Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine (Pfizer clinical trial)

BACKGROUND: ‘Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the resulting coronavirus disease 2019 (Covid-19) have afflicted tens of millions of people in a worldwide pandemic. Safe and effective vaccines are needed urgently.’

METHODS: ‘In an ongoing multinational, placebo-controlled, observer-blinded, pivotal efficacy trial, we randomly assigned persons 16 years of age or older in a 1:1 ratio to receive two doses, 21 days apart, of either placebo or the BNT162b2 vaccine candidate (30 μg per dose). BNT162b2 is a lipid nanoparticle–formulated, nucleoside-modified RNA vaccine that encodes a prefusion stabilized, membrane-anchored SARS-CoV-2 full-length spike protein. The primary end points were efficacy of the vaccine against laboratory-confirmed Covid-19 and safety.’

RESULTS: ‘A total of 43,548 participants underwent randomization, of whom 43,448 received injections: 21,720 with BNT162b2 and 21,728 with placebo. There were 8 cases of Covid-19 with onset at least 7 days after the second dose among participants assigned to receive BNT162b2 and 162 cases among those assigned to placebo; BNT162b2 was 95% effective in preventing Covid-19 (95% credible interval, 90.3 to 97.6). Similar vaccine efficacy (generally 90 to 100%) was observed across subgroups defined by age, sex, race, ethnicity, baseline body-mass index, and the presence of coexisting conditions. Among 10 cases of severe Covid-19 with onset after the first dose, 9 occurred in placebo recipients and 1 in a BNT162b2 recipient. The safety profile of BNT162b2 was characterized by short-term, mild-to-moderate pain at the injection site, fatigue, and headache. The incidence of serious adverse events was low and was similar in the vaccine and placebo groups.’

CONCLUSIONS: ‘A two-dose regimen of BNT162b2 conferred 95% protection against Covid-19 in persons 16 years of age or older. Safety over a median of 2 months was similar to that of other viral vaccines. (Funded by BioNTech and Pfizer; ClinicalTrials.gov number, NCT04368728. opens in new tab.)’

Read here (New England Journal of Medicine, Dec 31. 2020)

Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine

‘This phase 3 randomized, observer-blinded, placebo-controlled trial was conducted at 99 centers across the United States. Persons at high risk for SARS-CoV-2 infection or its complications were randomly assigned in a 1:1 ratio to receive two intramuscular injections of mRNA-1273 (100 μg) or placebo 28 days apart. The primary end point was prevention of Covid-19 illness with onset at least 14 days after the second injection in participants who had not previously been infected with SARS-CoV-2.

‘The trial enrolled 30,420 volunteers who were randomly assigned in a 1:1 ratio to receive either vaccine or placebo (15,210 participants in each group). More than 96% of participants received both injections, and 2.2% had evidence (serologic, virologic, or both) of SARS-CoV-2 infection at baseline... 

‘The mRNA-1273 vaccine showed 94.1% efficacy at preventing Covid-19 illness, including severe disease. Aside from transient local and systemic reactions, no safety concerns were identified. (Funded by the Biomedical Advanced Research and Development Authority and the National Institute of Allergy and Infectious Diseases; COVE ClinicalTrials.gov number, NCT04470427. opens in new tab.)’

Read here (New England Journal of Medicine, Dec 30, 2020)

China vaccinates a million (interim target: 15 million by mid-February) but some take a jab back

‘Workers kept in the dark about the vaccine injected and are warned not to take any photos of the process...

‘At least a million priority or at-risk Chinese have had their first shots of indigenous Covid-19 vaccines after guidelines kicked in on December 15. Several populous provinces and gateway cities from Guangdong to Shandong and Henan to Shanghai are included as Beijing triages vaccine distribution to regions more exposed to Covid flare-ups and “backflows.” The interim goal, cited by the National Health Commission (NHC) and Xinhua, is to immunize at least 15 million police officers and medical and customs personnel by the Chinese New Year in mid-February...

‘Yet initial feedback from those chosen for the pilot scheme appears to be less than ideal. As seen on forums and WeChat groups popular among medical workers and immigration officers and through Asia Times’ interviews of airport workers in Shanghai, major complaints center around the elusive manner in which these drugs are produced and administered.’

Read here (Asia Times, Dec 30, 2020) 

Spain to keep register of those who refuse Covid vaccine

‘Spain is to set up a register of people who refuse to be vaccinated against coronavirus and share it with other European Union nations, the health minister has said. Salvador Illa said the list would not be made accessible to the public or to employers. He said the way to defeat the virus was "to vaccinate all of us - the more the better".

Read here (BBC, Dec 29, 2020)

German Covid-19 vaccination campaign overshadowed by mishaps

‘Germany's COVID-19 vaccination campaign has been overshadowed by an overdose mishap in the north and problems with the transportation of the vaccine in the south which lead to 1,000 shots being sent back.’

Read here (Reuters, Dec 28, 2020)

Vaccine diplomacy not as simple as a shot in the arm

‘Concerns including dearth of vaccine data and perceived use for geopolitical goals stand in the way of China's soft power push...

‘Rich nations have bought almost all of next year's supply of the two vaccine front runners - one by Pfizer-BioNTech and the other by Moderna - according to the People's Vaccine Alliance (PVA), a network of organisations that includes Amnesty International, Oxfam and Global Justice Now. Canada, for instance, has ordered enough vaccines to inoculate each Canadian five times, although it has pledged to share any excess with other countries.

‘The situation is such that nine in 10 people in 67 developing countries - including nations like Cambodia, Laos and Pakistan - stand little chance of being vaccinated next year, said the PVA this month. To these countries, China's vaccines are a lifesaver.’

Read here (Straits Times, Dec 28, 2020)

Covid-19 vaccines for Malaysia: A call for transparency in registration & purchasing

By Citizens’ Health Initiative (citizenhealthinitiative@gmail.com)

With the exception of the People’s Republic of China and a few other countries like New Zealand, Vietnam, Cuba, Senegal, and Kerala state in India, which seem to have largely brought Covid-19 under control without the help of vaccines, most countries are struggling with succeeding waves of the pandemic and a likely global spread of a more contagious mutant of SARS-CoV-2.  

The collateral damage to economic and social well-being worldwide has been unprecedented, and it underscores the urgently felt need for vaccines and a return to some semblance of normalcy.

Despite a major lapse with a 16,000 plus person religious gathering which erupted into several clusters locally and in the region (March 2020), Malaysia had performed creditably earlier.

Sources of current outbreaks

Unfortunately, since October 2020, a resurgence of clusters emerged from non-compliant returnees from abroad, and porous Sabah state border controls, exacerbated by lax enforcement of SOPs during the September 2020 Sabah state elections. 

Immigration and health authorities were not sufficiently pro-active to prevent its further spread in the peninsula, resulting in numerous outbreaks, especially among workers in congested accommodations and workplaces, and in prisons and detention centres.

Unlike Singapore’s experience with outbreaks in migrant dormitory complexes, we in Malaysia are additionally reaping the consequences of decades of corrupt mismanagement of labor migration, viz. a persistently large pool of undocumented migrant workers (currently estimated at 1.2-1.5 million) who have strong incentives to avoid contact with government agencies.   

Senior Minister Ismail Sabri’s disastrous U-turn in going after undocumented migrants (after initially promising them sanctuary and no arrests and deportation during the pandemic) greatly complicated pandemic control efforts, in particular the crucially important contact tracing.

As generally younger daily-paid workers, more likely to ride out the milder symptoms of Covid-19 infection, they are now even less inclined to cooperate in testing and isolation, given the risks of arrest, detention and deportation.

\We thus face the prospect of protracted and repeated seeding of the general population by the asymptomatic or mildly symptomatic, especially undocumented workers reluctant to seek treatment unless severely ill. (We should also note that active avoidance of contact tracing and testing involves others disinclined to divulge network contacts or contact history, e.g. underworld elements, drug and sexual encounters, etc).

As in many other countries, many Malaysians support efforts to secure vaccines to enhance pandemic control efforts.

Procuring vaccines for Malaysia

The minister for Science, Technology, and Innovation Khairy Jamaluddin has announced commitments to purchase a basket of Covid-19 vaccines, and options for further orders .

Khairy Jamaluddin needs to be transparent about the technical rationales, criteria, and pricing for his ministry’s purchasing decisions.  In particular, he needs to respond to very pertinent points raised by the Covid Research Centre (KL) , chest specialist Dr Jeyakumar Devaraj , and others, which include the following:

• there is currently little information on long-term safety beyond 2 months or on durability of protection, for all candidate or approved vaccines (any late-manifesting adverse effects will only be detected by conscientious follow-up surveillance, monitoring, and reporting systems).  This is especially pertinent for novel mRNA vaccines, in comparison with the more familiar inactivated whole-virus vaccines with which we have decades of experience
• the decision by the UK’s Medicines and Healthcare Products Regulatory Agency (MHRA) to grant immunity to Pfizer from legal liability for late-manifesting adverse effects, and the Pfizer CEO declining to be among the early vaccinees (claiming selflessness in prioritising those more vulnerable, in contrast to some vaccine researchers who vaccinated themselves even before phase 1 human trials) perhaps reflects the true risk perception or assessment of the pharmaceutical corporations (whose profitable research and development work has been highly subsidised by governments for ‘vaccine nationalist’ reasons)
• stringent logistic requirements (deep-freeze or ultra-low temperature facilities) for the mass deployment of mRNA vaccines to under-served remote areas
• one additional advantage of the inactivated whole-virus vaccine is that the host immune response is mounted against a spectrum of antigens from the whole virus, rather than against a much more limited array of antigenic sub-components of say, the spike protein.  This could provide some insurance against mutations, say in the coding sequences for the spike protein, which might render vaccines directed solely against the spike protein wholly or partially ineffective.

