The ivermectin saga in Malaysia: Nov 2021

We don’t recommend Ivermectin to treat Covid-19, says health DG. Read here (Free Malaysia Today, Nov 3, 2021)

Ivermectin study: Doctor whose clinic was raided stands his ground, disputes findings Read here (Free Malaysia Today, Nov 3, 2021)

I’ll study findings, says MP who urged use of Ivermectin for Covid treatment Read here (Free Malaysia Today, Nov 3, 2021)

All about Molnupiravir, the anti-Covid pill

‘A new pill with the promise to treat Covid-19 is creating waves across the world and even at US$700 for a five-day course of treatment, it might just be a game changer. It is too early to tell if it will be available to Malaysians, although health minister Khairy Jamaluddin has revealed that he has started negotiations for Malaysia to procure the drug Molnupiravir, which is reputed to have shown a 50% reduction in the risk of hospitalisation and death.

‘Developed by US pharmaceutical giant Merck & Co, the pill has yet to get emergency authorisation by the US Food and Drug Administration (FDA). It would be the first Covid-19 oral antiviral medicine, if approved.

‘How does the pill work? The pill has been designed to introduce errors into the genetic code of the virus, thereby stopping effective replication. It is designed to be taken once someone displays Covid-19 symptoms. One course of the treatment lasts five days, with four capsules taken twice a day for a total of 40 pills.

‘How effective is it? Merck says the drug cuts the risk of hospitalisation or death in half according to trials conducted among 775 Covid-19 adults with mild-to-moderate Covid-19 symptoms. After 29 days, 7% of those who received the drug were hospitalised compared to 14% of those who received the placebo. No deaths were reported in patients who received Molnupiravir while there were eight deaths in patients who took the placebo, the company said.’

Read here (Free Malaysia Today, Oct 3, 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)

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)

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)

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)

Singapore SARS survivors yield hope for Covid super vaccine

‘Survivors who lived through the SARS crisis in Singapore nearly two decades ago may yield hope for the development of a super vaccine to combat potent Covid-19 variants and even other coronaviruses, new research shows.

‘Scientists from the city-state’s Duke-NUS Medical School and National Centre for Infectious Diseases (NCID) have found “highly potent functional antibodies” in people who had severe acute respiratory syndrome and were vaccinated with Pfizer-BioNTech’s shots for Covid-19.’

Read here (Free Malaysia Today, August 21, 2021)

Bar council slams ‘disturbing’ new fake news law

‘The latest clampdown on fake news comes as a shock for lawyers, with Bar Council president Salim Bashir describing the powers the government has given itself to clamp down on such news as “disturbing”. Speaking to FMT, he also said the “imprecise definition” of fake news that includes anything related to Covid-19 and the proclamation of emergency, was “worrisome.”

‘Gazetted today, the Emergency (Essential Powers) (No. 2) Ordinance 2021 penalises those who create, publish or distribute fake news with a fine of up to RM100,000, a jail term of up to three years or both. If they fail to apologise after being ordered to do so by the court, they can be fined an additional RM50,000, and those who pay to “create” such news can be fined up to RM500,000. All fines come with jail terms as well.’

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

Private hospitals to work with govt in vaccine rollout

‘Private hospitals across the country say they are ready to work with the government in vaccinating the public to speed up the National Covid-19 Immunisation Programme.

‘Association of Private Hospitals of Malaysia (APHM) president Dr Kuljit Singh said the group was waiting to discuss the mechanism of the programme as “many would be happy to be vaccinated in private hospitals”. “It is a service we can provide for the public. However, we are waiting for further instructions,” he said in a statement.’

Read here (Free Malaysia Today, Feb 16, 2021)

Is Noor Hisham a bystander in the Covid-19 crisis? Frankie de Cruz

‘Some claim the director-general of health, who wasn’t fazed by whatever was thrown at him in the early days of the crisis, is in a political straitjacket. Could it be that his views have narrowed the political and economic choices of those in power to relatively tight parameters?

