Dateline

COVID-19: The Facts About Myanmar’s ‘Second Wave’ and How Vaccines Work

By The Irrawaddy 5 September 2020

Ye Ni: Welcome to Dateline Irrawaddy! This week, we’ll discuss the ongoing second wave of COVID-19 that originated in Rakhine State, whether it is a new strain of the coronavirus, how to identify silent carriers who are infected with the virus but show no symptoms, and when a COVID-19 vaccine might be produced. Dr. Sid Naing, director of Marie Stopes Myanmar, an international nongovernmental organization providing public health care services, has joined me to discuss this. I’m Irrawaddy Burmese editor Ye Ni.

First of all, could you explain the local transmissions of COVID-19 that originated from Sittwe in Rakhine State? The director of contagious disease prevention and eradication at the Ministry of Health and Sports, Dr. Daw Khin Khin Gyi, has said a second wave of COVID-19 has begun in Myanmar. Her conclusion is based on the fact that while few imported cases were found over the past few months, local transmissions have erupted in Sittwe. It also seems that the most recent patients are infected with a new strain of the coronavirus that is more infectious. It has been said that other countries in our region are also experiencing a second wave of the coronavirus. How would you assess the second wave of COVID-19 in Myanmar?

Sid Naing: Public interest in COVID-19 is extremely high. And while there has been an abundance of coverage in the media, the terminology can be confusing. People find themselves talking about a second wave without knowing exactly what a second wave is. And it sounds scary.

It’s called a second wave because of the pattern. There were no cases at first, then a few cases occurred, and then the number of cases dropped. If we drew it as a graph on paper, we’d see that the line was at first straight, then went up, and then went down. We call that a wave. Like the waves in the ocean, it rises and falls.

People are talking about the second wave because of the history of global pandemics like influenza that broke out in the early 20th century. In those cases, the pandemic seemed to cease after a certain number of people had been infected and lost their lives. Then, the pandemic resurfaced—I mean globally— and the second wave was more infectious and more fatal than the first. So, there is a common assumption that a second wave would be worse. There are a number of factors that could make it worse, including changes in lifestyles of people and mutations in virus strains. And monitoring systems and human behavior also play a factor. These cause a wave. As long as you draw a graph, you will see the wave.

Countries are saying they are experiencing the second wave now based on their own graphs. But I don’t think there will be a second wave globally because today people understand how to prevent the spread of the disease. I say that even though there will still be people who defy health rules and regulations and pay no attention. If only 30 percent of the people follow rules and regulations, preventative measures will be effective to a certain extent. So the situation will not be that bad. It is just a wave if we plot the figures on a graph. And graphs will be different from one country to another. So, we don’t need to be confused by the words “second wave.” People just need to keep in mind that it is dangerous if the disease spreads again.

As I have said, people are now well informed about the health risks. Even people in the street are discussing the pandemic at a molecular level. They are even talking about the virus strain transforming from G614 to D614. So, health experts have to study more details about the disease in order to keep the public informed. The virus has mutated. It is natural for any virus to mutate. It is assumed that coronavirus is a variant of a virus found in bats. The mutation can lead to anything. Mutation could make it easier or harder to infect others.

From the perspective of a virus, it is good for it to have a high infection rate. It is better for the virus to infect people without harming the lives of the hosts because it will be able to infect more people if the hosts do not die. But that’s not always the case.

It’s been found that the new strain of the coronavirus can enter human cells more easily and stay in the upper part of the respiratory tract, so it is easier to infect people. It’s been said that it is 10 times more infectious. Yes, it is more infectious, but it might not be exactly 10 times more infectious. It is more infectious, but it is not strong enough to lead to fatalities.

Still, people should be careful. Suppose the mortality rate is two in 100 people. If the virus is 10 times more infectious, the number of infected people will be 1,000. In that case, 20 people will die. Even if the mortality rate declines, 10 to 15 people will die. Even if the mortality rate declines, if there are large numbers of infected persons, there will be more illness.

We will need to wait and see. It is not unusual for a virus to mutate. The virus was detected globally in mid-February. As the new strain is more infectious, we will only see it in future cases. A health expert who took part in examining the virus said on his Facebook page that it is the new virus.

