Covid: The countries that nailed it, and what we can learn from them

‘I have reported on Covid for the past year - now my mission was to find out from global leaders and senior health officials across four continents what their priorities were in tackling the virus.

‘What has emerged strongly for me are four key areas which have been most effective in containing the spread of the virus and preventing deaths.

• Early and effective action to control borders and monitoring of arrivals
• Testing, tracking and tracing everyone suspected of being infected
• Welfare support for those in quarantine to contain the virus
• Effective leadership and consistent and timely public messaging

Read here (BBC, Mar 22, 2021)

Ground SOPs in science: The Academy of Medicine of Malaysia

‘The Academy of Medicine of Malaysia is troubled by the introduction of the Prevention and Control of Infectious Diseases (Exemption) Order 2021, which states that Cabinet ministers returning from official overseas visits must only quarantine for 3 days instead of the mandatory 10 days for inbound travellers. The Health Minister clarified that only Cabinet ministers who travel in a ‘bubble itinerary’ will undergo 3-day quarantine. Moreover, this move is intended to open up the economy as the policy will eventually be applicable to foreign dignitaries and business travellers.

‘We, the Academy of Medicine of Malaysia, wholeheartedly oppose the Exemption Order as well as any plans to extend the 3-day quarantine rule to other travellers.

‘We wish to remind the government that all standard operating procedures (SOP) must be grounded in science. The quarantine period for inbound travellers is set at 10 days based on research which shows that the risk of transmission is extremely low (~1%) after 10 days with monitoring and testing in place. The incubation period for Covid-19 is on average 5 to 6 days but can be as long as 14 days. Therefore, three days is insufficient to detect symptoms. There must be an evidence-based, public health explanation for the government’s decision to reduce quarantine days.

‘The effectiveness of so-called ‘travel bubbles’ are also still in question as new variants of Covid-19 with increased transmission capability spread rapidly around the world. There is insufficient data on the mutations to develop robust protocols for safe travel. We understand there is urgency to restart the economy for the benefit of Malaysians and businesses that are struggling, but this can only be done by bringing the pandemic under control first. The government must not open up our borders to ‘bubble’ delegations and risk bringing in new variants that could overwhelm our health system.

‘We call on the government to revoke the Exemption Order and—until there is scientific evidence that suggests differently—enforce a 10-day quarantine for all.’

Read here (AMM press release, Feb 10, 2021)

Covid-19 - Improve management of mild cases, close contacts: MMA

‘Improvements are urgently needed in the Health Ministry's handling of mild cases of Covid-19 (category 1 and 2) and their close contacts to eliminate confusion and prevent possible flouting of the home quarantine SOPs which can lead to an increase in community transmissions. The Malaysian Medical Association (MMA) once again urges the Health Ministry to revert to its earlier policy of testing all close contacts. The Health Ministry's current policy is to only test symptomatic close contacts.

‘In its preventive measures, only isolating them will not be sufficient. The health status of all close contacts should be established early or there can be a risk of infections spreading among family members in the household and into the community if they breach the quarantine. Screening close contacts will also improve management of early symptoms of Covid-19.

‘MMA had earlier proposed that the government consider roping in the private sector doctors to test close contacts if it is faced with a shortage in manpower.’

Read here (Malaysiakini, Feb 6, 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)

NST editor under quarantine at MAEPS 2.0 shares 'humbling' experience

‘The ambience was quite festive with laughter and banter, not solemn, quiet and sedated as I had expected it to be. The residents — not patients — as I prefer to be called since I didn't feel any pain or discomfort, were either talking to each other at their beds or walking but not aimlessly. There were none within my sight seen lying on the bed covered by the thick white hospital blankets. But these were not the usual hospital beds, they were portable and foldable camp beds made of aluminium frames and canvas covers...

‘As I completed my first 24 hours at PKRC MAEPS 2.0, I had to admit that it was not too bad at all. The facilities were good — clean toilets/showers, two surau even though the spaces were quite small and food which was quite tasty though I wished for a bigger portion of vegetables. Truly, it was a most humbling experience. But my utmost appreciation went to the staff, everyone from the medical personnel to service staff and Rela personnel.’