Beyond the immediate urgency of securing access to adequate quantities of safe, efficacious and affordable vaccines, the larger question of our continuing dependency on foreign vaccine developers, producers and suppliers remains unaddressed.

National capabilities in production of medicines and vaccines

Consider Cuba, a nation of 12 million citizens hamstrung by a 60-year economic blockade by the US, which has invested in human and material resources to become a biotech power-house:  recombinant hepatitis B vaccines, synthetic polysaccharide vaccine against Haemophilus influenzae type B , CIMAvax vaccine against lung cancer , and innovative treatment of diabetic foot ulcers.

Cuba’s repeated offers of scientific collaboration in R&D, and joint ventures to position Malaysia as a regional production and distribution platform for Southeast Asia , have elicited only a lukewarm response.  Tan Sri Dr Abu Bakar Suleiman, the retired Director General of Health, has shown greater foresight and entrepreneurial verve as chairman of Bioven , which is shepherding CIMAvax through US-FDA and UK phase 3 clinical trials .

It is not too late to make the necessary strategic decisions for a promising growth area (pharmaceuticals and vaccines) in the national and regional economies of the newly launched RCEP.

For more information/clarifications, please contact:

• Chan Chee Khoon     cheekhoon50@gmail.com 
• Chee Heng Leng        cheehengleng@gmail.com 

Endorsers

• Aliran
• Citizens’ Health Initiative
• Freedom
• Kuala Lumpur & Selangor Chinese Assembly Hall (KLSCAH) 
• Malaysian Physicians for Social Responsibility (MPSR)
• North South Initiative
• Pengguna Pahang
• Parti Sosialis Malaysia (PSM)
• Pergerakan Tenaga Akademik Malaysia (GERAK)
• Suara Rakyat Malaysia (SUARAM)
•  Childline Foundation

Seismic change: How Covid-19 altered world events in 2020

‘The year 2020 has been like no other. The coronavirus infected more than 67 million people, impacted 80% of jobs, and placed billions in lockdown... Here are just four political issues, from four continents, which were altered by the pandemic:

1. The US election
2. Hong Kong's protests
3. Ethiopia's Tigray crisis
4. Israel's political crisis’

Read here (BBC, Dec 27, 2020)

Covid-19 has shown us that good health is not just down to biology

‘Of all the lessons we’ve learned from this pandemic, the most significant is how unequal its effects have been. Wealth, it turns out, is the best shielding strategy from Covid-19. As poorer people crowded together in cramped housing, the rich escaped to their country retreats. Two of the largest risk factors for dying from Covid-19 are being from a deprived background and being from a minority-ethnic background, pointing to the underlying role of social inequalities, housing conditions and occupation.

\‘Our society’s recovery from this disease should be centred on building more equal, resilient societies, where people in all parts of the world have access to both protection from the disease and access to research developments. It all starts with government. At the end of a gruelling 11 months, I’m left with Abraham Lincoln’s words in my mind: the pandemic has shown that we need “government of the people, by the people, for the people” – not just government for the wealthy elite. Perhaps that’s the strongest legacy of Covid-19.’

Read here (The Guardian, Dec 25, 2020)

UK scientists trial drug to prevent infection that leads to Covid

‘British scientists are trialling a new drug that could prevent someone who has been exposed to coronavirus from going on to develop the disease Covid-19, which experts say could save many lives.

‘The antibody therapy would confer instant immunity against the disease and could be given as an emergency treatment to hospital inpatients and care home residents to help contain outbreaks. People living in households where someone has caught Covid could be injected with the drug to ensure they do not become infected too. It could also be given to university students, among whom the virus has spread rapidly because they live, study and socialise together.’

Read here (The Guardian, Dec 25, 2020)

Sinovac's Covid-19 vaccine has 91% efficacy, Turkey says

‘Sinovac Biotech's COVID-19 vaccine candidate has shown an efficacy of 91.25% in Turkey, officials said Thursday, reporting the latest results of clinical trials of the Chinese-developed shot beyond China. Turkish Health Minister Fahrettin Koca and professor Serhat Unal, a member of the government's COVID-19 advisory board, reported the preliminary results of Phase 3 trials at a news conference in Ankara.

‘Unal added that the efficacy "is likely to increase" in the later stages of the trials, as the number of volunteers now administered a placebo is lower than the number of volunteers who have been administered the vaccine, known as CoronaVac.’

Read here (Nikkei, Dec 25, 2020)

Fauci says herd immunity could require ‘between 70% and 90%’ to get COVID-19 vaccine

‘Herd immunity against the novel coronavirus could require vaccination rates "between 70 per cent and 90 per cent", Dr Anthony Fauci, the most prominent US infectious disease expert, said in an interview published on Thursday (Dec 24). More than 1 million Americans have received a first dose of a vaccine since Dec 14, according to the US Centers for Disease Control, or only about 0.3 per cent of the population.

‘Fauci, who is advising both President Donald Trump and President-elect Joe Biden on the pandemic, acknowledged that he had incrementally increased his estimates from earlier in the year, when he tended to say only 60 per cent to 70 per cent would need to be inoculated for herd immunity to be reached.’

Read here (Channel News Asia, Dec 25, 2020)

Covid-19 vaccine: Hold your horses, let us play safe! Jeyakumar Devaraj

• Malaysia should rely on old tech vaccines comprise of viral proteins. Let us not experiment on our population with the “sophisticated” vaccines that use RNA and DNA technology.
• Offer the old tech COVID-19 vaccines to the high risk groups initially, and then later to the entire population. But do not make it mandatory for any particular group. Let people make an informed choice.
• Provide clear information to the public. We should be honest with our people. The authorities should also tell the people that at present we do not have data regarding long term safety of the RNA and DNA vaccines.
• Provide the old tech COVID-19 vaccine free to the population.
• Conduct post COVID-19 vaccination surveillance to obtain an accurate estimate of side effects arising from the vaccines.
• It is high time for civil society groups and concerned individuals to voice up and urge for a cautious and measured approach to the mass vaccination of the Malaysian public.

Read here (Focus Malaysia, Dec 24, 2020)

Special Reuters report: How a British Covid-19 vaccine went from pole position to troubled start

‘Much was riding on the Oxford vaccine, a British-led endeavour also involving UK drugs firm AstraZeneca. Prime Minister Boris Johnson’s government was desperate for a success story after its early mishandling of the pandemic contributed to one of the world’s highest death tolls from COVID-19 - around 65,000 by mid-December. The government has secured 100 million doses. On Nov. 23, Oxford and AstraZeneca delivered positive news. They announced that the regimen of a half dose followed by a full dose booster appeared to be 90% effective in preventing COVID-19. Two full doses scored 62%. Oxford researchers have said they aren’t certain why the half-dose regimen was much more effective.

‘Johnson called the vaccine team and tweeted his thanks “for their brilliant work.” He went on, “These results are incredibly encouraging and a major step forward in our fight against COVID-19.” Oxford and AstraZeneca are now hoping for quick authorization by Britain’s regulator. But questions about the trial and the results won’t go away...’

Read here (Reuters, Dec 24, 2020)

The autopsy, a fading practice, revealed secrets of Covid-19

‘The COVID-19 pandemic has helped revive the autopsy. When the virus first arrived in U.S. hospitals, doctors could only guess what was causing its strange constellation of symptoms: What could explain why patients were losing their sense of smell and taste, developing skin rashes, struggling to breathe and reporting memory loss on top of flu-like coughs and aches?

‘At hospital morgues, which have been steadily losing prominence and funding over several decades, pathologists were busily dissecting the disease’s first victims — and finding some answers. “We were getting emails from clinicians, kind of desperate, asking, ‘What are you seeing?’” said NYU Langone’s Dr. Amy Rapkiewicz. ‘Autopsy,’ she pointed out, means to see for yourself. “That’s exactly what we had to do.”

Read here (AP News, Dec 24, 2020)

Longform podcast: Ed Yong of The Atlantic

‘Ed Yong spent 2020 covering the pandemic for The Atlantic. His latest feature is "How Science Beat the Virus." He says: “I am trying to give readers a platform that they can stand on to observe this raging torrent that is the pandemic, this cascade of information that is threatening to sweep us all away. I’m trying to give people a rock on which they can stand so that they can observe what is happening without themselves being submerged by it. But I am trying to construct that platform while also being submerged in it.”

