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Since our Summer Newsletter, life in much of Europe is beginning to return to normal and the exit wave in the USA has peaked. This does not mean that the pandemic is over. Cases and deaths are still occurring, but a combination of vaccination and natural immunity has taken the bite out of the epidemic and health systems, at least those with access to vaccinations, are no longer under immediate threat. The fires are dying out for lack of residual combustible material.
We may see a minor resurgence over the winter and the development of new variants remains a potential threat, but it is likely that the acute phase of the pandemic is over in these locations. Covid is likely to continue as an episodic and still potentially severe disease, almost exclusively in the unvaccinated and vulnerable, for some time. We discussed this and other Covid matters in our latest podcast with Professor Ben Cowling, Division Head of the Department of Epidemiology and Biostatistics at the University of Hong Kong.
You can also listen, download and subscribe to the podcast on your favourite podcast provider. Click here to be directed to our Spotify page and here for our Apple iTunes Podcast page.
As we have previously explained, we have much to learn from countries and locations with different public health strategies. Denmark recently removed all public health restrictions having vaccinated 97% of the population over the age of 60. Whilst other locations are also doing well, the Danish data compares favourably with other European countries which have vaccinated a lower proportion of their elderly. There are other different demographic factors at play but very high levels of vaccination in the most vulnerable and at-risk groups appears to be the most important factor in population terms. As we have previously explained, herd immunity is impossible by vaccination alone. ‘70% to herd immunity’ is misinformation. The key is to develop the highest possible levels of vaccine-induced immunity, especially in the most vulnerable members of the population. This is by far the greatest challenge facing Hong Kong.
The evidence for vaccination is now irrefutable. Of 51,281 deaths in the UK between January and July 2021, only 1.2% were fully vaccinated. In Singapore, as expected, cases are rising as the city transitions to managed disease. There have been 39,702 cases in the last 28 days of which 98.3% have been asymptomatic or mild. Only 0.2% of new cases in Singapore are currently severe. Post-vaccination Covid is effectively a different and milder disease.
Recent research has shown that vaccination in addition to natural infection appears to give significantly better immunity than vaccination alone. We know that vaccination can significantly reduce the incidence of both death and serious disease but also the incidence and complications of Long Covid, which in itself is likely to produce a significant burden on health systems in the coming years. This provides further evidence that high levels of vaccination and managed disease (living with Covid) will be the most effective long-term strategy. We have collated some of the more interesting evolving evidence and research on Covid which we will keep up to date on our website.
As we have previously discussed, all public health interventions are ultimately political in that they involve a balance between the rights and responsibilities of the individual versus those of the population. Ideally, public health interventions should be both evidence-based and proportionate. OT&P has consistently been supportive of the public health response in Hong Kong. 90% of our patients were vaccinated within the first two months of the Hong Kong vaccination program. Hong Kong is a world centre for public health and virology research. In this article, we consider the current quarantine policy and ask whether it is either evidence-based or proportionate. Our answer will be unsurprising to the majority of our patients and indeed the overwhelming body of experts in public health and virology.
China now has high levels of vaccination and some leading Chinese public health experts are beginning to discuss the levels at which graduated opening will begin. It is impossible to keep Delta out forever. We have argued for some time that Zero Covid is not a long-term sustainable strategy. Ultimately high vaccine coverage and managed disease is the only possible solution. Australia and more recently New Zealand are beginning this transition. We have much to learn from Singapore about transitioning to living with Covid but also from China that has achieved a combination of zero Covid in addition to high vaccine coverage in the elderly and vulnerable. The absolute priority in Hong Kong must be to increase vaccination rates especially in the elderly. This surely must involve a transition away from the negative messaging associated with zero Covid and education around the inevitability of the exit wave that Hong Kong must eventually manage.
Notwithstanding our current zero Covid policy flu vaccination is advisable this year both to protect individuals but also to boost population immunity and avoid the potential impact of a combined flu and exit Covid epidemic. We have flu vaccinations available in all our clinics. You may also wish to try out our online vaccine calculator to assess your current status for other vaccine-preventable illnesses.
