India's Covid-19 emergency: The Lancet proposes two strategies

‘India must now pursue a two-pronged strategy. First, the botched vaccination campaign must be rationalised and implemented with all due speed. There are two immediate bottlenecks to overcome: increasing vaccine supply (some of which should come from abroad) and setting up a distribution campaign that can cover not just urban but also rural and poorer citizens, who constitute more than 65% of the population (over 800 million people) but face a desperate scarcity of public health and primary care facilities. The government must work with local and primary health-care centres that know their communities and create an equitable distribution system for the vaccine.

‘Second, India must reduce SARS-CoV-2 transmission as much as possible while the vaccine is rolled out. As cases continue to mount, the government must publish accurate data in a timely manner, and forthrightly explain to the public what is happening and what is needed to bend the epidemic curve, including the possibility of a new federal lockdown. Genome sequencing needs to be expanded to better track, understand, and control emerging and more transmissible SARS-CoV-2 variants. Local governments have begun taking disease-containment measures, but the federal government has an essential role in explaining to the public the necessity of masking, social distancing, halting mass gatherings, voluntary quarantine, and testing. Modi's actions in attempting to stifle criticism and open discussion during the crisis are inexcusable.’

Read here (The Lancet, May 8, 2021)

Vaccinations, increasing Covid-19 cases, and the Peltzman effect

‘How security measures and regulations meant to protect, actually increase risky behaviour in the public, and how not to become a stereotype...

‘So, what has this got to do with Covid-19 vaccinations? This is where Dr Puri and his message come in. Pakistan's Prime Minister Imran Khan reportedly tested positive with the coronavirus a few days after being vaccinated.  People assume, wrongly, that vaccination (especially after the first dose) makes you invincible and you can get back to partying and a pre-Covid-19 normal life. Not true. The immunity builds up only a few weeks after the second dose. Also, immunity is not absolute. You can still get infected after being vaccinated, just like you could die in a car accident even though you are wearing a seatbelt. If you wear a seatbelt, you should not drive recklessly. Similarly, if you are vaccinated, you should not behave recklessly. You need to follow the basics—wear a mask, maintain social distance and wash your hands. Furthermore, current vaccines may not be able to protect you against future variants of the virus.

‘So why take the vaccine? Because it does reduce the risk of you getting the virus, and more importantly the risk of dying is significantly reduced. But just like the seat belt can't protect you if you drive like an idiot, the vaccine won’t protect you if you behave like one. Sometimes a seat belt doesn't protect you even if you are driving carefully (because some other idiot is driving recklessly) or you are an innocent bystander. It's the same case with the vaccine. Some other idiot can get you infected, even if you are an innocent bystander. Hence, please don’t believe that being vaccinated makes you superhuman.’

Read here (Forbes India, Apr 8, 2021) 

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) 

Will I have to wear a mask after getting the Covid vaccine? The science explained

‘Public health authorities want people to keep wearing masks and social distancing, even after they receive a vaccine. This might seem counterintuitive – after all, if someone gets a vaccine, aren’t they protected from the coronavirus?

‘The answer is complicated: the vast majority of people who are vaccinated will be protected from Covid-19, the disease caused by the SARS-CoV-2 virus. However, vaccinated people may still be able to transmit the virus, even though they do not display any symptoms. “We know now the vaccines can protect, but what we haven’t had enough time to really understand is – does it protect from spreading?” said Avery August, professor of immunology at Cornell University.

‘That is because the the SARS-CoV-2 virus may still colonize the respiratory tract, even as systemic immune cells protect the overall body from the disease it causes – Covid-19.’

Read here (The Guardian, Feb 26, 2021)

It’s hard to enforce pandemic health rules on Halloween. Just look at what happened in 1918

‘Just as the state of the pandemic varied, so too did the precautions that cities took for Halloween. Newspaper articles in the digital archive of the Influenza Encyclopedia, produced by the Center for the History of Medicine at the University of Michigan, provide a glimpse at the range of Halloween safety protocols in major cities nationwide.

‘One thing they make clear: it’s already hard enough to enforce safety protocols on a day like Halloween, but that challenge gets even more intense during a pandemic.’

