This is Part 2 of this article. Read the last part here: Part 1Suggestion
After reading the above paragraphs, I believe you know why the pandemic is still going on and how important mask-wearing is. So how to end this pandemic, or more importantly, the next pandemic? There are a few suggestions from Bill Gates. I will list a few of them and add a few of my points of view.
Bill Gates points out a crucial problem that it takes time to manufacture a new drug and vaccine to deal with the current Omicron variant which outsmarts the current antiviral we have. The virus evolves so quickly, that a new variant may emerge when we are still developing a drug or a vaccine to deal with the current variant. To counter this problem, he suggests three suggestions as the following Point (1) to (4). I will add 4 additional points as my suggestions.
(1) Reduce the lead time of manufacturing antiviral drugs.
“There may be better ways of manufacturing mAbs (an antiviral drug) that reduce this lead time so we can get them out quickly and cheaply”, Bill Gates said in his book.
(2) Develop drugs that grab onto a piece of the virus that is unlikely to change.
(3) Develop drugs that are broadly effective against all the known variants.
Bill Gates said in his book, “A mAb (an antiviral drug) called Sotrovimab has shown to be broadly effective against all the known COVID variants”. He also said by combining three or more antiviral compounds, including drugs that work on a wide range of variants, we can reduce the chances that a drug-resistant variant will emerge.
(4) Develop vaccines that keep people from infection.
Bill Gates said in the book, “The main goal of vaccines is to prevent severe sickness and death, not to prevent infection. But that’s not ideal, of course: A perfect vaccine would in fact keep you from getting infected, which would make a big difference in cutting down transmission.” He further gave an example: The measle vaccine gives 97 percent protection against infection.
The above four suggestions from Bill Gates are about how scientific development can help, and the next four are my suggestions.
(5) Wear a mask and get vaccinated if you haven’t
On a personal level, you still need to wear masks to prevent breakthrough infections. At the beginning of the pandemic, some scientists said only infectors need to wear masks, but Bill Gates said in his book, “If you are wearing a loose surgical mask and sitting six feet away from an unmasked person with COVID, your mask will reduce your exposure by only 8 percent. Double masking helps a lot, reducing your exposure by 83 percent.” In fact, you don’t need to do double masking. According to an institution in Hong Kong, when both people wear surgical masks, the masks actually reduce the exposure by 84.3% [1]https://www.sphpc.cuhk.edu.hk/post/covid-tips-double-masking [2]https://www.publichealthontario.ca/-/media/documents/ncov/phm/2021/11/covid-19-community-masking-transmission.pdf?sc_lang=en . Another study also states that the protective efficiency against airborne transmission was higher when masks were worn by the virus spreader [3]https://www.researchgate.net/publication/346331575_Effectiveness_of_Face_Masks_in_Preventing_Airborne_Transmission_of_SARS-CoV-2 . From 8% to 84.3%, this indicates the importance of universal masking (Both source and inhalers wear masks – which means everyone wears a mask).
What Bill Gates suggests in his book to deal with the low protectiveness is universal double masking or ‘knot and tuck’ modifications of mask-wearing, which have higher protective efficiency than universal masking without ‘knot and tuck’.While double masking is great, Taiwan health officials convey just as what a reaction wearing an N95 mask can bring [4]https://www.commonhealth.com.tw/article/85792 , some people may feel stuffy when doing that, thus removing their masks more frequently – in the end, this reduces the protective effect of masks [5]https://www.appledaily.com.tw/life/20220114/E4RZVWNECZHNFJEFDPXZPS64YE/ . If you are worried about protectiveness, you may try ‘knot and tuck’ modifications instead. If you are going to use double masking, make sure you regularly wash your cloth mask.
One article on Healthline provides a good suggestion: If you can maintain a distance of at least 6 feet from others outside your household, a single mask can give good protection. However, a double mask can be beneficial when you’re going shopping, visiting a doctor, using public transportation, or working a job where you cannot maintain physical distancing.
In the earlier paragraphs, I talk about the importance of being cautious in terms of relaxing restrictions. Dr.Ramsay said in March 2021, “The economy can still go on with those less severe restrictions in place. So I think certainly for a few years, at least until other parts of the world are as well vaccinated as we are, and the numbers have come down everywhere, that is when we may be able to go very gradually back to a more normal situation [6]https://www.bbc.com/news/uk-56475807 ”. What level of global vaccine distribution is enough for us to take off our masks? In an earlier paragraph, it’s about it takes 70 to 85% of the U.S population to reach herd immunity in the U.S[7]https://www.pnas.org/doi/10.1073/pnas.2107692118 [8]https://www.self.com/story/dr-fauci-covid-19-vaccine-herd-immunity . The global vaccine coverage should be roughly the same to achieve herd immunity. Before that happen, you should put on your mask. Nevertheless, even if the global vaccine coverage of 3 doses reaches to 70%, a new variant that evades vaccine immunity may emerge before that happens; you need to have mental preparedness for the fact that we may be unable to take off our mask even when that time comes.
