How to manage vaccine liability in Malaysia

‘While different systems vary in terms of elements of compensation and funding mechanisms, we can adapt the policies related to funding, proving injury and distributing compensation involving multiple parties. For example, we can set up a bespoke Covid-19 vaccine compensation programme. The programme could be co-financed by a mixture of public and private funds (eg. led by insurers), to achieve effective immunisation roll-out while providing a fair and equitable remedy and reduce overall costs to society.  

‘Two, Malaysia’s government can adapt the Singapore model and completely assume the financial costs of any serious adverse events from the vaccine. The list of serious adverse events that are covered, the mechanism of approval and the ministry which will pay are details that can be decided by a relevant committee. Given serious adverse events are rare, the overall cost should be manageable and represents a good investment for public confidence.

‘A third option is the Covax Facility’s no-fault-compensation scheme for indemnification and liability. The scheme proposed by Covax aims to set up a compensation fund for vaccine recipients in participating countries who might suffer any side-effects from COVID-19 vaccines. The scheme proposes a new mechanism to pay a lump-sum based on severity of harm to victims from Covid-19 vaccines associated side effects. The proposed mechanism would be funded by earmarking funds from high income countries or by charging taxes on pharmaceutical companies.  

‘There are reasonable solutions to the problem, and Malaysia must have a full-frontal and honest conversation about how to manage adverse events, no matter how unlikely they might be. All the solutions described above are not mutually exclusive. However, implementing them requires political will and courage. Covid-19 vaccination is a collective national effort, and we must do all we can to increase public confidence in the vaccine by providing appropriate liability protections.’

Read here (Malay Mail, Feb 11, 2021) 

Why it’s so hard to make antiviral drugs for Covid and other diseases

‘Antibiotics abound, but virus-fighting drugs are harder to come by. Fortunately, scientists are getting better at making and finding them...

‘The pandemic has sent scientists scrambling to find treatments. Heise [virologist Mark Heise of the University of North Carolina at Chapel Hill], for one, is testing a wide range of drugs—not just standard antivirals—against SARS-CoV-2 in lab dishes, as part of the Rapidly Emerging Antiviral Drug Discovery Initiative (READDI). The idea is that, because the virus depends on many processes in human cells, a variety of medications that act on human proteins might give doctors an edge by hurting the virus more than the patient. That throws the doors open to considering medications that were originally designed for cancer, psychosis, inflammatory conditions and autoimmune disease, to see if they might have a shot against Covid-19.

‘But the READDI collaborators—including academic centers, pharmaceutical companies and nongovernmental organizations—are aiming for more than a Covid-19 treatment. READDI hopes to identify and test potential medications for as-yet-unknown infections that may crop up in the future.

‘By getting early human safety testing done ahead of time, they’ll be ready to spring into action when those future outbreaks happen. As Heise says, “We don’t want to repeat what we’ve just been through.”

Read here (Scientific American, Feb 11, 2021)

Online scammers are rushing to exploit people desperate to get the Covid-19 vaccine

‘Many Americans are eager to get the Covid-19 vaccine as quickly as possible. But that inevitably means there are scammers ready to use the internet to take advantage of these vaccine seekers to steal their money and personal information.

‘Similar to earlier in the pandemic, when fraudsters flooded the internet with ads for sketchy “cures,” bogus Covid-19 tests, and scarce personal protective equipment, online schemers are now selling fake vaccine appointments and knockoff vaccine cards. (These cards document the date that vaccinated people received their doses, the manufacturer of their vaccine, and its batch number; they’re seen as a record of vaccination.)

‘Vaccine schemes are alarming. In late January, one man in Washington state was arrested after advertising fake Covid-19 vaccines online for as much as $1,000, and even injected people with an unknown substance, according to the Department of Justice, which is investigating these types of fraud cases.’

Read here (Vox, Feb 11, 2021)

‘Pure, liquid hope’: What the vaccine means to me as a GP

‘Clinicians everywhere are all nervous about what will happen if that loosening of restrictions occurs too quickly. Though death from Covid among the under-50s is relatively rare, it can still be a terrible, terrifying disease, capable of rendering its victims breathless and exhausted for weeks (and in some cases, months) after its fevers have run their course. One of my own patients, a nurse in his 20s, used to run 10km three or four times a week. The staff vaccination programme was too late for him: he caught Covid on the wards just before Christmas. Though he’s now back at work, he still hasn’t recovered sufficiently to be able to get back to running.

