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Friday, September 17, 2021

How to live with Covid-19

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What does living with Covid-19 entail? How can Vietnam do so in the long run?

The Delta variant of SARS-CoV-2 is twice as infectious as the  original form from Wuhan (China) as its viral load is over 1,000 times as much and the incubation period is shorter (down from six days to four days). The Delta variant has swept through 124 countries and may spread to other places. Social distancing measures, including a lockdown, seem less effective than they were last year. In particular, HCMC has adopted social distancing since May 31, 2021 in line with Directive 15. This was extended on July 9 in line with Directive 16 and then extended to August 1, followed by August 15, with increasingly stringent measures adopted (Directive 16+). However, the number of cases has continued rising without signs of peaking.

From “zero Covid” to “living with Covid”

As the number of infections triggered by the Delta variant escalates but significantly fewer people are hospitalized or pass away, most countries, mainly in Asia have considered shifting from “zero Covid” (through social distancing and border closure) to “living with Covid.” What does this entail?

Some models are worth considering.

The United Kingdom: 70% of the population has received one dose and 55% has received two doses. All restrictions have been lifted since July 19 after six months of social distancing implemented to several degrees. For the five days following the lifting of restrictions, the number of new cases has dropped to 29,173 per day, down from over 46,000 on July 20. However, it is too early to tell whether this approach will succeed. It is advisable for wait for one to two weeks to see if gatherings at sport or entertainment facilities will lead to a surge.

Australia: The vaccination rate is low (30% with one dose and 12.6% fully vaccinated) and the number of Delta infections has soared, so some major cities such as Sydney and

Melbourne have re-imposed social distancing. However, the number of infections has hit record levels in New South Wales.

Vaccination rates in developing countries are generally low (mainly because of vaccine shortages). The percentage of fully vaccinated people in these countries is less than 20%, so widespread infections due to new variants have translated into more deaths, too. In the future, these countries must adopt social distancing.

Israel and Singapore boast high vaccination rates (64% with one dose and 57% fully vaccinated in Israel, as well as 74% with one dose and 51% fully vaccinated in Singapore) but still adopt some social distancing measures instead of lifting them. The same trend occurs in Germany, which adheres to social distancing despite its high vaccination rate (61% with one dose and 49% fully vaccinated).

Serbia has started its vaccination program since January using a combination of vaccines (mostly Sinopharm, followed by Sputnik V, AstraZeneca and BioNTech/Pfizer). 49% of its population has received one dose and 38% has received two doses. The number of Delta infections there is low (only 3% compared with the peak, compared with 71% in the U.K. and 84% in Russia). The economic impacts are less gloomy than in many European countries.

This underscores the importance of vaccination, which offers governments more options (reducing, removing or keeping social distancing measures). Low vaccination rates in the face of rampant infections leave a government with few choices (it will most likely have to rely on social distancing to slow infections but the economic impacts will be disastrous). In general, responses should balance three factors.

First, the rate at which the disease spreads, the hospitalization rate and the death rate compared with the capabilities of the healthcare system should be pondered to ensure that hospitals are not overloaded. Even if few people are hospitalized or die, the number of admitted cases and deaths will still be high in the long run. In HCMC, the healthcare system starts to show signs of being strained, so it has considered letting F0 cases with mild or no symptoms be quarantined at home; close contacts (F1) may also be allowed to be quarantined at home. However, what matters is that there should be a system to monitor those under quarantine (via various equipment, including electronic healthcare devices) and transport options to fetch them to hospital when necessary.

Second, vaccination should accelerate (at least 85% of the population so that there will be more protection, even if elimination of Covid-19 is not possible). As of August 2, Vietnam had received more than 18.7 million doses (updated by the Weekly); there are pledges and contracts for 105 million doses by the end of the year. As a result, there will be about 175 million doses by late 2021 or early 2022 (or even more when Nanocovax by Vietnam is endorsed). However, as of July 26, 2021, only 4.4 million doses have been administered. This rate is too slow. From the start of July to July 26, 2021, only 20,000-40,000 doses are administered a day, so 4.3% of the population has received one dose and 0.4% is fully vaccinated. By comparison, Thailand aims to administer 500,000 doses a day and has reached a rate of 200,000-300,000 doses per day. Consequently, Thailand has 17.4% of its population with one dose and 5.2% fully vaccinated. Vietnam must push its vaccination rate to 250,000 doses a day (and seven days a week) to vaccinate 70% of its population by April 2022. Even then, this still falls short of the target for herd immunity.

Third, the ability of the economy to cope with the pandemic and social distancing should be assessed. Persistent and widespread infections, as well as prolonged social distancing, will paralyze economic activities, adversely affect people’s lives and leave detrimental psychological impacts.

Three factors must be considered so that vaccination and calibrated social distancing can work together to ensure essential production activities continue and the people have access to necessities. Only then can Vietnam cope with Covid-19 in the long run. Crowds should be banned until herd immunity is achieved, so that superspreading events will not occur and cause infections to escalate.

If the pandemic cannot be eradicated and there is a need to live with Covid-19 in the long run, it is crucial to find appropriate lifestyle and production modes, with negative consequences minimized

Covid-19 is more dangerous than seasonal flu

When the notion of living with Covid-19 is brought up, some have compared it to seasonal flu. This is both flawed and dangerous. Covid-19 is dangerous due to two factors.