(6) Global Vaccine Distribution
As I said earlier before we take off our masks, we need enough global vaccine coverage to make this planet achieve herd immunity. Distributing vaccine globally is one of the key things we should do but didn’t do it well. Global vaccine coverage has become higher in recent times. Nevertheless, I think it’s necessary to prevent such a problem happen again if there is another pandemic of another virus. I will talk about its importance of it in detail and provide my suggestion on how we can distribute vaccines worldwide in Point 4: Vaccine distribution.
(7) Travel Restriction
At the early time of this pandemic, many countries doubt the effectiveness of travel restrictions. Though eventually it is proved that countries that adopted travel restrictions early had been better in controlling the pandemic domestically, previous doubt about the effectiveness is still not answered. Let’s start from what is the doubt of effectiveness.
The doubt started from the research of airport screening to counter SARS in Canada. According to the conclusion of this research, it states, ” the yields for airport screening measures were similarly low” [9]https://www.canada.ca/en/public-health/services/reports-publications/learning-sars-renewal-public-health-canada/executive-summary.html#imuunization . Another study in Australia explains, “The low identification rate was attributed to the low prevalence of SARS, the use of exit screening by affected countries, and the subjective measures used in the screening process”. It further pointed out, “Although Singapore used health declaration cards and measured the temperature of each arriving passenger, only 136 (0.03% of all arrivals) were referred for further investigations, and none had SARS. Nonetheless, the author reporting this considered this form of screening essential because of the high medical, social, economic, and international impact of even one imported case of SARS [10]Wilder-Smith A, Goh KT, Paton NI. Experience of severe acute respiratory syndrome in Singapore: importation of cases and defense strategies at the airport. J Travel Med 2003; 10: 259-262 . Similarly, the detection rates of people with SARS were extremely low in Hong Kong and Canada.” The study states that to determine if airport screening is still necessary when the efficacy is low, Canada’s health authorities concluded that, unless the disease is present in the general population and can be detected by screening, screening is an expensive and potentially highly intrusive measure [11]https://www.mja.com.au/journal/2004/180/5/border-screening-sars-australia-what-has-been-learnt#i1083112 .
Another study in Canada also conveys a similar view of the reason for low effectiveness: “With travel to Canada from anywhere in the world taking <24 hours, the possibility of detecting a dangerous infectious disease at border points of entry is challenging. Given the relatively short travel time, detecting persons at the border who are incubating any of the known infectious disease pathogens is unlikely. The absence of symptoms or signs of infection and a corresponding lack of specific, extremely rapid, easy-to-use diagnostic tests make border detection of infectious diseases unlikely. [12]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3294328/ ”
Indeed, an incubation period of a disease makes airport screening ineffective. One article of ComputerWeekly wrote that The International Air Transport Association (IATA)’s medical advisory group published a paper. It found that temperature screening would miss many of those with early-stage illness, those who are infected but have no symptoms, or have taken medication such as paracetamol to lower their temperature.” [13]https://www.computerweekly.com/news/252485233/Airports-deploy-thermal-cameras-to-control-Covid-19-science-suggests-its-merely-safety-theatre . A study from the London School of Hygiene and Tropical Medicine found that out of every 100 infected travelers taking a 12-hour flight, 42 would pass through both entry and exit thermal screening undetected [14]https://www.airport-technology.com/analysis/coronavirus-screening-at-airports/ .
There is another reason from Science magazine. To explain why airport screening won’t stop the spread of coronavirus, Science magazine wrote, “Taiwan, Singapore, Australia, and Canada all implemented entry screening for the severe acute respiratory syndrome (SARS), which is similar to COVID-19 and also caused by a coronavirus, during the 2002–03 outbreak; none intercepted any patients. However, the outbreak was largely contained by the time the screening was initiated, and it came too late to prevent the introduction of SARS: All four countries or regions already had cases.” Further, Science magazine wrote that, “screening is costly: Canada spent an estimated $5.7 million on its SARS entry screening, and Australia spent $50,000 per detected H1N1 case in 2009” [15]https://www.science.org/content/article/why-airport-screening-wont-stop-spread-coronavirus .
