Singapore's Covid response overlooked a major factor: Fear

‘Mastering data is only half the battle. A major reason hospitals were getting overwhelmed is because people were scared, and the government missed an opportunity to send the right message.

‘Singapore is very proud of its reputation for technocratic excellence. In recent months, government officials have tried to tackle the country’s most pressing question — how to live with Covid-19 — by scrutinizing, modeling and projecting data, as if staring hard enough at those little gray-rimmed boxes on Excel would produce the answer.

‘The trouble with this strategy is that living with Covid is messy, and the data will never look good. Countries that have been praised for the most meticulous of approaches to the outbreak have stumbled time and again. Ultimately, treating the coronavirus as endemic will require Singapore to do something it may find unnatural: think beyond the numbers.’

Read here (Bloomberg, Sept 29, 2021)

We’re already barreling toward the next pandemic: Ed Yong

‘This one is far from over, but the window to prepare for future threats is closing fast...

“To be ready for the next pandemic, we need to make sure that there’s an even footing in our societal structures,” Seema Mohapatra, a health-law expert at Southern Methodist University, in Dallas, told me. That vision of preparedness is closer to what 19th-century thinkers lobbied for, and what the 20th century swept aside. It means shifting the spotlight away from pathogens themselves and onto the living and working conditions that allow pathogens to flourish. It means measuring preparedness not just in terms of syringes, sequencers, and supply chains but also in terms of paid sick leave, safe public housing, eviction moratoriums, decarceration, food assistance, and universal health care. It means accompanying mandates for social distancing and the like with financial assistance for those who might lose work, or free accommodation where exposed people can quarantine from their family. It means rebuilding the health policies that Reagan began shredding in the 1980s and that later administrations further frayed. It means restoring trust in government and community through public services. “It’s very hard to achieve effective containment when the people you’re working with don’t think you care about them,” Arrianna Marie Planey, a medical geographer at the University of North Carolina at Chapel Hill, told me. 

Read here (The Atlantic, Sept 29, 2021)

Fraudulent Ivermectin studies open up new battleground between science and misinformation

‘Studies suggesting ivermectin is an effective Covid treatment relied on evidence ‘that has substantially evaporated under close scrutiny’, fresh research shows...

‘On Thursday (Sept 23, 2021), the prestigious medical journal Nature Medicine published an article authored by concerned epidemiologists and researchers who interrogated studies on ivermectin. “Many hundreds of thousands of patients have been dosed with ivermectin, relying on an evidence base that has substantially evaporated under close scrutiny,” the authors wrote.

“Several … studies that claim a clinical benefit for ivermectin are similarly fraught, and contain impossible numbers in their results, unexplainable mismatches between trial registry updates and published patient demographics, purported timelines that are not consistent with the veracity of the data collection, and substantial methodological weaknesses.”

Read here (The Guardian, Sept 25, 2021)

• The lesson of ivermectin: meta-analyses based on summary data alone are inherently unreliable

Read here (Nature Medicine, Sept 22, 2021)

Sinovac cuts Covid-19 death risk by 84%, AZ and Pfizer by over 90%: Malaysia survey on 1.26m people

‘The Sinovac vaccine can reduce the risk of death among Covid-19 patients by up to 84%, the health ministry said today. Citing data from the real-world evaluation of Covid-19 vaccines under the Malaysia national Covid-19 immunisation programme (RECoVaM), the ministry said the Pfizer jab decreased the risk of death by 93%.

‘In a Twitter post, it said the AstraZeneca vaccine showed the best result, with the lowest rate of “breakthrough deaths”, with the study finding that the jab reduced the risk of deaths among Covid-19 patients by 96%. This was based on a survey led by the health ministry’s Institute for Clinical Research (ICR) on 1,261,270 individuals.’

Read here (Free Malaysia Today, Sept 24, 2021)

Covid-19 increases the chance of getting an autoimmune condition. Here’s what the science says so far

‘SARS-CoV-2, the virus that causes COVID-19, can sometimes cause the immune system to mistakenly attack the person’s own body. This process, known as “autoimmunity”, can damage a number of different organs... The science on how and how often this occurs is still emerging. But here’s what we know so far...

This article attempts to answer the following:

• How do viruses trigger autoimmunity?
• What autoimmune conditions can COVID-19 trigger?
• What’s causing the damage?
• Could vaccination help?
• What’s next for research in this area?

Read here (The Conversation, Sept 23, 2021)

How Covid has shone a light on the ugly face of Australian antisemitism

‘The increased prominence of antisemitic incidents during the COVID pandemic may leave you wondering: has antisemitism always been part of the Australian social fabric, or are we facing a new, sinister trend? Members of Melbourne’s Jewish community have been subjected to a surge of antisemitic abuse in recent weeks, following breaches of public health orders by ultra-Orthodox Jewish worshippers.

‘And Victoria’s proposed law to ban Nazi symbols — a first for any state or territory — further reinforces how antisemitism is becoming an increasingly visible problem in Australia.’

Read here (The Conversation, Sept 22, 2021)

30 facts you need to know: Your Covid cribsheet

We get a lot of e-mails and private messages along these lines “do you have a source for X?” or “can you point me to mask studies?” or “I know I saw a graph for mortality, but I can’t find it anymore”. And we understand, it’s been a long 18 months, and there are so many statistics and numbers to try and keep straight in your head.

So, to deal with all these requests, we decided to make a bullet-pointed and sourced list for all the key points. A one-stop-shop.

Here are key facts and sources about the alleged “pandemic”, that will help you get a grasp on what has happened to the world since January 2020, and help you enlighten any of your friends who might be still trapped in the New Normal:

“Covid deaths” – Lockdowns – PCR Tests – “asymptomatic infection” – Ventilators – Masks – Vaccines – Deception & Foreknowledge

PART I: “COVID DEATHS” & MORTALITY

1. The survival rate of “Covid” is over 99%.

2. There has been NO unusual excess mortality.

3. “Covid death” counts are artificially inflated.

