© Hong Kong Academy of Medicine. CC BY-NC-ND 4.0
COMMENTARY
Waltzing with SARS-CoV-2 for Asia?
KL Hon, MB, BS, MD; Karen KY Leung, MB, BS, MRCPCH; WF Hui, MB, ChB, MRCPCH; WL Cheung, MB, BS, MRCPCH; FS Chung, MB, ChB, MRCPCH
Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital, Hong Kong SAR, China
Corresponding author: Dr KL Hon (ehon@hotmail.com)
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The severe acute respiratory syndrome coronavirus
2 (SAR-CoV-2) and the resultant coronavirus disease
2019 (COVID-19) pandemic has been with us since
2020 and caused millions of deaths. Pharmacological
and mechanical ventilatory support were largely
ineffective in containing the viral spread.1 The virus
continued to cause outbreaks across the world,
with many cases being asymptomatic or mild.
Unfortunately, the emergence of variants, vaccine
hesitancy, and various political issues hindered the
efficacy of >10 novel vaccines on a global scale.2
With a higher basic reproduction number than some
other common respiratory viruses, the spread was
likened to soldiers hidden in the Trojan horse.3 4
Many countries and cities worldwide, including the
United Kingdom, Denmark, Chile, South Africa, and
Thailand tried to transition to a post-pandemic ‘new
normal’ by living alongside SARS-CoV-2.5 They all
faced the similar situation of high case numbers,
hospitalisation rates, and death rates, even as the
numbers of those who had received vaccinations
increased.
Many countries and cities in Asia took a more
conservative approach in dealing with the pandemic.
Malaysia largely avoided the first wave of the virus
in 2020 after the early imposition of restrictions
and closing of its borders.6 Partly due to the Delta
variant, Malaysia faced its worst COVID-19 wave,
prompting authorities to impose a tough nationwide
lockdown. However, as case numbers fell and the
vaccine rollout increased in scope, authorities
began lifting curbs and businesses were allowed to
reopen. The government also eased domestic and
international travel restrictions in October 2021 for
those who were fully vaccinated, allowing travellers
to apply to enter Malaysia for home quarantine on
return.
Across the strait, by October 2021, Singapore’s
COVID-19 death toll had risen to 153 which coincided
with the highest number of deaths reported in a
single day.7 Despite this, Singapore planned to adopt
the Western approach of living with the virus once
vaccination rates had reached a high enough level,
as it was practically impossible to eradicate the virus
despite the high economic and psychosocial burdens
of ‘zero–COVID-19’ strategies.
Hong Kong maintained great control during the early phases of the pandemic with fewer imported
cases, though this required significant government
expenditure. However, the requirement for travellers
entering the city to isolate, which was a successful
strategy for minimising new local cases, can also
have deleterious effects of the mental health of
those undergoing isolation. The psychological
consequences of prolonged isolation of inbound
travellers can be unmeasurable. At the time of
writing, vaccination rates in Hong Kong had reached
reasonably high levels as the population desperately
tried to prevent a fifth wave of the pandemic. It was
at that time, however, debatable whether Hong Kong
should have considered a similar approach of living
with COVID-19.
When comparing the COVID-19 pandemic
with past influenza pandemics, the only difference in
management is that there are specific antiviral drugs
for influenza but limited treatments with proven
efficacy for severe COVID-19.8 Quarantine or
lockdown are not used in influenza outbreaks as they
do not work. We also compared SARS-CoV-2 and
the four common respiratory viruses of childhood
and found that SARS-CoV-2 is probably the least
severe in terms of morbidity, especially among
children (online supplementary Table).8 9 10 11 12 13 14 15 16 17 18 19 Again,
quarantine or lockdown are not used in outbreaks of
these respiratory viruses as they do not work. With
Christmas and New Year 2022 drawing near, the
million-dollar question was when will Hong Kong
be ready to embrace and accept the already very low
mortality and morbidity of COVID-19 despite high
transmission and potential upsurge of cases, even
with mutant strains. Despite concerns regarding
the transmissibility of the Omicron variant, most
countries avoided national lockdowns for the 2022
Christmas and New Year period.
Eradiation of SARS-CoV-2 seems impossible
for the foreseeable future and it is inevitable that the
virus will become endemic. The media plays a vital
role in the successful implementation of this strategy
of accepting the virus, as the public needs to be well-informed
regarding the ongoing global situation
and relevant policies.2 While we have to live with
COVID-19, due consideration should be given in
relation to the various epidemiological factors,
such as seasonality, vaccination coverage, non-pharmacologic interventions, healthcare system
capacity, and treatment options.20
Author contributions
All authors contributed to the concept or design, acquisition
of data, analysis or interpretation of data, drafting of the
commentary, and critical revision of the commentary for
important intellectual content. All authors had full access to
the data, contributed to the study, approved the final version
for publication, and take responsibility for its accuracy and
integrity.
Conflicts of interest
As an editor of the journal, KL Hon was not involved in the peer review process. Other authors have no conflicts of interest to disclose.
Funding/support
This commentary received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Supplementary material
The supplementary material was provided by the authors and
some information may not have been peer reviewed. Any
opinions or recommendations discussed are solely those of the
author(s) and are not endorsed by the Hong Kong Academy
of Medicine and the Hong Kong Medical Association.
The Hong Kong Academy of Medicine and the Hong Kong
Medical Association disclaim all liability and responsibility
arising from any reliance placed on the content.
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