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)

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)

Covid-19: What is coming our way? — Dr Amar-Singh HSS

‘We have all been occupied by the political situation in the country, but the Covid-19 virus is not. It is continuing its relentless march forward, whether we are focused on it or not. While an efficient government that deals with the pandemic decisively is crucial for the country, Malaysians need to be prepared for what is coming our way. I would like to share with you some possible scenarios for the coming weeks and months, and some thoughts and opinions based on current data.

• Continued recovery in the Greater Klang Valley
• Worsening crisis outside the Klang Valley
• Infections in children the next wave?
• Resolving Sinovac vaccine efficacy issues
• The myth of herd immunity and a resurgence of Delta as immunity wanes?

Read here (Code Blue, August 19, 2021)

Beware the fifth wave of Covid-19 — Amar-Singh HSS

‘On 8th May 2021 I wrote about how to “Avoid a Covid-19 Disaster in Malaysia”. This crisis has washed over us and the toll in deaths and loss of livelihood has been and continues to be significant. I am now writing about the impending, massive fifth wave. This wave may be so big as to make the current one look pale in contrast. In a sense we have, in the fourth wave, experienced what Italy did last year. Now the fear is that we may experience what India, Peru and some other countries in South America are experiencing.

‘Some of our leaders seem to live in denial of the reality; one even saying that the pandemic in Malaysia is under control. Others have set a value of '4000 cases' as a benchmark to use, but in the face of a high positivity and limited testing this is fraught with problems. A good look at the data and trends suggest that the worst may be yet to come.’

Read here (The Malay Mail, June 25, 2021)

Should we vaccinate our children against Covid-19 in Malaysia? — Amar-Singh HSS

While we take every protective measure to prevent children from getting infected, we need to ask ourselves if we should consider vaccinating children against Covid-19. Some issues to consider the risk and the benefit are discussed below.

• How severe is Covid-19 in children? Will vaccines benefit children?
• Are Covid-19 vaccines safe to use in children?
• Are there benefits to the family and society?
• Remember that children cannot be a priority for vaccination until we first vaccinate all adults that are keen. This includes the elderly, those with chronic illness, younger adults who comprise our workforce and our migrant workers.
• What are other nations doing?

Summary

‘The pandemic impacts all of us, even those not infected. We will have to grapple with these issues as parents and a society as we decide about Covid-19 vaccination for children. How effectively we control the outbreak locally and the spread and impact of variants (mutations) will also determine our response and decision regarding this issue.

‘In Malaysia we have yet to make a serious impact on vaccination rates for those at high risk of severe illness and death (the elderly and those with chronic illnesses). No matter how much we want to support children, it is imperative that we push for those at highest risk to be vaccinated before we vaccinate children. In addition, it is vital to vaccinate young adults who are working and mobile as they are important drivers of the pandemic. However we should consider selectively vaccinating children with severe disabilities in residential care, especially if at high risk of exposure to Covid-19.

‘My personal preference would be not to subject our children to mass vaccination against Covid-19 however to control Covid-19 in the community we may have to vaccinate children aged 12-17 years. The recovery of our nation from Covid-19 means the recovery of our children from the severe mental strain that currently impacts them daily. Lives are currently being lived on a ‘pause button’ and vaccination is an important measure to return our society to a semblance of normality.’

Read here (The Malay Mail, June 6, 2021)

Some personal insights into the Covid-19 situation in Malaysia — Amar-Singh HSS

‘This article offers some personal insights into the Covid-19 situation in the country. One concern is that the public in some states behave as though the worsening outbreak is confined to the Klang Valley, or only to selected states. This is a dangerous assumption as the situation is worsening in the whole nation. The lack of adequate data hampers the public’s appropriate response to the deepening crisis.’

The following matters are discussed:

• ICUs bed occupancy is at critical levels nationwide
• Mortality rate is rising
• Younger persons are dying and mutations spreading
• When will the current outbreak peak?
• What are the implications of these trends?
• What is possibly going to happen?
• What can we do as the general public?’

Read here (The Malay Mail, May 23, 2021)

Avoid a Covid-19 disaster in Malaysia — Amar-Singh HSS

‘A Covid-19 disaster is looming in Malaysia as we watch the numbers rise. It is semantics to argue if we consider this a fourth wave or a resurgence of the third wave. What we know as a reality is that our control measures are no longer effective, deaths are increasing, younger persons are dying (some with no chronic illnesses) and our intensive care units (ICUs) are getting choked.

‘Our fear is not just death but Long Covid-19; i.e. 10-30 per cent of all adults that get infected, even with a mild illness, may suffer long term damage to organs and be debilitated for many months. It would be foolish to think that we cannot reach a state like India is in today. Don’t forget what happened to Italy early in the pandemic — they have much better health infrastructure compared to us and yet were overrun.’