4. The vast majority of covid deaths have serious comorbidities.

5. Average age of “Covid death” is greater than the average life expectancy.

6. Covid mortality exactly mirrors the natural mortality curve.

7. There has been a massive increase in the use of “unlawful” DNRs.

PART II: LOCKDOWNS

8. Lockdowns do not prevent the spread of disease.

9. Lockdowns kill people.

10. Hospitals were never unusually over-burdened.

PART III: PCR TESTS

11. PCR tests were not designed to diagnose illness.

12. PCR Tests have a history of being inaccurate and unreliable.

13. The CT values of the PCR tests are too high.

14. The World Health Organization (Twice) Admitted PCR tests produced false positives.

15. The scientific basis for Covid tests is questionable.

PART IV: “ASYMPTOMATIC INFECTION”

16. The majority of Covid infections are “asymptomatic”.

17. There is very little evidence supporting the alleged danger of “asymptomatic transmission”. 

PART V: VENTILATORS

18. Ventilation is NOT a treatment for respiratory viruses.

19. Ventilators killed people.

PART VI: MASKS

20. Masks don’t work.

21. Masks are bad for your health.

22. Masks are bad for the planet.

PART VII: VACCINES

23. Covid “vaccines” are totally unprecedented.

24. Vaccines do not confer immunity or prevent transmission.

25. The vaccines were rushed and have unknown longterm effects.

26. Vaccine manufacturers have been granted legal indemnity should they cause harm.

PART VIII: DECEPTION & FOREKNOWLEDGE

27. The EU was preparing “vaccine passports” at least a YEAR before the pandemic began.

28. A “training exercise” predicted the pandemic just weeks before it started.

29. Since the beginning of 2020, the Flu has “disappeared”.

30. The elite have made fortunes during the pandemic. 

Read here (OffGuardian, Sept 22, 2021)

Leader of WHO’s new pandemic hub: Improve data flow to extinguish outbreaks

Former Nigeria CDC leader Chikwe Ihekweazu talks with Nature about the COVID crisis, and strengthening global response to future public-health emergencies...

What are the biggest problems you hope to fix — and why do you want to solve them at the WHO?

‘I want to make the mechanics of reporting disease-related information easier, and also demonstrate that the WHO can use that data to help countries that share it. One way to do that is to enable countries to derive value from their own data.

‘I wouldn’t want to do this at a venue other than the WHO. I know that different countries are creating hubs, as are some big donors. They may be able to analyse publicly available data, but they won’t have the same access to information from countries that the WHO does. Speaking as the current director of the Nigeria CDC, I can tell you that I wouldn’t share my data openly with a hub located in another country. We share our data with the WHO without worry because the WHO belongs to us and other countries as a member-state organization, and has a mandate from countries to monitor health risks and coordinate the response in health emergencies.’

Read here (Nature, Sept 21, 2021)

‘It’s almost like grooming’: how anti-vaxxers, conspiracy theorists, and the far-right came together over Covid

‘Far right nationalists, anti-vaxxers, libertarians and conspiracy theorists have come together over COVID, and capitalised on the anger and uncertainty simmering in some sections of the community. They appear to have found fertile ground particularly among men who feel alienated, fearful about their employment and who spend a lot of time at home scrolling social media and encrypted messaging apps.’

Read here (The Conversation, Sept 21, 2021)

OECD urges rich nations to share vaccines to even-up growth

‘A leading international economic watchdog urged developed countries to put more effort into providing low-income countries with coronavirus vaccines in order to ensure that the global recovery from the pandemic is more even.

‘In its latest assessment of the state of the global economy, the Paris-based Organization for Economic Cooperation and Development said Tuesday that the global recovery from the shock of the pandemic is faster than it anticipated a year ago. Though the global economy has more than recouped the 3.4% output lost in 2020, it cautioned that the recovery is “uneven.”

Read here (Associated Press, Sept 21, 2021)

Denmark appears to have beaten Covid-19 — for now. Here’s how it did it.

‘As part of Denmark’s largest behavioral covid-19 research project (the HOPE project), we surveyed more than 400,000 individuals in Denmark and seven other countries. Our findings suggest that citizens’ high and stable trust in their health authorities has been a crucial factor in Denmark’s success. This trust, shown in the figure below, encouraged high vaccination rates and the successful implementation of key policies such as mass testing and coronavirus passports.’

Read here (Washington Post, Sept 20, 2021)

Six rules that will define our second pandemic winter

The pandemic keeps changing, but these principles can guide your thinking through the seasons to come.

• The role of vaccines has changed (again)
• The proportion of vaccinated people matters, but who they are and how they cluster also matters
• The people at greatest risk from the virus will keep changing
• As vaccination increases, a higher proportion of cases will appear in vaccinated people—and that’s what should happen
• Rare events are common at scale
• There is no single “worst” version of the coronavirus

Read here (The Atlantic, Sept 20, 2021)

Pfizer announces positive results for Covid-19 vaccine for children

‘Pfizer and BioNTech on September 20 announced positive results from a Phase 2/3 trial of their SARS-CoV-2 vaccine in children aged 5 to 11 years. The researchers found that a 2-dose regimen of 10µg doses administered 21 days apart demonstrated a favorable safety profile and robust neutralizing antibody response. The findings—which are neither published nor peer-reviewed—are a crucial step toward a SARS-CoV-2 vaccine becoming available for younger children, and the companies expect to submit an application to the US FDA for the vaccine’s authorization for that age group by the end of September. US regulators have issued warnings to the general public to wait for authorization before seeking vaccination for younger children, as the full adult dose of 30µg may put children at a higher risk for adverse side effects, including myocarditis.

