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What could prolong the COVID-19 pandemic? Experts list the risks and unknowns ahead

What could prolong the COVID-19 pandemic? Experts list the risks and unknowns ahead

File photo of pedestrians wearing protective face masks along Orchard Rd in Singapore on Sep 9, 2020. (Photo: Gaya Chandramohan)

SINGAPORE: There are a number of factors that could lead to a prolonged COVID-19 pandemic, experts told CNA in response to comments on Monday (Jan 25) by Education Minister Lawrence Wong that the current crisis could stretch to four or five years.

The 1918 Spanish flu epidemic, which lasted about two years, gives a model for what might happen, said Associate Professor Alex Cook, vice-dean of research at the National University of Singapore's Saw Swee Hock School of Public Health.

That pandemic lasted until the virus that created it became endemic, causing yearly influenza outbreaks in temperate countries.

READ: COVID-19 pandemic could last 4 to 5 years: Lawrence Wong

Assoc Prof Cook said that one likely scenario was for most adults worldwide to have been either infected or vaccinated, but for children to have lower immunity and for the disease to become a common childhood infection like the cold.

"We can expect infection to persist in children because they won’t be getting vaccinated, at least for a while, and because new cohorts of immuno-naive children will enter into the population every year," he said.

Mr Wong, who co-chairs the COVID-19 Multi-Ministry Taskforce with Health Minister Gan Kim Yong, said at a conference on Monday that we can expect to live in the midst of a pandemic this year and for the most part of next year.

"Beyond that, the availability of COVID-19 vaccinations will progressively restart global travel. But getting the world vaccinated won't be quick or easy," he had said. 

He also mentioned that new mutant strains of the virus could prolong the pandemic around the world, concluding: "There are still tremendous uncertainties ahead of us. The bottom line is that we live in a shared world and no one is safe until everyone is safe. 

"Of course, no pandemic goes on forever. At some point in time the pandemic will pass, but it may take four to five years before we finally see the end of the pandemic and the start of a post-COVID normal.”


A healthcare worker receives the coronavirus disease (COVID-19) vaccine at the National Centre for Infectious Diseases (NCID) in Singapore December 30, 2020. Lee Jia Wen/Ministry of Communications and Information/Handout via REUTERS

Professor David Matchar from the health services and systems research programme at the Duke-NUS Medical School said there is a plausible case for a prolonged course of COVID-19, but he hopes it is a "worst-case projection". 

Factors that will extend the outbreak include delayed vaccination and waning immunity over time for those infected and those vaccinated. There may also be viral mutations that lead to vaccines becoming outdated to new strains.

"(The pandemic will be) shorter if none of the above comes to pass. Even if the pandemic burns out as we all hope, social and economic effects will persist for a generation," he said.

READ: Global COVID-19 cases exceed 100 million

READ: Dry ice, containers and overworked doctors: The hurdles for Japan's COVID-19 vaccine roll-out

Assoc Prof Cook also said that how global vaccination efforts will go and how the virus mutates are the "two key unknowns".

"It is not clear to me when the lower and middle-income countries can expect to get their populations sufficiently vaccinated to start to get back to normalcy," he said.

"If the virus mutates sufficiently, it may be that the vaccines will need to be reformulated. We have a working approach to doing this for influenza vaccines, but we need to think how to adapt this to COVID-19 vaccines." 

Pfizer and Moderna have both said that their vaccines work against variants of the COVID-19 virus that have been of concern lately - the UK B117 strain and a strain from South Africa, which appear more contagious.

READ: Moderna says vaccine effective against COVID-19 variants; testing extra booster for South African strain

Moderna recently announced plans for a booster shot that provides extra protection against the South African variant, said Assoc Prof Cook. 

"We may see that booster shots become part of the medium-term solution or that the base vaccine is reformulated periodically as the virus continues its evolution," he said.


And while Singapore is likely to be ahead of the curve in vaccinations, most other people in the world are not, he pointed out. 

Singapore authorities plan to get everyone in the country who is eligible for vaccination to be inoculated by the third quarter of 2021. 

During this period of pandemic limbo, life within Singapore may go back almost to normal but other countries may still suffer outbreaks and be subject to control measures that Singapore has relaxed, said Assoc Prof Cook.

FILE PHOTO: A passenger arrives from New Zealand after the Trans-Tasman travel bubble opened overnight, following an extended border closure due to the coronavirus disease (COVID-19) outbreak, at Sydney Airport in Sydney, Australia, October 16, 2020. REUTERS/Loren Elliott/File Photo

This means that Singapore residents' hopes for leisure travel or to visit their friends and family abroad will not come to pass anytime soon.

Professor Matchar said that with vaccination and testing, an optimistic guess is for limited, high-priority travel to resume in the middle of the year but if there are mutations that are of concern, the wait could be much longer.

Singapore had slowly eased travel restrictions to a few countries with low rates of infection, but thus far the move has not been reciprocated. Meanwhile, the detection of the more infectious virus strains from the UK and South Africa have led to governments around the world clamping down on travellers from those countries again.

READ: EU proposes more travel restrictions to stop coronavirus variants

READ: 3 previously reported COVID-19 cases positive for B117 strain, could be linked: MOH

Assoc Prof Cook presented a scenario for leisure travel that could come to pass, if a substantial number of people around the world are vaccinated. 

While they will at first mostly be the elderly and frail, who are unlikely to want to travel in large volume, more young people will soon get vaccines.

"Countries with large tourism sectors may feel pressure to open up to vaccinated travellers, but may still be experiencing outbreaks themselves, which may put off travellers for city breaks and the like," he said.

"What might work could be resorts, since you might be able to relax controls within the resort for guests who have been vaccinated."

Instead of forecasting a time period when global air traffic may take flight, a better approach would be to strive toward fortifying the world from the spread of the COVID-19, and a future where it would be safe to resume international travel, said Associate Professor Josip Car, director of the Centre for Population Health Sciences at Nanyang Technological University’s Lee Kong Chian School of Medicine.

He expects that it may take several years before a return to the frequency of travel before the pandemic.


But even before this crisis ends, many are looking ahead to the next one. In an interview marking one year of the COVID-19 pandemic, Mr Gan said that the next pandemic is "not very far away".

His assessment was that what happens next, after the next one to two years, depends on the pandemic situation in the rest of the world.

"It’s not so easy for us to just open up. Even after we’ve all been vaccinated, international travelling could still be challenging because other countries may not be opening," he said in the interview published on Jan 21.

He also said that the next pandemic could happen even before COVID-19 was over.

"I’m quite sure the next pandemic will happen so before we celebrate that finally COVID-19 is over, we have to always be vigilant that the next pandemic is just a short distance away. So we must always be ready, it could happen anytime.”

Assoc Prof Cook said that it was "inevitable" that the world will face more infectious diseases threats in the years ahead, urging people not to rush to "throw out your collection of face masks".

He pointed out that there were 10 years between the last pandemic - H1N1 in 2009 and the current one, but within that decade there was another global public health emergency - the Zika outbreak. 

Prof Matcher agreed with this, but added: "On the positive side, Singapore has demonstrated its capability to meet the challenges, with meticulous case finding and containment.

"If recurrent pandemics become the terrible 'new norm', we will figure out how to cope – use more tech but also to engage in new social patterns that permit satisfying human connection."

Said NTU's Assoc Prof Car: "There will be many lessons from the current pandemic as to how we can increase our resilience for the future ones – for example, how we can support one another in times of need, how we can work or study differently, how we can reduce economic, societal impact."

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Source: CNA/hm(hs)


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