How to emerge from a pandemic

Race ahead... or stay cautious?

Other regions appear to have left Asia in the dust in the race to put Covid-19 behind us. Only time will tell.

CHINA Domestic tourists waiting for a flag-raising ceremony last Wednesday at Tiananmen Square in Beijing. China is not considering opening its borders, but it has robust domestic tourism and consumer markets to rely on. UNITED STATES A packed bar in
SPAIN People sunbathing on Barceloneta beach in Barcelona earlier this month. Spain has lifted Covid-19 restrictions although only about 30 per cent of its population has completed inoculation.PHOTO: BLOOMBERG
CHINA Domestic tourists waiting for a flag-raising ceremony last Wednesday at Tiananmen Square in Beijing. China is not considering opening its borders, but it has robust domestic tourism and consumer markets to rely on. UNITED STATES A packed bar in
UNITED STATES A packed bar in Washington on June 11. Covid-19-related deaths and hospitalisations in the US have dropped significantly, with nearly half the population fully vaccinated. PHOTO: AGENCE FRANCE-PRESSE
CHINA Domestic tourists waiting for a flag-raising ceremony last Wednesday at Tiananmen Square in Beijing. China is not considering opening its borders, but it has robust domestic tourism and consumer markets to rely on. UNITED STATES A packed bar in
BRITAIN Supporters of the English national team at a public viewing in London of the Uefa Euro 2020 match between England and Croatia last Sunday. Britain has eased some curbs for vaccinated people. PHOTO: EPA-EFE
CHINA Domestic tourists waiting for a flag-raising ceremony last Wednesday at Tiananmen Square in Beijing. China is not considering opening its borders, but it has robust domestic tourism and consumer markets to rely on. UNITED STATES A packed bar in
THAILAND Businesses like Thaisho bar and restaurant in Bangkok - which decided earlier this month to shut down for good - have suffered from having to close at night because of Covid-19 restrictions. PHOTO: EPA-EFE
CHINA Domestic tourists waiting for a flag-raising ceremony last Wednesday at Tiananmen Square in Beijing. China is not considering opening its borders, but it has robust domestic tourism and consumer markets to rely on. UNITED STATES A packed bar in
CHINA Domestic tourists waiting for a flag-raising ceremony last Wednesday at Tiananmen Square in Beijing. China is not considering opening its borders, but it has robust domestic tourism and consumer markets to rely on. PHOTO: REUTERS
CHINA Domestic tourists waiting for a flag-raising ceremony last Wednesday at Tiananmen Square in Beijing. China is not considering opening its borders, but it has robust domestic tourism and consumer markets to rely on. UNITED STATES A packed bar in
SINGAPORE A nearly empty departure hall at Changi Airport Terminal 3 on June 11. More than a third of the people in Singapore are already fully vaccinated. SPAIN People sunbathing on Barceloneta beach in Barcelona earlier this month. Spain has lifted Covid-19 restrictions although only about 30 per cent of its population has completed inoculation.ST PHOTO: CHONG JUN LIANG

Across the Asia-Pacific, where several countries have witnessed alarming new Covid-19 outbreaks in recent weeks and governments have been forced to reimpose harsh anti-virus restrictions, people are gazing in envy at those on the other side of the globe.

In the United States, fully vaccinated Americans - nearly half the population - are revelling in their newfound freedom.

They are hopping onto planes, cramming into stadiums, flocking to malls and hosting celebratory parties to send off a miserable year of having been forced to stay apart. Best of all, they are casting off their masks.

Vaccinated individuals in parts of Europe, like Britain, France and Germany, are also being spared the cumbersome measures that had governed their lives for the past year. No more curfews and social limits, no more uncomfortable Covid-19 tests, and no more travel quarantines for most.

France - with about one in every four people fully vaccinated - is lifting its night-time curfew and outdoors mask mandate for all, even those who have yet to get their shots. Spain, with 30 per cent of the population having completed inoculation, is doing the same.

Why is much of the Asia-Pacific region not yet able to do likewise, despite most of its countries having lower infection and fatality rates than the West?

After all, some Asia-Pacific vaccination front runners are doing as well as - or even better than - their Western counterparts.

More than a third of the people in Singapore are already fully vaccinated. Elsewhere in the region, some are lagging behind with their second doses, but 20 per cent to 30 per cent of those in South Korea, Hong Kong, Macau and Australia have received at least one shot.

And judging by the total number of doses administered in China, at least one in three of its people should have had a first jab, if not the second.