‘The trial included nearly 2,300 children, and two-thirds of them in the vaccine group. The vaccinated children also were compared with a separate cohort of 16-25-year-old individuals who received the full adult course of the vaccine (2 doses of 30µg). The trial found that the neutralizing antibody response was similar between both vaccinated groups, with the neutralizing antibody levels within 5% of each other. Both groups also experienced similar post-vaccination adverse events.’

Read here (Pfizer news release) and here (Stat News, Sept 20, 2021)

The science behind Covid-19 vaccine boosters: Do we really need an extra shot?

‘The discussion took a new turn this week as fresh data backed up earlier findings - yet to be peer-reviewed - that the efficacy of both Pfizer's and Moderna's vaccines declines in a matter of months, and that one more dose of the Pfizer shot can reduce the rates of infections by 11 times and severe illness by 20 times in the elderly.

‘There are many arguments both for and against boosters, but what concerns policymakers and health professionals first and foremost is whether the science shows that they are a necessity. In considering this, we examine three key issues: Are immunity levels indeed dropping? Will extra shots really help and are they safe? What are the broader implications of giving another shot to those already vaccinated?’

Read here (Straits Times, Sept 19, 2021)

Bats in Laos caves found to carry coronaviruses that share key feature with Sars-CoV-2

‘Bats dwelling in limestone caves in northern Laos were found to carry coronaviruses that share a key feature with Sars-CoV-2, moving scientists closer to pinpointing the cause of Covid-19. Researchers at France's Pasteur Institute and the University of Laos looked for viruses similar to the one that causes Covid-19 among hundreds of horseshoe bats.

‘They found three with closely matched receptor binding domains - the part of the coronavirus' spike protein used to bind to human ACE-2, the enzyme it targets to cause an infection. The finding, reported in a paper released on Friday (Sept 17) that is under consideration for publication by Nature journal, shows that viruses closely related to Sars-CoV-2 exist in nature, including in several Rhinolophus, or horseshoe bat, species. The research supports the hypothesis that the pandemic began from a spillover of a bat-borne virus.’

Read here (Straits Times, Sept 18, 2021)

Frustration with those who refuse Covid-19 vaccination but making it compulsory is tricky: Infectious diseases experts

Ramping up communications to convince those on the fence, along with differentiated measures nudging more to take the shot can help get vaccination rates up, say infectious diseases experts on CNA’s Heart of the Matter podcast...

‘As someone who treats COVID-19 patients, Dr David Lye, Director of the Infectious Disease Research and Training Office at the National Centre for Infectious Diseases (NCID), says he has spoken to “thousands of people”, and he always has one message for them: Get vaccinated. As a researcher and a scientist, he admits he gets frustrated when he encounters people medically able to get a vaccine but choose not to. But would he go so far as to recommend that vaccines be made compulsory?

“To be honest, I am in favour of a vaccine mandate, but I'm also aware that the impact on individuals in these times can be devastating,” Dr Lye added, pointing to the possibility of the unvaccinated getting shut out of jobs if COVID-19 vaccination was made compulsory nationally.

‘He was speaking to Supervising Editor Lin Suling, host of Heart of the Matter podcast on Thursday (Sep 16).

‘Dr Ashley St John, Associate Professor at Duke-NUS Medical School’s Programme in Emerging Infectious Diseases, who was also on the podcast, agreed. "If you're asking me personally, it would be nice to have compulsory COVID-19 vaccines, but I also understand there are other policy considerations … beyond just the scientific aspects.”

Read here (Channel News Asia, Sept 18, 2021)

Doctors treating unvaccinated Covid patients are succumbing to compassion fatigue

“Compassion fatigue is the feeling, ‘It’s hard to care when you’re overloaded but still dedicated to the task,’” Dr Kernan Manion, executive director of the Center for Physician Rights, said. “Moral injury occurs when the nurse or doctor feels that, ‘The patients I’ve dedicated my life to treating are now here because of their own negligence and now they’re imposing upon me and my team to treat them, while also exposing us to continued danger from this virus.’”

These days, Meck knows that first-hand. She is seeing more children with Covid-19 at her Missouri hospital than ever before. At 46%, Missouri has one of the lowest rates of full vaccination in the country. “I don’t even get the chance to try to show you all the split-second decisions and critical thinking and compassion I’m capable of,” Meck said. “Practising mindfulness is not going to fix moral injury.”

Read here (The Guardian, Sept 18, 2021)

The countries that are vaccinating children against Covid-19: As at mid September 2021

‘While many high-income nations, including the United States and most members of the European Union, now offer Covid vaccines for children 12 and older, a handful of countries have now authorized the shot for younger people. Meanwhile, severe vaccine inequality persists on a global level, with many developing nations continuing to struggle to provide first and second doses to high-risk groups -- with the very idea of getting shots to children still a pipe dream. Here's a global snapshot of where things stand.’

Read here (CNN, Sept 17, 2021)

Underfunded and under threat

‘At least 29 US states have passed laws, enacted other initiatives, or succeeded in lawsuits that permanently weaken state and local government authority to protect public health, and similar efforts are pending in multiple other states. The analysis was published by Kaiser Health News and the Associated Press as part of their ongoing series “Underfunded and Under Threat,” which examines how US public health systems were unprepared to confront the COVID-19 pandemic and face ongoing politicization, funding cuts, and other hindrances. Legislators in at least 16 states have limited public health authorities’ ability to issue mask mandates or quarantines or isolation orders, and in some cases, legislatures gave themselves that authority or shifted it to other elected officials. In at least 17 states, lawmakers passed legislation banning SARS-CoV-2 vaccine mandates or passports or facilitated opt-out options. And in at least 14 states, new laws, executive orders, or court rulings ban or limit mask mandates. 

