully corrected the Straits Times reporter who implied that we were now in condition Red:

“Let me say first categorically that we are not in Dorscon Red”

Ok…

But let’s just say that the internet was skeptical.

Image credit: mrbrown
Image credit: Reddit

Regardless of the label that the government chooses to use, the message is loud and clear — flatten the curve. Mitigate the spread of the virus by social distancing and make sure that our healthcare system is not overwhelmed.

Image credit: Sam Whitney; CDC

The silver lining for us in Singapore is that this is not the first time that an outbreak has happened in recent memory. We had SARS in 2003 and then H1N1 in 2009, and in both cases, life gradually got back to normal and protocols were put in place.

I clearly remember living through the SARS period but only have a passing recollection of the H1N1 outbreak, probably because the mortality rate of SARS was significantly higher and hence the heightened fear level.

While Covid-19 has a lower mortality rate than SARS, it is way more contagious. Plus there’s the amplification of fear through the internet and social media, which wasn’t prevalent back then.

SARSH1N1Covid-19
StartNov 2002Apr 2009Nov 2019
EndJul 2003Aug 2010?
Duration9 months17 months4 months +
WHO StatusEpidemicPandemicPandemic
Infections (SG)238415,0001,375 +
Deaths (SG)33186 +
EndgameContainmentVaccine?
Source: Singapore Infopedia (SARS, H1N1)

While flattening the curve reduces the rate of infection, it doesn’t actually cure those already infected and unfortunately, there is no cure nor a vaccine at this time. However, the global scientific community is frantically working to come up with both.

The first step to any war is to understand the enemy — 知己知彼,百战百胜。And this is what the SARS-CoV-2 coronavirus looks like.

Image credit: CDC

Digging deeper, the genome of SARS-CoV-2 has been sequenced and this New York Times article gives an informative breakdown of the proteins encoded within the 30 kilobase genome (for comparison, the human genome is 3 billion kilobases, which is 100,000 times longer). It reads like a detective novel and worth the time spent.

Source: Bad News Wrapped in Protein: Inside the Coronavirus Genome, NYT, 3 Apr 2020

In order to find a cure, the World Health Organisation (WHO) has launched a large-scale global human trial, named Solidarity, to determine if any existing drugs can be re-purposed to effectively treat Covid-19. This Science article gives a good overview of the five candidate treatments and it’s well worth a read.

Source: WHO launches global megatrial of the four most promising coronavirus treatments, Science, 22 Mar 2020

Finding a cure will save countless lives and will put out the fires currently burning globally, but to prevent new fires from starting and effectively stopping this pandemic, a vaccine has to be found. But testing candidate vaccines takes time and appears to be at least 12-18 months away.

The different phases of human clinical trials exist to ensure that any widely administered vaccine is both safe and effective. Shortcuts could lead to unintended consequences that could be more devastating that the current pandemic, and I hope the scientific community stands firm against the overwhelming political pressure it must be facing.

Phase IPhase IIPhase III
Primary goalTesting on healthy volunteers for safetyTesting on patients to assess efficacy and side effectsTesting on patients to assess efficacy, effectiveness and safety
DosageSub-therapeutic, but ascending dosesTherapeutic doseTherapeutic dose
Typical size20-100 normal healthy volunteers100 – 300 patients300 – 3,000 patients
Success rateApproximately 70%Approximately 33%25-30%
Source: Phases of clinical research, Wikipedia

The fight to find a Covid-19 vaccine is spearheaded by the Coalition for Epidemic Preparedness Innovations (CEPI), a foundation launched in 2017 and funded by public and private organisations with seed funding of US$ 460 million from the Bill and Melinda Gates Foundation.

It issued a public funding request for US$ 2 billion on 14 March to accelerate Covid-19 vaccine research, testing and manufacturing, and I have no doubt the global community will donate generously. As of 6 Apr, they have already raised US$ 690 million or about 35% of their target. Given the fast and furious activity, updates will be dynamic and posted on the CEPI Covid-19 website.

There is no doubt that things will get worse before they start getting better, and we all have to play our part to mitigate the spread of this unrelenting virus. Country after country is going on lockdown to minimise human contact and slow down infections. Schools have closed, businesses have shut down and many livelihoods will be lost.

Yes, these are dark days. But this, too, shall pass.

The Pandemic Portal

“Who can look at anything any more — a door handle, a cardboard carton, a bag of vegetables — without imagining it swarming with those unseeable, undead, unliving blobs… waiting to fasten themselves on to our lungs?

… Who among us is not a quack epidemiologist, virologist, statistician and prophet? Which scientist or doctor is not secretly praying for a miracle? Which priest is not… secretly, at least… submitting to science?

The virus has… struck hardest, thus far, in the richest, most powerful nations of the world, bringing the engine of capitalism to a juddering halt…

The mandarins who are managing this pandemic are fond of speaking of war… But if it really were a war, then who would be better prepared than the US?

If it were not masks and gloves that its frontline soldiers needed, but guns, smart bombs… fighter jets and nuclear bombs, would there be a shortage?

… The tragedy is immediate, real, epic and unfolding before our eyes. But it isn’t new. It is the wreckage of a train that has been careening down the track for years…

What is this thing that has happened to us?

It’s a virus, yes. In and of itself it holds no moral brief. But it is definitely more than a virus… It has made the mighty kneel and brought the world to a halt like nothing else could.

Our minds are still racing back and forth, longing for a return to ‘normality’, trying to stitch our future to our past and refusing to acknowledge the rupture. But the rupture exists.

And in the midst of this terrible despair, it offers us a chance to rethink the doomsday machine we have built for ourselves. Nothing could be worse than a return to normality.

Historically, pandemics have forced humans to break with the past and imagine their world anew. This one is no different. It is a portal, a gateway between one world and the next.

We can choose to walk through it, dragging the carcasses of our prejudice and hatred, our avarice, our data banks and dead ideas, our dead rivers and smoky skies behind us.

Or we can walk through lightly, with little luggage, ready to imagine another world. And ready to fight for it.”

— Arundhati Roy

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