Indonesia: Bali set to welcome tourists in July

[Centrals]

COVID-19 is new and something we're not used to, plus it's killing a lot of people and straining healthcare resources. All those are reasons it's treated as a big deal. At some point, we hope to beat it down to be the 'new flu,' so to speak.

The next question is...how will annual mortality figures for COVID-19 compare to those for flu, once we're successfully into that period? Time may tell...

We under estimate the severity of this virus right from the start. It will disappear in the summer like SARS(another Corona virus) did in 2002. It did not and still persistence all over the world with no sign of abating. Vaccine(light at the end of the tunnel)? We are still inside the tunnel. And the variants probably move the end of the tunnel a lot further away!!
Only time will tell.
Hope for the best especially on scientific breakthrough.

 

[tursiops]

In the U.S., Dr. Anthony Fauci has shied away from naming a specific 'magic point' for herd immunity where all is well from that point on. And as you allude to mentioning the commonality of multi-generational households in Indonesia vs. more segregated social models in some places, that point may vary widely.

A big issue is what one thinks 'herd immunity' means. COVID-19 is not going the way of small pox. So, does herd immunity mean...

1.) Nobody (or almost nobody) can get the condition, and when someone does, it's a news-making surprise (likes measles in the United States)?

I don't think this is going to happen.

2.) It routinely moves through a small but substantial minority of the population, killing a small portion of them, and the rest of us don't make any lifestyle changes around it (other than maybe a vaccination shot). Those known sick with it are advised to 'stay home and drink plenty of fluids' and try not to spread it around. Most get over it...but a few don't. This is how the flu works in the United States. There's an annual death toll, but not particularly disruptive in the greater society.

This is going to happen.

Herd immunity reduces the number of people who have it, and their probability of encountering and transmitting it to a susceptible person, thus in a multi-factorial way cutting the total number of cases (particularly hospitalizations, deaths and long-term impairment cases) to something we can more conveniently deal with.

Put another way, the point of herd immunity depends in part on what body count we're willing to pay to get back to normal, plus some other factors.

COVID-19 is new and something we're not used to, plus it's killing a lot of people and straining healthcare resources. All those are reasons it's treated as a big deal. At some point, we hope to beat it down to be the 'new flu,' so to speak.

The next question is...how will annual mortality figures for COVID-19 compare to those for flu, once we're successfully into that period? Time may tell...

This, and the posts from Indah, are models of calm and reason.

See also Herd immunity - APIC where it says:

When can we expect herd immunity for COVID-19?
COVID-19 is a very contagious disease. A large percentage of the population will need to be immune against the disease (through infection or vaccination) before herd immunity will be achieved. It is not known when that will happen, but it will depend on how many people get vaccinated.​

See also Dissecting the indirect effects caused by vaccines into the basic elements, written before Covid-19, where it says:

High and maintained vaccine effectiveness
Good vaccine effectiveness is crucial in producing a positive indirect effect or good herd protection from a vaccination program.2 Vaccine effectiveness is the real-life measurement of a vaccine's ability to protect against infection. This is different from vaccine efficacy, which is the capacity of a vaccine to provide protection in a controlled environment like clinical trials.14 Vaccine effectiveness will vary between regions and different (sub)populations,6 and should therefore be taken into account when evaluating the positive indirect effect of a vaccine on a given population. Since vaccines are almost never 100% effective, the critical vaccination coverage level required to protect the population must necessarily increase.6,14​

The fundamental ideas of herd immunity are not new: “Herd Immunity”: A Rough Guide. If you dig into the math, there is a relationship between the required vaccination coverage level, Vsub-c, the R-naught (infectionness) of the virus, and effectiveness of the vaccine. If R-naught is 4 (a high estimate for Covid-19), then Vsub-c is 75%, for E=100%. But if E=90%, then Vsub-c goes up to 83%, and if E=75%, then Vsub-c goes up to 100%. So for an infectious virus (R-naught = 4) with a vaccine that is only 75% effective, you need 100% of the population vaccinated to get to herd immunity. The low estimate for the R-naught of Covid-19 is 1.9, in which case an E of only 60% will still provide herd immunity even if only 80% of the population is vaccinated. Those are all bounds based on simple models, but the point is.....you really do need to try and most of your population vaccinated, given the way Covid-19 works and given the effectiveness of our vaccines.

