Will the novel coronavirus pandemic end?
The impact of thenovel coronaviruspandemic is expectedto linger for manymore years, andsignificant shifts inthe global health caredelivery ecosystem areexpected.

After more than two years of a devastating novel coronavirus pandemic, there is population fatigue and strong desire to return to normalcy. It is arguable whether normalcy is attainable under the current situation. According to the New York Times , as of March 7, 2022, more than six million deaths have been recorded from COVID-19 globally. This would make it, perhaps the deadliest global occurrence in the past 50 years. The USA recorded more deaths than any other industrialised nation. The world has undergone significant trauma with massive disruption of the health systems, social and economic order. The impact of the COVID-19 is expected to linger for many more years. Significant shifts in the global health-care delivery ecosystem are expected. Telemedicine and digital health will become more prominent in health-care delivery systems and will require that societies adapt and invest in robust infrastructure to drive inclusive digital health programmes that expands access to large segments of the population. Remote workplaces will become the norm for many industries rather than the exception. Financial services will expand their digital offerings and the same pattern is expected to play out in other areas of the economy. As the pandemic ends, a new era will emerge and would require ongoing and sustained investment in digital education to ensure that the population is properly equipped to function in an increasingly digital environment.

At the beginning of the pandemic, most scientists were unanimous in the doctrine of “herd immunity” as a pathway to ending the pandemic. Herd immunity could be achieved through widescale infection of the community or widescale vaccination. Widescale vaccination was the safer and more predictable option and so was universally adopted as the preferred pathway to herd immunity. This acknowledgement led to a welcome race by the pharmaceutical industry to develop safe and effective vaccines spurred by massive investments from wealthy nations led by the USA. Prominent and ultimately successful in the race for safe and effective vaccine development were AstraZeneca, Pfizer-BioNTech, Moderna and Johnson & Johnson, among many others. Pfizer-BioNTech and Moderna COVID-19 vaccines contain messenger RNA (mRNA) and the Johnson & Johnson COVID-19 vaccine contains a harmless version of a virus unrelated to the virus that causes COVID-19. These give instructions to cells in your body to create an immune response. This response helps protect you from getting sick with COVID-19 in the future. After the body produces an immune response, all vaccine ingredients are discarded. These vaccines were among the safest vaccines ever made.

Vaccinations despite misinformation and vaccine hesitancy

Despite the remarkable safety and efficacy of the COVID-19 vaccines, there was an unprecedented onslaught of misinformation in the public space leading to vaccine hesitancy within many communities, sometimes expected because of lingering injustices and distrust of the establishment. The problem was compounded in countries where poor planning and execution hampered the delivery of vaccines to vulnerable populations. Many countries, especially the more advanced ones, have found mechanisms to vaccinate large populations to pave the way for return to normalcy. Globally, nearly 11 billion vaccine doses have been administered with 4.4 billion fully vaccinated, equating to about 56 per cent of the global population. About 75 per cent of the population of the USA and 87 per cent of the Chinese population is fully vaccinated compared to only 22 per cent of the Jamaican population. Only one per cent of the Jamaican population has received a booster dose. When compared to other low- and middle-income countries, Jamaica's poor vaccination rate is troubling and poses a problem for the return to normalcy in the island. Compared to other countries in the English-speaking Caribbean, Jamaica has one of the lowest vaccination rates. Trinidad and Tobago, Cayman Islands, Antigua, Barbados, all have vaccination rates more than 50 per cent of their population. Far away in Africa, countries like Rwanda and Morocco have achieved more than 60 per cent vaccination rates, significantly better than the 22 per cent underachievement in Jamaica.

Test to treat

In December 2021, the US Food and Drugs Administration (FDA) approved two oral antivirals from Pfizer (Paxlovid) and Merck (Molnupiravir) for the treatment of COVID-19 in patients at high risk of severe disease. Both medications are highly effective against COVID especially when administered within the first five days of symptom onset. The Pfizer pill, for example, has been documented to reduce the risk of hospitalisation from COVID by more than 90 per cent.

To ensure safety of the nation amidst the drive for normalcy, US President Joe Biden in his recent State of the Union address announced the launch of a new Test to Treat initiative that would increase testing for SARS-CoV-2 at pharmacy outlets with initiation of antiviral treatment on the spot at no cost to the patient. This initiative is part of the National COVID-19 Preparedness Plan that includes VA hospitals, community health centres and long-term care facilities across the USA.

The highly infectious but less severe Omicron variant has been a blessing in disguise as many individuals got infected and developed antibodies without enduring levels of severity of illness seen during the delta variant wave. With widescale vaccinations, early detection, and treatment and a large population with antibodies, we expect containment of the SARS-CoV-2 pandemic and return to normal life in the near term. With only 22 per cent vaccination rate in Jamaica, however, we may still have a longer way to go than comparable locations. It is time for us to do a proper introspection to understand why we have not performed as well compared to our peers and make corrective actions to improve our vaccination rates and overall pandemic response. We should also be aggressively engaging the pharmaceutical industry to gain access to the newly approved effective antivirals from Pfizer and Merck. A test to treat programme in Jamaica will also go a long way in preventing another surge so we can begin the process of social and economic recovery and ultimately a return to normal life. While some may argue that we may not have the funds to purchase, there are other leverages that we can bring to the table to ensure we gain access.

Dr Ernest Madu, MD, FACC and Dr Paul Edwards, MD, FACC are consultant cardiologists for Heart Institute of the Caribbean (HIC) and HIC Heart Hospital. HIC is the regional centre of excellence for cardiovascular care in the English-speaking Caribbean and has pioneered a transformation in the way cardiovascular care is delivered in the region. HIC Heart Hospital is registered by the Ministry of Health and Wellness and is the only heart hospital in Jamaica. Correspondence to info@caribbeanheart.com or call 876-906-2107

Ernest Madu
Paul Edwards
Ernest Madu and Paul Edwards

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