‘Proponents of the new measures argue that they are a necessary check on executive powers, particularly for appointed officials, and give lawmakers a voice in public health emergencies. Public health officials and experts have expressed frustration with these efforts and warned that the consequences of these actions will extend far beyond the current pandemic. These new limits could also impact public health officials’ ability to prevent and contain future outbreaks for any number of communicable diseases. At least 303 state and local public health department leaders have resigned, retired, or been fired during the pandemic, according to the analysis.’ Johns Hopkins Center for Health Security e-newsletter 

• Public health officials face wave of threats, pressure amid coronavirus response (June 12, 2020). Read here
• Pandemic backlash jeopardises public health powers, leaders (Dec 15, 2020). Read here
• Hollowed-out public health system faces more cuts amid virus (July 1, 2020). Read here
• Politics slows flow of US pandemic relief funds to public health agencies (August 17, 2020). Read here

Read here (KHN & AP, as at Sept 17, 2021)  

Visualising the world’s biggest pharmaceutical companies

‘Some of the world’s biggest pharmaceutical companies have played a central role in the COVID-19 pandemic. However, it’s likely no surprise that the pandemic has also been great for many healthcare businesses. In fact, in 2020 alone, the world’s 50 largest pharmaceutical companies still combined for a whopping $851 billion in revenues.

‘In this graphic, using data from Companies Market Cap, we list the largest pharmaceutical companies in the world by market capitalization. It’s worth noting this list also includes healthcare companies that work closely with pharmaceuticals, including biotech, pharmaceutical retailers, clinical laboratories, etc.’

Read here (Visual Capitalist, Sept 17, 2021)

Vaccine mandates have worked in the past. Can they overcome modern hurdles?

‘While some politicians have touted the new mandates as “un-American,” vaccine mandates are older than the United States itself. “General [George] Washington mandated smallpox inoculation—the precursor to the vaccine, and a more dangerous procedure—for the Revolutionary Army,” says Dorit Reiss, a law professor who specializes in vaccine policy at the University of California, Hastings College of the Law. “And I don't think it’s fair to describe Washington as un-American.”

Read here (National Geographic, Sept 16, 2021)

The fight to manufacture Covid vaccines in lower-income countries

‘Instead of holding out for today’s popular vaccines, some researchers hope that those in clinical trials will be easier to license and make in the global south. At the top of the list are protein-subunit vaccines, in which peptides matching those from SARS-CoV-2 teach the immune system to recognize the virus and fight it off. Researchers say the benefit of such vaccines is that vats of yeast or insect cells can churn out huge quantities of peptides, making the vaccines scalable. They add that many companies are familiar with the process because they produce vaccines for other diseases and recombinant drugs in a similar fashion.’

Read here (Nature, Sept 15, 2021)

Biolidics develops test detecting a person’s protective immunity against Covid-19; shares jump

‘Biolidics said the ClearEpi NAB Test is intended for the qualitative detection of circulating human IgG  antibodies capable of attaching to the Covid-19 spike proteins and preventing binding. "The company wishes to highlight that the ClearEpi NAB Test is intended for use as an aid in identifying individuals with an adaptive immune response to Sars-CoV-2 and should not be used to diagnose or exclude acute Sars-CoV-2 infection," Biolidics added.

‘Biolidics expects the development of the test and the receipt of the CE marking to contribute positively to its revenue for the financial year ending Dec 31, 2021, provided the company is able to successfully market and commercialise the test in the EU.’

Read here (Straits Times, Sept 15, 2021)

What’s the law on vaccine exemptions? A religious liberty expert explains

‘Many schools, businesses and governments requiring vaccination have offered religious exemptions. Some are loath to challenge people’s claims that getting the shot goes against their beliefs for fear of being sued, but organizations have come up with a variety of ways to assess claimants’ sincerity. But the legal basis of Americans’ supposed right to a religious exemption to vaccination is less clear than such policies’ popularity would suggest.

‘As a lawyer and scholar who focuses on religious liberties, I have supported religious exemptions for a baker who refused to create a cake for a same-sex wedding, a family-owned business that refused to provide emergency contraception to its employees, a Muslim prisoner who was obligated to grow a beard and many others.

‘Even so, I believe that under the general law of religious liberty – including the Constitution and state and federal religious freedom laws – the government has an easy case to refuse religious exemptions from vaccines against infectious disease.’

Read here (Religious News Service, Sept 15, 2021)

Sinopharm vaccine for children: Some findings

‘Results from another study evaluating the Sinopharm SARS-CoV-2 vaccine in children were published on September 15 in The Lancet Infectious Diseases. The Phase 1/2 trial examined the safety and immunogenicity of the vaccine in a cohort of children aged 3-17 years, with participants broken into several age groups (3-5, 6-12, and 13-17 years) and dosing groups (0 [control], 2µg, 4µg, and 8µg). Three (3) doses of each vaccine dosage or placebo were administered 28 days apart. All adverse events were categorized as mild or moderate severity, but the article does not report on serious adverse events. The study concluded that children who received the vaccine had robust immune responses and similar levels of neutralizing antibodies to those observed in older vaccine recipients. The study recommended a 2-shot 4µg dose regimen for future Phase 3 trials. Additional data are being collected through a Phase 3 trial currently taking place in the UAE. 

Read here (The Lancet Infectious Disease, Sept 15, 2021)

Nutrition and Covid-19: WHO

• Nutrition advice for adults during the COVID-19 outbreak
• Feeding babies and young children during the COVID-19 outbreak
• Breastfeeding advice during the COVID-19 outbreak

Read here (WHO East Mediterranean as at Sept 2020)

The most alarming problem about Long Covid: Chronic Fatigue Syndrome

‘The main problem with Long COVID is its complexity: dozens of symptoms, different causes, different treatments, vaccine protection, Delta variant, age impact, gender impact, evolution over time…

‘This complexity is crippling. We think “Hmmm Long COVID is bad but how bad? I don’t know… Maybe we should avoid it? But how careful should we be? I don’t know. Is it worth keeping masks? Staying indoors? I don’t know...” So how can we simplify things?

