Sabah's serious Covid-19 situation: Bridget Welsh

‘Beyond case numbers and widespread infection, there are other indicators of the growing intensity of Covid-19 in Sabah. Foremost is the stark number of unlinked cases, cases that show no clear tie to another infected patient. An estimate by Dr Amar-Singh places the most recent unlinked cases as high as 91 percent. This indicates that the virus is in the community and being spread untraceably in the community.

‘Second, the strain of the virus reported in Sabah is among one of the most infectious, contributing to higher rates of transmission. Third, even more troubling is the fact that more people are dying – a toddler last week, more women (who disproportionately are less mobile within Sabah and should be less at risk) and those without underlying health conditions...

‘The time for a “normal” response has passed. The normal response has repeatedly disadvantaged Sabahans as federal authorities lack adequate appreciation of the realities on the ground. It is important to understand those federal failures surrounding Covid-19 add to the deep resentments and divisions that already exist.’

Read here (Malaysiakini, Oct 11, 2020)

Dr Noor Hisham: Controlling large scale community transmission is top priority. At R0 of 2.2, 4,500 cases daily by Oct 31

"Controlling the large scale community transmission is our top priority. We need strong solidarity and unity, together we can better fight this common enemy," he said on his Twitter post on Tuesday (Oct 6). 

‘Separately, Dr Noor Hisham also posted a graph projecting the course of Covid-19 cases with an infectivity rate (R0 value) of 0.3, 1.5, and 2.2. With the R0 value of 0.3, it is estimated that cases will taper down to below 500 cases by Oct 31. However, with an R0 of 1.5 and 2.2, it is projected that the number of cases will rise to more than 1,000 and 4,500 cases, respectively, by Oct 31.’

Read here (The Star, Oct 6, 2020)

How superspreading is fueling the pandemic — and how we can stop it

‘We now know that, on average, most people with the novel coronavirus pass the virus to just one other person, or to no one else at all. But some go on to infect many, many more, often before they even experience symptoms. Many of these transmission chains begin with “superspreading” events, where one person (usually in a crowded indoor space) passes the virus to dozens of others. Early contact tracing studies suggest these events have been a large driver of transmission around the world. By some estimates, 10 percent of people have been causing 80 percent of new infections.

This article tries to answer the following:

• Why is the coronavirus so good at superspreading?
• Are certain people more likely to be superspreaders?
• Why superspreading is more common at concerts than in libraries
• What should we be doing to limit superspreading?

Read here (Vox, Oct 3, 2020)

Knowing Covid-19 was at their door, family of 8 planned strategy to fight it

‘When Aman Gwjwn, 17, developed a persistent cough and cold in July while on holiday at her grandmother's home in Bangalore, her family of eight went to war, preparing themselves for Covid-19 to sweep through their home. Everyone from a 14-year-old eighth-grade student to a near-octogenarian would go on to be infected. But the Chinese-Indian family slowly won their battle against the disease over the next 1½ months, armed with discipline, composure and logistical planning.

"Our approach was: We'll all surely get it, but we'll all survive it as a family. We just made sure everyone didn't fall sick together, so that some people were healthy enough to take care of the others," said Ms Jennifer Liang, 48, Aman's mother and a social worker in Assam who flew to Bangalore immediately. The Liangs formed what they called "a war council" of decision makers, which included Jennifer's husband Sunil Kaul, a doctor and public health activist in Assam. As Aman isolated herself in her uncle's house nearby, the family set up a WhatsApp group called Covid Planning.’

Read here (Straits Times, Sept 26, 2020) 

Can European countries avoid a second lockdown?

"Catastrophic," "disastrous," and "devastating" — the words European leaders are using to describe the consequences of a second lockdown are more than clear. In order to curb the spread of COVID-19 in the spring of this year, public life across Europe was brought almost completely to a halt. In the summer, many places relaxed those restrictions. For weeks now, however, infection rates have been rising in almost every European country. According to the World Health Organization, Europe is registering between 40,000 and 50,000 new coronavirus cases each day. That increase is down to more than just more widespread testing. The numbers from September "should serve as a wake-up call for all of us," said the WHO's regional director for Europe, Hans Kluge. The weekly infection numbers have even exceeded those reported in the first phases of the peak in March, the WHO says.’

Read here (DW, Sept 21, 2020)

Covid-19: UK could face 50,000 cases a day by October without action - Vallance

‘The UK could see 50,000 new coronavirus cases a day by mid-October without further action, the government's chief scientific adviser has warned. Sir Patrick Vallance said that "would be expected to lead to about 200 deaths per day" a month after that. It comes as the PM prepares to chair a Cobra emergency committee meeting on Tuesday morning, then make a statement in the House of Commons.’