‘If that is true, it needs fixing. In the meantime, the people expect professionalism and strong leadership at a time when Covid-19 infections and deaths are rising. That means Noor Hisham has to be firm and shoot straight to give Malaysians the confidence that the war is being fought with confidence.’

Read here (Free Malaysia Today, Jan 31, 2021)

Why use emergency when we freely offered help? Asks medical group

‘Galen Centre for Health and Social Policy CEO Azrul Mohd Khalib said the proclamation of an emergency appeared to involve harnessing the resources of the private sector, based on Prime Minister Muhyiddin Yassin’s speech on Tuesday. He said this could mean some private hospitals and medical facilities being requisitioned to increase the public health sector’s capacity for intensive care, beds and specialised personnel.

‘However, he told FMT that private healthcare stakeholders, particularly hospitals, had been trying to get some form of a public-private operational framework for Covid-19 and non-Covid-19 cooperation and funding since early 2020. “However, there has been limited movement on this issue. The latest decision must come as a shock, as the government seems to want to use emergency legislation to get what was willingly offered,” he said.’

Read here (Free Malaysia Today, Jan 14, 2021)

Military gets emergency power to detain MCO offenders

‘Officers and personnel of the Malaysian armed forces now have the power to detain and take action against those found violating the movement control order, senior minister for security Ismail Sabri Yaakob said today. He said that the Emergency Ordinance provides similar authority to the police and military, which would help efforts to manage the Covid-19 crisis better.

“If previously the armed forces could only take action if there was border intrusion, now they can detain suspects for further action without the presence of police,” he said at his daily media briefing.’

Read here (Free Malaysia Today, Jan 14, 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)

Revelations in Malaysia’s pioneering Covid-19 study

‘Malaysia has something new to be proud of... Just two weeks ago, a band of Malaysian medical professionals wrote and published Southeast Asia’s first national study on Covid-19 cases, representing an entire country’s experience.

‘It was featured in The Lancet, arguably the most prestigious and influential medical journal in the world. Titled “Clinical characteristics and risk factors for severe Covid-19 infections in Malaysia: A nationwide observational study”, it was written by Benedict Lim Heng Sim, Suresh Kumar Chidambaram, Xin Ci Wong, Mohan Dass Pathmanathan, Kalaiarasu M Peariasamy, Chee Peng Hor, Hiu Jian Chua, and Pik Pin Goh. It provides a detailed picture of the disease’s spread in Malaysia from Feb 1 till May 30, 2020.

Ethnic mix: ‘Malays account for 58.4% of all cases and 70.0% of all severe cases, while the Chinese account for 6.7% of all cases and 12.1% of severe cases and Indians account for 2.3% of all cases and 4.5% of severe cases. The ratio of severe cases to all cases of almost 2 to 1 for Chinese and Indians might be due to their slightly older-skewing population. Other nationalities account for 23.8% of all cases but only 4.9% of all severe cases – a ratio of almost 5 to 1. This, again, could be due to the foreign worker population which generally skews younger and so has a reduced chance of developing a severe instance of the disease.’

Co-morbidities: ‘Those with hypertension are the most at risk at 48.6%, followed by diabetes mellitus at 39.1% and chronic cardiac disease at 14.0%. Surprisingly enough, being an active smoker does not indicate an elevated risk of developing a severe infection. Smokers account for 9% of all cases and 7% of severe cases...’

Read here (FreeMalaysiaToday, Dec 2, 2020)

Clinical characteristics and risk factors for severe COVID-19 infections in Malaysia: A nationwide observational study

Read here (The Lancet, Nov 17, 2020)

Why is it hard to do what is right?

‘In the fight to contain the spread of coronavirus, Malaysians have split into two camps: the risk-takers and the rule-followers. On one side are carefree people who ignore public health measures; on the other are the anxious ones coming to grips with the reality of life with Covid-19. What a depressing spectacle has been the effect of the recovery movement control order involving public transport and eating out.’

Read here (Free Malaysia Today, June 14, 2020)