Read here (News Straits Times, Jan 20, 2021)

FTTISI:The bedrock of Covid-19 infection control — Dr Musa Mohd Nordin and Dr Mohammad Farhan bin Rusli

‘The key element in the blueprint of action to mitigate this Covid-19 national emergency, must surely be a well executed Find, Test, Trace, Isolate and Support (FTTIS) system recommended by the WHO, which has fallen terribly short in national implementation.

‘The FTTIS system Finds and Tests hotspots of Covid-19 outbreaks. Rapid Isolation of cases and quarantine of close contacts through Tracing is extremely critical. Isolation will only work if the rakyat, especially the B40, receive Support during the MCO period with food security and financial Support.

‘The government through its relevant ministries and agencies must provide this social security net and support to this new policy of home isolation to ensure its success. Otherwise, the rakyat will fail to comply with home isolation, in order to search for and put food on the table and scour for basic home essentials. The government already has in place Low Risk Isolation Centres for households who are unable to effectively isolate at home.

‘Clinical support is also vital for monitoring the health of cases and contacts who are undergoing home isolation in the community.’

Read here (Malay Mail, Jan 15, 2021)

Options to reduce quarantine for contacts of persons with SARS-CoV-2 infection using symptom monitoring and diagnostic testing

‘The US CDC published updated guidance regarding quarantine after known exposure to SARS-CoV-2. The CDC’s quarantine guidance continues to direct individuals to quarantine for 14 days* after the last known exposure to a COVID-19 patient, but the updated guidance provides options to shorten the quarantine period. Under the new guidance, individuals who do not exhibit any COVID-19 symptoms can end their quarantine as early as Day 10* without testing and Day 7* if they have a negative diagnostic test result (RT-PCR or antigen test). Importantly, for individuals who get tested, the test specimen should be collected within 48 hours of ending the quarantine period, which means that individuals should be tested at Day 5 or later. Even if a test conducted on Day 5 or 6 is returned before Day 7, in no case should quarantine be terminated prior to Day 7.’

Read here (US CDC, Dec 2, 2020)

Taiwan just went 200 days without a locally transmitted Covid-19 case. Here's how they did it

‘As much of the world struggles to contain new waves of the Covid-19 pandemic, Taiwan just marked its 200th consecutive day without a locally transmitted case of the disease. Taipei's response to the coronavirus pandemic has been one of the world's most effective. The island of 23 million people last reported a locally transmitted case on April 12, which was Easter Sunday. As of Thursday, it had confirmed 553 cases -- only 55 of which were local transmissions. Seven deaths have been recorded.’

Read here (CNN, Oct 30, 2020)

Non-pharmaceutical intervention (NPI) measures that work, lag time, population compliance and more: The Lancet

‘A recently published article in Lancet Infectious Diseases has taken a look at potential associations between country-level reproduction numbers (R) and non-pharmaceutical interventions introduced and lifted throughout the course of the pandemic.

‘Increases in R were associated with relaxing of the following measures: school closures, public event bans, bans on gatherings greater than ten people, stay-at-home orders and other movement restrictions. However, the only significant associations for increases in R above 1 were school reopening and lifting bans on gatherings over 10 people. 

‘Authors noted that the full effect of introducing or lifting non-pharmaceutical interventions took 1-3 weeks on average from the date of implementation. Authors made further recommendations regarding the use of non-pharmaceutical interventions by national governments, noting that other factors, such as population compliance, also influence the success of non-pharmaceutical interventions and may not be fully captured in the study.’

Read here (The Lancet via Johns Hopkins University, Oct 22, 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) 

Electronic wristband to ensure stay-home notice: Quarantine monitoring devices being used by others worldwide

Besides Singapore, many other places in the world have also turned to electronic monitoring devices to help them control the spread of the coronavirus. Here are some places that do so: Hong Kong, South Korea, Malaysia (Sarawak), Jordan, Bahrain, Kuwait, Liechtenstein.

Read here (Straits Times, August 4, 2020)

Travellers to Singapore to wear electronic tracking device while serving Covid-19 stay-home notice outside of facilities

‘All travellers entering Singapore who are serving their stay-home notice (SHN) outside of dedicated facilities will soon have to wear an electronic monitoring device. From Aug 10, 11.59pm, such travellers will have to wear the device throughout the 14-day stay-home period. They include citizens, permanent residents, long-term pass holders, work pass holders and their dependants. Children aged 12 and below are exempted.’