‘By looking at the most alarming problem that Long COVID most likely causes: Chronic Fatigue Syndrome. There are other problems, such as unregistered deaths, post-intensive care syndrome, chronic loss of smell... But they’re too much, and I don’t think they change our takeaways, so we will look at them in the premium deep dive this week, along with other things.’

Read here (Uncharted Territories, Sept 13, 2021)

Considerations in boosting Covid-19 vaccine immune responses

‘In an expert review published September 13 online in the peer-reviewed journal The Lancet, a group of US and international scientists claim current evidence does not support providing booster doses of SARS-CoV-2 vaccines to the general public. The group—including 2 departing US FDA officials and WHO experts—said that any decision to provide additional vaccine doses should be evidence-based, concluding that despite a small drop in protection against symptomatic disease caused by the Delta variant, authorized vaccine regimens continue to provide high levels of protection against severe disease and hospitalization for all major SARS-CoV-2 variants. The authors acknowledged that some additional doses might be needed immediately for certain elderly and immunocompromised populations, but they encouraged prioritizing primary immunizations over booster shots for the general public.

‘The authors also acknowledged that booster doses might be necessary in the future due to waning immunity or the emergence of a vaccine-resistant variant but that current evidence does not warrant additional doses now because “efficacy against severe disease remains high.” The authors noted that currently available vaccine doses could save more lives and provide better protection against the emergence of new SARS-CoV-2 variants if used in previously unvaccinated populations, especially those in low- and middle-income countries.’

Read here (The Lancet, Sept 13, 2021)

The role of built environments in preventing contamination and reducing the spread of Covid-19 for future pandemics

‘The built environment contributes to the spread and contamination of the virus, as people spend more than 90% of their time indoors and even more during lockdown and community quarantine. During the current pandemic, healthy and asymptotic individuals are staying in their houses, and many people that are affected by the virus are now in hospitals and in healthcare facilities. These situations might affect the spread and contamination of the virus, as well as individuals’ interactions with each other.

‘To reduce the contamination and spread of the virus in the built environment that might affect healthy individuals – such as health care professionals, office workers – it is important to understand the steps that need to be taken and the policies to be implemented along with the theories underlying them. One of the approaches to be considered in designing effective fresh air supply and air extraction ventilation systems to minimize the concentration of suspended viruses. This is in addition to other essential procedures to understand the movement of viruses in the indoor air and its suspension/resuspension to and from surfaces.’

• Is it safe to reopen theaters during the Covid-19 pandemic?
• What’s in the pipeline? Evidence on the transmission of SARS-CoV-2 via building wastewater plumbing systems
• Ventilation for residential buildings: Critical assessment of standard requirements in the Covid-19 pandemic context
• Ventilation system design and the coronavirus (Covid-19)
• Outdoor airborne transmission of coronavirus among apartments in high-density cities

Read here (Frontiers in Built Environment, as at September 12, 2021)

Ethical dilemma of mandatory vaccination

‘In the absence of a mandatory vaccine policy, the government can consider other lesser restrictive options. They are as follows:

1. The government can emphasise the educational approach on the vaccine-hesitant population by informing them of the risk-benefit analysis of the vaccine and the importance of taking the vaccine while also addressing their concerns.
2. The government can use behaviour nudge techniques, such as providing incentives or gift cards as the cost incurred will be minimal in comparison to them contracting Covid-19.
3. The government should actively ensure they clamp down on disinformation on social media that further reinforces the false belief of people who hold such extreme views.
4. The health ministry should release data and statistics that are available to bring
5. transparency to help the vaccine-hesitant population make an informed decision.
6. Teachers should not be allowed to teach in schools if they are not vaccinated and continue teaching from home until they get vaccinated.
7. Those who are fully vaccinated can play their role by sharing their experiences as studies have shown people tend to believe their own peers. Social media influencers can use their star power to influence the fence-sitters.
8. The education ministry should consider setting up vaccination centres at schools and provide counselling for school children who refuse vaccines.

‘In a nutshell, the government should navigate through this ethical dilemma cautiously. The government should consider other less restrictive alternatives that will protect the individual’s self-determination which is also in the state’s interest.’

Read here (Free Malaysia Today, Sept 12, 2021)

Covid-19 deaths among vaccinated rare, mostly Sinovac recipients

‘These deaths of the fully vaccinated, that occurred between June 7 and Sept 6, were mainly senior citizens (744; 80.6 percent), had comorbidities (750; 81.3 percent) - usually both (605; 65.6 percent). Deaths among those below 60 with no comorbidities only accounted for 33 cases (3.6 percent).

‘Based on Malaysiakini's analysis of the data, Sinovac vaccine recipients account for 710 out of 922 of these deaths (77.0 percent), even though Sinovac vaccine recipients only make up 51.5 percent of fully vaccinated people as of Sept 6 including the 14-day period after the second dose. In comparison, Pfizer vaccine recipients account for 206 deaths (22.3 percent) while accounting for 43.6 percent of the fully vaccinated population in Malaysia. 

‘In other words, there are 10.11 vaccine breakthrough deaths for every 100,000 people fully vaccinated with the Sinovac vaccine, and 3.47 per 100,000 for Pfizer recipients.’

Read here (Malaysiakini via YahooNews, Sept 10, 2021) 

WHO more doubtful about vaccines ending pandemic

‘The head of WHO Europe was today pessimistic about vaccines’ ability to put an end to the Covid pandemic, as new variants dash hopes of reaching herd immunity. Faced with the possibility that the virus may be around for many years, health officials must now “anticipate how to gradually adapt our vaccination strategy”, in particular on the question of additional doses, Hans Kluge told reporters.’

Read here (Free Malaysia Today, Sept 10, 2021)

Science alone can’t heal a sick society

‘Science is a social process, and we all live amid the social soup of personalities, parties and power. The political dysfunction that holds America hostage also holds science hostage. Dr. Virchow wrote that “mass disease means that society is out of joint.” Society’s being out of joint means that epidemiological research is out of joint, because it exists inside the same society. This is not a new problem, but the dominant “follow the science” mantra misses the fact that the same social pathology that exacerbates the pandemic also debilitates our scientific response to it.