 

[Indah]

In the U.S., Dr. Anthony Fauci has shied away from naming a specific 'magic point' for herd immunity where all is well from that point on. And as you allude to mentioning the commonality of multi-generational households in Indonesia vs. more segregated social models in some places, that point may vary widely.

A big issue is what one thinks 'herd immunity' means. COVID-19 is not going the way of small pox. So, does herd immunity mean...

1.) Nobody (or almost nobody) can get the condition, and when someone does, it's a news-making surprise (likes measles in the United States)?

I don't think this is going to happen.

2.) It routinely moves through a small but substantial minority of the population, killing a small portion of them, and the rest of us don't make any lifestyle changes around it (other than maybe a vaccination shot). Those known sick with it are advised to 'stay home and drink plenty of fluids' and try not to spread it around. Most get over it...but a few don't. This is how the flu works in the United States. There's an annual death toll, but not particularly disruptive in the greater society.

This is going to happen.

Herd immunity reduces the number of people who have it, and their probability of encountering and transmitting it to a susceptible person, thus in a multi-factorial way cutting the total number of cases (particularly hospitalizations, deaths and long-term impairment cases) to something we can more conveniently deal with.

Put another way, the point of herd immunity depends in part on what body count we're willing to pay to get back to normal, plus some other factors.

COVID-19 is new and something we're not used to, plus it's killing a lot of people and straining healthcare resources. All those are reasons it's treated as a big deal. At some point, we hope to beat it down to be the 'new flu,' so to speak.

The next question is...how will annual mortality figures for COVID-19 compare to those for flu, once we're successfully into that period? Time may tell...

I agree with you. However, the unknown factor are variants.

 

[Indah]

This, and the posts from Indah, are models of calm and reason.

See also Herd immunity - APIC where it says:

When can we expect herd immunity for COVID-19?
COVID-19 is a very contagious disease. A large percentage of the population will need to be immune against the disease (through infection or vaccination) before herd immunity will be achieved. It is not known when that will happen, but it will depend on how many people get vaccinated.​

See also Dissecting the indirect effects caused by vaccines into the basic elements, written before Covid-19, where it says:

High and maintained vaccine effectiveness
Good vaccine effectiveness is crucial in producing a positive indirect effect or good herd protection from a vaccination program.2 Vaccine effectiveness is the real-life measurement of a vaccine's ability to protect against infection. This is different from vaccine efficacy, which is the capacity of a vaccine to provide protection in a controlled environment like clinical trials.14 Vaccine effectiveness will vary between regions and different (sub)populations,6 and should therefore be taken into account when evaluating the positive indirect effect of a vaccine on a given population. Since vaccines are almost never 100% effective, the critical vaccination coverage level required to protect the population must necessarily increase.6,14​

The fundamental ideas of herd immunity are not new: “Herd Immunity”: A Rough Guide. If you dig into the math, there is a relationship between the required vaccination coverage level, Vsub-c, the R-naught (infectionness) of the virus, and effectiveness of the vaccine. If R-naught is 4 (a high estimate for Covid-19), then Vsub-c is 75%, for E=100%. But if E=90%, then Vsub-c goes up to 83%, and if E=75%, then Vsub-c goes up to 100%. So for an infectious virus (R-naught = 4) with a vaccine that is only 75% effective, you need 100% of the population vaccinated to get to herd immunity. The low estimate for the R-naught of Covid-19 is 1.9, in which case an E of only 60% will still provide herd immunity even if only 80% of the population is vaccinated. Those are all bounds based on simple models, but the point is.....you really do need to try and most of your population vaccinated, given the way Covid-19 works and given the effectiveness of our vaccines.

Thanks a lot for helping me to understand this. This seems to be the position of the Indonesia government.: The low estimate for the R-naught of Covid-19 is 1.9, in which case an E of only 60% will still provide herd immunity even if only 80% of the population is vaccinated.

 

[drrich2]

I agree with you. However, the unknown factor are variants.

True. A couple of follow up observations...

1.) Variants are going to keep happening. For the foreseeable future, there will always be periodic variants, just as we get with the flu now. Some years back there was the big fear of the H1N1 'swine flu.'