First, the virus SARS-Cov-2 can mutate due to its single-stranded RNA structure (less stable than double-stranded DNA virus), so there can be many waves of infection from one country to another. Variants such as Alpha, Beta and Delta are more infectious than the original virus. In the near future, Vietnam needs to guard against Delta-plus and Lambda, which are spreading in some countries and can pose many threats.

Delta-plus may be more infectious than Delta, binds more tightly to the ACE2 receptor in lung cells and can avoid antibodies produced by vaccines or past infections. The India Health Ministry considers Delta-plus as a variant of concern but the World Health Organization (WHO) has not endorsed this view. This variant has emerged in some countries such as India, Nepal, Canada, Germany, Russia, Japan, the United Kingdom and the United States.

The Lambda variant has swept through 29 countries, mainly in

Latin America, especially Peru, where it accounts for 90% of new cases there. Peru also relies on social distancing to curb Covid-19 and is slow to roll out its vaccination program. So far, only 21% of its population has received one dose and 12% is fully vaccinated. The death rate in Peru is the highest in the world (5,848 deaths per million people). WHO considers Lambda a variant of interest.

Second, long Covid is worth paying attention to. About 25% of recovered Covid patients still experience symptoms such as fatigue, shortness of breath and brain fog for a long time. There are about 200 post-Covid symptoms affecting internal organs such as the brain, lung, liver and intestines. They are considered a sign of autoimmune disorders triggered by Covid. Those suffering from long Covid have a high amount of autoimmune antibody, which attacks the protein of internal organs.

If long Covid is considered as an autoimmune disorder, things will be extremely complicated—full recovery will be hard and there will be deleterious and persistent effects on the patients’ lives. If more people catch long Covid, the economic impacts will be deleterious. Although the Delta variant does not come with high hospitalization and death rates, it is highly infectious and, therefore, should be controlled as fast as possible.

The impacts of long Covid show that letting infections rage to attain herd immunity is dangerous. Moreover, given the infection rate of Delta and other variants, full herd immunity is impossible. Many fully vaccinated people are still infected although the symptoms are mild and there are few deaths. 20-30% of people in many countries do not want to be vaccinated due to several reasons.

Finding appropriate lifestyle and production modes

If the pandemic cannot be eradicated and there is a need to live with Covid-19 in the long run, it is crucial to find appropriate lifestyle and production modes, with negative consequences minimized. In the near future, apart from treating patients, Vietnam should speed up vaccination efforts and maintain social distancing at varying degrees so that there will not be too much chaos and the Government can maintain production where necessary and continue providing the people with essential items and supporting poor households.

In particular, Vietnam needs more budget deficits to finance efforts to combat the pandemic and support the production of essential products, so that the long-term harm inflicted by Covid-19 upon society and the economy can be minimized. According to the International Monetary Fund (IMF), Vietnam only increased its budget deficit by a small margin of 2.1% of GDP in 2020 (from 3.3% of GDP in 2019 to 5.4% of GDP in 2020). In comparison, the figures were 5% of GDP for Asia, 7% for Europe and 10% for the U.S. In 2021, Vietnam plans to reduce the budget deficit by 0.7% of GDP (from 5.4% of GDP to 4.7% of GDP). The Government needs to change its financial approach and run a budget deficit of 8-9% of GDP in 2021 to tackle Covid-19/Delta. It can do so as its public debt as a share of GDP in 2021-2022 is 39% on average, below the average of 60% incurred by those with the same credit rating of BB (according to Fitch).

Moreover, it is important to prepare for the scenario in which Covid-19 cannot be eradicated and herd immunity cannot be achieved due to scientific and social reasons.

Vietnam should pull out all the stops to speed up digital acceleration, especially in the growth of telecom infrastructure, to combat the pandemic and fuel economic development. In 2020, the percentage of the population with Internet access rose to 70.4% from 46.5% in 2018 and mobile network coverage of 99.7% but the number of households with Internet connections was only 47%. To develop electronic health services so that the fight against the pandemic will be more effective (especially regarding the monitoring of patients and close contacts on home quarantine), Vietnam can provide poor households with subsidized access to the Internet. e-government services, which are on the rise, should be enhanced. According to the United Nations, Vietnam ranked 86th in 2020, up from 99th in 2014, with above-average performance.

When the new academic year is about to unfold, online teaching and learning platforms should be developed so that partial online learning can take place and help to reduce transmission risks in schools. The Government can offer needy students financial assistance so that they can embrace online learning.

In general, e-commerce activities can be boosted. In 2020, Vietnam attained an e-commerce revenue of US$11.8 billion, or 5.5% of retail sales, with 53% of the population using e-wallets and making online payments.

The shift to e-government and e-commerce will increase the efficiency and growth potential of the economy and partially offset the economic damage inflicted by Covid-19. In the short run, it also helps Vietnam fight Covid-19 better.

Conclusion

Vietnam must change its Covid-19 strategy. Besides treating patients, it must accelerate vaccination and channel more budget revenue into supporting production, providing necessities to the people and helping poor households, so that there will be more stability and the risk of protracted social distancing can be reduced. Infrastructure should be developed to make the economy more efficient. Vietnam also needs to boost digital transformation to improve e-government and e-commerce services. Only then can it live with Covid-19 in the long run.

(*)Economist in the United States. This article is a contribution to a forum on Covid-19 by Edu-Sci.

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