‘To restore faith in science, there must be faith in social institutions more broadly, and this requires a political reckoning. Of course one can cite many specific challenges for scientists: The wheels are coming off the peer review system, university research is plagued by commercialization pressures, and so on. But all of these are the symptoms, not the underlying disease. The real problem is simply that sick societies have sick institutions. Science is not some cloistered preserve in the clouds, but is buried in the muck with everything else. This is why, just eight days after his investigation in Upper Silesia, Dr. Virchow went to the barricades in Berlin to fight for the revolution.‘

Read here (New York Times, Sept 10, 2021)

Our weapon against Covid, one money can’t buy: Exercise

Our weapon against Covid, one money can’t buy... We have to work for it. For those vaccinated, it will elevate our fight against Covid to a higher level. The answer is exercise.

View here (Dr Ling Health Wave, Sept 9, 2021)

Covid-19 vaccines don't raise miscarriage risk, three studies show

Pregnant women who received at least one dose of a COVID-19 vaccine were not at higher risk for miscarriage than their unvaccinated counterparts, according to a trio of new US studies:

Miscarriage no more likely in vaccinated: In the first study, published yesterday in JAMA, researchers from the Vaccine Safety Datalink (VSD) surveillance network used diagnostic and procedure codes and electronic health records to identify and assign gestational ages of miscarriages and ongoing pregnancies from Dec 15, 2020, to Jun 28, 2021... Read here.

More evidence of vaccine safety in pregnancy: Similarly, in a letter yesterday in the New England Journal of Medicine (NEJM), CDC scientists enrolled 2,456 women who were part of the agency's COVID-19 vaccine safety pregnancy registry... Read here.

A revised risk estimate: And in response to a letter yesterday in NEJM, a separate group of CDC researchers updated its analysis of 2,456 pregnant women who received one or two doses of an mRNA COVID-19 vaccine before conception or 20 weeks' gestation... Read here.

Read here (Center for Infectious Disease Research and Policy, Sept 9, 2021)

A strong start by the Health Minister, and more is needed

The Malaysian Health Coalition (MHC) welcomes the strong start by Minister Khairy Jamaluddin, and note the recent evaluation criteria that he set for the Ministry of Health (MOH). We hope to see the entire MOH machinery, as well as inter-agency collaborations, be mobilized to achieve these goals.

We urge the following:

1. Clarify the specific policy changes for an endemic COVID

The Minister stated that Malaysia “can expect to move into an endemic COVID-19 phase” by the end of October 2021. The MOH must clearly communicate this new strategy to the public by announcing the specific policy changes to its COVID-19 responses. Controlling virus transmissibility,  routine vaccination programmes, efficient testing, and improving healthcare capacity, are among the areas that require clear policy shifts, so that we can treat COVID-19 as part of daily Malaysian life. We urge some caution in labelling COVID-19 as endemic, unless these parts of our health system are strengthened. Otherwise, we risk a complacent population or a public administration that stops focusing on COVID-19.

2. Involve expertise from outside MOH when making decisions.

We believe that it is the Minister’s right to build a team which he feels comfortable working with. Nevertheless, we recommend the Minister to get appropriate health advisors and implementation partners, especially from among health experts outside the MOH. Therefore, we urge that non-MOH health advisors and implementation partners be systematically embedded within the decision-making and implementation process, rather than be consulted on an ad hoc basis. A good working model is the Greater Klang Valley Task Force. The MHC and our member organisations are ready to assist.

3. Establish phased Key Performance Indexes (KPIs) for 30-60-90 Days

We commend the Minister’s 100 Day KPIs. However, as we are in the middle of a raging pandemic, some urgent measures must be taken earlier than the 100 days. Therefore, we suggest the Minister agrees on a phased set of KPIs to be achieved within 30, 60, and 90 days, together with MOH and non-MOH experts. This phased KPIs must be publicized for accountability, and also to unite all of Malaysia to achieve these KPIs together. These phased KPIs must be merged with the National Recovery Plan, Budget 2022 and Rancangan Malaysia ke-12, where Health must be at the forefront of all policy considerations.

We must now make up for some lost time due to the political instability of the last 18-months. Therefore, we stand behind the new Health Minister as he leads the MOH to turn the COVID-19 tide in Malaysia’s favour. We will fulfill our duties as responsible health professionals and citizens.

Read here (Malaysian Health Coalition (MHC), Sept 9, 2021)

The plan to stop every respiratory virus at once

‘The benefits of ventilation reach far beyond the coronavirus. What if we stop taking colds and flus for granted, too?

‘The challenge ahead is cost. Piping more outdoor air into a building or adding air filters both require more energy and money to run the HVAC system. (Outdoor air needs to be cooled, heated, humidified, or dehumidified based on the system; adding filters is less energy intensive but it could still require more powerful fans to push the air through.) For decades, engineers have focused on making buildings more energy efficient, and it’s “hard to find a lot of professionals who are really pushing indoor air quality,” Bahnfleth said. He has been helping set COVID-19 ventilation guidelines as chair of the ASHRAE Epidemic Task Force. The pushback based on energy usage, he said, was immediate. In addition to energy costs, retrofitting existing buildings might require significant modifications. For example, if you add air filters but your fans aren’t powerful enough, you’re on the hook for replacing the fans too.

‘The question boils down to: How much disease are we willing to tolerate before we act? When London built its sewage system, its cholera outbreaks were killing thousands of people. What finally spurred Parliament to act was the stench coming off the River Thames during the Great Stink of 1858. At the time, Victorians believed that foul air caused disease, and this was an emergency. (They were wrong about exactly how cholera was spreading from the river—it was through contaminated water—but they had ironically stumbled upon the right solution.)’