2.) I don't think the major nations of the world can afford frequent economic shutdown.

Combining these points, I think eventually the balance of competing forces will favor getting back to international tourism, industrial activity, etc...even if COVID-19 is killing substantially more people on an ongoing basis than pre-pandemic. How many more we'll tolerate I don't know. Since the 9-11 World Trade Center terrorist attack in the U.S., many of us have adjusted to the perpetual 'new normal' of changes in how air ports operate, so maybe decently reliable very rapid disease tests will become a routine part of passing through security checkpoints before boarding.

Speaking of which, one potential factor in this is the reliability, cost and time to result of testing. Perhaps big changes there could lead the way to reopening. If testing reliably assured people on the plane are negative today (not 3 days ago), maybe that'd be good enough?

 

[drrich2]

...in which case an E of only 60% will still provide herd immunity even if only 80% of the population is vaccinated.

Big question - does that 80% include kids? In the U.S., there are research trials on kids, but the perceived barrier to justify routine use of the vaccines in kids is higher, because they are seen as at much lower risk of severe effects from the disease.

Let's apply this on 2 fronts. Let's say I want to fly to Raja Ampat for a live-aboard (and I do...).

1.) Does it matter than I have an 8-year old daughter who can't be vaccinated now, even though I've completed the Moderna 2-shot series? I should be really low risk, so maybe not.

2.) What of the risk of tourists spreading SARS-CoV-2 to unvaccinated Indonesian kids, leading to higher prevalence and making them a virus reservoir?

I read an article today in Apple News + where someone opined children's nasal and oral linings generate more fight against the virus so they may not shed it as long. At issue was whether there's a need to vaccinate kids because they're potential disease vectors to vulnerable people. Are they lower risk to transmit it, and how much does that change things?

My long-winded point is this...vaccinating 80% of Indonesian adults will be a huge task, and when might it be finished? Vaccinating 80% of all Indonesians, including kids? Wouldn't that take years?

 

[Centrals]

Reply to #45.

1. Fact of life. No escape.
2. No one can.
3. I used to carry spare mask in my travelling bag and I might have to wear it now during travelling. Most transportation terminals have IR temp detector and we might need to carry a vaccine cert. issued by Gov for travelling. Have to adapt what is necessary.
4. The rapid test is reliable enough but not 100%.

#46.
1. Lower risk for vaccinated person to transmit the disease. Finger crossed.
2. Same as 1 ie. for a vaccinated person.
3. Inoculate those under certain age? I believe there is on going study on this.
4. As for vaccinating 80% of 230m Indonesian? Good luck.

 

[Indah]

Big question - does that 80% include kids? In the U.S., there are research trials on kids, but the perceived barrier to justify routine use of the vaccines in kids is higher, because they are seen as at much lower risk of severe effects from the disease.

Let's apply this on 2 fronts. Let's say I want to fly to Raja Ampat for a live-aboard (and I do...).

1.) Does it matter than I have an 8-year old daughter who can't be vaccinated now, even though I've completed the Moderna 2-shot series? I should be really low risk, so maybe not.

2.) What of the risk of tourists spreading SARS-CoV-2 to unvaccinated Indonesian kids, leading to higher prevalence and making them a virus reservoir?

I read an article today in Apple News + where someone opined children's nasal and oral linings generate more fight against the virus so they may not shed it as long. At issue was whether there's a need to vaccinate kids because they're potential disease vectors to vulnerable people. Are they lower risk to transmit it, and how much does that change things?

My long-winded point is this...vaccinating 80% of Indonesian adults will be a huge task, and when might it be finished? Vaccinating 80% of all Indonesians, including kids? Wouldn't that take years?

Still unknown for how long the Sinovac and AstraZeneca (or any of the other) vaccines offer protection. If this would be 18 months, it means that many people need to be revaccinated before the last groups in Indonesia receive their first shots.

 

[Dan]

Here’s what happens when you claimed “herd immunity” prematurely:

https://www.google.com/amp/s/www.th...or-covid-19-at-india-religious-festival-.html

We’ll see if Indonesia will follow India next month, during the May Islamic holiday exodus.

 

[Centrals]

Long long long way to go!!!
17.60m had so far been administered in which 6.34m had completed the course ie. 2.3% of the population
The country has a population of 2.7B.