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The Current State of COVID: What Will We Face in 2023?

Within this first month of the new year, the world’s population has already been inundated with news about the Coronavirus, with headlines ranging from new variants of concern to how countries are preparing for the opening of borders and the return of tourism. In this article, we explore the latest issues circling this global health challenge.

New Variants

All viruses including SARS-CoV-2 change over time, and for the most part, these changes have little or no impact on its properties. However, there are some changes that will affect these properties, including factors such as how easily it can be spread, how severe the disease will be, or the performance of the measures we are taking to combat it (such as vaccines, therapeutic medicines, diagnostic tools, and movement control orders).

Before we get into the latest variant of concern, it’s also important to know the difference between a variant of interest and a variant of concern.

Variant of Interest (VOI)

This type of variant refers to specific genetic markers that have been associated with changes to receptor binding, which implies that the variant may be more difficult to treat, have more severe symptoms, or have a high infection rate. However, these strains are likely to appear in specific regions and have not spread to other countries. The WHO has agreed to continue to monitor the development of this type of variant.

Variant of Concern (VOC)

Arguably the more “heard about” type of variant, variants of concern have the same attributes as VOIs but are marked as having the potential to cause greater disease severity worldwide. They also pose a higher risk for hospitalisations and express more significant antibody responses, which in turn may increase the rate of infection or viral load. Additionally, VOCs can be harder to treat; these strains show reduced effectiveness in pharmaceutical interventions and/or vaccines. Due to their highly transmissible nature, VOCs are more likely to transcend global borders.

Essentially, once a VOI becomes a dominant strain, such as was the case with Delta and Omicron, its status is changed to VOC.

The XBB Variant

The latest variant to make headlines, particularly in North America is the XBB variant. In a report from USA Today, this latest COVID-19 strain is so contagious that even people who have not been infected with the disease thus far are getting infected by it, and an estimated 80% of Americans who have already had it are likely to catch it again.

Despite this concerning statistic, it’s worth noting that the number of severe infections and deaths is currently relatively low, despite the high level of infections; this can be credited to the number of Americans that have been vaccinated as well as the population that has already been infected by previous outbreaks. However, the article has also noted the fact that the lack of universal masking puts everyone at risk of catching it, even those people who are still practicing mask-wearing in public.

Separately, the NBC reported in December that there is a lot still unknown about the XBB 1.5, including whether it is more contagious than other COVID variants. Scientists are now looking into the possibility that it can get around the antibodies that populations have built up from vaccines and previous infections. What is known is that XBB 1.5 is a relative of the omicron XBB variant, which is a recombinant of the omicron BA.2.10.1 and BA 2.75 subvariants. Thus far, the XBB variant has been identified in 70 countries, and surges of infection occurred in parts of Asia in October 2022.

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In fact, the Star reported in October that Singapore was keeping a close watch on the XBB variant, due to the higher infection rate for those who have never caught the disease before. In fact, the health ministry noted that the incidence rate of COVID-naïve patients was 162.5 infections per 100,000 person-days in October; by comparison, the incidence rate for people who were previously infected by COVID-19 was 147.4 infections per 100,000 person-days.

The Global Economy, Reopened Borders, and XBB 1.5

In recent weeks, there has been a flurry of news over the fact that one of the world’s biggest economies, China, has reopened its borders. For many countries across the APAC region, this should serve as a boon for their businesses. However, the recent surge in cases in China has also prompted a call for cautiousness.

The BBC has noted that official numbers from the Chinese government when it comes to the infected population have been low. However, the WHO has warned that the country’s healthcare system could be under severe pressure, and there are reports coming out of China that long queues have been spotted in Chinese hospitals. Despite this, China has stated its intent to fully open its borders from 8 January, with no travel restrictions or quarantine measures for inbound passengers. As a response, several countries have begun to impose COVID testing on visitors from China.

It’s also worth noting that the vaccination rate in China is in question; while the government has said that over 90% of the population has been fully vaccinated, less than half of its people aged over 80 have received three doses of the vaccine.