Read here (Time, Oct 28, 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)

With effective prevention of outbreaks, nations do not need to choose between public health and economy: WHO chief

‘The head of the World Health Organisation (WHO) has debunked arguments that countries have to choose between public health and the economy when they look at whether to ease restrictions following a lockdown. "That is a false choice," said WHO director-general Tedros Adhanom Ghebreyesus. Instead, the WHO urges countries to focus on four essential priorities:

• Prevent Covid-19 amplifying events. All around the world, explosive outbreaks have been linked to gatherings, in places like stadiums, nightclubs and places of worship.
• Protect the vulnerable to save lives and reduce the burden on the health systems in terms of severely and critically ill patients.
• Educate and empower communities to protect themselves and others. Physical distancing, hand hygiene, respiratory etiquette and masks can help to curb transmission and save lives, not when done in isolation, but by practising all the measures together.
• Persist with the public health basics. Find, isolate, test and care for people who have been infected, and trace and quarantine their contacts.

Read here (Straits Times, Sept 17, 2020)

Covid-19 is transmitted through aerosols. We have enough evidence, now it is time to act

‘We should continue doing what has already been recommended: wash hands, keep six feet apart, and so on. But that is not enough. A new, consistent and logical set of recommendations must emerge to reduce aerosol transmission. I propose the following: Avoid Crowding, Indoors, low Ventilation, Close proximity, long Duration, Unmasked, Talking/singing/Yelling (“A CIViC DUTY”). These are the important factors in mathematical models of aerosol transmission, and can also be simply understood as factors that impact how much “smoke” we would inhale.’

Read here (Time Magazine, August 25, 2020)

WHO warns of long road ahead, may never be a ‘silver bullet’

‘The World Health Organisation warned on Monday that there might never be a “silver bullet” for Covid-19 in the form of a perfect vaccine, and that the road to normality will be long, with some countries requiring a reset of strategy. WHO director general Tedros Adhanom Ghebreyesus and WHO emergencies head Mike Ryan exhorted nations to rigorously enforce health measures such as mask-wearing, social distancing, handwashing, contact tracing and testing. “For now, stopping outbreaks comes down to the basics of public health and disease control. The message to people and governments is clear: ‘Do it all’,” Tedros told a virtual news briefing from the UN body’s headquarters in Geneva.’

Read here (South China Morning Post, August 3, 2020)

Covid-19: Getting our SOPs right - Amar Singh HSS and Lim Swee Im

This article discusses a number of issues on SOPs pertaining to Malaysia today:

• How can we best monitor our pandemic when our numbers are low?
• How ready are our testing capabilities for a second and subsequent waves?
• How good are our safe physical distancing measures?
• Optimising masks in Covid-19 prevention
• There is no way for the poor (B40) to comply with this ruling without a government mandated free programme
• Mask etiquette and our leaders

Read here (The Malay Mail, July 27, 2020)

Antibody levels in recovered COVID-19 patients decline quickly, Chinese study finds

‘Levels of an antibody found in recovered COVID-19 patients fell sharply in two to three months after infection for both symptomatic and asymptomatic patients, according to a Chinese study, raising questions about the length of any immunity against the novel coronavirus. The research, published in Nature Medicine on Jun 18, highlights the risks of using COVID-19 "immunity passports" and supports the prolonged use of public health interventions such as social distancing and isolating high-risk groups, researchers said.’

Read here (Channel News Asia, June 22, 2020)

An analysis of three Covid-19 outbreaks: How they happened and how they can be avoided

‘A crowded restaurant to celebrate the Chinese New Year; 100 workers infected inside a 19-story building; a group of devout Buddhists travelling by bus for a religious ceremony. These were the scenarios for three outbreaks of Covid-19 that have been carefully documented by the authorities. What happened in each one? What were the risk factors? What lessons can be learned, now that we are trying to get back to normal and return to restaurants, offices and other shared spaces?’

