Vaccination, social distancing matter ahead of sixth wave of COVID-19

Charles Ng says draconian measures would be harsh but necessary way to protect children and elderly residents

In Hong Kong, the mood has recently turned uplifting. Gone are the times when more than 70,000 citizens are infected with COVID-19 each day. Reminiscent of social-distancing policies erected in the darkest months, people fear that an incoming sixth wave would prompt the government to impose equally strict measures. 

When the fifth wave hit, the Hong Kong Special Administrative Region government emphatically encouraged vaccination of the mass public. In less than two months, the city achieved the feat of 87 percent of all citizens having received two doses, and 62 percent having received three. 

Owing to much higher vaccination rates than earlier in the year, the immunity level against COVID-19 in society has risen enough to nip transmission chains in the bud, at least for now. That was the precondition for reopening the city. 

Across both the Atlantic and Pacific, many countries are canceling previously imposed COVID-19 policies such as wearing masks outdoors, showing vaccination passports before entering crowded spaces, and getting a second booster shot. Looking toward these countries, some local residents grumble about restrictions on freedom. 

They argue that by publicly announcing the daily number of new infections, the Hong Kong government is fearmongering. Only metrics such as serious infections, hospitalization rates and deaths matter, even some health care workers clamor. The former is wrong; the latter is parochial.

To start with, how SARS-CoV-2 infection affects our health in the long run is still largely unknown. A cluster of severe hepatitis in children has been retrospectively linked to COVID-19 infections that occurred more than three weeks ago. 

A team of researchers suggest in The Lancet Gastroenterology and Hepatology, one of the most impactful journals in gastroenterology, that lingering coronavirus particles in the gastrointestinal tract could prime human immune systems to overreact to other viruses in the enteric system, thereby releasing highly inflammatory proteins that damage livers.

Cardiologists from Johns Hopkins University revealed in a study that patients infected with COVID-19, regardless of severity, are at an increased risk of all sorts of heart diseases ranging from arrhythmias to blood clots that trigger heart attacks. They went as far as to tweet officially “IT SPARES NO ONE” while tagging their published study.

Aside from directly attacking our nervous system and causing encephalitis, a potentially deadly brain disease, neurologists and psychiatrists are investigating a newly minted condition termed “long COVID”. Albeit vaguely defined, healthcare professionals are beginning to recognize the complications such a syndrome entails. 

Chronic fatigue, persistent shortness of breath and cognitive dysfunction (brain fog) among many other symptoms with no distinct attribution to known diseases are grouped under the umbrella of long COVID. 

As a part of its information dissemination strategy, the World Health Organization has set up a page dedicated solely to COVID-19. Long COVID itself takes up an entire episode, which includes a podcast interview with health professionals and other written content. Research shows a range of between 2.5 and 13 percent of patients infected with COVID-19 suffer from long COVID. 

Up to 30 percent of hospitalized COVID-19 patients may continue to live under the shroud of long COVID, impairing their quality of life for an indefinite period. The American Centers for Disease Control and Prevention and the British National Health Service both acknowledged that the poorly defined nature of long COVID renders a targeted cure nigh impossible.

Even if naysayers doubt long COVID for all its ad libitum (symptoms could involve any organ to any extent) and unscientific (no biomarker or reliable metric to prove such entity) notions, they must take heed against new variants overwhelming the city that people have fought so hard to defend. 

Rapid turnover of new genetic sequencing technologies allows near real-time tracing of COVID-19 variants across the globe. Data in the UK and Australia are displaying some concerning trends that the new subvariants BA.4 and BA.5 are infecting their population at exponential rates. BA.4 and BA.5 evolved with the capacity to escape immunity granted by ancestral infection and undermine the health of people who received three shots of vaccine. 

Virologists are debating about an outmoded naming system, as BA.4 and BA.5 belie transmissibility far beyond what their nomenclature suggests — despite sharing the same lineages with earlier subvariants BA.1 and BA.2; BA.4 and BA.5 harbor material mutations in spike protein that equip the virus with the ability to evade immunity previously trained to identify and destroy cells infected with earlier strains. 

Public health experts are proposing that BA.4 and BA.5 will take over the current subvariants as dominant strains, eventually straining health systems across the world as COVID-19 breaks through the immunity wall we have arduously built over the last few months.

Admittedly, achieving herd immunity requires not only jabbing a majority of the population (or in Darwinian ways, exposing the entire race to viral wreckage to sift out the weakest so that those who survive are sure to gain immunity against COVID-19) but also constructing an immunity barrier against specific strains. Hence, the purported threshold of 80 percent is arbitrary and mercurial. 

The good news is that a few vaccines targeting newer mutant strains are in the pipeline. Early phase studies proved them effective and they may be rolled out later this year. When Hong Kong will get hold of them is uncertain. Two years into the pandemic, it is remotely ambivalent to see that vaccination remains the single most effective weapon against COVID-19.

Hong Kong is on the cusp of a sixth wave. Upcoming is a new wave that looks set to hit the globe in which few are spared. Look closer to a surge of recent tweets raging “Are American public health officials giving up on COVID?” 

In Hong Kong, it helps little that the two most vulnerable groups, children 3-11 years old and elderlies 65 years and above, remain vastly undervaccinated. For unvaccinated residents to amble around a city as vibrant as Hong Kong is fodder for a new wave of infection. 

To impose draconian measures ahead of a new wave is painstaking, yet for the past few waves, it has served well as an emergency backstop lest elderlies and children be murdered. Prevention trumps cure. No one enjoys tighter social restrictions. 

And there are ways to curtail transmission before the virus ravages our city out of control: Wash hands frequently; wear a mask when outside of home; maintain social distance, especially in confined areas. We must not fall prey to complacency, and we must take up arms to defend our residents — by encouraging all those around us to get vaccinated, we shall emerge victorious.

The author is a licensed medical doctor in Hong Kong and holds a Master of Public Health degree from Johns Hopkins University in the US state of Maryland.