‘For the next six months, all my colleagues and I will be vaccinating as needed, as many hours as we’re able to. This week I’ve been gladly trudging the streets in the snow, vaccinating our housebound patients, and there aren’t too many still to go. In Scotland, the programme is anticipated to go on at least until 31 July, and the hope is that everyone over 50 will have had a first dose by May.

‘The numbers are daunting, but there’s a spirit of anticipation and celebration in the air. Many are starting to dare to plan for a world post-Covid, and I’m tempted to share that optimism. Opening my first box of vials, I thought of a friend in Orkney, a GP who’d already vaccinated all the over-80s of his practice, and who’d begun to call in the over-70s. We met briefly in Kirkwall, outdoors, on my journey from Orkney back to Edinburgh. “How did it feel to get started?” I asked him.

“I almost wept as I opened that box of vials,” he said, smiling at the memory. “Each one was hope – pure, liquid hope.”

Read here (The Guardian, Feb 11, 2021)

Immunitee Malaysia's first health passport accepted in Singapore

‘Malaysia’s Immunitee Health Passport has partnered with Temasek-founded Affinidi to become the country’s first health passport to be accepted in Singapore, via Affinidi’s Unifier digital credential platform.

‘The Immunitee Health Passport is a system designed to store personal immunisation records and vaccine data, which helps to facilitate users’ clearance at border health checkpoints, ensure data protection and security through blockchain, and verify the authenticity of Covid-19 tests and vaccines.

‘In a statement today, Immunitee said the Unifier platform provided interoperability, enabling the secure sharing of necessary data with the various national health check systems being put in place globally.’

Read here (The Edge, Feb 10, 2021)

Ground SOPs in science: The Academy of Medicine of Malaysia

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

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

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

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

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

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

Common asthma drug cuts Covid-19 hospitalisation risk, recovery time: Oxford study

‘A commonly used asthma treatment appears to reduce the need for hospitalisations as well as recovery time for COVID-19 patients if given within seven days of symptoms appearing, researchers at the University of Oxford said on Tuesday (Feb 9).

‘The findings were made following a mid-stage study of the steroid budesonide, sold as Pulmicort by AstraZeneca and also used for treating smoker's lung.

‘The 28-day study of 146 patients suggested that inhaled budesonide reduced the risk of urgent care or hospitalisation by 90 per cent when compared with usual care, Oxford University said.’

Read here (Channel News Asia, Feb 10, 2021)

What Covid-19 has done to our well-being, in 12 charts

‘How has Covid-19 and the related shift to WFH affected workers? A group of researchers surveyed HBR readers and others in the fall of 2020 and found that the vast majority reported declines in both general and workplace well-being. The biggest culprits? Mental health struggles, increased job demands, and home-life challenges. A much smaller percentage reported an increase in well-being, attributing it to reduced commutes and business travel and having more time to focus on health.’

Read here (Harvard Business Review, Feb 10, 2021)

Trust in Covid vaccines is growing

‘Attitudes towards COVID-19 vaccines seem to be improving in some parts of the world, a survey of thousands of people in 15 countries has found. Researchers have welcomed the results, which suggest that an increasing proportion of people are willing to be immunized. But they caution that some problems persist, such as concerns about vaccine safety. “For the first time since the pandemic began, I can sense that optimism is spreading faster than the virus,” says behavioural scientist Sarah Jones at Imperial College London, who co-led the global attitudes towards a COVID-19 vaccine survey.

‘The survey is part of the COVID-19 behaviour tracker, run by Imperial together with the UK market-research company YouGov.’

Read here (Nature, Feb 10, 2021)

Rebuilding a better, post-Covid-19 world with a new mindset of stakeholders: WEF founder Klaus Schwab

‘World War II was a time of great crisis and hardship, which forged a sense of solidarity that helped pull ravaged communities together. "To a certain extent, we are in a similar situation today...we went through a major crisis, which affected everybody in the world," says the founder and executive chairman of the World Economic Forum (WEF).