Read here (The Malay Mail, May 8, 2021)

Covid-19 vaccination: Can we achieve herd immunity? ― Amar-Singh HSS

‘To achieve herd immunity against Covid-19, a substantial proportion of a population would need to be vaccinated but we are currently uncertain as to what this percentage is. In some diseases like measles 90-95 per cent of a population need to be vaccinated to achieve herd immunity; in others like polio we require about 80 per cent.

‘It is very likely that for Covid-19 we will require at least 75-85 per cent of the population to be vaccinated. This can be supplemented by those who had prior infection with Covid-19.’

Read here (Malay Mail, Mar 18, 2021)

I have allergies – Can I take the Covid-19 vaccine? — Dr Amar-Singh HSS

‘I believe there are three possible options for those of us with severe allergies:

• We may choose not to get vaccinated as we feel the risk is too high. But we will have to accept a much stricter SOP for our lives and be prepared to have our lives restricted for some time.
• The second option is that we choose to vaccinate and, due to the high risk, ask that it be done with enhanced health professional support, i.e. vaccinate in a hospital and have good backup with adrenaline at hand.
• The third option is to delay vaccination and watch the data as more is made available. The risk of anaphylaxis is small and likely to be even smaller as we get more vaccination data. We will also have a clearer idea which vaccine has the lowest rate of severe allergic reaction. Once this data is available we hope to be able to choose the least allergic vaccine and vaccinate in a hospital with good physician backup.’

Read here (Code Blue, Mar 1, 2021)

Pre-empting the anti-Covid-19 vaccine propaganda ― Amar-Singh HSS, Alan Teh Kee Hean, Lim Joo Kiong, Nor Azmi Kamaruddin and Lim Swee Im

‘This is a brief article to help us understand that there will be some expected deaths after receiving Covid-19 vaccination, especially in the elderly. The aim of the article is to pre-empt the anti-vaccine lobby and any attempt to damage our national Covid-19 vaccination programme. We will use data from the United Kingdom (UK), United States of America (USA) and the European Union (EU) to explain what we mean...

‘It is important for the public to understand this as we embark on our national Covid-19 vaccination programme. Some of our loved ones may die after the vaccination but this will likely NOT be due to the vaccination. As members of the public we should stay abreast of the science and data as it emerges and not fall prey to rumours or anti-vaccine propaganda.’

Read here (The Malay Mail, Feb 23, 2021)

Key measures to reduce the Covid-19 raging fire ― Amar-Singh HSS

‘Many individuals and groups have voiced suggestions to manage our raging Covid-19 pandemic in Malaysia. However few appear to have been considered. Allow me to summarise five key measures we critically need to take to help put out the Covid-19 raging fire in our nation:

• Test extensively
• Restore contact tracing
• Support MoH staff
• Improve home quarantine
• Widen pick-up services

Read here (The Malay Mail, Jan 23, 2021)

Where is Malaysia headed with Covid-19? Dr Amar-Singh HSS

‘For Malaysia to have a hopeful 2021 where Covid-19 is concerned we need the following changes in outlook and behaviour.

• Transparency is crucial: ‘If we want to move forward then there must be transparency. We must not learn about things first from whispers on social media and cries for help on Twitter or Facebook. We must learn it first from the authorities, no matter how unpalatable the situation...’
• Stop blame shifting and take responsibility: ‘Stop putting the entire blame on the public for the failure to control the pandemic. It is time to stop fining and arresting the average citizen for SOP violations. The failure of some elected representatives in government to maintain effective SOPs and the lack of penalty for them is a major thorn in the side of the public...‘
• We need many voices: ‘We need many people with ideas to speak up. We need many divergent views to be aired and discussed. We need an ongoing national dialogue to chart the best way forward...’ 
• More support is required: ‘The amount of resources and support we have put into dealing with this pandemic is still limited. We need to ramp up our support and initiatives. We urgently need to absorb all the health manpower that is available (before we lose them to our neighbours)...’

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

Covid-19: Protecting our children ― Amar-Singh HSS

‘This recent infant death will have alarmed parents and those of us working with children. We want to know how we can protect our children better. The clear message is that we cannot protect our children without controlling the pandemic in the community; these two are intricately linked. I would like to offer some suggestions of what we can do in the face of the extensive community spread that is currently occurring in the country.’

• Improve SOPs at schools, taskas, child care facilities
• Strengthen our contact tracing with data transparency
• Advocate for health support to be ramped up with regards to (1) testing (2) use of rapid antigen detection tests (3) boost of manpower at MOH (4) injection of funds at MOH for equipment, PPEs, etc
• Stop poor leadership by example that hampers population compliance

Read here (Malay Mail, Oct 7, 2020)

There is no ‘new normal’: We were not normal to begin with

‘We would like to say that there is no ‘new normal’ because we were not normal to begin with. We have been abnormal as a society for a very long time. The coronavirus has helped to unmask our sick society and systems that we have developed and evolved over many decades. Greed, corruption, power hunger, control, oppression, lies and self-interest have become the hallmarks of our present society, and in most nations. While there are altruistic individuals and some who are trying to improve the situation, many are caught in the chase for wealth and power. Most have become cynical, hope-less and weary.’