Listen to the podcast here (Longform, Dec 23, 2020)

The vaccine news is great, but Big Pharma is still fooling us

‘Heroic work went into the development of the coronavirus vaccines. But that does not mean this industry deserves your affection...

‘I recall feeling, at the start of this pandemic, both horror at the unfolding calamity, and also a small sense of hope that as in other times of hardship, people would find ways to change the world for the better. There was talk of community support, mutual aid and the rediscovery of the positive powers of the state to protect its citizens. Much of that has dimmed now, and it often seems that we simply want relief - to go back to the way the world was before, and as soon as possible.

‘We have to get back to that place. Yet this may be the best chance in our lifetimes to break the hold of an industry that, until recently, was rightly vilified. The public is following these developments closely, and the state support that underwrites pharmaceutical profits couldn't be more obvious: Operation Warp Speed alone has dispensed over US$10 billion to the industry.

‘Pay it to make the vaccine, sure. That's a service. But we shouldn't be afraid to demand more: Public support should mean a public vaccine, one that reaches people as quickly as possible - profitable or not. The pharmaceutical industry wouldn't be able to rake in its profits and restore its reputation without funding that comes from our tax dollars. We shouldn't let Big Pharma forget it.’

Read here (Straits Times, Dec 22, 2020)

The mysterious link between Covid-19 and sleep

‘The coronavirus can cause insomnia and long-term changes in our nervous systems. But sleep could also be a key to ending the pandemic... 

‘The newly discovered coronavirus had killed only a few dozen people when Feixiong Cheng started looking for a treatment. He knew time was of the essence: Cheng, a data analyst at the Cleveland Clinic, had seen similar coronaviruses tear through China and Saudi Arabia before, sickening thousands and shaking the global economy. So, in January, his lab used artificial intelligence to search for hidden clues in the structure of the virus to predict how it invaded human cells, and what might stop it. One observation stood out: The virus could potentially be blocked by melatonin...

‘After he published his research, though, Cheng heard from scientists around the world who thought there might be something to it. They noted that, in addition to melatonin’s well-known effects on sleep, it plays a part in calibrating the immune system. Essentially, it acts as a moderator to help keep our self-protective responses from going haywire—which happens to be the basic problem that can quickly turn a mild case of COVID-19 into a life-threatening scenario.’

Read here (The Atlantic, Dec 22, 2020)

World's media ask how it went so wrong for 'Plague Island' Britain

‘In the eyes of the world’s media, Britain – a “Plague Island” led by a man who thinks “optimism is a substitute for hard truths and proper management” – is currently getting a good lesson in “what ‘reclaiming sovereignty’ means”...

‘Much of the blame was on Boris Johnson, whose U-turn on Christmas had “once more shown the yawning gulf between the prime minister’s airy promises and the real world,” said Germany’s Die Welt. That vacuum, however, is now “fast being filled with the anger and fear of a nation hit ever since by horror story upon horror story”. The continental blockade could well be “preparing the British for what Brexit might actually mean”, the paper said, “since there is still no agreement on a trade deal, 10 days before the deadline.”

‘The Netherlands’ NRC Handelsblad said that no one in the UK would have a normal Christmas: “not even a tiny bit of one. The ports are closed; London’s stations witnessed a veritable exodus; tens of kilometres of trucks are stranded on the country’s motorways; ministers are publicly saying the virus is out of control.”...

The Sydney Morning Herald: ‘Britain’s response to the pandemic had been “mired in inaction, plagued by failures of the state to mobilise and Johnson’s own destructive habit of promising false dawns simply because he cannot stand to be the bearer of bad news”.’

Read here (The Guardian, Dec 22, 2020)

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)

There are thousands of Covid strains, so this new scare is NOT a big deal, but politicians just love their new authoritarianism

‘Let me set the scene. The world (we are told) is in the grip of a deadly plague. Health services (we are told) are on the brink of collapse. And just when you think things cannot get any worse, the horrific news comes down from on high that our invisible enemy has mutated into an even scarier form. Although it is too early to know anything of substance about it, it is entirely possible that it is more contagious, or more dangerous, or – who knows – maybe both.

‘Was that the situation at the weekend as the UK was plunged into what’s rapidly become its worst crisis since World War II (and certainly the worst self-induced one), just ahead of Christmas? No, this was the precise situation FIVE MONTHS AGO, when I wrote about Spike D614G, a mutant variant of coronavirus that we were told could be up to NINE TIMES more contagious. You may not remember because that mutant strain turned out to be a total nothing burger. So why would this one be any different?’

Read here (RT, Dec 21, 2020)

Suspicions grow that nanoparticles in Pfizer’s COVID-19 vaccine trigger rare allergic reactions

‘Severe allergy-like reactions in at least eight people who received the COVID-19 vaccine produced by Pfizer and BioNTech over the past 2 weeks may be due to a compound in the packaging of the messenger RNA (mRNA) that forms the vaccine’s main ingredient, scientists say. A similar mRNA vaccine developed by Moderna, which was authorized for emergency use in the United States on Friday, also contains the compound, polyethylene glycol (PEG).

‘PEG has never been used before in an approved vaccine, but it is found in many drugs that have occasionally triggered anaphylaxis—a potentially life-threatening reaction that can cause rashes, a plummeting blood pressure, shortness of breath, and a fast heartbeat. Some allergists and immunologists believe a small number of people previously exposed to PEG may have high levels of antibodies against PEG, putting them at risk of an anaphylactic reaction to the vaccine.’

Read here (Science magazine, Dec 21, 2020)

New Covid strain in the UK: What we know in 500 words

‘European countries ban UK passengers in bid to contain new mutation, which is 70 percent more infectious and ripping through London...

‘Vaccines should still be effective against it and the new strain is not believed to be any more deadly, but people are increasingly worried because this mutation appears to be 70 percent more infectious. The new variant, which has been named VUI-202012/01 (the first Variant Under Investigation in December 2020), is thought to have first occurred in mid-September in the country’s southeast, in the capital London or the county of Kent.

‘Susan Hopkins of Public Health England said the agency notified the government on December 18 when modelling revealed the full seriousness of the new strain. The UK submitted its findings to the World Health Organization the same day.’

Read here (Aljazeera, Dec 20, 2020)

A-Z inventions of Covid-19

‘The pandemic may have brought the world to its knees, but the side effects are not all negative. The Straits Times locks down the upsides of the coronavirus.’

Read here (Straits Times, Dec 20, 2020)

European Commission embarrassed by Covid-19 vaccine price leak

‘The tweeted information gave the following price per dose for each vaccine maker, in either euros or US dollars according to the respective contract:

1. AstraZeneca: €1.78
2. Johnson & Johnson: US$8.50
3. Sanofi/GlaxoSmithKline: €7.56
4. Pfizer/BioNTech: €12.00
5. Curevac: €10.00
6. Moderna: US$18.00’

Read here (Malay Mail, Dec 18, 2020) 

The influence of the anti-vaccine movement

‘To try to understand why anti-vaccine sentiment is so prevalent in the United States, I recently spoke by phone with Dr. Peter Hotez, a professor of pediatrics and molecular virology at Baylor College of Medicine, and the co-director of the Texas Children’s Center for Vaccine Development. In March, he will publish a book called “Preventing the Next Pandemic: Vaccine Diplomacy in a Time of Anti-Science.” During our conversation, which has been edited for length and clarity, we discussed the historical reasons for vaccine skepticism among many Black Americans, how doctors can speak the truth without appearing political, and how the fight over vaccines became so similar to the fight over every political issue in America.’

Read here (The New Yorker, Dec 18, 2020)

From control rooms to testing, several strategies helped Uttar Pradesh contain pandemic

‘Several factors distinguish the handling of the pandemic in the state but I aim to discuss a few in this article. Of the many innovative steps taken there are three clear winners. 

‘First is the setting up of Team 11 — a group of 11 senior government officials tasked with managing different aspects like surveillance and contact tracing, testing and treatment, sanitisation, containment, enforcement, doorstep delivery, issues of migrants, communication strategy, etc — in March itself...

‘The second winner is the Integrated Covid Command and Control Centre (ICCC) set up in every district. This is the nerve centre of pandemic management in the district, sending testing teams to different areas as per plan, ensuring surveillance and contact tracing, sending positive patients to different Covid hospitals or placing them under home isolation...

‘The third winner is the integrated data management portal (upcovid19tracks.in). It provides us with the ability to crunch and analyse data on a daily basis... 

‘Let me also discuss two strategic interventions, out of many, which we have taken. 

‘The first is the widespread use of the drug, ivermectin, not just for treatment of cases but also as a prophylactic. The state government provides free medicines to all patients in home isolation or in government COVID-19 facilities, which have more than 1.5 lakh beds. We have used the combination of ivermectin and doxycyclin to successfully treat over three lakh home-isolated patients with mild symptoms so far. This combination has also been used by the hospitals across the state for admitted COVID-19 patients. But what is more interesting is the state’s successful use of ivermectin as a prophylactic.