Read here (El Pais, June 18, 2020)

What social distancing reveals about East-West differences

‘In short, while the Chinese may not experience social-distancing anxiety as we Americans do, the pandemic seems to have brought out individualistic ways of thinking in some. Of course, divorce rates and rationales can only tell a small part of the sprawling story that is China. Still, might the globalization that has drawn East and West so much closer together physically also, via the pandemic, draw us ever so slightly closer together psychologically as well? It’s possible.’

Read here (Scientific American, June 6, 2020)

Distancing and masks cut Covid-19 risk, says largest review of evidence

‘Keeping at least one metre apart and wearing face masks and eye protection are the best ways to cut the risk of Covid-19 infection, according to the largest review to date of studies on coronavirus disease transmission. In a review that pooled evidence from 172 studies in 16 countries, researchers found frequent handwashing and good hygiene are also critical - though even all those measures combined can not give full protection.’ The findings were published in The Lancet journal on Monday.

Read here (Malaysiakini, June 2, 2020)

We have different attitudes toward social distancing, and it's straining relationships

‘The coronavirus isn't just threatening our health, it's threatening our relationships as we try to navigate how a socially distanced world should look -- something never done before. And now that states have replaced stay-at-home orders with various guidelines on reopening, there's more room for differing views on social distancing. These conflicts can be an opportunity for growth if we try to understand each other's mindset, according to psychologist Holly Parker, but that depends on both parties' willingness to embrace vulnerability.’

Read here (CNN, May 29, 2020)

The coronavirus killed the handshake and the hug. What Will replace them?

‘If you feel that personal connections are harder to form when talking to someone six feet away or through a screen on Zoom, you’re not alone. “You’re having to verbalize a lot more things that you would normally express with touch,” Suvilehto says. Hugging someone who needs comforting or placing a hand on their shoulder often feels easier and more natural than finding the right words. Being forced to voice these feelings might turn us into better communicators. “But the other option is that people will just stop communicating about emotions,” Suvilehto says.’

Read here (Time Magazine, May 27, 2020)

Major challenges remain in Covid-19 testing

‘The phrase “when we have adequate testing” has become the siren song within many conversations around return, namely in reopening the economy. Unfortunately, many of these conversations do not fully consider some critical issues around availability, test characteristics, and — importantly — test strategy. These issues suggest a need to rapidly consider other methods of protecting the population during reentry that can be implemented to complement testing. Such protective methods could include physical barriers, universal masking (while acknowledging supply-chain issues with personal protective equipment), and physical distancing in public spaces.’

Read here (Mckinsey & Co, May 2020)

There is no exit from coronavirus, only containment: A perspective from India

‘Devi Sridhar, the chair of global public health at Edinburgh Medical School and director of the Global Health Governance program, recently tweeted on the three options open. Sridhar wrote: “There are few short-term options. 1: Let the virus go and thousands die. 2: Lockdown and release cycles which will destroy economy and society. 3: Aggressive test, trace, isolate strategy supported with soft physical distancing.”

‘Having said that, the horrifying twin-reality still remains to be that an end to lockdown will by no means represent a return to normality, and, equally, a second, far more destructive wave is virtually an unavoidable possibility, notwithstanding the infection-reducing social distancing as a “new normal” in our daily life.’

Read here (Indian Punchline, April 29, 2020)

Is it too early to expand our ‘social bubbles’?

‘Drastically limiting people's contact with others seems to be helping many countries stem the spread of the coronavirus. But as economies slump and people become fatigued with rules, governments are weighing up how to ease lockdowns without risking a second wave of infections.

‘One option being touted is to allow people to slightly expand the "social bubbles" - meaning they'd be able to see a select few friends and family.’

Read here (BBC, April 27, 2020)

Kerala's unique way to promote social distancing: Use umbrellas

‘Amid the outbreak of novel coronavirus in India, the government and state authorities have been rigorously urging the citizens to ensure social distancing among one another. In a similar manner, the Thanneermukkom gram panchayat in Alappuzha has come up with a unique idea to enforce social distancing in the area. The authorities have mandated everyone residing there to hold an umbrella when they go out. “Two opened umbrellas, not touching each other, will ensure minimum distance of 1 meter from one another,” said state finance minister Thomas Isaac.’

Read here (Live Mint, April 26, 2020)