So, if airport screening is ineffective, should we give up it? To counter the ineffectiveness of airport screening due to the incubation period of viruses, western scientists suggest self-isolation instead. Jeanine Pommier of the European Centre for Disease Prevention and Control (ECDC), points out that healthcare settings have strong infection control measures in place, which should be sufficient to prevent any sustained local transmission in Europe. These measures have already proven effective in controlling SARS and MERS (which were both also forms of coronavirus).” [16]https://www.airport-technology.com/analysis/coronavirus-screening-at-airports/ . The study in Canada also states, “Rather than investing in airport screening measures to detect rare infectious diseases, investments should be used to strengthen screening and infection control capacities at points of entry into the healthcare system. “[17]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3294328/
I wouldn’t doubt that self-isolation could be more effective than airport screening in the COVID-19 case. However, in my view, though there is an issue of ineffectiveness accompanied by high cost, airport screening measure is still necessary to contain all infected travelers from infecting other people. Therefore, I suggest that governments can remove screening of inbound travelers, but should still keep screening outbound travelers. For inbound travelers, self-isolation after arriving at the airport is sufficient if there is an incubation-period issue and no effective method for an accurate result at the moment. But keep in mind, this has to make sure inbound travelers are not able to contact airport personnel such as store personnel in the airport, and these travelers still have to use independent taxis for going back home instead of public transportations. Otherwise, just as one of the studies I quoted said, “Nonetheless, the authors reporting this considered this form of screening essential because of the high medical, social, economic and international impact of even one imported case of SARS”. I think it’s better to keep part of preventive measures toward inbound travelers running. As for outbound travelers, the reason I suggest keeping outbound screening running is that I think certain measures to prevent diseases from spreading into other countries are necessary.
(8) Vaccine approvals and the regulations
According to Fortune, a Brazilian study found that people fully inoculated with Sinovac reduced their risk of infection by only 54%, while the AstraZeneca vaccine appeared to offer more protection, reducing the risk of infection by 70%. Though China’s vaccines are less effective, experts said China’s vaccines still can reduce the risk of death. True, China vaccines can still prevent the risk of death. However, while a study that has not yet been peer-reviewed, showed that the China vaccines were 100% effective in preventing severe cases and deaths, another study from Bahrain showed that recipients of the Sinopharm vaccine, especially older populations, faced a higher risk of breakthrough infections, hospitalizations, and deaths, compared with people vaccinated with one of the other vaccines – Russia’s Sputnik V, Germany’s BioNTech, and the U.K.’s AstraZeneca [18]https://fortune.com/2021/08/31/china-covid-vaccine-sinovac-sinopharm-delta-variant-effective/
The ineffectiveness of China’s vaccine had become a problem. New York Times indicates that in four countries – Seychelles, Chile, Bahrain, and Mongolia, 50 to 68 percent of the populations have been fully inoculated, outpacing the United States. But all four ranked among the top 10 countries with the worst Covid outbreaks as recently as last week (at the time the article of the New York Times was published). And all four are mostly using shots made by two Chinese vaccine makers, Sinopharm, and Sinovac Biotech [19]https://www.nytimes.com/2021/06/22/business/economy/china-vaccines-covid-outbreak.html . While the article points out that scientists know that variants, social controls that are eased too quickly, and careless behavior after only the first of a two-shot regimen are also the possibilities behind these outbreaks, the article also said, “But the breakthrough infections could have lasting consequences”.
