It’s a marathon, not a sprint

Today is Day 352 of the on-going global Covid-19 pandemic. Global infection stands stands at 46,809,252 with 1,205,194 deaths. Singapore has 58,019 infections and 28 deaths.

As the northern hemisphere approaches winter, clear signs of a second wave have resulted in several countries re-imposing nation-wide lockdowns, starting with Ireland, France and the UK.

Other countries have had more success in containing the spread of the virus, including Taiwan, New Zealand and to a lesser extent, Singapore. We are cautiously approaching Phase Three of the re-opening roadmap, with travel and social restrictions being carefully relaxed.

However, the fact remains that Covid-19 is still very much a global pandemic and given the open nature of Singapore’s economy, once global travel resumes, however restricted, the virus will be imported and local transmission will re-surface.

The progress in developing safe and effective vaccines and therapeutics has been greatly accelerated, albeit with minor setbacks including the pause of various vaccine trials and early results of non-efficacy for some treatments, including:

Studies also seem to be pointing to the outcome that any vaccine will not impart lifelong immunity, but will only offer protection for only 5-7 months. This increases the likelihood of Covid-19 becoming endemic, joining the four other endemic human coronaviruses (229E, NL63, OC43 and HKU1) which circulate indefinitely within the human population and contribute to about 15% of annual influenza cases.

Which means that the discovery and distribution of a vaccine will not be the endgame solution. Covid-19 will likely remain with us for the foreseeable future, with occasional and localised outbreaks that hopefully do not overwhelm available medical resources.

The role of treatment and therapeutics will therefore be of primary importance as we learn to live with this virus. As we learn more about the virus, treatments and therapeutics will likely improve such that serious cases can be pre-empted, but if not, then hopefully mortality can be reduced.

And even though it’s only a sample of one, the case of US President Donald Trump’s infection and subsequent rapid recovery shows one treatment pathway.

Starting with Remdesivir and Regeneron’s monoclonal antibody (MAb) treatment, followed by several courses of Dexamethasone steroid to pre-empt the deadly “cytokine storm” immune response. I have to assume that there must be good reason to choose this particular course of treatment for the most powerful person in the world.

Judging from his performance during the final presidential debate and his intensive campaigning on the last few days before the elections, he is not displaying any lingering or long-lasting issues, unlike many who have recovered but still suffering from fatigue and various respiratory issues.

Regeneron’s MAb treatment is still experimental and unavailable to the common folk, but Remdesivir, despite WHO’s recent findings, appears to be selectively distributed. Dexamethasone has been around for a long time, is widely available and will most likely to be used in extreme cases, even though risk of serious side-effects is high.

The situation is continually evolving and the current concern is how bad the second wave will be, and how long it will last. Clearly, this is going to be a marathon and we’re all going to have to learn how to live with this virus.

The world, as we know it, has changed forever.

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