Read here (Straits Times, August 4, 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)

New rules: Malaysians to pay RM30-RM150 for Covid-19 test upon return abroad; foreigners pay RM60-RM250

‘Malaysians returning from overseas will have to pay a range of RM30 to RM150 to be tested for Covid-19 upon entering the country from today onwards, while non-citizens will pay higher fees depending on the type of tests conducted, new rules issued by the government said.

‘In the regulations made on June 26 by Health Minister Datuk Seri Dr Adham Baba, any Malaysian or foreigner entering Malaysia will be required to pay the specified fee depending on the type of Covid-19 detection tests taken "before proceeding for immigration clearance at any point of entry", with the type of tests used to be decided by the health director-general.’

Read here (The Malay Mail, June 29, 2020)

No shortcuts and people must get used to a new way of living, warns WHO's chief scientist

‘It is critically important for governments to present facts in a way that people really understand what the Covid-19 coronavirus is, and the logic behind some of the measures put in place, said Dr Soumya Swaminathan, chief scientist at the World Health Organisation (WHO). When countries open up, their basic principle must be to test people with symptoms, identify the contacts and quarantine them until they are free of the risk of getting the disease, she said in an interview. "Those basic principles will have to be actually followed by governments and cities everywhere. There's no shortcut to that," she warned.

Read here (Straits Times, May 18, 2020)

Vienna Airport to offer coronavirus tests to avoid quarantine

‘Vienna Airport will offer onsite coronavirus testing from Monday to enable passengers entering Austria to avoid having to be quarantined for 14 days. Passengers arriving at the airport have been required to present a health certificate showing a negative COVID-19 result which is no older than four days, or go into quarantine. From Monday passengers can have a molecular biological (polymerise chain reaction or PCR) COVID-19 test at the airport, and get the result in two to three hours, the airport said.’

Read here (Reuters, May 3, 2020)

In Italy, home is also a dangerous place that may be propping up the infection curve the lockdown was meant to suppress

‘Italy’s leading virologists now consider home infections, alongside clusters in retirement homes, to be a stubborn source of the country’s contagion. Living together in close quarters and the failure to move the infected into dedicated quarantine facilities have, they say, paradoxically propped up the curve of infections that “stay home” measures were designed to suppress.

‘The problem is one the Chinese government bludgeoned quickly. It ordered the roundup of all residents in Wuhan infected with the coronavirus, warehousing them in quarantine camps, sometimes with little care. While that approach may have helped contain the virus, ripping people apart from their homes is anathema to Western democracies, especially Italy, where tight-knit families are the rule.’

Read here (New York Times, April 24, 2020)

Transmission of Covid-19 to health care personnel during exposures to a hospitalised patient

What is already known about this topic? ‘Health care personnel (HCP) are at heightened risk of acquiring COVID-19 infection, but limited information exists about transmission in health care settings.’

What is added by this report? ‘Among 121 HCP exposed to a patient with unrecognised COVID-19, 43 became symptomatic and were tested for SARS-CoV-2, of whom three had positive test results; all three had unprotected patient contact. Exposures while performing physical examinations or during nebuliser treatments were more common among HCP with COVID-19.’

What are the implications for public health practice? ‘Unprotected, prolonged patient contact, as well as certain exposures, including some aerosol-generating procedures, were associated with SARS-CoV-2 infection in HCP. Early recognition and isolation of patients with possible infection and recommended PPE use can help minimise unprotected, high-risk HCP exposures and protect the health care workforce.’

Read here (US CDC, April 17, 2020)

Media consumption in the age of Covid-19

‘Due to the frenzy of pandemic-induced quarantines, media consumption has seen a massive increase. But what exactly are people doing, and how are they staying informed? GLOBAL WEB INDEX surveyed almost 4,000 internet users between the ages of 16-64 across the US and the UK to find out how the COVID-19 outbreak has changed their media consumption.’

Read here (Visual Capitalist, April 7, 2020)

18 lessons of urban quarantine urbanism

This is a most succinct and informed piece of communication on our present predicament and what we could/should do.

‘To what world will we reemerge after the distress and devastation of the COVID-19 pandemic? Calling for a geopolitics based on a deliberate plan for the coordination of the planet, design theorist and The Terraforming Program Director Benjamin H. Bratton looks at the underlying causes of the current crisis and identifies important lessons to be learned from it.’

Read here (Strelkamag, April 4, 2020)