So far, the WHO has recognized China’s vaccine. However, if China’s vaccines are that ineffective, I think that we have to adopt certain measures to prevent possible breakthrough cases due to the ineffectiveness of specific vaccines
What kind of measures should be adopted? According to CNBC, “When vaccines have lower efficacy, more people need to be inoculated to reach “herd immunity.” It points out a study by the University of New South Wales’s Kirby Institute in Sydney which claimed that the proportion of the population that needs to be vaccinated rises to 86% if the vaccine efficacy is 70%, and herd immunity is not achievable if the vaccine efficacy is below 60%[20]https://www.cnbc.com/2021/07/08/five-vaccinated-countries-with-high-covid-rates-rely-on-china-vaccines.html . In addition, one article in Nature also points out “China will probably wait until the vaccination rate reaches 80% in that group before easing restrictions further” [21]https://www.nature.com/articles/d41586-022-00884-z . It’s clear that China understands how to achieve herd immunity within the country. Therefore, I suggest that before China or any country which mainly uses China’s vaccine reaches herd immunity by getting a higher level of vaccine coverage, the screening of inbound travelers from such countries is necessary. So far, China has reached 87% vaccine coverage [22]https://www.statista.com/statistics/1279024/china-coronavirus-covid-19-vaccination-rate/ . However, if we follow the suggestion of the study in Sydney, since the efficacy of China’s vaccine is lower than 60%, whether China already reached herd immunity or not is a question. Bahrain and Mongolia, countries which use China’s vaccines and reach around 70% two-doses vaccination rate, have a lower vaccination rate than China does. Since the two countries don’t even reach to 86% vaccination rate assuming the vaccine efficacy is 70%, they are more questionable in terms of whether they already reach herd immunity at the current time or not [23]https://ourworldindata.org/covid-vaccinations?country=OWID_WRL . For such countries, I recommend we have to be careful in relaxing travel restrictions for travelers from these countries. Right now, the vaccination rate of rich countries is high enough and the vaccines people of these rich countries used have a good level of protection, so we may not need to restrict inbound travelers from entering your country. However, I suggest a certain level of airport screening for inbound travelers from countries such as China where the efficacy of the vaccines used is low is still necessary. Though China has been strictly regulating departures from China, which is good at a certain level, other countries should also enact certain measures to contain the spread of the virus while welcoming inbound travelers. In addition, other countries which use China’s vaccine don’t all adopt strict departure restrictions as China does
In addition, remember the imbalanced vaccination rate in the California case I mentioned earlier? While a high percentage of the total California population is fully vaccinated, the vaccination rate in some areas is still low as of July 2022 [24]https://covidactnow.org/us/california-ca/county/shasta_county/?s=38022553 . Since vaccination rates in some areas of rich countries are still low at the moment, relaxing all of the regulations for inbound travelers may not be a good option.
Conflicts Of Mask Mandate Between The Federal Government And States; States And Local People.
Now you know the importance of wearing a mask. Let’s talk about the conflict of mask mandate occurring in some parts of the western world. I will take the U.S as an example.
In the U.S, the mask mandate has always been a concern of infringing freedom among parts of Americans, mostly Republicans, according to data from KFF [25]https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-july-2021/ . Since I said the major problem of this still-on-going pandemic after inoculation is still not wearing a mask, I think Republicans in the U.S and any political party that are against mask mandate in other countries have to be partially responsible for this chaos. Anyway, let’s talk about the problem; the problem in the U.S is that there are some conflicts between the Federal government and state governments; and between state governments and normal citizens. I will describe it in detail and provide my suggestions.
(1) Conflict: Between federal government and state governments
According to Constitutional Daily, there are some constitutional issues of mask mandate. Federal constitutional precedents made it unlikely that the federal government could issue a national mask-wearing mandate that can apply to the states. In late July 2021, President Biden ordered federal employees and contractors to attest to their vaccinations, or wear masks on the job and get Covid-19 tests. At the same time, Florida Governor Ron DeSantis banned all Florida schools from requiring mask-wearing for preventing COVID-19 [26]https://constitutioncenter.org/blog/the-constitutional-issues-related-to-covid-19-mask-mandates .
Suggestion:
The problem is that the U.S is a federal country – a country where there are state laws regulating some of the matters in states rather than a central law regulating all matters across the whole country. This is different from Taiwan, a country that makes all of the health regulations controlled by the central government – in Taiwan, the local governments’ responsibilities are to execute the health regulations, not to enact them [27]https://law.moj.gov.tw/LawClass/LawAll.aspx?pcode=A0040003 [28]https://law.moj.gov.tw/LawClass/LawAll.aspx?pcode=L0050001 . The problem of the U.S, though seems complicated as it’s because of the country’s system, is still solvable. As most Americans know, the U.S constitution applies to all of the U.S states. The U.S should consider making health law a constitutional right owned by the federal government, rather than state governments. Why is this important? Because the mask mandate has become a tool for Republicans to play politics. I am not being anti-Republican; it’s simply because the importance of wearing a mask is scientific-proved; therefore, the mask mandate is so important that no political party should use it as a tool to be against the opposing parties. To prevent mask mandates or any health regulation which is scientific-proved becoming a subject of political attack again, the U.S government or any government in the world which encounters the same problem should make health law a constitutional right owned by the federal government.
(2) Conflict: Between state governments and local people
In Michigan, a school filed a suit which is against the mask mandate. Two parents argued that Michigan’s mask-wearing mandate for all schools violated their religious freedoms. The lawsuit reasoned that the ability of students to see the faces of other people was essential to the Catholic faith “because God created us in His image.” Following that, a lower court judge rejected an injunction against the mask mandate sought by the school, deciding that the mask mandate was neutral and did not target the school for its religious beliefs. However, the school’s attorneys told a three-judge panel that the Supreme Court’s recent decision in Fulton v. City of Philadelphia expanded legal exceptions for religious institutions [29]https://constitutioncenter.org/blog/the-constitutional-issues-related-to-covid-19-mask-mandates.
