US CDC issues ‘Interim public health recommendations for fully vaccinated people’

Fully vaccinated people can:

• Visit with other fully vaccinated people indoors without wearing masks or physical distancing
• Visit with unvaccinated people from a single household who are at low risk for severe COVID-19 disease indoors without wearing masks or physical distancing
• Refrain from quarantine and testing following a known exposure if asymptomatic

For now, fully vaccinated people should continue to:

• Take precautions in public like wearing a well-fitted mask and physical distancing
• Wear masks, practice physical distancing, and adhere to other prevention measures when visiting with unvaccinated people who are at increased risk for severe COVID-19 disease or who have an unvaccinated household member who is at increased risk for severe COVID-19 disease
• Wear masks, maintain physical distance, and practice other prevention measures when visiting with unvaccinated people from multiple households
• Avoid medium- and large-sized in-person gatherings
• Get tested if experiencing COVID-19 symptoms
• Follow guidance issued by individual employers
• Follow CDC and health department travel requirements and recommendations

Read here (US CDC, Mar 8, 2021) 

Without official vaccine guidance, pregnant people are left to do their own research

‘The lack of clear guidance around pregnancy has ripple effects. Despite abundant evidence that the vaccines are safe for lactating parents and their babies, last month the Chicago Tribune reported that a new mom who was breastfeeding was denied the COVID-19 vaccine by her county’s health department. Officials said they decided not to allow pregnant or lactating women to receive the vaccine, citing a lack of data.

‘Dr. Peter Hotez, a vaccinologist and dean of the National School of Tropical Medicine at Baylor College of Medicine, told me he was appalled by the mixed messaging around vaccines in pregnancy, which he said leaves patients “reading the tea leaves.” The government “has not made a good faith effort to take down the anti-vaccine misinformation and disinformation,” he said. “So by telling a pregnant woman to do her own research online means you’re basically telling her not to get vaccinated.”

Read here (Mother Jones, Mar 4, 2021)

Pregnant women get conflicting advice on Covid-19 vaccines

‘Pregnant women looking for guidance on Covid-19 vaccines are facing the kind of confusion that has dogged the pandemic from the start: The world’s leading public health organizations — the U.S. Centers for Disease Control and Prevention, and the World Health Organization — are offering contradictory advice. Neither organization explicitly forbids or encourages immunizing pregnant women. But weighing the same limited studies, they provide different recommendations.’

Read here (New York Times, Feb 2, 2021)

Malaysia in Covid-19 crisis? — Musa Mohd Nordin

‘We are plagued with the Double Whammy. MCO + EO. A poorly managed Pandemic in bed with a poorly managed Politics. Pandemic + Politics. It cannot get any more worse! Yesterday Malaysia was in panic mode! Triggered by the humongous Covid-19 numbers Chill out Malaysia! It is NOT REAL TIME case numbers. These are just BACKLOG cases only just being reported

‘Contact Tracing is virtually at a STANDSTILL. An officer at a PKD had 600 contacts to trace and yesterday was slapped with another 700 to trace These are all the manifestations of a failure of the system. There is a breakdown in the FTTIS work flow! How much longer can we tolerate these failings and lackluster performance?

‘It has been SYSTEMS GO in Selangor over and above the efforts of JKNS. They are our buddies in Selangor to rid Covid-19. Please share this widely with your friends in Selangor.

‘STFO is the Operations arm of STFC [Selangor Task Force on Covid-19] led by Public Health Physician, Prof Farhan [Asst Prof Dr Mohammad Farhan bin Rusli (Consultant Public Health Physician, International Islamic Universiti Malaysia)] to bust Covid-19. It aims TO FLATTEN THE CURVE IN THE COMMUNITY WITHIN 4 WEEKS. The MCO + EO has interrupted STFO operations. With JKNS they are resuming with vigor with the blessings of the State Government.