Read here (The Atlantic, Sept 8, 2021) 

5 things to know about the Delta variant

“Breakthrough cases,” where people who are fully vaccinated get COVID-19, are still considered rare, even with Delta, according to the CDC, but if a vaccinated person is infected, they can transmit the virus. (The CDC is continuing to assess data on whether people with breakthrough cases who don’t have symptoms can spread the virus.) Here are five things you need to know about the Delta variant.

1. Delta is more contagious than the other virus strains
2. Unvaccinated people are at risk
3. Delta could lead to 'hyperlocal outbreaks'
4. There is still more to learn about Delta
5. Vaccination is the best protection against Delta

Read here (Yale Medicine, Sept 8, 2021)

End vaccine apartheid

‘Vaccine costs have pushed many developing countries to the end of the COVID-19 vaccination queue, with most low-income ones not even lining up. Worse, less vaccinated poor nations cannot afford fiscal efforts to provide relief or stimulate recovery, let alone achieve Agenda 2030.’

This story is well argued and contains several relevant and informative links under the following subheadings:

• Excluding by appropriating:
• Profits booster
• Profits over science
• Apartheid booster
• Vaccine equity necessary

Read here (IPS News, Sept 7, 2021)

New studies find evidence of 'superhuman' immunity to Covid-19 in some individuals

‘So who is capable of mounting this "superhuman" or "hybrid" immune response? People who have had a "hybrid" exposure to the virus. Specifically, they were infected with the coronavirus in 2020 and then immunized with mRNA vaccines this year. "Those people have amazing responses to the vaccine," says virologist Theodora Hatziioannou at Rockefeller University, who also helped lead several of the studies. "I think they are in the best position to fight the virus. The antibodies in these people's blood can even neutralize SARS-CoV-1, the first coronavirus, which emerged 20 years ago. That virus is very, very different from SARS-CoV-2."

Read here (NPR, Sept 7, 2021)

Living with Covid-19 – Is Malaysia ready? — Dr Amar-Singh HSS

‘In recent days and weeks, there have been statements made about moving from a Covid-19 pandemic state to an endemic phase by the end of October 2021. The argument for this is that higher adult vaccination rates will be achieved nationwide by that time. So we need to ask this question: Is Malaysia ready to move to an endemic phase by the end of October 2021? I would like to describe some ‘movements’ we need to make as a nation for us to be ready to enter an endemic phase, as well as offer you a ‘report card’ of our preparedness measures.

• Move from looking at adult vaccination rates to total population vaccination rates
• Move away from herd immunity concepts to mitigating outbreaks
• Move from vaccinating adults to vaccinating children (before reopening schools)
• Move from SOPs to a sustainable change in lifestyle, move from external enforcement to societal checks, and move from dependence on vaccines to using all tools and mitigation measures
• Malaysia’s report card on its preparedness in entering a Covid-19 endemic phase

Three possible ‘phases’ impending

‘Finally, a note about what is to come. No one can predict what will happen with Covid-19, but after hearing international experts and looking at our situation, I would like to offer some ideas.

‘We are currently in what I call the primary protection phase, whereby we are racing against Delta and trying to complete adult vaccination. Many states outside the Klang Valley are in trouble, and we are starting to see rising cases of children hospitalised nationally.

‘We will then move to what I call a consolidation phase, where we try to increase societal protection and reduce the spread of Covid-19 by vaccinating teenagers. Meanwhile, we have to look at the data carefully for any signs of waning immunity, and if adult boosters are required.

‘We then enter a phase I call the long-term danger phase. Here is where we must not let down our guard and risk more outbreaks, especially if worse variants appear. We can do this by a change in lifestyle to address the long term Covid-19 journey. There may be a need to invest in new vaccines.’

Read here (Code Blue, Sept 6, 2021)

India may be reaching ‘endemicity’ after emerging from second COVID-19 wave

‘The number of new COVID-19 cases and deaths in India has dropped dramatically since a second wave of the virus peaked in May. First the Alpha and then the Delta variant — which was first detected in India and is now causing strife elsewhere in the world — ravaged the country. But the seven-day average of daily reported cases this week is just a tenth of the 400,000 recorded during the peak.

‘According to health authorities, more than 439,000 people in India have now died with the virus. The relatively stable numbers, which lasted throughout August, prompted the World Health Organization's chief scientist to suggest India may have reached a state of "endemicity". That is, it may be endemic or constantly present in a particular place. So how did they get there and is the worst of the pandemic over for India?’

Read here (ABC News, Sept 6, 2021)

G20 health ministers aim to vaccinate 40% of global population against Covid-19 by end-2021

‘Health Minister Ong Ye Kung and his counterparts from the Group of Twenty (G20) are aiming to vaccinate at least 40 per cent of the world against COVID-19 by the end of the year. The target was announced at the G20 Health Ministers’ Meeting, held from Sunday (Sep 5) to Monday in Rome.

‘In a press release on Monday, Singapore's Ministry of Health (MOH) said the meeting had also adopted a Health Ministers’ Declaration emphasising the importance of strong multilateral collaboration in managing the COVID-19 pandemic and supporting global recovery, with the World Health Organization (WHO) taking a central and leading role. The health ministers also agreed that vaccination was key.’

Read here (Channel News Asia, Sept 6, 2021)

MOH estimates three undetected Covid-19 cases for every reported infection

‘Malaysia likely has four times more Covid-19 cases than are being officially reported due to limited testing, said Greater Klang Valley Special Task Force (GKVSTF) chief Dr Chong Chee Kheong. Dr Chong said he agreed with views that the real case tally could be undercounted as the government’s policy is to focus on testing symptomatic cases rather than all suspected cases. “On whether it is true that for every Covid-19 case we detect, there are three more undetected cases, that is true,” he told a media briefing today. The Ministry of Health (MOH) reported a record high 20,596 new Covid-19 cases yesterday.’