‘He is also here for the launch of his new book, Stakeholder Capitalism: A Global Economy That Works For Progress, People And Planet, which he has written with a WEF colleague, Mr Peter Vanham...

‘Indeed the stakeholder concept has featured prominently in his work since the 1973 Davos Manifesto, which set out the role of business managements to "serve clients, shareholders, workers and employees, as well as societies, and to harmonise the different interests of the stakeholders".

‘It is a theme he delves into deeper in his new book. "The idea that we need to rebuild differently post-Covid is widely shared. The sudden and all-encompassing impact of Covid-19 made us understand, much more than the gradual effects of climate change or increasing inequality, that an economic system driven by selfish and short-term interests is not sustainable...’

Read here (Straits Times, Feb 10, 2021)

Nonstimulus arithmetic: Why the American Rescue Plan has to be big -- Krugman

‘We are not in a conventional recession — a decline in output due to insufficient aggregate demand. What we’re suffering from, instead, is a partial lockdown, the result of both public policy and private choices, that has sharply curtailed high-infection-risk activities, like indoor dining.

‘Pumping up overall spending with fiscal and monetary policy wouldn’t send diners back into restaurants, nor should it. So we aren’t experiencing a normal output gap, something that should be closed by stimulus. It’s actually not clear whether we even want employment and GDP to be higher before vaccination gives us herd immunity.

‘What, then, is the role of policy? As some of us have been arguing all along, it’s not stimulus, it’s disaster relief: an attempt to shore up the living standards of those hurt by the temporary lockdown, as well as providing resources to deal with the pandemic itself. Or as I recently argued, you can think of what we’re doing as being something like fighting a war — special expenditure in the face of an emergency.’

Read here (paulkrugman.substack, Feb 10, 2021)

Bhutan: The unlikeliest pandemic success story

‘On January 7, a 34-year-old man who had been admitted to a hospital in Bhutan’s capital, Thimphu, with preexisting liver and kidney problems died of COVID-19. His was the country’s first death from the coronavirus. Not the first death that day, that week, or that month: the very first coronavirus death since the pandemic began.

‘How is this possible? Since the novel coronavirus was first identified more than a year ago, health systems in rich and poor countries have approached collapse, economies worldwide have been devastated, millions of lives have been lost. How has Bhutan—a tiny, poor nation best known for its guiding policy of Gross National Happiness, which balances economic development with environmental conservation and cultural values—managed such a feat? And what can we in the United States, which has so tragically mismanaged the crisis, learn from its success?’

Read here (The Atlantic, Feb 10, 2021)

WHO team says theory Covid began in Wuhan lab ‘extremely unlikely’

‘The World Health Organization team that visited Wuhan to investigate the origins of the coronavirus pandemic has all but dismissed a theory that the virus leaked from a laboratory, while giving some credence to China’s focus on the possibility of transmission via frozen food.

‘They said the team’s work did not dramatically change the picture they had before they began, but had added important details to the story. The team found no evidence of widespread circulation of the virus in Wuhan prior to December 2019, and said it was still unclear how it got into the Huanan seafood market, where the virus was initially detected. But, they added, “all the work that has been done on the virus and trying to identify its origin continue to point toward a natural reservoir”.’

Read here (The Guardian, Feb 9, 2021)

Prevalence and outcomes of SARS-CoV-2 infection among migrant workers in Singapore

‘There were 43 dormitories housing 198 320 migrant workers with a median occupancy of 3578 (interquartile range, 1458-6120); 99.8% of residents were male, with a median age of 33 years (interquartile range, 28-39 years). As of July 25, 95.1% of all residents had at least 1 SARS-CoV-2 test, including 63.6% with PCR and 68.4% with serology. There were 111 280 residents with a positive PCR or serology result, for an overall infection prevalence of 56.1% (95% CI, 55.9%-56.3%) (range per dormitory, 0%-74.7%; median, 52.9%). 