Read here (BBC, Sept 21, 2020)

Millions more in India may have caught coronavirus, antibody study suggests

‘More than a quarter of New Delhi's 20 million residents may have caught the novel coronavirus without showing symptoms, a study released on Thursday (Aug 20) indicated, raising fresh doubts about India's official case numbers. Extrapolated, the antibody study on 15,000 residents means 5.8 million people in the bustling capital could have caught the virus - more than 37 times the official tally of 156,139 infections.’

Read here (Straits Times, August 20, 2020) 

Evidence grows that children may play a larger role in transmission than previously believed

Are children the coronavirus’s secret weapon? Because they experience few symptoms of covid-19, children were largely ignored and untested during the early weeks of the pandemic. “But they may have been acting as silent spreaders all along,” our health desk wrote.

A study in the Journal of Pediatrics found high levels of the virus in children's airways, even when they had mild or no symptoms. Previous studies have reached similar conclusions, and researchers are trying to figure out how worried we should be about the children. "Some people thought that children might be protected,” one of the study's authors told The Washington Post. “This is incorrect. They may be as susceptible as adults — but just not visible.”

Read here (Washington Post, August 20, 2020)

New Zealand considers freight as possible source of new Covid-19 cluster

‘New Zealand officials are investigating the possibility that its first Covid-19 cases in more than three months were imported by freight, as the country plunged back into lockdown today. Investigations were zeroing in on the potential the virus was imported by freight... Bloomfield [Director General of Health Ashley Bloomfield] said surface testing was underway in an Auckland cool store where a man from the infected family worked... “We are very confident we didn’t have any community transmission for a very long period,” Bloomfield said during a televised media conference. “We know the virus can survive within refrigerated environments for quite some time.”

Read here (Malay Mail, August 12, 2020)

Proportion of youth with COVID-19 triples in five months: WHO

‘Young people who are hitting nightclubs and beaches are leading a rise in fresh coronavirus cases across the world, with the proportion of those aged 15 to 24 who are infected rising three-fold in about five months, the World Health Organization said. An analysis by the WHO of 6 million infections between Feb. 24 and July 12 found that the share of people aged 15-24 years rose to 15% from 4.5%.’

Read here (Reuters, August 5, 2020)

Careless young people driving some Covid-19 spikes, says WHO

‘The World Health Organisation (WHO) on Thursday (July 30) warned that spikes in coronavirus transmission in a number of countries were being driven by young people "letting down their guard". "Young people are not invincible," WHO chief Tedros Adhanom Ghebreyesus told a virtual news conference in Geneva.

‘WHO's technical lead for Covid-19 Maria Van Kerkhove lamented in particular that nightclubs in a number of places had become "amplifiers" of transmission. "We are asking for all people, including young people, to be your own risk manager" and avoid behaviours that could easily increase transmission of the disease.’

Read here (Straits Times, July 31, 2020)

One more reason to wear a mask: You’ll get less sick from Covid-19

‘It’s likely that face masks, by blocking even some of the virus-carrying droplets you inhale, can reduce your risk of falling seriously ill from COVID-19, according to Monica Gandhi, MD, an infectious disease specialist at UC San Francisco.

‘These epidemiological observations are among the evidence that Gandhi and colleagues cite in a paper in the Journal of General Internal Medicine, in which they propose that masks can lead to milder or asymptomatic infections by cutting down on the dose of virus people take in...

‘To Gandhi, these case studies [comparing situations at cruise ships, seafood processing centres, etc] suggest that if more people wore masks, we could see less serious illness from COVID-19 and a higher proportion of asymptomatic cases, currently estimated to be around 40 percent of cases by the Centers for Disease Control and Prevention. Milder infections would ease the burden on the health care system, save lives, and even nudge us closer to herd immunity before a vaccine becomes available, said Gandhi.’

Read here (The University of California, San Francisco, July 31, 2020)

Vietnam let down its guard, and cases surged

It’s a familiar story in Asia: Vietnam seemed like a miracle, where months went by without a single coronavirus death or even local transmission. 

 

The economy reopened, travel restarted and residents began leaving their masks at home. But over the weekend, the country announced that the virus was lurking after all — and spreading. Experts do not know the source. 

 

It followed a pattern in places that seemed to have done everything right: Japan, China, Australia and South Korea all recorded spikes on Wednesday. And the mystery is worrying medical experts and residents alike. 

 

Details: Shortly after a 57-year-old man from Danang tested positive, clusters emerged in five hospitals. By Wednesday, the virus had spread north to Hanoi, south to Ho Chi Minh City, to two provinces in the country’s center and even the remote Central Highlands. 

 

Quotable: “In my opinion, this outbreak is more dangerous than the previous one because it is happening at the same time in many places,” said the dean of public health at Quang Trung University.

Read here (New York Times, June 29, 2020)

Dengue fever, second wave: What are the hurdles Singapore faces in its coronavirus fight?