The statistics show that vaccination works: Covid-19 deaths in the US - the worst-hit country - have slowed significantly.

The death toll in the US topped 600,000 this past week, taking more than four months to add its latest 100,000. This was a stark contrast from the situation back in winter, when it was adding 100,000 deaths in a matter of weeks.

Weekly new hospitalisations - indicating disease severity - have dropped to an all-time low. Daily new cases this month have also fallen to about 7,000 from a peak of more than 300,000 in January.

For some regions in Asia, vaccine accessibility is an issue. Where the life-saving shots cannot be obtained quickly enough in sufficient quantities - as in the cases of Thailand and Vietnam - governments are forced to continue relying on a combination of tight restrictions or border controls.

But even where vaccination is progressing well, some authorities are still keeping social and economic activities on a tether, like in Australia, which is ever ready to lock down entire cities at the emergence of a handful of new local cases.

South Korea took big steps in easing measures last week, scrapping its outdoor mask mandate for those who have had at least their first jab, and allowing up to 4,000 people to attend K-pop concerts.

But with daily new cases bouncing back above 500 and barely 8 per cent of the population fully vaccinated, it remains to be seen if locals and tourists will be in a hurry to flock back to big events and ditch mask-wearing, a practice already widespread in the country before the pandemic.

VACCINES NOT A CURE-ALL

Health policy and management professor Peter Muennig of Columbia University's Mailman School of Public Health puts the dichotomy in government approaches down to caution versus recklessness.

"It's not clear quite yet that vaccination and immediate reopening of society thereafter is the way towards ending the pandemic," said Professor Muennig, who specialises in analysing the burdens of disease and has written on the health implications associated with different economic systems.

"I would want to see infections drop substantially and vaccination rates with the more effective vaccines - such as the mRNA-based vaccines - climbing above 70 per cent before considering it safe to drop public mask-wearing, (allow) big-group mingling, or resume international travel," he said.

"Otherwise, we are just giving the virus a chance to adapt to vaccinated bodies. This is reckless."

Vaccination alone is not a cure-all. Neither is any other preventive measure, on its own.

Experts like Professor Keiji Fukuda from The University of Hong Kong's School of Public Health point to what has famously been described as the "Swiss cheese approach" in countering the pandemic. Each layer of pandemic defence has holes, but when combined, they can block the spread of the virus.

Prof Fukuda said: "What all countries should strive to have is (1) a stepwise national strategy for opening up; (2) high levels of vaccination, probably in the range of at least 70 per cent; (3) a functional surveillance system capable of detecting an increase in cases; (4) a health system capable of handling a significant increase in cases; and (5) a strong communication initiative that engages the public and private sector."

Prof Muennig sees China as one key example of having effectively implemented a cautious approach, aided by its strong control over its borders, media messaging and other state apparatus. It has also massively scaled up its vaccination blitz, averaging a whopping 17 million doses daily this past week - almost the total of what South Korea has administered.

"China has really done an outstanding job because the government - and to some extent the people - would rather live with restrictions like electronic monitoring, strict quarantine rules and mandatory testing, than die or suffer lifelong disability," Prof Muennig said.

China's robust domestic tourism and consumer markets also make it "unique in that it can remain economically prosperous with closed borders," he added.

The Chinese authorities are not even considering relaxing their travel barriers.

"As long as outbreaks remain uncontrolled outside our borders, it's possible to have them anywhere in China, no matter how long there have been no local cases," Dr Wu Zunyou, chief epidemiologist at the Chinese Centre for Disease Control and Prevention, said last month as he justified keeping the country's strict border controls.

BURDEN OF DISEASE

That may be for the best, as experts say China has yet to provide satisfactory data to show that its vaccines effectively block transmission of the virus and its variants. Of the seven shots approved for use in the Chinese mainland, five are inactivated-virus vaccines. Four of these have considerably lower efficacy rates than the mRNA shots developed in the West.

Countries like Seychelles and Chile, which have fully vaccinated half or more of their populations largely with Chinese vaccines, have reported continued surges in daily caseloads, though deaths remain relatively low.

Last week, hundreds of Indonesian healthcare workers were reported to have contracted Covid-19, with dozens hospitalised, despite having been inoculated with the Chinese vaccines.

Even with the mRNA shots, like those from Pfizer and Moderna, "it is still possible that a future variant will be able to break through to produce another iteration of the pandemic", said Prof Muennig.

"Even if there are no hospitalisations or deaths, the risk of upwards of 25 per cent of the population being permanently disabled by long-term Covid-19 symptoms should give us all pause," he said, adding that long-haul Covid-19 is likely to be a public health problem for decades to come.