‘There were 24 197 clinical cases (12.2% of all residents; 21.7% of infected) from 42 dormitories and 87 083 subclinical cases (43.9% of all residents; 78.3% of all infected) (Table). Of all clinical cases, 20 cases required ICU admission (0.08% [95% CI, 0.05%-0.13%]), with 1 COVID-19 attributable death (case-fatality rate, 0.004% [95% CI, 0.0002%-0.027%]).’

Read here (JamaNetwork, Feb 9, 2021) 

Safely reopening requires testing, tracing and isolation, not just vaccines

‘The Moderna and Pfizer vaccines were developed in record time. However, these announcements highlight significant challenges: delivering two-dose vaccines with stringent cold-chain requirements to almost eight billion people, many of whom reside in communities with underfunded and strained health systems, is no small feat. Even if we address the logistical challenges, the reality is that it takes time and funding to deliver vaccines, treatments and tests that reach everyone in need. It is a sobering reminder that when lifesaving antiretrovirals were introduced for HIV-positive people, it took seven years before the medicine reached the poorest communities. And during that time, millions of people died, and millions more were infected, and the HIV pandemic continued to grow.

‘Until we can overcome these obstacles and ensure equitable delivery of vaccines and treatments once available across the globe, the fundamentals of controlling this virus remain as important as ever.

‘For a long time, many countries will continue to rely on already proven tools to control the pandemic. The formula is simple: test, trace and isolate. This straightforward but effective process is key to safely reopening economies and societies. It is made possible through the rapid and equitable scale-up of diagnostics, which have proven to be the most important tool for limiting the spread of COVID-19. Test, trace and isolate—and ultimately test, trace and treat once more treatments become available—is an efficient, sustainable way to control the virus, especially in contrast to last-resort emergency lockdown measures, which can erode the public support and trust necessary for the success of many other helpful public health measures, including vaccination and mask-wearing.

‘We have seen this strategy implemented successfully around the world for decades with age-old diseases like tuberculosis. This strategy is also making a difference in the fight against COVID-19.’

Read here (Scientific American, Feb 9, 2021)

Protein behind corona’s slow Asia spread: Study

‘Deficiency in a particular human protein, which is more common in Europe and the United States than in Asia, could explain why coronavirus is not spreading as fast in Asian countries. A team of scientists from the National Institute of Biomedical Genomics in Kalyani, West Bengal, have found a biological reason for the slower spread of a mutant of coronavirus in Asia compared to the West. The team has explained how higher levels of a human protein — neutrophil elastase — helps the virus to enter the human cell, multiply and also spread faster from infected individuals... 

“However, some naturally-occurring mutations in the AAT-producing gene results in deficiency of the AAT protein. This deficiency is known to be much higher in the Caucasians of Europe and America than among Asians,” said Majumder. “While we used AAT deficiency data from East Asia, along with North America and Europe, for the study, considering the pace at which the coronavirus is spreading, the numbers are representative of other Asian regions too, including India.”... 

‘As per their data, AAT deficiency is the least in East Asian countries — 8 per 1,000 individuals in Malaysia, 5.4 per 1,000 in South Korea, 2.5 in Singapore. On the other hand, 67.3 in per 1,000 individuals in Spain are AAT deficient, 34.6 in the UK and 51.9 in France and in the US it is prevalent in 29 individuals among 1,000.’

Read here (Times of India, Feb 9, 2021)

Tribal health providers have figured out the key to Covid-19 vaccine success. Here's their secret

‘It's important to note that there are 574 federally recognized tribes, making it difficult to broadly characterize how the vaccine rollout is going across Indian Country. Native people get their health care from a patchwork system of Indian Health Service facilities, tribally-operated clinics and urban Indian health centers, and vaccination efforts have varied from tribe to tribe and state to state.

Still, the successes of some tribal health providers offer lessons for communities struggling to vaccinate their populations efficiently. Here are some of them.

• They tailored their messaging to build trust
• They have the autonomy to decide who gets priority
• This health system is owned by its people
• They made big investments in health care
• Ultimately, success depends on the nation's vaccine supply

Read here (CNN, Feb 9, 2021)

Covid lockdowns in Hong Kong: Ambush-style action clearly works

‘The ambush-style lockdowns in Hong Kong are being criticised as a violation of human rights. However, such sudden lockdowns may remain the most efficient way for the city to control the spread of Covid-19 (“Hong Kong’s latest lockdowns uncover four Covid-19 cases in three buildings”, February 8).