‘The second strategic intervention is the targeted testing of selected groups. We started doing this in June with residents of urban slums, workers at nursing homes, pharmacy shops, bus and auto drivers, shopkeepers, security guards in malls, hospitals, etc.’  

Read here (Indian Express, Dec 17, 2021) 

Hang on for 3 more months

‘Some simple advice for anyone contemplating a holiday gathering: Wait until March...The fight against the coronavirus has been called a “national marshmallow test” [for the United States] that we’re failing. In a famous study, children were left alone with a marshmallow for 15 minutes, and promised a second if they didn’t eat the first. Kids who were better at delaying gratification were found to be more successful later in life. At first, this correlation was explained as demonstrating the importance of willpower and executive function.

‘Later, a team of researchers set out to replicate this study and uncovered something profound. Once they adjusted for factors such as household income, mother’s education, and home environment at age 3, the effect disappeared...

‘If we failed our national marshmallow test this summer and fall, perhaps that says something about how little reason the public was given for optimism. Hope can’t just be a slogan or a pep talk; it must be justified by facts, experiences, and trustworthy promises. And in fairness, until last month, it was less clear when and how this would all end... But hope is justified today.’

Read here (The Atlantic, Dec 17, 2020)

Twenty images that offer a lens on 2020

‘McKinsey designers highlight the photos and illustrations that helped us tell the visual story of a remarkable year...

‘The way we see the world may well have changed in the course of 2020—as the global pandemic has upended our personal and professional lives. As the year draws to a close, we turned to McKinsey’s designers to get perspective on the images that helped bring our insights to life.

‘While we sometimes commission bespoke art for our articles and reports, for the most part we curate our visuals from outside image libraries. Even in prepandemic times, this presented special challenges when it came to selection (does the visual messaging fit the topic and tone of the piece?) and adaptation (is the image treatment consistent with our style and brand?). But in a year where much of the world spent many months maintaining some level of physical distancing, large swaths of the images in the libraries we access—those that showed people in the close proximity we were all used to before the pandemic—became unusable.

‘See our designers’ favorites from this year and why they resonated, then read the stories behind them to understand some of the year’s most important issues.’

Read here (McKinsey & Co, Dec 17, 2020)

WHO vaccine scheme 'risks failure', leaving poor countries with no COVID-19 shots until 2024

 ‘In internal documents reviewed by Reuters, the scheme's promoters say the programme is struggling from a lack of funds, supply risks and complex contractual arrangements which could make it impossible to achieve its goals.

"The risk of a failure to establish a successful COVAX Facility is very high," says an internal report to the board of Gavi, an alliance of governments, drug companies, charities and international organisations that arranges global vaccination campaigns. Gavi co-leads COVAX alongside the WHO.’

Read here (Reuters, Dec 16, 2020)

A pandemic atlas: How Covid-19 took over the world in 2020

‘Journalists from The Associated Press around the world assessed how the countries where they are posted have weathered the pandemic — and where those countries stand on the cusp of year two of the contagion.’ Wonderful pictures...

View here (Associated Press, Dec 16, 2020)

Rapid Covid-19 home test developed in Australia approved for emergency use in US

‘A rapid, over-the-counter Covid-19 test developed by Australian firm Ellume has been given emergency approval in the United States. The US Food and Drug Administration (FDA) approved the Brisbane-based company’s 20-minute Covid-19 Home Test on Tuesday as the US battles the virus that has infected 16.5 million people and killed more than 300,000 people in the country.

“By authorising a test for over-the-counter use, the FDA allows it to be sold in places like drug stores, where a patient can buy it, swab their nose, run the test and find out their results in as little as 20 minutes,” the FDA commissioner, Stephen Hahn, said in a statement.’

Read here (The Guardian, Dec 16, 2020)

Teachers should receive COVID-19 vaccine priority: UNICEF

‘The head of the UN children's agency, UNICEF, called on Tuesday (Dec 15) for teachers to be among those given priority access to the COVID-19 vaccines. "The COVID-19 pandemic has wreaked havoc on children's education around the globe. Vaccinating teachers is a critical step towards putting it back on track," UNICEF chief Henrietta Fore said in a statement. Teachers should be "prioritised to receive the COVID-19 vaccine, once frontline health personnel and high-risk populations are vaccinated," she said.’

Read here (Channel News Asia, Dec 15, 2020)

How to wear a face mask with style: Match Covid-19’s must-have accessory with top fashion brands

‘Masks, the must-have accessory of 2020, historically served as a theatrical tool in Greek theatre. Employed to magnify actors’ emotions and allow easy multitasking between different roles, the stage props were heavy on drama and often depicted exaggerated visages. Way before Covid-19, creative names like Alexander McQueen, Thom Browne, Viktor & Rolf, Marc Jacobs for Louis Vuitton and Japan’s Anrealage all offered interpretations of this theatrical tradition in their fashion collections.

‘As masks have become the new normal in 2020, designers and fashionistas alike are incorporating the accessory into daily fashion ensembles; think of Lady Gaga’s rivet-embellished pink mask. Here in our latest shoot, we blend the whimsy of the accessory’s past with the season’s newest high fashion to reveal a real style statement...’

Read here (South China Morning Post, Dec 15, 2020)

Relaxing Covid rules at Christmas will cost lives: Rare joint statement by two major UK medical journals

‘The British government came under intense pressure on Tuesday to revise its plan to relax COVID-19 restrictions for five days around Christmas, with two influential medical journals making a rare joint appeal for the policy to be scrapped... In what was only their second joint editorial in more than 100 years, the British Medical Journal and the Health Service Journal said the government should be tightening the rules rather than allowing three households to mix over five days. “We believe the government is about to blunder into another major error that will cost many lives,” the editorial said.’

Read here (Reuters, Dec 15, 2020)

These drugs might prevent severe Covid

‘Even with vaccines on the way, treatments are needed to prevent the disease from getting worse—and to be ready for COVID-25, COVID-37, and so on...

‘In an interview with Scientific American, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, described the desired characteristics of early COVID treatments. “My overwhelming preference is for direct-acting antiviral agents that can be administered orally” and that suppress the virus completely within a week or less, he said. “That, to me, is the highest priority.” 

‘Scientists have begun on differing paths to search for these drugs... One of the current leading contenders for treating mild COVID is an antiviral pill that was previously developed for influenza. At first called EIDD-2801, the drug was found to protect mice from severe lung disease caused by two other coronaviruses—SARS-CoV and MERS-CoV... 

‘Repurposing existing drugs can also yield some surprises by finding ones that are not logical candidates to work against COVID-19. Fluvoxamine, a pill used for treating anxiety disorders, shows some promise in treating early COVID...’

Read here (Scientific American, Dec 14, 2020) 

Intellectual property monopolies block vaccine access

‘The authors of “Want Vaccines Fast? Suspend Intellectual Property Rights (IPR)" argue that IPR are the main stumbling block. Meanwhile, South Africa and India have proposed that the World Trade Organization (WTO) temporarily waive its Trade-Related Aspects of Intellectual Property Rights (TRIPS) rules limiting access to COVID-19 medicines, tools, equipment and vaccines.

 ‘The proposal – welcomed by the WHO Director-General and supported by nearly 100 governments and many civil society organisations around the world – goes beyond the Doha Declaration’s limited flexibilities for national emergencies and circumstances of extreme urgency. But Brazil, one of the worst hit countries, opposes the proposal, together with the US, the EU, the UK, Switzerland, Norway, Canada, Australia and Japan, insisting the Doha Declaration is sufficient.’

Read here (ksjomo.org, Dec 14, 2020)

Whose liability for Pfizer’s vaccine?

‘The well-known The Independent newspaper reports that the United Kingdom Department of Health and Social Care has confirmed that Pfizer required, and has been given, an indemnity by the government, protecting it from legal action if any ill-effects arise from the dispensation of the vaccine.

‘What does this mean? What is the effect in law of such an indemnity? Simply, that the country that provides the indemnity becomes primarily and independently liable if anything goes wrong with the uptake of the vaccine.’

Read here (The Sun Daily, Dec 14, 2020)

Oxford-AstraZeneca vaccine: Bogus reports, accidental finds - the story of the jab

‘In the early hours of Saturday 11 January, Prof Teresa Lambe was woken up by the ping of her email. The information she had been waiting for had just arrived in her inbox: the genetic code for a new coronavirus, shared worldwide by scientists in China. She got to work straight away, still in her pyjamas, and was glued to her laptop for the next 48 hours. "My family didn't see me very much that weekend, but I think that set the tone for the rest of the year," she says...

‘That weekend was the first step on a journey to create a vaccine at lightning speed, for a disease that would, in a matter of months, claim more than 1.5 million lives. I have been following the efforts of the Oxford scientists since the start. There have been dramas along the way, including:

• A rush to charter a jet when a flight-ban prevented vaccine from getting into the country
• Dismay at totally false reports on social media that the first volunteer to be immunised had died
• Concern that falling infection rates over the summer would jeopardise the hope of quick results
• How an initial half-dose of the vaccine unexpectedly provided the best protection
• An admission from the chief of Oxford's partner, drug company AstraZeneca, that it would have run the trials "a bit differently".