STFO Blueprint of Action

1. ALL +ve or household that is +ve to register under SELangkah (so that state govt can provide home kits
2. ALL high risk and household with HIGH risk persons, to pre register SELangkah: (a) for B40, we provide voucher (FREE testing) to go to nearest Selcare clinic panel (static) or mass screening (mobile); (b) for non-B40, encourage them to do testing (we provide list of participating Selcare panel clinic)
3. Community mass screening (mobile) to HIGH RISK RANK areas (from ACURA) to HIGH RISK individuals OR HOUSEHOLDS with HIGH RISK individuals (from pre-register SELangkah) e.g. (a) Old folks home (b) Hemodialysis centers (c) Nursing homes for the elderly 
4. Mass screening (mobile) to HIGH RISK super spreaders e.g. (a) communities living in crowded spaces (b) families in PPR flats (c) migrants (d) refugees. Data obtained from community leaders, refugee/migrant centric NGOs, UNHCR.
5. State / Selgate to buy RTK-Ag in bulk. To provide at minimal cost to Selcare Clinic panel. Participating Selcare Clinic panel to provide at standard low cost price. At least 2 participating Selcare panel per district.
6. To encourage ADUN to subsidise the cost and liase with respective participating Selcare clinic panels
7. To increase  Health Education Advocacy to do testing and isolate: (a) SYMPTOMATIC individuals with +ve close contacts must ASAP do testing & treatment (if needed) at nearest KKM's facility. Call 999 if severe symptoms (b) ASYMPTOMATIC individuals with +ve close contacts, encourage to do testing at nearest participating Selcare Clinic panel (c) SYMPTOMATIC inviduals with NO +ve close contacts, must do testing at nearest KKM's facility (or participating Selcare clinic - if KKM reject testing)
8. Activate GEOFENCING via SELangkah AND communicate SELamat warning system
9. Home Kits provided by STFO: Face Masks, Hand sanitiser, Information pamphlet,  Foodpack / vouchers -- for B40, unemployed, does day jobs,  SpO2 monitors include training and monitoring (for high risk patients only)

Read here (Malay Mail, Jan 31, 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)

Long Covid guidelines need to reflect lived experience

‘Since May, 2020, increasing attention has been given to the experiences of people with COVID-19 whose symptoms persist for 4 or more weeks. According to the Office for National Statistics (ONS), an estimated 186 000 people (95% CI 153 000–221 000) in private households in England currently have COVID-19 symptoms 5–12 weeks or longer after acute infection. The ONS estimate that one in five people have symptoms that persist after 5 weeks, and one in ten have symptoms for 12 weeks or longer after acute COVID-19 infection. Research on long COVID is growing, including into the underlying pathology, consequences, and sequelae, as well as rehabilitation for patients. Evidence suggests that a considerable proportion of people with long COVID have severe complications. We have lived experiences of long COVID, with a range of symptoms lasting for more than 6 months...

‘Guidelines must represent the complexity of long COVID, including the areas where evidence is still emerging. Hasty attempts to rename the condition or compare it to other conditions is a disservice to thousands of people, and could result in missed pathology to the detriment of the patient. Comprehensive long COVID guidelines are essential to prevent an epidemic of long-term, chronic disease as a result of early mismanagement of pathology, and the potential implications of such an epidemic for health systems and economies.’

Read here (The Lancet, Dec 21, 2020)

Infected after 5 minutes, from 20 feet away: South Korea study shows COVID-19's spread indoors

‘KJ Seung, an infectious disease expert and chief of strategy and policy for the nonprofit Partners in Health’s Massachusetts COVID response, said the study was a reminder of the risk of indoor transmission as many nations hunker down for the winter. The official definition of a “close contact” — 15 minutes, within 6 feet — isn’t foolproof.

‘Lee and his team recreated the conditions in the restaurant... “Incredibly, despite sitting a far distance away, the airflow came down the wall and created a valley of wind. People who were along that line were infected,” Lee said. “We concluded this was a droplet transmission, and beyond two meters.”

“Eating indoors at a restaurant is one of the riskiest things you can do in a pandemic,” she [Linsey Marr, a civil and environmental engineering professor at Virginia Tech who studies the transmission of viruses in the air] said. “Even if there is distancing, as this shows and other studies show, the distancing is not enough.”

