By Dr Rais Hussin and Dr Margarita Peredaryenko

On July 3, 2021, Khairy Jamaluddin, the Coordinating Minister for the National COVID-19 Immunisation Programme (PICK), conveyed optimistic news that the current vaccination rate exceeds previously set target levels, and the country is currently vaccinating at a rate per capita higher than the world average. This delivers massive hope to our devastated socio-economy.

However, we must also be mindful of the possible stall in the vaccination rate, which many nations have encountered sooner or later irrespective of successful vaccine procurement but rather due to vaccination hesitancy. This is where each citizen must play their civic role, and the following are the scientific reasons why.

Most of the public, far from the forefront of scientific research, have been gravely underestimating COVID-19 (save probably for those less fortunate ones who met with it already) while mounting empirical evidence paints a more staggering and sobering picture of COVID-19 than we initially thought.

The emerging evidence (refer for a good review here) suggests that the COVID-19 virus, which binds to the angiotensin‐converting enzyme 2 (ACE2) receptor of a host’s cell, appears to particularly favour human lung and small intestine epithelium as well as the vascular endothelium. The latter is a single cell layer that lines all blood vessels (all 100,000 km in total length if laid end to end) and regulates exchanges between the bloodstream and the surrounding tissues.

Dr William Li, renowned physician, vascular biologist, and one among the scientists leading research related to the cardio-vascular nature of COVID-19, summarised in more simple terms the astonishing findings that he and an international team of other accolated researchers have stumbled upon (Dr William’s interview with Dr Mark Hyman is available here).

Affected blood vessels in the entire body

The team has carefully examined autopsy tissue from people who have died of COVID-19. The scientists have studied tissue from lungs to heart, brain, kidney – from the entire body. What they found was startling and absolutely disheartening at the same time. This “respiratory” virus affected the lungs, but it also affected the blood vessels in the entire body.

By getting inside the endothelium cells, the SARS-CoV-2 virus disrupted cell membranes –literally scuffing up the smooth endothelium lining and making it incapable of performing its vital functions, among which one of the most important is to bring oxygen and nutrition to every part of our body.

Now, this scientific discovery sheds a whole new light on multiple organ failures happening at once in acute COVID-19 patients and on a close link between pre-existing cardiovascular conditions and adverse COVID-19 outcomes, which was evident from the pandemic onset.

“But this is the acute COVID-19 in older patients and patients with pre-existing comorbidities” – the younger people might exclaim.

Not so fast! The known comorbidities and diagnosed symptoms might be only the tip of an iceberg of deeper immune disbalances and hidden chronic conditions increasingly prevalent in public, including younger generations.

Therefore, it should hold no mystery that, as COVID-19 continues to spread and community transmission reaches wider circles of population, many countries, including Malaysia, begin to report the severity of COVID-19 among younger and seemingly healthy cohorts.

The post-COVID-19 or “long-haulers’ syndrome” is another unexpected twist in the COVID-19 saga. This refers to an increasing number of patients, vastly including young and seemingly healthy, who initially had mild to moderate symptoms and didn’t require hospitalisation but three to six months later have been crushing with a bizarre constellation of more than a hundred different symptoms ranging from brain fog, chronic fatigue, racing heart, shortness of breath, extreme muscle weakness, vomiting, anxiety, panic attacks, depression etc.

Dr William Li, who tried to build on his original discovery of vascular damage in COVID-19 patients and continued to study the long-haulers, explains what he has discovered: “In long haulers syndrome patients, the endothelial injury still appears to be there. It is like the entire internal part of your body turns into a chronic wound, stuck in the inflammatory phase, not completing the cycle of healing itself up”.

Vaccination may be safer alternative road

Another observation the scientist made is that 41 per cent of long-haulers reported that some of their symptoms got better after they took a COVID-19 vaccine. This leads to an interesting hypothesis that similar to diseases like lyme, shingle, or syphilis, there could be hidden reservoirs of COVID-19 virus even post supposed recovery which are not detectable with the usual tests.

Having this fuller picture of what COVID-19 entails, perhaps not many would be willing to throw their dice with COVID-19. The COVID-19 vaccination might be a safer alternative road.

Yes, COVID-19 vaccination does not protect an individual 100 per cent from contracting COVID-19. However, it does protect in 99.999 per cent of cases from the severity of this disease.

For example, according to the recent statistics made available by the Center for Disease Control and Prevention, United States, for the period January 1–April 30, 2021, for approximately 101 million people fully vaccinated against COVID-19, a total of 10,262 COVID-19 vaccine breakthrough infections had been reported from 46 US states. Out of these 10,262, some 2,725 (27%) were asymptomatic, 995 (10%) were hospitalised, and 160 (2%) patients died. Furthermore, among the 995 hospitalised patients, 289 (29%) were asymptomatic or hospitalised for a reason unrelated to COVID-19.

The following graphs, constructed using data from the countries with ICU occupancy statistics available, underscores the same point – vaccination appears to effectively prevent the severity and mortality of COVID-19.

Note that these countries used a variety of COVID-19 vaccines (COVID-19 vaccine tracker) and by now have various COVID-19 variants of concern circulating in their populations (explore here and here). Also, note particularly the experience of the United Kingdom (UK). Although the UK currently experiences another rise in recorded infections mainly driven by B.1.617.2 (the Delta variant), it does not correspond with the increase of ICU patients or COVID-19 related deaths. And that is what our wounded socio-economy needs to reopen as soon as possible.

Data source: Our World in Data, https://covid.ourworldindata.org/data/owid-covid-data.csv.

It is important to note that the same countries have been gradually reducing their movement control restrictions as well – step in step with the progress of their COVID-19 vaccination programmes (see the graph below).

Data source: Our World in Data, https://covid.ourworldindata.org/data/owid-covid-data.csv.

All in all, it is evident that vaccination plays a crucial role not only for personal protection but for our society as a whole longing to get back to some “normalcy” in our socio-economic interactions.

Fortunately, according to the recent pre-COVID-19 empirical evidence collected by Our World in Data group, Malaysia appeared among the countries that have a very low vaccine hesitancy in general and very high trust in our healthcare staff (doctors and nurses). Hopefully, this trend can continue with regards to the current PICK effort.

The systemic information about the COVID-19 disease and vaccines might tremendously help the rest of the public, who might still be hesitant, to make their informed choices. The vast data accumulated for the five months of COVID-19 PICK is the richest input for Machine Learning algorithms that can be used to evaluate the safety of various types of vaccines for individuals based on their pre-existing chronic conditions and illnesses.

It is the absence of such solid data base and transparency that becomes the fertile ground for unfounded fears.

With the vaccine hesitancy remaining low and Covid-19 PICK efforts gearing up at a constant pace, Malaysia might be well poised to finally break out of the recurrent and devastating movement control restrictions.

-- BERNAMA

Dr Rais Hussin and Dr Margarita Peredaryenko are part of the research team of EMIR Research, an independent think tank focused on strategic policy recommendations based on rigorous research.