Read here (The Malay Mail, August 30, 2020)

Unmasking the masks facts and fallacies: Lecture on masks by Dato' Dr Amar Singh

This is highly relevant current information on Covid-19 transmission and the use of face masks including reusable cloth masks and emerging ones.

Watch here (Youtube, August 1, 2020)

Covid-19: Getting our SOPs right - Amar Singh HSS and Lim Swee Im

This article discusses a number of issues on SOPs pertaining to Malaysia today:

• How can we best monitor our pandemic when our numbers are low?
• How ready are our testing capabilities for a second and subsequent waves?
• How good are our safe physical distancing measures?
• Optimising masks in Covid-19 prevention
• There is no way for the poor (B40) to comply with this ruling without a government mandated free programme
• Mask etiquette and our leaders

Read here (The Malay Mail, July 27, 2020)

Guide for Covid-19 prevention in schools

‘As we attempt to open schools and learn from the few countries that have done so, we must recognise that the key will be to try and create a bubble (a shield) in which students who go to school "live in" so as to minimise infection spread. This "bubble" also means that if one group has Covid-19 infection, only they are isolated and the rest of the school can probably continue.’

This guide by Amar-Singh HSS and Shyielathy Arumugam can be downloaded here.

Read here (Malay Mail, May 20, 2020)

Guide for Covid-19 prevention in aged residential care facilities — Amar-Singh HSS, Vivienne Yong and Liew Tuan Hock

‘Older individuals in residential care need to be shielded from the risk of getting coronavirus infection. The key will be to try and create a bubble (a shield) in which the residents and staff live and operate, so as to minimise new individuals and infection entering the group. This guide and standard operating policy (SOP) aims to help offer ideas and initiatives that could be taken.

‘The guide covers the areas to consider with suggestions for improving Covid-19 prevention. It looks at policy, staff, residents, healthcare workers/therapists and visitors policies. The guide will be useful for nursing homes, old folks homes, retirement villages, palliative care facilities and also relevant to other residential care facilities for any age. It is relevant to non-governmental, private and governmental facilities.’

The full Aged Residential Care Facilities Guide is available for download and use from this link.

Read here (Malay Mail, May 18, 2020)

Are you and your office ready for post-MCO? 18 questions from Dr Amar-Singh

We need to behave and act as though everyone around us is Covid-19 positive. We need to behave and act as though we have an asymptomatic infection of Covid-19 and can infect others. We need to protect all older persons as if they are our parents and all those vulnerable to Covid-19 as our sisters and brothers.

As you plan to return to the office, here is a checklist of some of the things you need to consider and prepare for:

1. How are you going to manage public transport?
2. Has your office prepared a clear standard operating policy (SOP) or checklist to minimise the risk of staff getting the virus or spreading it?
3. How is the office building going to limit the number of people who enter and leave when coming to work and going home?
4. Has your office thought about staggered working hours or work from home?
5. How is the office building going to handle lifts?
6. What are you going to do about the office air-conditioning?
7. How can we modify the open office environment?
8. How will you modify the office meeting?
9. How to avoid contamination of common used items?
10. How are you going to deal with the pantry, prayer areas and common staff areas?
11. Have you a plan for mask safety and changing masks?
12. What is the plan to limit staff socialising?
13. What is the policy for the toilets?
14. What is the new cleaning routine for the office?
15. How will we use gloves optimally?
16. What is the policy if someone is unwell?
17. How do we deal with travelling, site visits, conferences, etc?
18. Do you have a plan to minimise virus transmission to your family?

Read here (The Malay Mail, April 28, 2020)

Malaysia not ready to lift MCO, says medical expert

‘Malaysia is not ready to lift the movement control order (MCO), implemented to contain the spread of Covid-19, in the near future due to many issues that still need to be addressed, said senior consultant paediatrician Datuk Dr Amar Singh HSS.

‘According to the former head of the paediatric department at the Raja Permaisuri Bainun Hospital in Ipoh, Perak, out of the six criteria listed by the World Health Organisation (WHO) with regard to lifting the movement order, Malaysia was still lacking in four aspects—testing and screening, health system capacity, contact tracing and, most importantly, community’s mindset.

‘(The six criteria listed by WHO are transmission is under control; health systems are able to detect, test, isolate and treat every case and trace every contact; hot spot risks are minimised in vulnerable places, such as nursing homes; schools, workplaces and other essential places have established preventive measures; the risk of importing new cases can be managed; and communities are fully educated, engaged and empowered to live under a new normal.)’

Read here (The Malay Mail, April 26, 2020)