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This issue notwithstanding, countries across the APAC region have slowly been reopening their economies in 2022, and this action has provided modest results. In Malaysia specifically, the economy expanded by 5% in Q1 2022, thanks to the reopening of borders, which happened on April 1. This was driven by local demand and a recovery in jobs, and is a promising start, given that the Russia-Ukraine conflict had also been factored into its projections.

By contrast, Australia, which reopened its borders in February 2022, faces another conundrum – unemployment and labour shortages. For businesses, the reopening of borders and the economy has seen a rise in consumers and a bigger pool of workers to choose from; however, ordinary Australians have been impacted by this development due to the influx of foreign workers.

During the past two years, Australia’s unemployment rate decreased to 4.2%, because the country opted to employ local workers in lieu of migrant ones; furthermore, although the government injected a massive stimulus into the economy to mitigate the impact of its lockdowns, the rate of job creation across the nation has been lagging behind pre-COVID levels.

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Simply put, Australia’s labour market has become tight despite the decrease in job growth, which has caused alarm bells to ring for several industries including the F&B sector, as well as public services. Additionally, the growth in labour supply due to the reopening of borders, has raised the country’s unemployment level once more.

The Fight Against COVID-19 and Vaccines – Where Do We Go From Here?

Alongside the threat of new variants and the challenges of reopening economies, the world also faces another dilemma which is specific to healthcare providers globally; should vaccination against the virus still be a priority?

At present, there is indeed still a push for vaccination, as it is crucial to end the pandemic, however, even this effort continues to face challenges, such as new strains, global competition over a limited supply of doses, and continued resistance against vaccines by a number of vulnerable populations.

While it can be hard to fathom, there is indeed a strong opposition to vaccines, as evidenced by the results of a survey in 2021 that covered 23 countries and found that ¼ of those surveyed were vaccine hesitant.

As such, the battle against COVID-19 is likely to rage on in 2023. Here are five key factors supporting the argument that healthcare players must continue to tackle the disease.

1.     The Rise of XBB 1.5

As mentioned above, the XBB variant is a cause for concern as it slowly spreads across the globe. It is the most immunity-evasive variant to date and there are current no accessible therapies in existence that can neutralise it.

2.     COVID-19 Sepsis

Medical experts have been discussing the need for new diagnostics that can speedily distinguish one infection from another as two infections can indeed coexist. This will be an important task for the healthcare industry, as delaying an accurate diagnosis means delaying administering targeted therapy, which then leads to poorer outcomes.

The fact of the matter is, COVID-19 sepsis is deadly, and current lab methods of testing require several days to determine the presence of a second pathogen, identify it, and determine its sensitivity to treatment. In order to treat, physicians should seek to have a better understanding of the destructive processes such as hyperactivation, dual infections can have on the lectin pathway (one limb of the immune system); being able to restore normal function for this particular malady will save lives.

3.     Overwhelmed hospitals

Across the globe, hospitals are continuing to struggle with COVID-positive patients, alongside having to treat those with non-COVID related injuries and chronic diseases. One report out of Singapore points to patients having to wait over 50 hours for a bed, thus increasing the risk of patients not being cared for appropriately in accordance to their health issue.

4.     Supply chain disruptions

Even with the reopening of borders and increased business, supply chain disruptions continue to plague many parts of the world, thus leading to a delay in the delivery of common medications. As of December, the FDA listed nearly 125 medications and medical devices that are currently in shortage. Furthermore, the price of medications has increased due to these disruptions, thus making it harder for the average patient to secure what is needed to treat their ailment.

5.     Economic fluctuations and inflation

The threat of a recession has engulfed the West, with many already bracing for impact. Inflation will only worsen the situation as people struggle to keep jobs, pay the bills, and keep healthy. In terms of COVID-19, this recession may make it difficult for people to pay for treatment or medication, thus leading to a possible new wave of hospitalisations.

2023 – The battle continues

With all of these challenges and issues, it is safe to say that the world’s population has a long way to go in terms of the fight against COVID-19. While infections rate are down and economies are coming back to life, this disease will continue to be a part of our daily lives. For the healthcare industry, finding new medication and new ways of treatment and prevention aside from vaccines will continue to remain a priority for this year.