‘To know the reason for this, we must know the answer to two questions: why a lockdown, and why ambush-style... (1) Lockdowns are the most effective way known for tracing or eliminating the virus infection chain... (2) As for the ambush style adopted, the lack of notice is the only way to ensure that no one can escape the lockdown...’

Read here (South China Morning Post, Feb 9, 2021)

Travelling during Covid: ‘I was nervous using a fake Covid-19 test certificate’

‘Coronavirus has changed the way we travel and many countries now demand proof of a negative Covid test before letting you in - with tests often costing hundreds of pounds. BBC reporter Joice Etutu has been speaking to two women who admit using and selling fake certificates...

‘Jessica* is also 24. She admits to selling fake Covid-19 certificates to people who wanted to travel abroad by advertising her services on social media. She says it was "easy money". "They just didn't want to pay £150 for a private test," she says. "We charged them £50. "Because it was so cheap people were asking so many questions, like 'how does it work?', 'when I get to the place are they gonna double check?', 'how did you do it?', 'am I gonna get in trouble?'"

‘Buying or even attempting to buy a forged certificate is a crime in the UK and using a forged certificate to travel is fraud by false representation. If you're caught selling fake certificates in the UK, you might face a prison sentence. Currently, it's the responsibility of airlines to check that passengers have a negative test result.’

Read here (BBC, Feb 9, 2021)

Four principles for urgent pharma action to combat Covid-19

‘Collaboration is needed between pharmaceutical companies and governments to combat the spread of COVID-19 and accelerate access to tests, treatments and vaccines. Norway, which co-chairs the Facilitation Council of the ACT-Accelerator, is committed to ensuring the global vaccination effort is managed effectively. Here are four principles which could ensure equitable access to COVID-19 tools and health products, particularly for low and middle-income countries:

• Principle 1: File for registration rapidly, widely and on the basis of the most rigorous standards
• Principle 2: Price health technologies fairly
• Principle 3: Expand production and supply capacity
• Principle 4: Transparency

Read here (World Economic Forum, Feb 9, 2021)

Is China to blame for Covid-19: Interview with The Lancet's editor Richard Horton

‘Whether it's Donald Trump, Tom Tugendhat or Paul Joseph Watson, various voices during this pandemic have blamed China for the mess we're in. How true is this? Editor-in-chief of the Lancet medical Journal, Richard Horton, argues that much of this stems from anti-Chinese racism and that we owe a debt of gratitude to the doctors, nurses and scientists of China.’

View here (Youtube, Novara Media, Feb 8, 2021)

Dawn beckons as Covid vaccines roll out, but the next few months promise to be the darkest yet, and echoes of the AIDS era

‘One strange aspect of plagues is that they often finish strong. I learned this the hard way last time around. Many people have a general sense of AIDS being terrible in the 1980s and then slowly petering out in the 1990s, as treatments improved. It’s intuitive to think this way, and even to remember things this way. But, in reality, the worst ever year for deaths from AIDS in the US was 1995 — over a decade after the first deaths in America — and just before the arrival of the cocktail therapy that turned everything around. The virus killed more people in America in the year right before the medical breakthrough than in any other previous year.

‘...this [Covid] plague, like many others, could become worse yet before it suddenly turns the corner. The next couple of months may be the most fatal of the entire pandemic — even as freedom from this virus is within sight. There’s a special agony to those deaths, as there will be for all those human beings who will die of a virus for which a vaccine already exists.’

Read here (Genetic Literacy Project, Feb 8, 2021)

Intellectual property cause of death, genocide

‘Refusal to temporarily suspend several World Trade Organization (WTO) intellectual property (IP) provisions to enable much faster and broader progress in addressing the COVID-19 pandemic should be grounds for International Criminal Court prosecution for genocide. 

‘Making life-saving vaccines, medicines and equipment available, freely or affordably, has been crucial for containing the spread of many infectious diseases such as tuberculosis, HIV-AIDS, polio and smallpox. 