Read here (BBC, Dec 14, 2020)

A 4-point checklist for assessing countries' vaccine readiness

‘Even before the vaccines begin to arrive in ports around the world, the focus will shift to the preparedness of in-country logistics, especially in low and middle-income countries (LMICs) and to their health systems' ability to deploy and administer the vaccine to their populations. Any weaknesses in health system readiness – in vaccine distribution, storage, refrigeration, prioritization or delivery – will need to be quickly assessed, addressed and resolved at unprecedented speed before any effective immunization campaign can begin.

‘Here's how countries, and especially LMICs, can assess their readiness along four key dimensions: awareness, acceptance, accessibility and availability.’

Read here (World Economic Forum, Dec 14, 2020)

Readmission and death after initial hospital discharge among patients with Covid-19 in a large multi-hospital system

‘Although more patients are surviving severe coronavirus disease 2019 (COVID-19), there are limited data on outcomes after initial hospitalization. We therefore measured the rate of readmission, reasons for readmission, and rate of death after hospital discharge among patients with COVID-19 in the nationwide Veterans Affairs (VA) health care system...

‘In this national cohort of VA patients, 27% of survivors of COVID-19 hospitalization were readmitted or died by 60 days after discharge, and this rate was lower than matched survivors of pneumonia or heart failure. However, rates of readmission or death were higher than pneumonia or heart failure during the first 10 days after discharge following COVID-19 hospitalization, suggesting a period of heightened risk of clinical deterioration. Study limitations include the inability to measure readmissions to non-VA hospitals and an older, male-predominant study population, who may be at higher risk of severe manifestations of COVID-19. Public health surveillance or clinical trials focused exclusively on inpatient mortality may substantially underestimate burdens of COVID-19.’

Read here (JAMA Network, Dec 14, 2020)

How science beat the virus... And what it lost in the process

“To study COVID‑19 is not only to study the disease itself as a biological entity,” says Alondra Nelson, the president of the Social Science Research Council. “What looks like a single problem is actually all things, all at once. So what we’re actually studying is literally everything in society, at every scale, from supply chains to individual relationships.”

‘The scientific community spent the pre-pandemic years designing faster ways of doing experiments, sharing data, and developing vaccines, allowing it to mobilize quickly when COVID‑19 emerged. Its goal now should be to address its many lingering weaknesses. Warped incentives, wasteful practices, overconfidence, inequality, a biomedical bias—COVID‑19 has exposed them all. And in doing so, it offers the world of science a chance to practice one of its most important qualities: self-correction.’

Read here (The Atlantic, Dec 14, 2020)

When a virus is the cure

‘As bacteria grow more resistant to antibiotics, bacteriophage therapy is making a comeback...

‘Phages, or bacteriophages, are viruses that infect only bacteria. Each kingdom of life—plants, animals, bacteria, and so on—has its own distinct complement of viruses. Animal and plant viruses have always received most of our scientific attention, because they pose a direct threat to our health, and that of our livestock and crops. The well-being of bacteria has, understandably, been of less concern, yet the battle between viruses and bacteria is brutal: scientists estimate that phages cause a trillion trillion infections per second, destroying half the world’s bacteria every forty-eight hours. As we are now all too aware, animal-specific viruses can mutate enough to infect a different animal species. But they will not attack bacteria, and bacteriophage viruses are similarly harmless to animals, humans included. Phage therapy operates on the principle that the enemy of our enemy could be our friend.’

Read here (The New Yorker, Dec 14, 2020) 

Is mass vaccination the best strategy for all countries? A doctor's surprising view

‘COVID-19 is now the second-leading cause of death in the U.S. for 2020. The virus has killed more than 90 people per 100,000, reports Johns Hopkins University. 

‘But in other parts of the world, the virus hasn't been such a big problem. It's not a top killer. Some global health experts are beginning to ask whether immunizing large swaths of the population is the best use of resources for these countries. That's a question that Dr. Chizoba Barbara Wonodi of Johns Hopkins University has been thinking about as mass nationwide vaccine campaigns begin rolling out in rich countries such as the United Kingdom and the United States.’

Read here (NPR, Dec 14, 2020)

PM Muhyiddin: Govt to order more Covid-19 vaccine to cover 60-70pc of Malaysians

‘The government has plans to increase its purchase of the Covid-19 vaccine to cover the immunisation needs of about 60-70 per cent of Malaysians compared to 30 per cent currently. Prime Minister Tan Sri Muhyiddin Yassin said this was because some nations had purchased doses exceeding their population.

“As for Malaysia, we have already got 30 per cent. I have instructed Health Minister Datuk Seri Dr Adham Baba along with Khairy Jamaluddin Abu Bakar (Minister of Science, Technology and Innovation) to negotiate and increase it from 30 per cent to 60 or 70 per cent.’

Read here (Malay Mail, Dec 13, 2020)

Malaysia's Top Glove fired whistleblower before virus outbreak

‘Afraid of losing his job if he complained directly to management, Khadka, 27, sent the photos to a workers’ rights campaigner in his native Nepal who sent them on to the company and the Malaysian government, without identifying who took them.

‘On Sept. 23, Top Glove sent Khadka a letter terminating his employment for sharing the photos. In the letter, seen by Reuters, the company said it identified him as the originator of the photos from CCTV coverage of workers entering the factory.

‘Fast-forward almost three months, Top Glove’s complex of factories and dormitories in Klang, 40 km (25 miles) west of Kuala Lumpur, has become Malaysia’s biggest coronavirus cluster with more than 5,000 infections, about 94% of them foreigners, the country’s health ministry said in a statement on Dec. 1.’

Read here (Reuters, Dec 13, 2020)

Covid-19 vaccine is permissible for Muslim use, preservation of life is key consideration: MUIS

‘The Islamic Religious Council of Singapore (MUIS) said on Sunday (Dec 13) that it "holds the position that a COVID-19 vaccine is permissible for Muslim use". "We would advise and encourage Muslims to be vaccinated once it is available and when the vaccine has been medically authorised as safe and effective, as this is a basic necessity to protect lives in the context of a global pandemic," said MUIS.’

Read here (Channel News Asia, Dec 13, 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)

WHO to make decisions on Pfizer, Moderna, AstraZeneca COVID-19 vaccines in weeks

‘The World Health Organization expects to make decisions on whether to give emergency use approval to COVID-19 vaccines from Pfizer, Moderna and AstraZeneca in the coming weeks, its chief scientist said on Friday (Dec 11).

‘Soumya Swaminathan said the global health body could decide on Pfizer's vaccine candidate in the next "couple of weeks", and later said it could also review Moderna's and AstraZeneca's candidates in a few weeks.’

Read here (Channel News Asia, Dec 12, 2020)

Ivermectin and Covid 19: Dr John Campbell

Dr John Campbell examines the evidence on ivermectin and suggests that health authorities the world over study its efficacy as a prophylactic and treatment for Covid-19; they should consider including it in the treatment regime if it is found to be effective. 

View here (Youtube, Dec 12, 2020)

Covid-19 vaccine: Will you take it? 8 in 10 say yes in ST poll

‘A recent survey commissioned by The Straits Times of 1,000 people aged 16 and above here found that about eight in 10 would say "yes" to getting a Covid-19 vaccination, with more than half in this group willing to get it the moment it is available. About 18 per cent of respondents, however, would not want to receive a Covid-19 vaccine, regardless of whether one was available today or in six to 12 months, although about half were willing to consider having one eventually.’

Read here (Straits Times, Dec 12, 2020)

Spotlight on China’s competing Covid vaccines

‘Chinese authorities have already approved multiple Covid-19 vaccines for emergency use in the country, and nearly a million Chinese have already been vaccinated with one candidate. Several local governments are already placing orders for domestically developed vaccines, though the Chinese government hasn’t confirmed how many people it’s aiming to vaccinate as part of emergency approval. The first international shipments of the vaccine, by private Chinese company Sinovac, have also already arrived in Indonesia this week in preparation for a mass vaccination campaign ahead of expected local approval...

‘So who are the companies developing these vaccines in China, and what do we know about them?’ 

Read here (Asia Times, Dec 12, 2020)

IHME projects 5,000 daily Covid-19 cases in Malaysia end-Feb

‘Malaysia is projected to experience a continuous rise in Covid-19 cases until mid-March 2021, hitting over 5,000 infections daily on February 25, according to US-based Institute for Health Metrics and Evaluation (IHME).

‘The IHME model, which is also used by the Trump administration, predicted 2,987 new coronavirus cases in Malaysia on January 1, increasing to 4,176 Covid-19 infections on February 1, and 5,130 cases on March 1. The trend is projected to rise until March 21 with 5,379 infections that day, and then declining to 5,301 cases on April 1.’

