There’s no doubt already that in the Philippines, Covid-19’s Delta variant has clearly overtaken the formerly dominant Alpha variant in terms of transmissibility. Over the past week, new record highs in daily infections were logged in just a matter of days, resulting in hospitals inundated with a tsunami of Covid-19 cases. Many of them have already driven away patients due to the lack of Covid-19 beds in the Emergency Room and the ICUs.
Sadly, many of them perish before they can be properly attended to. But is the Philippines the only one undergoing this predicament? Surely not. But how do countries deal with the debilitating Delta?
During the recent University of the Philippines webinar, “Delta Variant: What is happening around the world?” Dr. Franco Felizarta, Infectious Disease and Internal Medicine Specialist, UP Medical Alumni Society in America (UPMASA) provided an update on the US experience.
He said the variant’s transmissibility went up from the previous 5.8 people to as high as 9.5, and herd immunity is now at 80-90 percent. He said all vaccines are effective in reducing severe cases, hospitalization and deaths by at least 85 percent. “Breakthrough infections will not be uncommon but will be milder with decreased secondary transmission.”
Dominant variant
In the US, Delta clearly became the dominant variant with 99 percent of cases compared to less than two months ago, and hospitalization and deaths continue to rise. He attributed this to the large number of areas, particularly the US southern states, whose population are still unvaccinated.
He cited a study made in Singapore, which showed that the increased transmissibility of Delta is due to its higher viral load compared to other variants. For breakthrough infections, Dr. Felizarta pointed out that the viral load remains high for the unvaccinated but there’s a severe drop for vaccinated individuals since they are more protected from severe disease infection or hospitalization.
As for Japan’s Delta variant situation, Atsuro Tsutsumi, a Professor at the United Nations University—International Institute for Global Health (UNU-IIGH) in Malaysia and the Kanazawa University in Japan, pointed to Aichi Prefecture, one of the biggest cities in Japan, where cases doubled to 18 percent from eight percent the week before, most likely because of the Delta variant.
He said estimates from Japan’s National Institute of Infectious Diseases said the Delta variant accounted for around 70 percent of the total new infections in late July in Tokyo and 80 percent in Okinawa prefecture, with latest news saying it reached up to 90 percent. He said more stringent control measures are required to curb the variant’s transmissibility.
Poster case
From a communications standpoint, Roy Wadia, Communications Adviser, United Nations, said Thailand was considered a “poster” case for Covid-19 management and response due to its earlier successes against Covid-19. The arrival of Delta, however, changed the situation.
Wadia said studies that looked into the failure of the vaccine policy in Thailand, once considered the best recovering country to being the worst, and attributed this to complacency. Due to the concerns about the vaccines’ side effects, the country’s public health experts “did not consider vaccines as necessary and did not consider the economic impact of this decision.”
He said the Delta variant is now the dominant strain, accounting for 78 percent of infections in Thailand, infecting many including the young, and the health-care system was overwhelmed. However, volunteerism is stepping up now, especially in the countryside. The government has increased its vaccination rollout using the homegrown and by importing other vaccine brands, with Thailand’s Health Ministry looking at 120 million jabs by 2022, while current caseloads are going down.
“Thailand is not out of the woods yet. Delta will continue to circulate, with new variants circulating, the country is opening up although economic recovery may be slow but luckily, Thailand will have more vaccines in the year ahead.”
Small outbreak
For Dr. Chun-Yu Lin, consultant for Covid-19 Pandemic (Delta variant), of Kaohsiung City government, said a small outbreak of the Delta variant started in late June and was caused by returning travelers from Peru. Contact tracing was immediately started and all contacts were quarantined. Heavy testing was conducted and village lockdowns were implemented in the country.
To control the Delta variant’s entry, Taiwan implemented strict border controls to maintain the low number of cases but high number of deaths. “This may be because of short response time in May, inadequate medical equipment and manpower, and some undiscovered cases,” Dr. Lin said.
Taiwan, he said, uses three vaccine brands: Moderna, AstraZeneca and local brand Medigen, while Pfizer will come in by September. The first dose of the vaccination was done on 46 percent of the population but only five percent had their second shot.
He cited major concerns, moving forward with the Delta variant, among which is how long can the antibodies the vaccines carry last and how it will protect them against the Delta and all the other variants.
Game changer
Finally, for the Philippines, Dr. John Wong, Epidemiologist and Senior Technical Advisor, EpiMetrics, Inc., said the Delta variant is a game changer, with herd immunity beginning to be out of reach. There’s a need to change in mindset, from eradicating the virus to preventing severe disease and death and prioritize the elderly and improve vaccine supply and availability.
As for herd immunity being out of reach, this may be due to the failure of vaccines to transmit blocking, the Delta variant being more transmissible and probably resistant, uneven vaccine rollout, waning vaccine immunity among the elderly and those with comorbidities, and changing people’s behavior. “You cannot have herd immunity if there’s unevenness in vaccination, plus changes in risky behavior—not wearing masks, etc.—will lead to more breakthrough infections also,” Dr. Wong said.
He also proposed a three-phase vaccination strategy to get more people vaccinated. For the willing but not yet vaccinated, they just need to be assured of a steady vaccine supply. For the undecided, this is where vaccine education comes. For the unwilling, “soft mandates” like wearing of face masks and regular testing when going back to work can be imposed.
“Eventually, Covid-19 may be something like influenza. It will be endemic, always there but because of vaccination, there will be much lower percentage of hospitalization or deaths, while those vaccinated can carry on with their daily lives: no more lockdowns/quarantines, people and children can go back to work and school, there will be fewer controls, and also live safely.”