‘Jonas Salk, who developed the polio vaccine, insisted that it remain patent free. Asked who owned the patent 65 years ago, he replied, “The people I would say. There is no patent. You might as well ask, could you patent the sun?”

Read here (ksjomo.org, Feb 8, 2020)

China, Russia steal a vaccine diplomacy march

‘Russia and China are rising to the rich versus poor challenge by supplying much-needed vaccines to nations that would otherwise be far down on the global list. While the US and EU remain preoccupied with their own Covid-19 problems, Russian and Chinese companies are forming partnerships with each other and countries around the world.

‘That “vaccine diplomacy” success, however, is already starting to raise concerns in the West. Russia’s Sputnik V vaccine, originally poo-pooed in the West as a mere publicity stunt by President Vladimir Putin, has not only proved to be one of the most effective vaccines – providing over 90% protection – but also is inexpensive and easy to use...

‘Until recently, China’s vaccine industry was considered a relatively minor player on the international scene. But the race to develop and deploy Covid-19 vaccines has provided China the impetus to massively upgrade its capacities while establishing itself as a major global supplier. 

‘Covid-19 vaccines by at least four Chinese producers are in final, Phase III trials in a dozen countries, with more in the pipeline. More importantly, the two presently leading Chinese vaccines, produced by the Sinovac and Sinopharm companies, have already been administered to many millions of people in emergency vaccination campaigns in the developing world.’ 

Read here (Asia Times, Feb 8, 2021)

Inhaled budesonide in the treatment of early Covid-19 illness: A randomised controlled trial

Background Multiple early hospital cohorts of coronavirus disease 2019 (COVID-19) showed that patients with chronic respiratory disease were significantly under-represented. We hypothesised that the widespread use of inhaled glucocorticoids was responsible for this finding and tested if inhaled glucorticoids would be an effective treatment for early COVID-19 illness.

Methods We conducted a randomised, open label trial of inhaled budesonide, compared to usual care, in adults within 7 days of the onset of mild Covid-19 symptoms. The primary end point was COVID-19-related urgent care visit, emergency department assessment or hospitalisation. The trial was stopped early after independent statistical review concluded that study outcome would not change with further participant enrolment.

Results 146 patients underwent randomisation. For the per protocol population (n=139), the primary outcome occurred in 10 participants and 1 participant in the usual care and budesonide arms respectively (difference in proportion 0.131, p=0.004). The number needed to treat with inhaled budesonide to reduce COVID-19 deterioration was 8. Clinical recovery was 1 day shorter in the budesonide arm compared to the usual care arm (median of 7 days versus 8 days respectively, logrank test p=0.007). Proportion of days with a fever and proportion of participants with at least 1 day of fever was lower in the budesonide arm. Fewer participants randomised to budesonide had persistent symptoms at day 14 and day 28 compared to participants receiving usual care.

Conclusion Early administration of inhaled budesonide reduced the likelihood of needing urgent medical care and reduced time to recovery following early COVID-19 infection.

Evidence before this study The majority of interventions studied for the COVID-19 pandemic are focused on hospitalised patients. Widely available and broadly relevant interventions for mild COVID-19 are urgently needed.

Added value of this study In this open label randomised controlled trial, inhaled budesonide, when given to adults with early COVID-19 illness, reduces the likelihood of requiring urgent care, emergency department consultation or hospitalisation. There was also a quicker resolution of fever, a known poor prognostic marker in COVID-19 and a faster self-reported and questionnaire reported symptom resolution. There were fewer participants with persistent COVID-19 symptoms at 14 and 28 days after budesonide therapy compared to usual care.

Implications of all the available evidence The STOIC trial potentially provides the first easily accessible effective intervention in early COVID-19. By assessing health care resource utilisation, the study provides an exciting option to help with the worldwide pressure on health care systems due to the COVID-19 pandemic. Data from this study also suggests a potentially effective treatment to prevent the long term morbidity from persistent COVID-19 symptoms.