Read here (Code Blue, Dec 11, 2020)

What an FDA committee weighed in voting for the Pfizer Covid vaccine

‘An all-day hearing of the Food and Drug Administration’s vaccine advisory committee closed, on Thursday evening, with a vote to recommend an Emergency Use Authorization of the Pfizer-BioNTech covid-19 vaccine for people sixteen and older. 

‘The proceedings involved a great deal of data and technical talk, but might be quickly summarized this way: there are things we still do not know about the vaccine, but nothing that we do know looks bad. Indeed, the vaccine looks very, very good. And its known goodness applies to a diverse range of populations, including Black and Latinx and older people. An F.D.A. analysis of the raw data, released earlier this week, confirmed previous reports that the vaccine’s efficacy in preventing disease in trial participants was close to ninety-five per cent. That number held up under questioning from committee members, who represented a range of specialties, from pediatrics to virology, throughout the eight hours of the hearing. 

‘Amid a pandemic—on a day when more than three thousand people in this country were reported to have died from covid-19—that result is far more than it would have been reasonable to hope for even a couple of months ago. As Dr. Doran Fink, of the F.D.A., said in one of the day’s presentations, there is no “adequate, approved, and available alternative.” It was a long day, but a reassuring and even energizing one.’

Read here (The New Yorker, Dec 11, 2020)

Covid: Trials to test combination of Oxford and Sputnik vaccines

‘UK and Russian scientists are teaming up to trial a combination of the Oxford-AstraZeneca and Sputnik V vaccines to see if protection against Covid-19 can be improved. Mixing two similar vaccines could lead to a better immune response in people. The trials, to be held in Russia, will involve over-18s, although it's not clear how many people will be involved.’

Read here (BBC, Dec 11, 2020)

Research finds 5 genes linked to severest form of Covid-19

‘A study found five key genes central to many severe cases of COVID-19 and pointed to some existing drugs that could be repurposed to treat those at risk of getting critically ill from the disease...

‘Five key genes are linked with the severest form of COVID-19, scientists said on Friday, in research that also pointed to several existing drugs that could be repurposed to treat people who risk getting critically ill with the pandemic disease.

‘Researchers who studied the DNA of 2,700 COVID-19 patients in 208 intensive care units across the United Kingdom found that five genes involving in two molecular processes – antiviral immunity and lung inflammation – were central to many severe cases.’

Read here (Aljazeera, Dec 11, 2020)

The magnifying glass: How Covid revealed the truth about our world

‘A fitting symbol of this global pandemic would be a magnifying glass. For while the virus ended and upended so many lives, and spawned a whole new vocabulary – social distancing, furlough, herd immunity, R number, circuit breaker, bubble, unmute – it did not remake the global landscape so much as reveal what was already there, or what was taking shape, just below the surface.

‘It amplified it, sometimes distorting it, sometimes illuminating it in alarming detail. Covid‑19, the disease that was first reported to the World Health Organization one year ago this month, served as a lens through which we were able to see our politics, our planet and ourselves with a new and shocking clarity. It made 2020 a year of revelation, even if what was uncovered was not nearly as new as we might imagine.’

Read here (The Guardian, Dec 11, 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)

The billionaires who profited from the pandemic should help pay for our recovery

‘The collective wealth gain of roughly a trillion dollars that the billionaires have enjoyed is more “than it would cost to send a stimulus check of $3,000 to every one of the roughly 330 million people in America,” the report states. “A family of four would receive over $12,000.” The report points out that a trillion dollars is also “double the two-year estimated budget gap of all state and local governments”—the deficit facing states that will certainly prompt them to make more cuts in public jobs and services if it isn’t addressed. The authors of the report don’t argue that taxing the recent gains of the mega-rich would cover the entire fiscal cost of the pandemic. They stress, instead, the undoubted fact that, at the very apex of U.S. society, there is now a staggering—and historic—amount of wealth that could be taxed.’

Read here (The New Yorker, Dec 10, 2020)

How kids’ immune systems can evade Covid

‘Their immune system sees the virus “and it just mounts this really quick and effective immune response that shuts it down, before it has a chance to replicate to the point that it comes up positive on the swab diagnostic test”, says Melanie Neeland, an immunologist who studied the family, at the Murdoch Children’s Research Institute in Melbourne, Australia.

‘Even in children who experienced the severe but rare complication called multisystem inflammatory syndrome in response to SARS-CoV-2 infection, studies report that the rate of positive results on RT-PCR range from just 29% to 50%.‘

Read here (Nature, Dec 10, 2020)

Not without India: World's pharmacy gears up for vaccine race

‘India, the world’s biggest vaccine maker, is getting set for the massive global blitz to contain the coronavirus pandemic with its pharmaceutical industry and partners freeing up capacity and accelerating investments even without firm purchase orders. India manufactures more than 60% of all vaccines sold across the globe, and while its $40 billion pharmaceutical sector is not yet involved in the production of the expensive Pfizer Inc and Moderna shots, the nation will play a pivotal role in immunizing much of the world. Indian companies are set to produce eight, more affordable vaccines designed to fight COVID-19, including AstraZeneca's Covishield, called the "vaccine for the world here" by its developers.’

Read here (Reuters, Dec 10, 2020)

In an Iranian intensive care unit, doctors grapple with Covid-19 and US sanctions

"The most worrying thing for a doctor is to know there are medicines (plentifully) available in some parts of the world but not here," said Dr. Alireza Fatemi. This how the agony of coronavirus differs in Iran: nowhere else in the world faces this monster of a virus with the added scourge of President Donald Trump's "maximum pressure" sanctions, which Iranian officials and doctors insist have hampered their Covid-19 fight.

Read here (CNN, Dec 10, 2020)

Man named William Shakespeare, one of the first to get Pfizer vaccine, sets off pun cascade

‘To be or not to be vaccinated, that is the question. After an 81-year-old named William Shakespeare became the second person in the West to receive the Pfizer-BioNTech coronavirus vaccine in Britain outside clinical trials Tuesday, social media erupted with joy, puns and many quotes from the great British playwright. “They really are prioritising the elderly: this guy is 456,” wrote one user, while the term “Two Gentlemen of Corona,” a play on “The Two Gentlemen of Verona,” swiftly became a top trend in Britain. Others quipped that the first batch of inoculations, part of the first mass coronavirus immunization campaign in the West, marked the “Taming of the Flu.”

Read here (Washington Post, Dec 9, 2020)

Rich countries have bought too many Covid-19 vaccines: Amnesty International

‘Rich countries have secured enough coronavirus vaccines to protect their populations nearly three times over by the end of 2021, Amnesty International and other groups said on Wednesday (Dec 9), possibly depriving billions of people in poorer areas. "Nearly 70 poor countries will only be able to vaccinate one in 10 people against COVID-19 next year unless urgent action is taken," Amnesty International said, based on recent calculations. "Updated data shows that rich nations representing just 14 per cent of the world's population have bought up 53 per cent of all the most promising vaccines so far," it said.’  

Read here (Channel News Asia, Dec 9, 2020)

People with a history of ‘significant’ allergic reactions shouldn’t have Pfizer jab, UK regulator warns

‘The UK’s Medicines and Healthcare products Regulatory Agency updated its guidance to British health service trusts on who should receive the vaccine. The precautionary advice came after two members of Britain’s National Health Service, who received the vaccine on Tuesday, experienced allergic reactions to the shot. Both are recovering well, according to the national medical director for the NHS.’

Read here (CNBC, Dec 9, 2020)

How a history of ‘medical racism’ may fuel mistrust in Covid-19 vaccines

‘A history of neglect and deception has been cited for the skepticism many Black Americans feel about COVID-19 vaccines. A similar dynamic has affected ethnic groups in other countries. That may pose a challenge to health officials trying to save lives and vaccinate sufficient portions of the population.’

Read here (World Economic Forum, Dec 9, 2020)

The Covid-19 vaccines are here: What comes next?

‘The outstanding progress made by the scientific community has brought the vaccine closer to our doorstep. The baton now passes from the scientific community to a new collaborative effort, led by government and policy makers, healthcare professionals, the private sector, and other community groups. The COVID-19 vaccine rollout will be unlike any other prior vaccine delivery effort. Governments and their partners will be expected to rapidly accelerate their efforts to ensure they are able to address community expectations.

‘Multiple factors will make the rollout of a COVID-19 vaccine more complex than any other previous vaccine effort.

‘Accelerated pace and giant scale of delivery: Countries face a four-by-four challenge: a vaccine arriving at four times the pace and requiring delivery at four times the scale.

‘Four times the pace. The coronavirus vaccine has been developed four times faster than the mumps vaccine, which was the previous record for a vaccine developed for use in a widespread community setting. The consequence of this pace of clinical development is that governments and policy makers have had far less time than previously to prepare for a robust vaccination program.

‘Four times the scale. The COVID-19 vaccine rollout is expected to be four times larger than any previous effort because the aspiration is for broad adoption at significantly higher rates than typically achieved with seasonal adult vaccines, such as the flu. Compared with the flu, for which roughly half the adult population across the OECD is covered each year with a single dose, the COVID-19 situation may require vaccinating more than half the adult population with two doses. Globally, that means billions of people could seek the vaccine.’