YN: Previously, the assumption was that there were only imported cases, and if they were placed in quarantine, the virus could be controlled. But this assumption has been disproved by local transmissions and silent carriers in Sittwe. This gave rise to speculation that there might have been silent carriers earlier. Is the current monitoring system adequate or is it in need of reform?

SN: The first COVID-19 cases were detected in Myanmar in March, and at the time most of the cases were imported cases. If the origin of a global pandemic is not known, countries blame each other for the cause of it. For example, in the case of HIV, as it has been around for decades, countries have traded blame. At first, we blamed neighboring countries for transmission of the disease through the border. But a few decades later, after they had the disease under control, they blamed us for failing to control the disease properly, because it was spreading back to them again. Even a big neighbor blamed us like that.

Any virus must come from somewhere. It is unusual for a virus to stay long in one place; it is natural for it to be transmitted from one place to another.

Suppose there is a group of 100 non-infected people in a place. Then, an infected person joins them. Some will get infected and some will not. Some infected people will die and some will recover, then the situation will become stable again, which marks the end of a wave. Normally, there won’t be a second outbreak in that 100-member group unless another infected outsider comes into that group. The virus must come from somewhere else. The first cases were imported cases, and I am sure the ongoing cases are not local transmissions, but they have come from somewhere else. It is of no use to try to find out which countries are responsible for it. We were able to control the spread of the virus thanks to early detection and prompt action while the number of cases was small. The strategy we are pursuing is to do more than just what is necessary.

Because our country has a lot of shortcomings and lacks facilities, we decided to put extra efforts into what we can. The strategy worked because there were not many infected persons. If we had experienced the same degree of outbreak as some European countries, the US and India, we would not have been able to control it. If the outbreak had been that large in scale, we would not have been able to cope with it.

We continue to implement the same strategy now. The number of cases has increased significantly lately. That is worrisome obviously, but other countries would be envious. Many countries would point out that the total number of cases found since Aug. 21 in Myanmar is less than their counts for a single day. The number is low here and therefore it’s easier to control the disease compared to other countries. People here are worried because our resources are very limited, and it is not convenient to implement the stay-at-home method of containing the virus.

A few days ago, we talked about the situation in Singapore during a discussion about the virus. Singapore is an economic hub, and people from all over the world come to it. So it had high risks. But it is an island city-state, with a small population and abundant resources. It was therefore able to contain the virus. Singapore admitted that it then made a mistake by allowing the people to undergo quarantine at their homes. [The Singaporean government] allowed its citizens to undergo quarantine at their homes thinking that it had the resources and money, and that its citizens have a certain level of education [and thus are expected to follow health guidelines]. But the virus spread widely due to this. [The Singaporean government] urged other countries to learn from its example. Some are suggesting that infected people should be allowed to undergo quarantine at their homes. It is not convenient for infected persons to stay at quarantine facilities. All the infected persons will say they will strictly follow health guidelines if they are allowed to stay at their homes for quarantine. But health experts know it is hard to handle those who are distressed. There is also a need to consider the response from community members. But then, if the number of infected persons is too large, it is impossible to keep them at quarantine centers. Anyway, it is necessary to continue with quarantine in our country.

Speaking of silent carriers, there were silent carriers in the past and there are also silent carriers now. The severity of symptoms seems to have declined now. I am sure there were silent carriers from the very beginning. Symptomatic patients can be more infectious, though health experts have argued about that theory. Anyway, if people are showing symptoms, it can be more infectious, as they will be sneezing and coughing. Again, it is now generally accepted that the virus can be emitted through speaking and shouting, and that you can be infected by breathing.

So, there will be silent carriers. People do not need to be afraid of that fact. There are two types of silent carriers—those who will never fall sick, and those who are not showing symptoms temporarily but may fall sick a few days later. We can’t detect infections just by measuring body temperatures. We have to test a large number of people, but our resources are questionable.

Suppose a country has 5 million people. The WHO [World Health Organization] will not order that they all be tested. That’s partly because it is costly and partly because only a small number of infections will be found. Their notion is that even if all people tested negative, if people from other places are going to arrive later, then testing is useless. Some countries target vulnerable and at-risk groups and areas. In countries that are experiencing massive outbreaks, authorities provide tests and people can receive tests of their own volition round the clock.

