Dear Editor,

The authors of the editorial COVID-19: what comes after elimination?[[1]] deserve congratulations for writing a well-articulated, thoughtful and perhaps one of best “think pieces” from a multi-disciplinary perspective on what may happen as the country moves away from a strict COVID-19 elimination strategy to a strategy reliant on “zero tolerance for COVID-19 deaths.”

I’d like to take this opportunity to make a few observations on some of their assumptions, which may be pertinent given the state of the knowledge of COVID-19 is changing.

Notably, the authors make several assumptions, but it was not quite clear from the text how they might address them, even as those unstated assumptions will bear on several of their ideas and suggestions. First of all, it is now established that COVID-19 is airborne,[[2,3]] and as such, ventilation and masking have a more prominent role in non-pharmacological intervention than what may have been considered earlier. But in order to enforce or enable this, individuals need to change their behaviours about precautionary practices, and businesses will need to adjust their practices, such as ventilation on shop floors and modes of operation (eg, restaurants may consider being more open spaced and limiting customers). Second, although the authors discussed endemic COVID-19, the jury is still out. By suggesting that the virus will become endemic, the authors assumed that COVID-19 will have re-infection[[4]]; so far, there is little evidence of re-infections as a dominant mode of transmission of this virus.[[5]] Besides, as it is now known that extant vaccines do not confer “sterilising immunity,” the discussions around “booster vaccinations” are in order.[[6]] The question of an endemic infection, and thereby the premise that there will be a “shift in public risk tolerance,” needs careful consideration. Finally, the authors did not discuss the potential issues around “long COVID”; perhaps this was beyond the scope of their review, yet the need to study the implications of long COVID is unavoidable. Albeit, we may be in the throes of the birth of a new speciality in public health and medicine devoted to the study of the causes and consequences of COVID. What the implications of long COVID will be is open to speculation.

All said, I commend the authors for their vision and laying out the considerations from a multi-disciplinary perspective, weaving in the needs of business and health sector organisations. Going forward, other issues, particularly given the transmission dynamics of COVID-19 and long COVID, deserve due consideration.

Dear Editor,

The authors of the editorial COVID-19: what comes after elimination?[[1]] deserve congratulations for writing a well-articulated, thoughtful and perhaps one of best “think pieces” from a multi-disciplinary perspective on what may happen as the country moves away from a strict COVID-19 elimination strategy to a strategy reliant on “zero tolerance for COVID-19 deaths.”

I’d like to take this opportunity to make a few observations on some of their assumptions, which may be pertinent given the state of the knowledge of COVID-19 is changing.

Notably, the authors make several assumptions, but it was not quite clear from the text how they might address them, even as those unstated assumptions will bear on several of their ideas and suggestions. First of all, it is now established that COVID-19 is airborne,[[2,3]] and as such, ventilation and masking have a more prominent role in non-pharmacological intervention than what may have been considered earlier. But in order to enforce or enable this, individuals need to change their behaviours about precautionary practices, and businesses will need to adjust their practices, such as ventilation on shop floors and modes of operation (eg, restaurants may consider being more open spaced and limiting customers). Second, although the authors discussed endemic COVID-19, the jury is still out. By suggesting that the virus will become endemic, the authors assumed that COVID-19 will have re-infection[[4]]; so far, there is little evidence of re-infections as a dominant mode of transmission of this virus.[[5]] Besides, as it is now known that extant vaccines do not confer “sterilising immunity,” the discussions around “booster vaccinations” are in order.[[6]] The question of an endemic infection, and thereby the premise that there will be a “shift in public risk tolerance,” needs careful consideration. Finally, the authors did not discuss the potential issues around “long COVID”; perhaps this was beyond the scope of their review, yet the need to study the implications of long COVID is unavoidable. Albeit, we may be in the throes of the birth of a new speciality in public health and medicine devoted to the study of the causes and consequences of COVID. What the implications of long COVID will be is open to speculation.

All said, I commend the authors for their vision and laying out the considerations from a multi-disciplinary perspective, weaving in the needs of business and health sector organisations. Going forward, other issues, particularly given the transmission dynamics of COVID-19 and long COVID, deserve due consideration.