Read here (McKinsey & Co, Dec 9, 2020) 

WHO against mandatory Covid-19 vaccines

‘The World Health Organization said on Monday (Dec 7) that persuading people on the merits of a COVID-19 vaccine would be far more effective than trying to make the jabs mandatory. The WHO said it would be down to individual countries as to how they want to conduct their vaccination campaigns against the coronavirus pandemic.

‘But the UN health agency insisted making it mandatory to get immunised against the disease would be the wrong road to take, adding there were examples in the past of mandating vaccines use only to see it backfire with greater opposition to them.’

Read here (Channel News Asia, Dec 8, 2020)

‘This was a gift to us’: Ivermectin effective for Covid-19 prophylaxis, treatment

‘Numerous studies have provided evidence supporting the use of ivermectin to prevent and treat COVID-19, according to the Frontline COVID-19 Critical Care Alliance. Paul Marik, MD, FCCM, FCCP, founder of the alliance and a professor and chief of the division of pulmonary and critical care medicine at Eastern Virginia Medical School, said that ivermectin “is a safe drug that is exceedingly cheap.”

‘He added that “what is truly remarkable — this was a gift to us — ivermectin has high activity against COVID-19.” In a press conference, researchers said that ivermectin is an FDA-approved anti-parasitic drug that has been available for approximately 40 years and previously earned researchers a Nobel Prize.’

Read here (Healio, Dec 8, 2020)

FLCCC Alliance: Review of the emerging evidence demonstrating the efficacy of Ivermectin in the prophylaxis and treatment of COVID-19

Read PDF here (FLCCC Alliance, Dec 7, 2020) 

Blunders eroded US confidence in early vaccine front-runner

‘On the afternoon of Sept. 8, AstraZeneca officials had a conference call with the Food and Drug Administration. The discussion covered important ground: What would AstraZeneca need to do to win the F.D.A.’s blessing for the coronavirus vaccine it was developing with the University of Oxford?

‘But the AstraZeneca representatives neglected to mention a crucial development: Two days earlier, the company had quietly halted trials of its vaccine around the world, including a late-stage study in the United States. It acted after a participant in Britain fell ill.

‘A few hours after the conference call, the story broke about the halted trials. That was how key F.D.A. officials heard the news, according to people with knowledge of the discussions.’

Read here (New York Times, Dec 8, 2020)

The institutional crisis and Covid-19

‘This is what an institutional crisis looks like. The most extreme claims of corruption become readily embraced by one faction and condemned by another. The belief that the presidency is corrupt becomes the framework of political life.

‘This goes beyond the political. I have written about the crisis of expertise, of experts who know their own field brilliantly but cannot comprehend the consequences of their actions beyond that field. The American government after World War II was built on the sanctity of expertise. That principle has since come under challenge in many areas, where the myopia of the experts undermined its depth.

‘The COVID-19 pandemic drove the point home. There were those who invoked the authority of medical experts as paramount. There were those who argued that, absent a cure, the solution the experts submitted – masks and social distancing – was only marginally effective and ignored the devastating economic and social consequences of the solution. There was no clear institutional authority that could strike a reasonable balance.’

Read here (Other News, Dec 8, 2020)

When will you be eligible for the Covid vaccine? Britain

Broadly, vaccines are being given to the most vulnerable first, as set out in a list of nine high-priority groups, covering about a quarter of the UK population. They are thought to represent 90-99% of those at risk of dying from Covid-19.

1. Residents in care homes for older adults and their carers
2. 80-year-olds and over and frontline health and social care workers
3. 75-year-olds and over
4. 70-year-olds and over and clinically extremely vulnerable individuals
5. 65-year-olds and over
6. 16 to 64-year-olds with serious underlying health conditions
7. 60-year-olds and over
8. 55-year-olds and over
9. 50-year-olds and over

People aged over 80 in hospital, frontline health staff and care home workers have been the first to get the jab at 70 designated hospitals hubs across the UK.

Read here (BBC, Dec 8, 2020)

Anti-inflammatory therapy for Covid-19 infection: The case for colchicine [also used for gout]

‘Given the large body of data demonstrating colchicine’s inhibitory effects on neutrophil activity, cytokine generation and the inflammation/thrombosis interface, together with an overall lack of evidence for systemic immunosuppression, there is a rationale to study colchicine as a potential treatment for COVID-19. Given that colchicine is generally well tolerated, simple to take and inexpensive, demonstration of colchicine as a useful agent in COVID-19 would potentially spare patients morbidity and mortality, help to conserve valuable clinical resources (hospital floor and ICU beds, ventilators, etc), and dramatically reduce the cost of COVID-19 care. Colchicine might be of particular use in resource-poor rural and developing world settings, both of which have been increasingly affected by COVID-19. However, unless and until evidence is obtained from adequately designed and randomised placebo-controlled trials, this hypothesis must remain speculative.

‘The optimal dose of colchicine for daily use, even in well-established conditions such as gout, is unknown. Many but not all patients tolerate up to 1.2 mg daily in divided doses; whether lower doses such as 0.5 mg or less daily can be equally effective is unknown. The largest colchicine study for COVID-19 (ColCorona) is testing a dose of 0.5 mg daily based on prior cardiology trials. The duration of colchicine therapy for SARS-COV2 infection would also need to be determined. Most studies to date test a treatment duration of 2–4 weeks, concordant with the acute course of the infection; whether a shorter or longer treatment would be optimal is unknown. Finally, the timing of colchicine initiation is uncertain, with some studies beginning treatment in the outpatient setting, and others in the early inpatient setting. Given the recent track record of failure of treatment of severe COVID-19 treatment with anti-IL-6 biologics such as tocilizumab (a much more potent but also more specific immunosuppressive agent), it is likely that the severe inpatient setting is not the optimal condition under which to assess colchicine efficacy.’

Read here (BMJ, Dec 8, 2020)

The vaccines are coming. It’s time to call your mom

‘The next, crucial step in beating the pandemic? Having conversations with our vaccine-shy loved ones...

‘Uncomfortable relatives are my specialty. As a doctor, I’ve been trying for years to get my family and friends to follow prudent medical advice. It hasn’t gone so well. A decade ago, they’d say, “You’re just in medical school.” Then I was “just in residency.” Now, unfortunately, I’m a pathologist, which doesn’t exactly scream “people person.” I have had some successes, though. Last year, after a hundred gentle conversations, I finally convinced my parents to get the flu vaccine. (Verdict: “It wasn’t so bad.”) A couple months later, Covid-19 struck. I try not to feel completely responsible for this irony...’

Read here (Wired, Dec 7, 2020)

Coronavirus: How can we imagine the scale of Covid's death toll?

‘The suffering from the coronavirus pandemic has come to define 2020. But how do you grasp the immense scale of loss? Flowers - symbols of grief, peace, and love - serve as a tribute to those who have died.

‘Imagine the pandemic as a  flower. In the animation below, the stem grows as Covid-19 cases increase over time and the petals unfurl as more people die with the disease.’

View here (BBC, Dec 7, 2020)

The science behind an RNA vaccine

‘In just 10 months, a vaccine developed by Pfizer and BioNTech has been approved by Britain for emergency use to prevent Covid-19. Another by Moderna is being evaluated for emergency use authorisation by several regulators, including the United States Food and Drug Administration...

‘This 10-month timeline for vaccines to get from concept to licensing is ground-breaking; most take more than 10 years to reach this stage. There are several other RNA vaccines in the pipeline, including the one our team at Duke-NUS Medical School is working on in partnership with Arcturus Therapeutics. Here is the science behind such vaccines...’

Read here (Straits Times, Dec 7, 2020)

Neutralising the threat of Covid-19

Informative and interesting talk with Q&A relevant to Malaysia, live-streamed on Dec 7, 2020. Professor William James, is Professor of Virology and Tutor in Medical Sciences, Jeffrey Cheah Professorial Fellow, and is attached to The Sir William Dunn School of Pathology. He is currently contributing to the work on the Oxford University AstraZeneca COVID-19 vaccine. The talk is moderated by Prof. Abhi Veerakumarasivam, Co-Chair & Professor, ASEAN Young Scientists Network & Sunway University.

View here (YouTube, Dec 7, 2020)

UK ready for roll-out but Pfizer CEO 'not certain' if vaccine stops transmission

‘Days after getting back-to-back approvals from the United Kingdom (UK) and Bahrain health regulatory bodies for the emergency use of its coronavirus vaccine, Pfizer Inc CEO Albert Bourla is now "not certain" if the company-made vaccine to prevent the Covid-19 can actually stop the transmission of the infection. The basic.

‘...during an interview with NBC's Lestor Holt, Pfizer CEO, when asked whether a person can still transmit the virus after vaccination, said he was "not certain". "I think this is something that needs to be examined. We are not certain about that right now with what we know," he was quoted as saying.’