Read here (LA Times, Dec 12, 2020)

Information for UK recipients on Pfizer/BioNTech COVID-19 vaccine: UK government

‘Warnings and precautions: Talk to your doctor, pharmacist or nurse before you are given the vaccine if you have:

• Had a serious allergic reaction to a previous vaccine, medicine or food
• Had any problems following previous administration of COVID-19 mRNA Vaccine BNT162b2 such as allergic reaction or breathing problems
• A severe illness with high fever. However, a mild fever or upper airway infection, like a cold, are not reasons to delay vaccination.
• A weakened immune system, such as due to HIV infection, or are on a medicine that affects your immune system
• A bleeding problem, bruise easily or use a medicine to inhibit blood clotting

‘As with any vaccine, COVID-19 mRNA Vaccine BNT162b2 may not fully protect all those who receive it. No data are currently available in individuals with a weakened immune system or who are taking chronic treatment that suppresses or prevents immune responses.

‘Other medicines and COVID-19 mRNA Vaccine BNT162b2: Tell your doctor or pharmacist if you are using, have recently used or might use any other medicines or have recently received any other vaccine.

‘Pregnancy and breast-feeding: There is currently limited data available on the use of this vaccine in pregnant women. If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before you receive this vaccine. As a precaution, you should avoid becoming pregnant until at least 2 months after the vaccine.’

Click here to read more (UK government, Dec 2020)

Wear masks in public says WHO, in update of COVID-19 advice

The WHO's technical lead expert on Covid-19, Maria Van Kerkhove, said in a Reuters interview: "We are advising governments to encourage that the general public wear a mask [in public areas where there is a risk of transmission of COVID-19]. And we specify a fabric mask - that is, a non-medical mask... We have new research findings... We have evidence now that if this is done properly it can provide a barrier ... for potentially infectious droplets."

Read here (Straits Times, June 6, 2020)

Harnessing our humanity — How Washington’s health care workers have risen to the pandemic challenge

‘Given mounting PPE shortages and the rising death toll from Covid-19 among health care workers globally, such scenarios [of protocol modifications -- including the use of bandannas in place of face masks] induce terror and necessitate rethinking of routine standards of care. Should we run to codes of patients with known or suspected Covid-19? Should physicians refuse to intubate a patient unless they have adequate PPE? Should we offer bedside comfort to the elderly patient with possible Covid-19 who becomes increasingly delirious as unrecognizable health care workers speed in and out of the room while TV coverage of the pandemic drones on in the background? The clarion call of the profession — to put our patients’ needs above our own — is far less directive when meeting one patient’s needs may leave us too ill to care for the next.’

Read here (New England Journal of Medicine, May 28, 2020)

Singapore schools to open in phases from June 2 after Covid-19 circuit breaker: How this will work

‘Students will return to school from June 2 over two phases as part of the easing of the coronavirus circuit breaker measures that are expected to end on June 1. Here are some of the adjustments planned for schools and pre-schools that the Government announced on Tuesday (May 19).’

Read here (Straits Times, May 19, 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)

CDC publishes flowcharts to help communities and businesses weighing whether to reopen

The US Centers for Disease Control and Prevention published six "decision trees" Thursday aimed at helping businesses, communities, schools, camps, daycares and mass transit decide whether it's safe to re-open. The one-page decision trees are much shorter than a much-anticipated, lengthy and detailed document that has been delayed at least once.

Read here (CNN, May 15, 2020)

• For workplace, download here
• For schools, download here
• For restaurants, download here
• For mass transit, download here
• For camps, download here
• For daycare, download here

National action plan for expanding and adapting the healthcare system for the duration of the Covid pandemic

This 24-page report by the Johns Hopkins Center for Health Security offers answers and recommendations related to the following problems, for which there are tractable solutions:

• How can we improve infection prevention in hospitals and maintain a robust supply chain for personal protective equipment (PPE)?
• What approach should we take to restarting deferred healthcare services?
• What financial support is needed for hospitals and healthcare providers?
• How should the healthcare workforce be sustained and augmented?
• How can we provide mental health support for healthcare workers in this crisis?
• How can we provide medical care and sick leave for all people in the United States?
• How can we make telemedicine a new normal?
• How can we reduce the number of undiagnosed infectious diseases in our hospitals?
• How can we better protect emergency medical services (EMS) personnel from infectious diseases?
• How can we better coordinate the healthcare response to COVID and the next pandemic?

