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)

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)

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)

CDC: Covid-19 surface transmission risk below 1 in 10,000

‘The likelihood of contracting Covid-19 from touching contaminated surfaces is low at less than one in 10,000, announced the United States’ Centers for Disease Control and Prevention (CDC).

‘In new guidance released on April 5, the CDC said although it is possible for people to contract the coronavirus from surface transmission, the main mode of transmission of the disease is through direct contact with an infected person, droplet transmission (most likely to occur when one is within two metres of an infected person exhaling virus-containing respiratory droplets), and airborne transmission (exposure to smaller virus-containing respiratory droplets that can remain suspended in the air).’

Read here (Code Blue, Apr 9, 2021)

Khairy welcomes private sector procuring approved Covid-19 vaccines

“With regards to the purchase of vaccines by the private sector, as I have mentioned yesterday, most of the vaccine manufacturers only carry out negotiations with governments,” Khairy responded to Najib in a comment on his Facebook post...

“But if there are private parties who are able to carry out negotiations with vaccine manufacturers, especially those that have received approval from the NPRA (National Pharmaceutical Regulatory Agency) (Pfizer, AstraZeneca, and Sinovac), please do so. I really welcome it,” added the science, technology and innovation minister. 

‘Previously, Malaysian-based pharmaceutical company Pharmaniaga Bhd announced that it planned to sell some of its Sinovac vaccine doses to the private sector. Pharmaniaga is undertaking the fill-and-finish processing of Sinovac’s vaccine. Solution Biologics, the distributor of Chinese CanSino’s vaccine, has also expressed plans to supply private health care providers with the vaccine, on top of selling 3.5 million doses to the Malaysian government.’ 

Read here (Code Blue, Mar 10, 2021)

Malaysia vaccinates one third of frontliners within fortnight

‘A third of 500,000 frontliners have received their first dose of the Covid-19 vaccine, some three weeks before the targeted vaccination completion by March 31. As of March 8, a total of 166,363 frontliners have received their first dose of the coronavirus vaccine, achieving 33.3 per cent of the national Covid-19 immunisation programme’s Phase One target in 13 days after the vaccines were rolled out from February 24.

‘If the current pace continues, the government will need another 26 days to administer at least the first dose to all 500,000 frontline workers, just slightly missing the March 31 target by three days.’ 

Read here (Code Blue, Mar 9, 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)

10 steps to prevent Malaysia's Covid-19 pandemic slipping into ICU

This back-to-basics public health management of a pandemic, endorsed by 46 experts in their respective fields, was sent to the Malaysian Prime Minister on January 7. They are:

1. To ramp up testing with triaged, mass and frequent testing regimen, utilising inexpensive rapid testing kits (RTK-Ag), instead of PCR, to help slow the transmission of Covid-19.
2. Early RTK-Ag diagnosis of cases within 24 hours will enable rapid isolation of cases and facilitate prompt contact tracing.
3. Automating contact tracing with digital apps will hasten the tracking process, while leveraging on data science and machine learning can identify the hotspots in the nation for targeted screening. Only this find-test-trace-isolate rapid response will bust the Covid-19 clusters and mitigate the sporadic spread of the virus.
4. In anticipation of the increasing Covid-19 cases and to protect the healthcare capacity, we advocate that clinical stage 1 and 2 cases be isolated at home with clear guidelines from the health ministry. Their well-being can be tracked daily with digital apps supported by empowering the local community, and urgent transfers to Covid-19 hospitals organised for cases that deteriorate.
5. We must protect the excellent work of our medical professionals in the Covid-19 hospitals by decanting all non-Covid cases to non-Covid government and private hospitals. This will allow them to focus on the most severe cases and not be distracted by asymptomatic and mild cases, thus ensuring the best outcomes.
6. The POIS initiative (Preventing and early detection of Outbreaks at Ignition Sites) is a tripartite government, private sector and NGO partnership which emphasises early detection testing regime, enhances public health measures and health education of industry and migrant workers. This POIS initiative developed in consultation with industry and WHO can be replicated elsewhere as a public health operational tool, truly embracing a whole-of-government and whole-of-society approach.
7. Similar initiatives must be developed for the other hotspots of Covid-19 outbreaks, namely the prison and detention centres.
8. Expedite the regulatory processes so that immunisation can begin as soon as the first doses of vaccines arrive at the airport. Debunking Covid-19 and vaccine disinformation will empower our rakyat with informed consent when the vaccines arrive. Apart from prioritising the high-risk groups, seriously consider vaccinating migrant workers to protect our industries and the refugee community who are silent epicentres of Covid-19 outbreaks. The cost of the vaccines must be capped at less than RM100 per dose for those getting their shots privately and by extension, the rapid test kits must be capped at less than RM100 per test to ensure more affordable and wider coverage as well as uptake of both vaccines and rapid testing.
9. A Covid-19 task force comprising a cross-sectoral and empowered team of subject matter experts must be immediately formed to provide evidence-based advice on a harmonised whole-of-government response across ministries and agencies. The task force will help steer the nation out of this pandemic by regularly presenting its recommendations and audit of the health economic impact of key decisions to the Cabinet. To ensure independence of the task force, the Malaysian Medical Association, Academy of Medicine Malaysia, Malaysian Public Health Physicians’ Association and Association of Private Hospitals Malaysia are best positioned to select the members.
10. Do not politicise the pandemic but instead secure a bipartisan consensus and approach to flatten the pandemic curve, accelerate efforts to achieve herd immunity as a form of community protection to coexist with the virus. GE15 in the midst of an uncontained pandemic is an unmitigated disaster waiting to happen as the Sabah election has exemplified.

Read here (Free Malaysia Today, Jan 7, 2021)

Open letter to PM: 10 critical actions to manage Covid-19 — Health experts

Read here (Code Blue, Jan 7, 2021)

Covid-19 is dangerous, not vaccines — 20 scientists, doctors, and concerned individuals

‘Statements propagating fear-mongering and pseudoscience that attack Covid-19 vaccines’ mRNA (messenger RNA) technologies – which have now been approved by the US’ Food and Drug Administration, the UK’s Medicines and Healthcare Products Regulatory Agency, the European Medicines Agency, and the regulatory bodies of at least seven other countries – risk turning Malaysians off all Covid-19 vaccines entirely, as some may not differentiate between one type of Covid-19 vaccine with another. mRNA and vector-based therapies have actually been used for nearly a decade to treat people with cancer, inherited immunodeficiencies, and metabolic, eye, and neuro-muscular diseases.’

Read here (Code Blue, Jan 4, 2021)