Read here (India Today, Dec 6, 2020)

Coronavirus pandemic could push over 1 billion people in extreme poverty by 2030, says UN

‘Due to the severe long-term impact of the coronavirus pandemic, an additional 207 million people could be pushed into extreme poverty by 2030. This will bring the total number of the world's extremely poor to more than a billion, according to a new study by the UN Development Programme (UNDP).

‘The study assesses the impact of different coronavirus recovery scenarios on the Sustainable Development Goals (SDGs), evaluating the multidimensional effects of the pandemic over the next decade. It is part of a long-standing partnership between the UNDP and the Pardee Center for International Futures at the University of Denver.’

Read here (India Today, Dec 6, 2020)

Tucked into the Covid-19 stimulus package? Protection for corporations

‘US Representative Alexandria Ocasio-Cortez has been one of the few Democratic lawmakers to spotlight what’s really going on. Last week, she tweeted: “If you want to know why Covid-19 relief is tied up in Congress, one key reason is that Republicans are demanding legal immunity for corporations so they can expose their workers to Covid without repercussions.”

‘The bipartisan initiative aims to obscure its Dr Evil level of depravity by superficially depicting the liability shield as merely temporary. But that seems like a ruse, as indicated by private equity mogul and senator Mitt Romney of Utah, who said the federal Covid-19 liability shield provision “provides a temporary suspension of any liability-related lawsuits, state or federal level associated with Covid-19, giving states enough time to put in place their own protections”.’

Read here (The Guardian, Dec 5, 2020)

The governance of Covid-19: Anthropogenic risk, evolutionary learning, and the future of the social state

‘We consider the implications of the Covid-19 crisis for the theory and practice of governance. We define ‘governance’ as the process through which, in the case of a given entity or polity, resources are allocated, decisions made and policies implemented, with a view to ensuring the effectiveness of its operations in the face of risks in its environment. Core to this, we argue, is the organisation of knowledge through public institutions, including the legal system. Covid-19 poses a particular type of ‘Anthropogenic’ risk, which arises when organised human activity triggers feedback effects from the natural environment. As such it requires the concerted mobilisation of knowledge and a directed response from governments and international agencies. 

‘In this context, neoliberal theories and practices, which emphasise the self-adjusting properties of systems of governance in response to external shocks, are going to be put to the test. In states’ varied responses to Covid-19 to date, it is already possible to observe some trends. One of them is the widespread mischaracterisation of the measures taken to address the epidemic at the point of its emergence in the Chinese city of Wuhan in January and February 2020. 

‘Public health measures of this kind, rather than constituting a ‘state of exception’ in which legality is set aside, are informed by practices which originated in the welfare or social states of industrialised countries, and which were successful in achieving a ‘mortality revolution’ in the course of the nineteenth and twentieth centuries. Relearning this history would seem to be essential for the future control of pandemics and other Anthropogenic risks.’

Read here (NCBI, Dec 4, 2020)

As first Pfizer vaccine doses arrive in UK, officials tell doctors and nurses they won’t get priority

‘Priority will go to people over 80 years old and to nursing home caregivers, and even for those groups, demand could quickly outstrip supply in the early months, public health officials cautioned. The 800,000 doses Britain expects to get this month “could be the only batch we receive for some time,” warned Chris Hopson, chief executive of NHS Providers.’

Read here (Washington Post, Dec 4, 2020)

Covid survivors with long-term symptoms need urgent attention, experts say

‘There is an urgent need to address long-term symptoms of the coronavirus, leading public health officials said this week, warning that hundreds of thousands of Americans and millions of people worldwide might experience lingering problems that could impede their ability to work and function normally.

‘In a two-day meeting Thursday and Friday, the federal government’s first workshop dedicated to long-term Covid-19, public health officials, medical researchers and patients said the condition needed to be recognized as a syndrome, given a name and taken seriously by doctors. “This is a phenomenon that is really quite real and quite extensive,” Dr. Anthony S. Fauci, the nation’s top infectious diseases expert, said at the conference on Thursday.’

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

Vaccine nationalism? An incurable disease called hope

‘It is disheartening to see ‘vaccine nationalism’ eclipse the hope around the development of the vaccine. The rich countries, with 13% of the world’s population, have already secured 3.4 billion doses of the potential vaccines; the rest of the world has pre-committed vaccine orders of 2.4 billion doses. The poorest countries, with a population of 700 million people, have no agreements for the vaccine. They depend on the Covax vaccine, developed in partnership between the World Health Organization, the Vaccine Alliance (GAVI), and the Coalition for Epidemic Preparedness Innovations (CEPI). Covax has agreements to secure about 500 million doses, which would be enough to vaccinate 250 million people and cover about 20% of the populations of the poorest countries. In contrast, the United States of America, by itself, has made agreements to purchase enough doses to cover 230% of its population and could eventually control 1.8 billion doses (about a quarter of the world’s near-term supply).

‘The way things are going, two-thirds of the world’s population will not have a vaccine before the end of 2022... The struggle between ‘vaccine nationalism’ and the ‘people’s vaccine’ mirrors the fight between the North and the South over questions of debt and over vast areas of human development... Precious resources need to go toward testing, tracing, and isolation to break the chain of infection of the virus; they need to go toward building up the public health infrastructure, including training health care professionals who would need to give the two-dose injection to billions of people; they need to be used for the building of regional pharmaceutical production; and certainly they need to go toward the immediate relief for people, including income support, food provision, and social protection against the shadow pandemic of patriarchal violence.’

Read here (The Bullet, Dec 4, 2020) 

Unconventional measures for extraordinary times no excuse for more abuse

‘...There are widespread concerns that bolder expansionary fiscal policies are likely to be abused by typically short-termist governments of the day, tempted by macroeconomic (ethno-)populism, and unconcerned about the medium- and long-term consequences of increased spending, borrowing and debt. 

‘Only much better governance, transparency and accountability can minimise harm due to likely ‘leakages’ and abuses associated with increased government borrowing and spending. Such fiscal policies typically involve governments borrowing, especially by selling bonds and other securities, including to central banks. 

‘Publics often presume that governments tax first in order to spend. In fact, they usually spend first, and then tax. Poorly accountable governments often take advantage of real, exaggerated or imagined crises to pursue more populist macroeconomic policies to secure regime survival and benefit the politically well-connected.’

Read here (ksjomo.org, Dec 3, 2020)

Vaccination cards will be issued to everyone getting Covid-19 vaccine, health officials say

‘The Department of Defense released the first images of a Covid-19 vaccination record card and vaccination kits Wednesday. Vaccination cards will be used as the "simplest" way to keep track of Covid-19 shots, said Dr. Kelly Moore, associate director of the Immunization Action Coalition, which is supporting frontline workers who will administer Covid-19 vaccinations... Every dose administered will be reported to the US Centers for Disease Control and Prevention, said Claire Hannan, executive director of the Association of Immunization Managers. The CDC did not immediately respond to CNN's inquiry about whether such a database would include a record of everyone immunized.’

Read here (CNN, Dec 3, 2020)

Designing vaccines for people, not profits

‘The Covid-19 crisis is a perfect test of whether a more public-health-oriented approach to innovation and production will prevail in the years ahead. While Pfizer is sticking with the model of maximising shareholder value, AstraZeneca has at least pledged not to profit from its vaccine ‘during the pandemic.’ Yet, despite all the public investment that underwrote these innovations, the process will remain opaque, leaving one to wonder if AstraZeneca is actually ready to prioritise public health over profit and offer its vaccine at cost.

‘While the recent vaccine news has brought hope, it also has exposed the pharmaceutical industry’s broken business model, casting doubt on the prospects of delivering a people’s vaccine and achieving health for all. Business as usual may allow us to scrape by in this crisis. But there is a better way to do things. Before the next pandemic arrives, we must recognise vaccines as global health commons, and start to reorient the innovation system toward symbiotic public-private partnerships governed in the public interest.’

Read here (Social Europe, Dec 2, 2020)

Covid vaccines: Calling the shots

‘The lesson of the coronavirus vaccine response is that a few billion dollars a year spent on additional basic research could prevent a thousand times as much loss in death, illness, and economic destruction. At a news conference, US health adviser, Anthony Fauci, highlighted the spike protein work. “We shouldn’t underestimate the value of basic biology research,” Fauci said. Exactly. But as many authors, such as Mariana Mazzacuto have shown, state funding and research has been vital to development of such products.

‘What better lesson can we learn from the COVID vaccine experience than that the multi-national pharma companies should be publicly owned so that research and development can be directed to meet the health and medical needs of people rather than to the profits of these companies. Then the necessary vaccines can get to the billions in the poorest countries and circumstances rather than to just those countries and people who can afford to pay the prices set by these companies.

“This is the people’s vaccine,” said corporate critic Peter Maybarduk, director of Public Citizen’s Access to Medicines program. “Federal scientists helped invent it and taxpayers are funding its development. … It should belong to humanity.”

Read here (The Bullet, Dec 2, 2020)

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)

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)