YN: So, it appears that there is a need to contain the virus by taking preventative measures like washing hands, wearing masks, social distancing and quarantine. Can you explain about the vaccine? What is the progress in making a vaccine? What is the potential and how long will it take for the vaccine to be widely accessible in poor countries like ours?

SN: In world history, no vaccine trials have ever been done this early and this swiftly. That is partly because of scientific developments worldwide and also because of the risks of the pandemic, including health, economic, social and political risks. The risks are grave, and in order to reduce the risks, desperate efforts have been put into vaccine trials. Some pharmaceutical firms have even shifted their focus to a COVID-19 vaccine. A number of countries now have potentially successful vaccines under clinical trials. As everyone knows, Russia said it has passed the test. In fact, it is still being tested, and the results are not yet known. Other countries have not recognized its vaccine. China is also developing its own vaccine. Other countries are also developing vaccines depending on the degree of technologies they have. I am not discussing the details of vaccines here.

Usually, there are several stages in making vaccines including clinical trials on animals and humans. In the first phase of clinical development, the vaccine is tested on people with the strongest immune systems. Then, it is tested on a wide variety of people who vary in age, strength of immune system, and so on. Two factors are taken into consideration in making a vaccine. First of all, the vaccine must be safe, before we consider its effectiveness. If the patients suffer from serious complications like paralysis and stroke after receiving the vaccine, that vaccine should not be used at all. Then, we consider its effectiveness in boosting the immune system of humans.

Safety must come first. Russian President Vladimir Putin said one of his daughters had been inoculated. But we will be able to tell whether it is effective or not only after tens of thousands of people get shots. Compared to the past, every country, government and firm approves [testing of COVID-19 vaccine] more swiftly. Many vaccines are now under clinical trial, which will allow manufacturing once they can make sure it is safe. Some have said they are on the path to success. But nobody can guarantee it. The process is like taking an exam. You may or may not achieve success. You have tried hard, but you may not achieve the result you want. Nobody can guarantee that the vaccine can be successful. Still it is now likely that a successful vaccine will be developed.

A scientist from the US pointed out that the vaccine does not need to be and will not be 100 percent effective. Suppose 100 people are immunized, but not all of them will have resistance against the virus. There is little likelihood that the vaccine will make all of them invulnerable. The effectiveness of the vaccine will vary from one person to another depending on their immune systems. So some people will still be infected even if they are inoculated. That was the case with the typhoid vaccine. No vaccine will always be 100 percent effective. The scientist said it is enough if the vaccine can prevent the disease in 60 percent of the people who receive it. He would be satisfied even if it were less than 60 percent. The most important thing is the vaccine must be 100 percent safe. He said he will be very satisfied if the vaccine is effective in some 50 percent of the people who receive it. If 50 percent of the people who receive the vaccine have increased resistance against the coronavirus, this will help stop the spread of the virus to a certain extent.

In the case of highly infectious diseases like measles, a vaccine should have around a 90 percent protection rate. A person infected with measles can transmit the disease to 15 to 20 people, whereas coronavirus will only be transmitted to two to six people, depending on conditions. So, in the case of COVID-19, the vaccine will work if it has a certain level of effectiveness. Transmissions will be cut over time as more people take the vaccine.

We can’t rely solely on a vaccine, but must take other preventative measures like the ones you have said. There is also a question about the effectiveness of the vaccine if the virus mutates. The vaccine is used to show the “bad guys” to the immune system so that the immune system can recognize and attack them when they come in. But if the “bad guy” has a different appearance, the immune system will not recognize it. Even if it is the same virus, if the immune system doesn’t recognize it—it won’t fight it back. We will need to wait and see how the vaccine responds to mutations of the virus. As everyone knows, influenza mutates every year and we need to get flu shots every year. And there are also flu strains for which there is no vaccine. It is important that the vaccine is safe, and it is said that vaccine production is on the right track. People are now advised to avoid crowds and enclosed spaces, and keep 6 feet [1.8 meters] apart from others even if they have to stay in an enclosed space. Besides this, they are advised to wear masks and wash hands. Even after a vaccine is developed, it is likely that such preventative measures will still be a must, and we won’t be able to just go back to our pre-crisis lifestyle.

YN: Thank you for your insights.

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