Nearly a fifth of Covid-19 patients without symptoms went on to experience conditions consistent with long-haul Covid-19 a month after their initial diagnosis, according to a recent US study that surveyed nearly two million Americans over a year.

The figure grew to 27.5 per cent among symptomatic patients who were not hospitalised, and to half among those who were. Their most common complaints were pain, breathing difficulties, high cholesterol, fatigue and high blood pressure.

Moreover, these long-haul symptoms are now afflicting more younger people.

A relatively small but increasing percentage of American children has been struggling for months with extreme fatigue, rapid heart rate, memory loss, depression and other symptoms after recovering from Covid-19, Bloomberg reported.

Going by these observations, the world could be in for a far bigger and longer-lasting health crisis if countries do not act urgently to control the spread of the disease when infections occur.

'ASIAN' VALUES

Nonetheless, Asian governments are under increasing pressure to ease restrictions, as recent news spotlights the region's lag in returning to normalcy, and inaction could cause their economies to lose out as others reopen.

On the Bloomberg Covid-19 Resilience Ranking for last month, the Asia-Pacific region - often lauded for its effective handling of its outbreaks - accounted for all seven of the biggest declines in the measure of the best and worst places to be during the pandemic.

The US and parts of Europe rose on the ranking as their comparatively higher proportions of vaccination brought down infections and deaths.

However, the ranking - which scores where the pandemic is being handled most effectively, with the least social and economic disruption - assesses economies only at a point in time, and does not take into account the potential costs of any premature opening up.

Ultimately, governments' choices of action are rooted in the cultural traits and values of their people.

"In terms of reopening, whether it is about allowing larger gatherings, lifting mask restrictions, or easing quarantine requirements, we can link a country's public health directives to its cultural values," said associate professor of management Umar Ruhi at the University of Ottawa.

He explained this using late Dutch social psychologist Geert Hofstede's cultural dimensions framework of country-specific differences, in a recent study in the Canadian Health Policy journal.

"To ensure effective citizen participation in (Covid-19) measures, countries need to adopt public health policies and protocols that are aligned with their culture and underlying societal values."

The dimensions in Professor Hofstede's framework measure nationalities' cultural preferences for individualism versus collectivism; indulgence versus self-restraint; strength of social hierarchy, and uncertainty avoidance, among others.

For example, a national culture that prizes individualism and thus personal freedoms over the collective welfare of the people - like in the US - may have been a driving force behind its authorities' decision to allow vaccinated Americans to go without masks.

In comparison, countries like Singapore, whose societies espouse more collectivist values, may place greater emphasis on mask-wearing as individuals' duty to protect others around them.

Meanwhile, a culture that values self-restraint and a longer-term outlook over instant gratification - as Prof Hofstede found in East Asian regions - may explain some Asian governments' greater propensity to prioritise keeping infections low and thus avoid future health implications, over immediate economic imperatives to reopen quickly.

Essentially, it is also about striking a balance, and no one way is necessarily the best as the circumstances differ from place to place.

As Professor K.K. Cheng, director of the Institute of Applied Health Research at the University of Birmingham, pointed out, the scrapping of outdoor mask mandates in some countries makes sense, as "the risk of transmission outdoors is much lower; though most places in Singapore would be densely populated by Western standards, and so the considerations may be different".

Prof Fukuda also noted that the approach of countries in North America and Europe of heavily emphasising vaccination over social distancing and other preventive measures has worked "reasonably well" - but only after the vaccines became available to them, and it came at the cost of multitudes of earlier cases and deaths.

The stark memories of the tragedy and wariness of history repeating itself could have given British leaders pause in a planned lifting of lockdown measures. Britain postponed the move last week by a month as it seeks to contain the spread of the highly transmissible Delta variant and races to get more people vaccinated.

Dr Steven Woolf, director emeritus of the Centre on Society and Health at Virginia Commonwealth University, told USA Today as he reflected on the more than 600,000 deaths that have occurred in the US since the pandemic began: "The light at the end of the tunnel is in sight, but it doesn't bring back any of those lives or bring solace to the grieving families."

Asian nations may have fallen behind for now as countries in the West surge ahead in the global race to return to normalcy - but the marathon to end the coronavirus pandemic is far from over, and its final outcome remains to be seen.

A version of this article appeared in the print edition of The Sunday Times on June 20, 2021, with the headline 'Race ahead... or stay cautious? '. Subscribe