Read here (Medrxiv, Feb 8, 2021)

Variants v Vaccines: The race between the tortoise and the hare -- Tomas Pueyo

‘The B117 variant will probably take over between February and March in most developed countries. That’s without taking into account the Brazilian and South African variants. Emerging countries are in an even worse position: Not only will they have the 3 variants. They will also receive vaccines much later. And in the Southern hemisphere, they’re now enjoying summer. Winter, with more variants and not enough vaccines, might be less forgiving.

‘So keep tight for a few more months. Don’t let your guard down. The end of the tunnel is near. Get a vaccine if you can. If not, wait till the summer. By September, we’ll likely be back to the new normal in developed countries. And in emerging ones, let’s hope more vaccines and a fast rollout avoids a repeat of 2020.’ 

Read here (substack.com, Feb 8, 2021)

Growing number of Covid-19 patients dying at home [in Malaysia]

‘In the first week of this month, 10 Covid-19 patients have died before they could receive treatment at a hospital. The youngest to suffer such a fate this month is an 18-year-old girl who was brought in dead at the Selayang Hospital, Selangor. Her infection was compounded by asthma. Her death was reported by the Health Ministry in its daily statistics yesterday.

‘According to Malaysiakini’s tracking, 22 people infected with Covid-19 were brought in dead in December last year. Another 41 people were brought in dead in January this year. That means since December last year, 73 out of the 512 recorded fatalities were brought in dead, slightly above 14 percent.’

Read here (Malaysiakini, Feb 8, 2021) 

Equity in vaccination: A plan to work with communities of colour toward Covid-19 recovery and beyond -- Introduction

‘The coronavirus disease 2019 (COVID-19) pandemic has had tragic and disproportionate adverse effects on Black, Indigenous, and People of Color (BIPOC) communities across the United States. The number of cases, hospitalizations, and deaths related to this disease is significantly higher in these groups. Additionally, members of BIPOC communities are among those hit the hardest by the economic and social upheavals caused by the pandemic.

‘As the COVID-19 vaccination campaign begins, it is critical that vaccines be delivered fairly and equitably—so that everyone has the same level of access to this lifesaving technology. Just as pressing is the need to address longstanding disparities that have created the unequal situation that BIPOC communities are now in.

‘This plan provides elected and appointed officials with the tools to create, implement, and support a vaccination campaign that works with BIPOC communities to remedy COVID-19 impacts, prevent even more health burdens, lay the foundation for unbiased healthcare delivery, and enable broader social change and durable community-level opportunities.

‘The 5 key principles and their associated action items in the plan are:

‘Iteration: Repeated engagement with BIPOC communities is necessary. There is a race to get as many people vaccinated as soon as possible, and this urgency must be balanced with the need to build real trust in BIPOC communities. In many areas, this trust is low or nonexistent, which means that building trust will take time. It will require committing to engaging with BIPOC communities, including organizing productive “listen-and-plan” sessions in which community members have the opportunity to explain their thoughts on COVID-19 vaccination and where officials have the opportunity to listen and hear what is being said, and in partnership, put these ideas into action.

 ‘Involvement: Moving forward, BIPOC community representatives and advocates must become active collaborators in the public health process. This will involve implementing mechanisms for 2-way communication (particularly with trusted leaders, influencers, and pillar institutions in local BIPOC communities) and engaging with these key representatives as partners, not as audiences to persuade or subordinates to command. One way this can be done is by encouraging BIPOC individuals and community organizers to actively participate in the COVID-19 vaccination campaign in ways that respect their self-determination and strengthen their self-reliance. A longer-term approach is to ensure BIPOC individuals are in positions of power in government and public health.

 ‘Information: Effective communication with BIPOC community members is essential in the ongoing COVID-19 vaccination effort. Applying best practices for communication during this time will be useful for moving forward. As a starting point, it is important to recognize that vaccination messages must be tailored to address the specific concerns of local BIPOC communities. This can be done in one of the following ways (or through a combination of these approaches): identify and support trusted BIPOC individuals and organizations who can relay information and help set community norms related to COVID-19 vaccination, apply learning from “listen-and-plan” sessions to frame COVID-19 vaccination in the communities’ own terms, and enlist allies to blanket BIPOC communities with accurate information that can drown out misinformation.