(1) Clearing the Covid-19 disease from worker dormitories remains the biggest challenge. ‘The testing in dorms is now in the “final stretch”, with 232,000 cases confirmed as recovered or virus-free as of July 16.’
(2) Singapore’s second challenge comes from imported cases, although the city state has limited this risk by shutting its borders.
(3) Singapore also faces the risk of a resurgence in infections triggered by a failure to comply with safe-distancing rules, which remain in place despite the lockdown being lifted.
(4) The fourth challenge is the simultaneous onset of dengue fever in Singapore, which has seen some 19,000 cases so far this year.

Read here (South China Morning Post, July 22, 2020)

Household contacts over 6 times more likely to become infected: South Korea study

‘A recent study by researchers in South Korea, published in the US CDC’s Emerging Infectious Diseases journal, found that SARS-CoV-2 transmission was far more common in household settings compared to public settings. Based on analysis of more than 59,000 contacts of more than 5,700 COVID-19 “index patients,” the researchers found that household contacts were more than 6 times more likely to become infected than non-household contacts. The study identified cases in 11.8% of household contacts, compared to only 1.9% of non-household contacts.

‘Notably, households with an “index patient” aged 10-19 years were at even higher risk for transmission—cases identified in 18.6% of household contacts, compared to 11.8% in households with “index patients” of other ages. The lowest transmission risk among household contacts was for “index patients” aged 0-9 years. In these households, cases were identified in only 5.3% of household contacts; however, this was still greater than the overall risk for non-household contacts. This indicates that children who are infected at school could transmit the infection at home more easily than in other settings, particularly for older children, which would put other family members at increased risk.‘

Source: Newsletter, Center for Health Security, John Hopkins University.

Read here (EID Journal, 2020)

Anger in Japan as US army bases report mounting Covid-19 outbreak

‘An escalating Covid-19 outbreak at American bases in Okinawa has seen 136 US military personnel and dependents infected so far, with the governor of the southern Japanese island complaining that United States officials have refused to provide details of infections among service members...

‘The question of quarantine regulations for US troops and their family members is a particularly contentious one, with local media reporting that Tokyo has little control over the US nationals who fly into Japan, even if they are arriving at commercial airports. The SOFA [Status of Forces Agreement between Japan and the US] permits service personnel to sidestep testing that is presently mandatory for all other arrivals from overseas.’

Read here (South China Morning Post, July 16, 2020)

Airborne transmission of SARS-CoV-2: Theoretical considerations and available evidence

‘All told, current understanding about SARS-CoV-2 transmission is still limited. There are no perfect experimental data proving or disproving droplet vs aerosol-based transmission of SARS-CoV-2. The balance of evidence, however, seems inconsistent with aerosol-based transmission of SARS-CoV-2 particularly in well-ventilated spaces. What this means in practice is that keeping 6-feet apart from other people and wearing medical masks, high-quality cloth masks, or face shields when it is not possible to be 6-feet apart (for both source control and respiratory protection) should be adequate to minimize the spread of SARS-CoV-2 (in addition to frequent hand hygiene, environmental cleaning, and optimizing indoor ventilation).’

Read here (JAMA Network, July 13, 2020)

School openings across globe suggest ways to keep coronavirus at bay, despite outbreaks

“Outbreaks in schools are inevitable,” says Otto Helve, a pediatric infectious disease specialist at the Finnish Institute for Health and Welfare. “But there is good news.” So far, with some changes to schools’ daily routines, he says, the benefits of attending school seem to outweigh the risks—at least where community infection rates are low and officials are standing by to identify and isolate cases and close contacts.

This article discusses the following:

• How likely are children to catch and transmit the virus?
• Should children play together?
• Should kids wear masks?
• What should schools do when someone tests positive?
• Do schools spread the virus to the wider community?
• What lies ahead?

Read here (Science Magazine, July 7, 2020)

239 experts with 1 big claim: The coronavirus is airborne

‘The World Health Organization has long held that the coronavirus is spread primarily by large respiratory droplets that, once expelled by infected people in coughs and sneezes, fall quickly to the floor. But in an open letter to the WHO, 239 scientists in 32 countries have outlined the evidence showing that smaller particles can infect people, and are calling for the agency to revise its recommendations. The researchers plan to publish their letter in a scientific journal next week.’

Read here (New York Times, July 4, 2020)

Asymptomatic patients may shed virus for longer than others, study says

‘Asymptomatic coronavirus patients could shed the virus for longer than those with symptoms, according to a new study in southwest China. “The emergence of these silent spreaders … has caused difficulties in the control of the epidemic,” the researchers led by Huang Ailong, from Chongqing Medical University, wrote in a peer-reviewed paper in Nature Medicine on Thursday. Huang’s team found that the median duration of viral shedding among the 37 asymptomatic patients in the Chongqing study was 19 days – a third longer than the patients with mild symptoms.’

Read here (South China Morning Post, June 22, 2020)