Read and download here (Johns Hopkins Center for Health Security, May 5, 2020)

Preparing a safe return to work

As businesses prepare to reopen amid the Covid-19 outbreak, employers face the challenge of ensuring a safe environment for their workforce. Social purpose organisation Think City has some guidelines. To access the full guide, please visit http://thinkcity.com.my/workplace-guides/⁣

Read here (The Edge, May 5, 2020)

Govt needs a U-turn on conditional MCO

‘Yes, it is conditional, but it is physically impossible to ensure everyone complies. You need to give businesses more time to prepare for this, especially the smaller businesses – the small and medium enterprises or SMEs which employ about 70% of workers.

‘This is where infection is most likely – the most number of people are there and the ones most likely to ignore SOPs. They include all sorts of businesses – food and beverage, services, shops, workplaces – virtually all can reopen except for those that involve close contact and mass gatherings.’

Read here (FocusMalaysia, May 4, 2020)

Singapore: New safe distancing guidelines, standards for workplaces after Covid-19 circuit breaker

‘When workplace activities gradually resume after the circuit breaker lifts, the Government will need to put in place new guidelines and standards to ensure that they remain safe from potential Covid-19 outbreaks, National Development Minister Lawrence Wong said on Friday (May 1).Speaking at a virtual press conference, Mr Wong said these guidelines will build upon existing measures to ensure safe distancing in workplaces for workers in essential services, such as wearing masks at work or not having workers socialise among themselves.

‘These guidelines... will also be complemented by a testing regimen as well as some form of technology that can ensure better tracking and monitoring should a confirmed case emerge in the workplace.’

Read here (Straits Times, May 1, 2020)

Resolve to Save Lives releases a colour-coded

‘Resolve to Save Lives released a color-coded COVID-19 alert system to signify the risk of transmission in communities and recommend appropriate levels of individual precautions. Dr. Tom Frieden, former director of the US CDC, likened this system to wildfire risk level signs on hiking trails or ocean hazard flags on beaches; it is up to individuals reading these signs to understand the risk level around them and act accordingly. This system includes four levels ranging from “new normal” to “high alert,” with corresponding measures that communities and individuals can take at each level to mitigate transmission risk.’

Download here (Resolve to Save Lives, May 2020)

Strengthening preparedness for Covid-19 in cities and urban settings

‘This document is to support local authorities, leaders and policy-makers in cities and other urban settlements in identifying effective approaches and implementing recommended actions that enhance the prevention, preparedness and readiness for COVID-19 in urban settings, to ensure a robust response and eventual recovery. It covers factors unique to cities and urban settings, considerations in urban preparedness, key areas of focus and preparing for future emergencies.’

Beyond traditional recommendations—such as multisectoral collaboration, protecting vulnerable populations, and evidence-based policy decisions—the guidance also addresses 4 focus areas in the context of COVID-19 preparedness:

1. Coordinated local plans to address unique issues, characteristics, and capacities of individual cities; 
2. Risk communication and education to promote compliance with recommended actions, using media that can effectively reach target audiences; 
3. Contextually and culturally appropriate approaches to public health, including social distancing, enhanced hygiene, and respiratory etiquette; and 
4. Adequate access to care for COVID-19 and other essential health services, including prevent services like vaccination. The document also includes an annex with more specific details, considerations, and recommendations under each focus area.

Read and download here (WHO, April 28, 2020)

Amar Singh and other doctors offer guidelines for supermarkets

‘Supermarkets play an important role in Covid-19 prevention. Many supermarkets have put in place measures to limit the spread of Covid-19 at their premises. However, as the movement control order is relaxed, and client numbers increase, supermarkets will have to be even more vigilant.

We offer here a “Guide for Supermarkets to Standardise Covid-19 Prevention”: The “new normal” for supermarkets. This guide aims to help standardise the measures to be taken by all supermarkets, as well as offer ideas and initiatives that could be taken.’

Read here (The Malay Mail, April 22, 2020)