COVID-19 in 2021

The COVID-19 pandemic is still not under control both globally and nationally in Indonesia. Of course, it is not easy to predict how this health crisis will develop in 2021.

This can be analyzed at least from five factors. The first factor is the virus itself: SARS CoV-2. Since February, the mutation of the virus has been detected mainly in the form of D614G. This mutation has also been reported in our country, aside from several ASEAN, European and other countries.

The publication of a scientific journal on Nov. 12 discusses this mutation in detail and presents three things. First, this mutation makes the virus more contagious. Second, fortunately, it does not increase the malignancy. And third, fortunately, there is possibility that this mutation makes the work of neutralizer antibodies easier, meaning that it will make it easier for vaccines to work to provide immunity. Of course, further research is still needed to make sure.

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On the other hand, the D614G mutation is thought to also play a role in the virus transmission among millions of minks in Europe. In this case, there is something worrying, namely the presence of mutations in the form of "cluster 5", which is being studied to measure whether it will impact the effectiveness of later vaccinations.

Another mutation, the variant 20A.EU1, was reported in Spain and is later thought to have existed in more than 10 European countries. There have also been changes in other regions of the SARS-CoV-2 genome.

Also read: Anticipating Covid-19 Vaccine

Even though there are various mutations, in general, experts are of the opinion that no mutations will actually cause significant changes. If this opinion is correct, and we hope so, we can hope that the virus that causes COVID-19 will not experience many changes that will impact the pandemic in 2021.

The second factor is humans; all of us who have been living in a pandemic for months with all its restrictions and impacts. As an illustration, Europe used to be quite good at handling pandemics. And in the ongoing crisis, it managed to bring cases under control. But now Europe is experiencing a second wave of infections. Cases have increased again and several countries had to implement a second lockdown in early November.

Experts’ analysis states that one of the main causes of this second wave was "restriction fatigue". It seems that people were so tired of restricting their activities that they eventually disobeyed health protocols and then, infection rates began to rise again.

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If this "fatigue" factor is true, and it seems so even though the pandemic has not yet lasted a year, then in 2021 this could be more widespread. There will be more and more people who feel they have been restricted for too long and will end up being negligent and non-compliant with health protocols. If this happens in 2021, it will of course adversely affect the pandemic across the world; the chain of transmission will continue and the number of cases will continue to grow.

Detection and treatment

The third factor is the ability of science to detect COVID-19. We now know that the definite way of diagnosis is using a nucleic acid amplification test (NAAT), especially a nose and throat swab that is then tested using polymerase chain reaction (PCR). In September, the World Health Organization issued the emergency use of listing (EUL) for antigen detection tests that have a sensitivity of more than 80 percent and a specificity of more than 97 percent.

On the other hand, there are also various studies to detect COVID-19 in ways that are expected to be easier, for example shortening the extraction in the PCR process so that the results are obtained within one to two hours, or detection by blowing, checking through saliva and so on. All of this will continue to develop and if it gives good results in 2021, it will certainly play a positive role in testing for pandemic mitigation.

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KOMPAS/RONY ARIYANTO NUGROHO

One of the KRL passenger candidates was taken a liquid sample for the Covid-19 polymerase chain reaction test at Bojong Gede Station, Bogor Regency, Monday (11/5/2020).

The fourth factor is treatment. Until now, no antiviral drug has been proven to be effective in killing SARS-CoV-2. The drugs currently in use are basically drugs that were previously used for other diseases and then, because of their pharmacological properties, can also be used for COVID-19 even though they have not been fully successful.

So far, there have been no significant developments in the discovery of such a drug, although of course, research is still ongoing. The latest WHO publication on Nov. 20 also discusses known drugs, such as remdesivir and corticosteroids. We hope that in 2021, drug research will continue to be conducted for better results.

Vaccine

The fifth factor is vaccine development. Many people hope that a vaccine can be a "game-changer" for this pandemic. We know that now there are various vaccine candidates that are in the final process of their third phase of clinical trials, and at least by early 2021, there will be already those that can be used in communities.

However, there are at least five factors that need to be considered in assessing the impact of vaccines on the pandemic in 2021, namely availability, effectiveness and coverage, efficacy, distribution and public acceptability.

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If it is to be approved by the US Food and Drug Supervisory Agency, the new vaccine will start to be produced in late 2020 or early 2021. Thus, at early stages, of course, the number will not be sufficient for the entire global population, so in 2021, availability will not be optimal. Certain countries will certainly try to get the best vaccines for their people, and at global level, there are already programs such as CO-VAX initiated by various international organizations.

AFP/JOEL SAGET

This file photo taken on November 18, 2020 shows a syringe and a bottle reading "Vaccine Covid-19" next to the Moderna biotech company logo. - The European Union said on November 24, 2020 it would sign a sixth contract to reserve doses of an upcoming coronavirus vaccine, this time for up to 160 million from US giant Moderna.

Recent talks involving G-20 leaders also discussed vaccine access for all countries. Regarding effectiveness, there are several vaccine candidates that claim to be more than 90 percent effective, even totally safe for people over 60 years of age. And there are also those whose effectiveness is not that high. This will certainly affect the formation of herd immunity in a country, which is influenced by the effectiveness of vaccines, the indicator of transmission (Ro) and coverage.

The lower the effectiveness of the vaccine the greater the need for higher coverage, with various challenges, such as the distribution of the vaccine to all corners of the country. This requires coolers to preserve the vaccine. The efficacy of vaccines also plays an important role. If the immunity that is formed lasts too short, of course its role in controlling the pandemic will be more limited. Another thing, public acceptability of vaccines is certainly one of the main key factors. We know that there are groups in society who refuse to be vaccinated for various reasons.

Shared responsibility

From these five analyses, it appears that the situation of the COVID-19 pandemic in 2021 will still depend on many factors. It is the responsibility of us all to give our best participation in the mitigation of the pandemic. Regarding virus mutations, what we can do is to always be vigilant about detecting possible changes, then act on them accordingly.

Regarding the possibility of people being "fatigued" of facing months or even more than a year of the pandemic, then in 2021, there is no other way and collective awareness needs to be improved. Adherence to health protocols is for the safety of ourselves, our families and relatives, our society, even for the safety of the nation and the world. So, never be apathetic; it\'s the responsibility of us all.

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As for detection and treatment, at least two things need to be done. First, testing, treatment and tracing must be promoted as the backbone of control. Second, if possible, be active in research to find detection tests and or new drugs for this disease.

Regarding the crucial role of the vaccines, it is indeed the responsibility of the international community in terms of availability of the vaccines for all countries, there is the responsibility of each state to provide the most optimal vaccines for its people and there is a responsibility of community members to actively participate in the vaccination program, of course, using a vaccine that has been proven to be effective and safe.

Kompas

Tjandra Yoga Aditama

All of the above factors will affect how the COVID-19 pandemic will develop in 2021. Hopefully all of us, Indonesia and the world, can together overcome the biggest pandemic of our time.

Tjandra Yoga Aditama, Professor of Lung at University of Indonesia School of Medicine, former director of WHO SEARO and former director general of contagious disease and head of Health Ministry Research Body (Balitbangkes)