Pandemics, elections, and how to protect yourself (Sabong News)

With only one week left until the May 9 election, campaigns are in overdrive with their final pushes and rallies. While candidates look favorably upon huge crowds of people coming out to support them, healthcare workers look on in horror as people are packed like sardines at these potential super spreader events. Decreasing adherence to masks and other public health standards will likely cause an increase in Covid-19 cases, even without the election fever. What then will happen when the next wave hits? Is it inevitable? WHO and FASSSTER, among the more reputable modeling groups, have shown that substantial decreases in public health standards can lead to 5,000 to 10,000 cases per day in late May 2022. While these numbers sound large, projections of severe and critical cases are much more sedate. The last few weeks have shown lower and lower new cases per day, in the 100 to 300 range. More encouraging is that the weekly DOH reports are showing very few new severe cases each week as well as the continued decline in active hospitalized cases. As a direct result of the massive vaccination and boosting program, any substantial increase in cases will be predominantly mild and will not require hospitalization. This in turn means that hospital capacity will be sufficient when the next spike in cases does occur. Despite the rosy outlook of a seemingly immune-resilient population, some threats remain. The emergence of a new variant, which may be more deadly or vaccine-resistant, or both, can precipitate a new health crisis. It is unlikely, however, that such a variant will mimic the death and destruction from the early days of the pandemic. There will remain significant protection from severe disease even if vaccine efficacy for preventing infection drops as antibody levels wane over time. In addition, the availability of effective medications such as paxlovid and remdesivir will go a long way in tempering risk of death, especially in the vulnerable population. Many other treatments and the next generation of vaccines are due to show results very soon, further increasing our tools for mitigating the impact of Covid-19. Another threat is the waning of immunity in populations that are not sufficiently boosted. Aside from increased risk of breakthrough infection, unboosted populations are seeing modest increases in hospitalization rates, especially with the newer Omicron sublineages. Uptake of booster shots has been dismal, and may be a function of pandemic fatigue, complacency, or lower prioritization by local governments with many other things on their plates. Waning population immunity increases the risk of substantial case spikes and the potential to overwhelm healthcare systems just by sheer numbers. If this occurs, alert levels with increase and economic recovery will be derailed. Local governments should see a poorly boosted population as a major risk to its fiscal health and should act accordingly. Even after more than a year of non-stop vaccination, there are still areas with inadequate vaccine uptake. These areas can serve as foci for the emergence of new variants, as well as persistent sources of infection that can threaten neighboring areas as their vaccine immunity wanes. Neighboring local governments adjacent to LGUs with low vaccination coverage should encourage and assist these poorly vaccinated communities in order to protect their own population against Covid-19. What about second boosters? While the Philippine FDA has approved EUAs for second doses for the A1 (healthcare workers), A2 (elderly), and A3 (persons with comorbids) population, only immunocompromised individuals from these three groups are allowed to get a second booster at this time.  “Immunocompromised” in this case refers to patients with the following conditions:  persons living with HIV, persons with active cancer, transplant patients, patients receiving immunosuppressive therapy, frail and bedridden patients, and those with significant immunodeficiency conditions as attested to by their attending physician. The Health Technology Assessment Council has approved the rollout of the second booster for immunocompromised individuals but has not yet signed of on the other eligible populations at the time of this writing. There are new publications that support the use of a second booster/fourth dose in the elderly.  There is strong evidence that two doses of a Covid-19 vaccine are very good at preventing infection as well as severe Covid-19 and death by >90 percent with the original virus early in the pandemic. With the rise of the variants, a third dose (first booster) helps restore some of the lost protection against infection, and “tops off” the protection against severe Covid-19 and death. A single booster/third dose in the era of the variants of concern is therefore very important. It is strong recommended among those 18 years old and above, especially with Omicron now becoming the predominant variant. There is also data that the first booster is helpful for the 12- to 17-year-old population, but the EUA is still being vetted by the FDA. A second booster/fourth dose does seem to improve over the protection of a third dose in elderly individuals. Comparing rates of infection, hospitalization, severe disease, and death show statistically significant differences. The baseline risk of hospitalization, however, severe disease and death are already quite low with just the first booster/third dose. Therefore, the actual improvement is modest. In addition, the only vaccine that has been studied for a fourth dose is the Pfizer vaccine. There is currently no data on other brands or on heterologous vaccination (mixed vaccines) given as a second booster/fourth dose.  The bottom line is that the first booster/third dose is essential for those 18 years and above. It significantly improves protection against infection and severe disease. If you haven’t gotten your first booster/third dose, get it now if you are at least three months from the second dose. The first two shots don’t expire, so it doesn’t matter if it is delayed. You won’t have to start from scratch. The fourth dose is optional for 60 years and above (once with HTAC approval) as well as immunocompromised persons. It is given four months from the third dose. There is evidence of a modest benefit, but the only study we have at this time is for the Pfizer vaccine. Other brands are still being studied, but it is reasonable to extrapolate that other vaccines will be effective. The DOH allows heterologous vaccination with a fourth dose with some vaccines. The table below shows which is acceptable. If you are below 60 years old and not immunocompromised, it is best to wait before getting a fourth dose until there is better data that shows substantial benefit. Finally, here is a list of reminders on how to protect yourself during the remaining campaign period especially when attending rallies, and on Election Day when you go out to vote: Wear the best mask you can tolerate that you will keep on for the duration of the activity. A surgical mask that you wear consistently will work better than an N95 that you constantly have to adjust and remove, so make sure you try on the mask before you leave home, and it is comfortable.  The minimum mask type should be a surgical mask.  Adding a cloth mask on top of a surgical mask can improve fit. Do not layer two medical grade masks together. You can add a pair of goggles or a face shield on top of a medical mask as added eye protection and as a second layer instead. Make sure you are fully vaccinated and boosted. Bring your vaccine card in case proof of vaccination is required. Maintain physical distance while in line, and in the precinct while voting. Bring your own pen/pencil and hand sanitizer. Minimize the time spent indoors. Try to time your voting when the lines are not likely to be long. If you are a senior, use the express lanes to further shorten your exposure time. Decide on your list of candidates ahead of time so you don’t have to spend too much time in the voting booth. If you have symptoms of Covid-19, it is best to stay home so as not to expose other people. Contact the LGU to see if there are other alternative ways to vote safely.