Read here (Code Blue, Aug 6, 2021)

Much more to do before reaching endemic phase, says expert

‘Malaysia is not ready to enter an endemic phase of the Covid-19 crisis, which the health ministry said the country would reach by the end of October, according to a consultant doctor. Dr Amar-Singh HSS, a consultant paediatrician, said Malaysia could only enter an endemic phase by January or February. The term refers to the presence of an infectious disease being permanently present in the population...

‘Amar said Malaysia would endure three phases in the current health crisis. The current phase was the Primary Protection Phase, with the country racing to control the Delta variant and trying to complete adult vaccination. Many states outside the Klang Valley are in trouble and a rising number of children are being hospitalised, he said.

‘Next would be the Consolidation Phase, with increased societal protection, and teenagers being vaccinated to reduce the spread of the virus. (Yesterday, health minister Khairy Jamaluddin said vaccinations of teenagers would begin in Sarawak this month.)

‘Amar said the final phase would be the Long-term Danger Phase. “Here is where we must not let down our guard and risk more outbreaks, especially if worse variants appear. We can do this by a change in lifestyle to address the long-term Covid-19 journey,” he said, adding there may be a need to invest in new vaccines.’

Read here (Free Malaysia Today, Sept 5, 2021)

Health officials quietly moved the date of the 1st US COVID-19 death to January 2020

‘The first recorded death from COVID-19 in the U.S. occurred a month earlier than previously thought: A Kansas woman's death certificate was recently amended to say she died from the disease in January 2020, according to news reports.

‘The 78-year-old woman, Lovell "Cookie" Brown, died on Jan. 9, 2020 in Leavenworth, Kansas, several weeks before the first cases of COVID-19 were identified in the U.S., according to The Mercury News. Initially, Brown's death certificate said she died of a stroke and chronic obstructive lung disease. But in May 2021, her doctors quietly updated the certificate to add "COVID-19 pneumonia" as a cause of death, The Mercury News reported...

‘Before her death, Brown had experienced symptoms of headache, fever, diarrhea and body aches, and on Christmas Day 2019, her family remembered Brown saying that her favorite foods tasted bland, The Mercury News reported. When she began gasping for air, Brown was rushed to the hospital, where she spent a week in the ICU before her death.’

Read here (LiveScience, Sept 4, 2021)

WHO starts data-sharing effort to prevent pandemics. Will nations cooperate?

‘WHO Hub for Pandemic and Epidemic Intelligence opens in Berlin backed by initial US$100 million from Germany. It aims to pool global disease data, and produce tools to predict outbreaks – but is reliant on countries taking part.’

Read here (South China Morning Post, Sept 3, 2021)

What we actually know about waning immunity

‘Vaccines don’t last forever. This is by design: Like many of the microbes they mimic, the contents of the shots stick around only as long as it takes the body to eliminate them, a tenure on the order of days, perhaps a few weeks.

‘What does have staying power, though, is the immunological impression that vaccines leave behind. Defensive cells study decoy pathogens even as they purge them; the recollections that they form can last for years or decades after an injection. The learned response becomes a reflex, ingrained and automatic, a “robust immune memory” that far outlives the shot itself, Ali Ellebedy, an immunologist at Washington University in St. Louis, told me. That’s what happens with the COVID-19 vaccines, and Ellebedy and others told me they expect the memory to remain with us for a while yet, staving off severe disease and death from the virus at extraordinary 

‘That prediction might sound incompatible with recent reports of the “declining” effectiveness of COVID-19 vaccines, and the “waning” of immunity. According to the White House, we’ll all need boosters very, very soon to fortify our crumbling defenses. The past few weeks of news have made it seem as though we’re doomed to chase SARS-CoV-2 with shot after shot after shot, as if vaccine protections were slipping through our fingers like so much sand.’

Read here (The Atlantic, Sept 3, 2021)

India’s DNA Covid vaccine is a world first – more are coming

‘India has approved a new COVID-19 vaccine that uses circular strands of DNA to prime the immune system against the virus SARS-CoV-2. Researchers have welcomed news of the first DNA vaccine for people to receive approval anywhere in the world, and say many other DNA vaccines might soon be hot on its heels.

‘ZyCoV-D, which is administered into the skin without an injection, has been found to be 67% protective against symptomatic COVID-19 in clinical trials, and will probably start to be administered in India this month. Although the efficacy is not particularly high compared to that of many other COVID-19 vaccines, the fact that it is a DNA vaccine is significant, say researchers.

‘It is proof of the principle that DNA vaccines work and can help in controlling the pandemic, says Peter Richmond, a paediatric immunologist at the University of Western Australia in Perth. “This is a really important step forward in the fight to defeat COVID-19 globally, because it demonstrates that we have another class of vaccines that we can use.”

Read here (Nature, Sept 2, 2021)

Lessons learnt for pandemic preparedness in Malaysia ― Chan Chee Khoon

1. Undocumented migrants in novel infectious outbreaks

‘Malaysia, sadly, is reaping the consequences of decades of corrupt mismanagement of the “supply chain” for foreign labour, viz. a persistently large pool of undocumented migrant workers, often in congested workplaces and dormitories, who have strong incentives to avoid contact with government agencies. 

‘Already fearful of detection, arrest, and deportation in pre-pandemic times, undocumented migrants’ insecurities were exacerbated by the policy reversals of the Majlis Keselamatan Negara (MKN) and its contradictory messaging over an offer of temporary amnesty to facilitate Covid testing, contact tracing, isolation & treatment, and vaccination.

‘This deeply rooted problem with undocumented migrants, which persists despite repeated rounds of amnesties, will prolong our catastrophic experience with Covid-19 (and future pandemics as well).’

2. Local manufacture of vaccines

‘The major bottleneck was vaccine supply.  The likelihood of further variants and endemic Covid emphasises the importance of local capacity for manufacturing vaccines and other pandemic essentials, as part of Malaysia’s pandemic preparedness.’

Read here (The Malay Mail, Sept 1, 2021)