New Strategy Against Pandemic
One year into the Covid-19 pandemic, the global community is still struggling to deal with the virus. The virus is able to mutate rapidly, making it hard for experts to control.
One year into the Covid-19 pandemic, the global community is still struggling to deal with the virus. The virus is able to mutate rapidly, making it hard for experts to control.
This pandemic has also created a health crisis, tearing down the global economy as well as providing lessons that public health and the economy are inseparable. We will all become witnesses to history.
If we agree that health is more important, Indonesia must immediately draft a national health system as an important part of the nation\'s resilience system.
Resolving a pandemic requires a scientific leadership approach. Whatever the political background and ideology of the country, it must be guided by the latest scientific approach to end the pandemic. There are many hoaxes and speculations that keep policymakers away from science, and now is the time for us to return to the path of true science.
Will the pandemic end in the near future or will it last longer with the various viral mutations? Both are possible, both can happen.
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The most important thing is that the immediately create a pandemic-immunity system so that the mutation of the virus does not spread fears and problems, and development can continue.
Thus, the state can be protected from catastrophic damage to the economy and society as well as paralysis of government.
This economic and health relationship is very significant to note. Economic paralysis has a direct impact on increasing infections and mortality (Petersen et al, 2020) so that both systems must be restored simultaneously. Thus, the state can be protected from catastrophic damage to the economy and society as well as paralysis of government.
Life has to move and the termination of daily activities will disrupt economic routine, even cause chronic stress, which in the long run will lead to immunity, endocrine and nervous system disorders (Dahmen et al, 2018; Juruena et al, 2020) .
One step ahead of viruses
Studies show that prolonged stress also leads to the release of inflammatory mediators in the brain so that if infected with Covid-19 it tends to become severe (Brenhouse and Schwarz, 2016), causes systemic disorders (Jiang et al, 2018), predisposes to disease. There are psychopathological disorders (anxiety and depression) in later life, becoming aggressive, psychotic, depressed and neurotic and becoming susceptible to Covid-19 infection (Ibi et al, 2008; Veenema, 2009; Calcia et al, 2016) .
The question is, why is the pandemic not under control even though we have already practiced 3M (wearing masks, keeping distance and washing hands)?
This assessment must be carried out and efforts to mitigate the spread of Covid-19 which have not been effective must be immediately changed to other methods before it is too late and the country is eliminated by the virus. It is necessary to think about a protection strategy that is one step ahead of the virus attack.
The executive board of the Indonesian Doctors Association (IDI) has collected a number of important data that the public must know in order to protect themselves as best they can.First, we are dealing with a new virus, with a different nature from the existing viruses, a fast mutation speed. Not long ago, researchers in UK found again the latest variant, N439K. This variant is even more intelligent than the previous variant, because the binding to the ACE2 receptor in human cells is stronger, and is not recognized by the polyclonal antibody formed by people who have been infected in more than 30 countries (Thomson et al, 2021).
Second, from the data that was found, the transmission of the virus was through aerosols, so the most difficult thing is to control people who are asymptomatic. WHO reminds the world that the spread of SARS-CoV-2 is airborne transmission (via airborne droplets) of microdroplets (5μm). Aerosol transmission does not have to be through coughing or sneezing, even normal breathing can be contagious.
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Spread in the form of droplets (coughing, sneezing, breathing and talking) measuring more than 5 micro microns will settle on the floor, while sizes less than 0.8 to 10 micro microns remain in the air for up to 1-3 hours ( viruses can stay alive). The largest virus aerosol size (0.5 to 5 micro microns) is the most common measure that can be inhaled (Zuo et al, 2020).
Transmission can occur without realizing it because one in three people can be asymptomatic/presymptomatic (asymptomatic, but have the same ability to spread the virus as a symptomatic infected person).
In someone who is infected, whether symptomatic or not, the virus can unnoticeably spread from the breath he or she exhales. Reportedly, when a person is infected, he/she will spread the virus up to 1.03x105 and 2.25x107 RNA SARS-CoV-2 virus per hour indoors (26.9 percent) (Ma et al, 2020). The rates of transmission occurred 35 percent from droplets (especially close-range), 57 percent from inhalations (microdroplets) and only 8.2 percent from contacts (the surface of objects that stick to the face) (Jones, 2020).
If the concentration of the virus in the room is high, even very healthy people can catch it.
Closed rooms with poor air circulation have the potential to become a place for virus transmission (Kumar and Morawska, 2019). The infected person will release virus particles into the room. If the concentration of the virus in the room is high, even very healthy people can catch it. Moreover, the ventilation system generally uses central air conditioning. When air circulation is poor and lack of ultraviolet light, SARS-CoV-2 can survive up to three hours indoors (Van Doremalen et al, 2020).
Other factors, such as climate, weather, temperature, humidity and sunlight also influence their distribution (Chen et al, 2020; Coccia et al, 2020).Third, the use of appropriate masks (medical masks, N95, KN 94, KF 94) can protect up to 90 percent of preventing transmission and infection. The use of a good and correct mask is very important even though there is a risk of up to 10 percent of the release of droplets and microdroplets even with the correct use of masks. However, this is very meaningful in reducing transmission. Wearing masks in public places is mandatory, considering that 5-80 percent of people who test positive for SARS-CoV-2 may not show symptoms (Heneghan, et al, 2020).
Also read: Virus Mutation Becomes an Obstacle for COVID-19 Vaccinations
Fourth, fitness and not stressful are the main keys, people who are healthy and fit when infected even tend to be asymptomatic or mild symptoms and people who have the disease, whether known or not, are at risk of experiencing a cytokine storm that leads to severe illness or critical with progressivity that is sometimes difficult to predict.
Maintain health
From the findings above, we can conclude that implementing 3M is not enough. It must be ensured that all rooms where people gather should have open ventilation or have air cleaners installed that can kill 99.9 percent of the virus. The ability to produce antibodies is in fact individual, so in addition to Covid-19 vaccination, adherence to health protocols and efforts to reduce viral load are needed to end the pandemic.
Of course, another important thing that must be maintained is a healthy body and not stressful. Therefore, people must maintain the best health possible. Those who have comorbidity must be treated regularly and controlled. They have to get comorbid screening, so that it can be treated immediately if there is a problem, so that it can be safer and at a lower risk when infected with Covid-19.
Second, people need to ensure that the masks that are worn — both from online purchase and direct purchase at outlets — are protective masks, that are able to cover all openings to the nose and mouth, have the correct virus filtering layer and have distribution permits.
Third, all rooms or public places, whether business places, offices, schools, places of worship, or others, must open windows. Open ventilation is essential for minimizing virus-ridden air (lowering viral load), especially from exhaling, talking or even coughing/sneezing from asymptomatic and pre-symptomatic persons.
WHO recommends people to open windows in closed rooms. If the windows cannot open, the air in the room where people assembly must be cleaned with a sterilizer or an air purifier which can filter and kill viruses up to 99.9 percent.
It would be great if the management of the convention center or office space are responsible for providing a safe environment where people will gather. For this matter, it is good if there are regulations so that they are obeyed by the management of the convention center or office building.
In addition, there should be a standard for protective masks so that people do not spread the virus to one another. It needs harmonious cooperation between the community and policy makers so that the suffering caused by this pandemic can be controlled immediately and hopefully it will end soon. To reach that stage, life and the wheels of the economy must keep running. The two factors must be balanced and not mutually sacrificed.
Daeng M Faqih, Chairman of the Indonesian Doctors Association (IDI)
This article was translated by Kurniawan Siswoko).