Not only parents but there have also been some protests from U.S students which are about rejecting the mask mandate because of freedom issues [30]https://www.youtube.com/watch?v=9vEqcwUEMFI . The concern of infringing freedom is among not only students but also adults – Actually, this concern is spread among adults first; the students were influenced by these adults as some of them don’t like to wear masks, just as these adults don’t.
Suggestion:
So how to solve this problem? If you ask Taiwanese – citizens who have no question about wearing masks according to the government instructions, just like Americans who wear masks, they will say just wear masks to protect yourself from infection and don’t know how to answer the claim of “freedom” from the Western people. The U.S and many people in western countries said it’s their freedom to choose to wear masks or not. Indeed, it seems like a good reason, but is it? If not, why? The answer is NO, such freedom should not appear in a pandemic situation. Why? Because when we talk about “freedom”, it’s not about unlimited freedom; there is a boundary. How to define that boundary? Let me explain it. When I was in junior high school, there are a few lines of sentences in the civics textbook carved in my brain very deeply when reading them until now. The lines of sentences are about the Taiwan government trying to use the U.S as a model to define rights and laws when the Taiwan government was established. The rights certainly include freedom, a crucial item in U.S history. So how to define what is “freedom”? The textbook explains “It’s your freedom to do the things you want, but you can’t undermine the freedom of other people. For example, you can’t kill people, because by killing people, you undermine the freedom of other people.” These sentences are actually applicable to all of the cases, including the mask mandate case. The textbook didn’t say what kind of freedom is undermined when someone is killed. If I have to explain it, I would say it’s “the freedom of living”. See, by killing a person, you undermine that person’s freedom of living; by not wearing a mask, you put yourself and other people in danger of getting infected and potentially dead; you, therefore, undermine other people’s freedom of living, too. That’s why you should follow the government’s instructions by wearing a mask. You may say that “other people can wear masks to protect themselves, so I won’t infect them if I am infected.” No. You will certainly infect other people. First, even if you don’t infect strangers, you will infect your family members because you live behind the same door. Therefore, you undermine your family members’ freedom of living, especially your children at a time when children’s vaccines were not available. Second, you still will infect strangers. Remember what I quoted about Bill Gates’s words earlier “If you are wearing a loose surgical mask and sitting six feet away from an unmasked person with COVID, your mask will reduce your exposure by only 8 percent”? So of course you can still infect strangers if you don’t wear a mask. I also said that’s why universal masking (Both source (infector) and receiver wear masks ) is important. When both people wear surgical masks, the masks reduce the exposure by 84.3%[31]https://www.sphpc.cuhk.edu.hk/post/covid-tips-double-masking [32]https://www.publichealthontario.ca/-/media/documents/ncov/phm/2021/11/covid-19-community-masking-transmission.pdf?sc_lang=en
In terms of religious freedom, though no one thinks of it, this reason for undermine-freedom-of-living actually applies to religious freedom, too. It’s your freedom to believe in any religion you like, but you can’t undermine other people’s freedom of living. When you follow one of the religious instructions and take off your masks, you undermine other people’s freedom of living. You can continue to believe in the religion you like, but at the current time, you should put on your mask to prevent you undermine other people’s freedom of living.
There is a particular concern from a student in one of the student protests. He said that he has asthma and struggles with breathing, so it is difficult for him to put on a mask. Indeed, this is a concern. I don’t object if he can’t wear a mask due to his health factors. Nevertheless, I suggest that schools should enact measures to prevent students like him get infected and infecting other students. What kind of measures? I suggest that schools should keep remote learning running while physical lessons are held if there are such students who can’t wear masks due to personal health concerns – This means schools should demand such students continue remote learning at home. When you are holding a physical lesson, you still open your camera and let such students be able to join the lesson remotely.
Another reason for people who don’t wear a mask is that the survival rate of Covid, 99.8 %, is high so we don’t need to wear a mask. I would say the problem is not about whether you can still survive after getting infected – it’s about other people. Yes, you may survive, but note that not everyone can survive as you do, and you can infect other people, too. To protect other people’s freedom of living, it’s your responsibility to put on a mask. In addition, variants are keeping emerging. You don’t know if the virus you get infected with is a new variant that is unlike the previous variants and may cause you and other people to die.
Read Part 3
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Chrissy Slora
The articles published in this website are all written by Chrissy Slora. Chrissy Slora aims to make people learn about how the world can be better and provide her intelligent and wise insight by writing about various topics from technology to issues happening in the world. Follow her on social media: Facebook | Twitter | Linkedin