 ‘Investment: All of the efforts described above will require investments of time, attention, and funding. At the same time, the vaccination process itself can be viewed as an opportunity for economic revitalization, with the potential to lead communities out of the pandemic and its economic hardships. This type of revitalization is particularly important to BIPOC communities that historically, and presently, are often economically challenged. Practical suggestions for investment include: pull together the necessary resources to ensure COVID-19 vaccination is equitable (meaning, easily available to the most marginalized individuals in the community) and then fight to keep these resources in place moving forward; creatively finance nonprofit and for-profit entities with BIPOC community roots to strengthen the vaccination enterprise; and enlist the help of private capital to support vaccination, for example, by getting transportation companies to commit to providing free rides to and from vaccination sites or by having a local grocery store sponsor a “get vaccinated” poster contest for schoolchildren.

 ‘Integration: Looking forward to the end of the pandemic, it is important to recognize that recovery will take time. COVID-19 will have long-lasting physical, psychological, and financial effects, especially in BIPOC communities. Because of this, the COVID-19 vaccination campaign cannot be viewed as a final step in returning to “normalcy.” Instead, it needs to be seen as a step toward a more complete recovery that can, and should, include meaningful social change. This can take place as the recommendations outlined above—including “listen-and-plan” sessions, empowering BIPOC individuals and communities, and investing in equitable public health—are integrated into ongoing community initiatives and as government and public health officials commit to ensuring durable social change and community benefits that include adequate housing, food security, living wages, and leadership opportunities.

‘This approach will be challenging. Some may argue that a lack of time or funding or interest are barriers that make such an approach unrealistic, especially in the middle of a pandemic that is challenging on every front. However, it is important to keep in mind that challenges like the one we are currently facing often stem from social inequity and provide opportunities to change and improve. Some actions may be more appropriate to prioritize in the near term, but many actions that are crucial for the long term will have more of an overall impact if those efforts are initiated now.

‘COVID-19 vaccination is the most likely way out of the current pandemic. It is also an opening to create equity and durable benefits for BIPOC communities, who have been devalued and too often cut out of opportunities in the United States. We hope that you consider this and the specific recommendations made in this report as you begin to implement COVID-19 vaccination campaigns in your own towns, cities, and states.’

Download PDF here (John Hopkins Center for Health Security, Feb 09, 2021) 

Israel is the world’s most vaccinated country. Why are cases rising?

‘Rahav [Galia Rahav, the head of the infectious-disease unit at Tel Aviv’s Sheba Medical Center] attributes the soaring rate of infection in the general population to the weariness of Israelis — on their third or fourth lockdown, depending on how you count — with having their children at home, restrictions limiting them to 1,000 yards from their homes, and of the “politicization” of the ever-shifting rules of confinement.

‘Like many other countries, Israel launched its vaccination campaign with the two most vulnerable sectors: frontline medical workers and citizens over the age of 65. In January, as jubilant grandparents and ambulance drivers got vaccinated, and slowly stopped falling ill, younger and less cautious Israelis flouted caution — turning themselves into spreaders just as the highly infectious British mutation of the virus wafted into the country.’

Read here (New York magazine, Feb 7, 2021)

MCO 2.0 should have been tool of last resort, says ex-deputy defence minister Liew Chin Tong

‘The current movement control order (MCO) would not have to be implemented if the Health Ministry (MOH) had properly conducted Covid-19 tracing and screening as far back as April last year, according to deputy defence minister Liew Chin Tong. The DAP senator said a whole-of-government approach from the start, rather than one that placed the burden solely on the MOH, would have prevented the current high number of infections in the country.

“To put it into context, it doesn’t inspire confidence if halfway into a war, the army general (in this case, the Health DG) complained to the media that the air force (the other health institutions/labs) has forgotten to provide for air cover,” Liew said on his Facebook page today. He was referring to Health director-general Tan Sri Dr Noor Hisham Abdullah’s recent statement that MOH labs have nearly reached their maximum capacity of 76,000 Covid-19 tests daily, even as there is a need to increase screening to between 150,000 to 200,000 tests daily.

“Dr Noor Hisham lamented that so far the testing capacity at university hospitals was at 27 per cent, private laboratories (31 per cent) and laboratories in the Malaysian Armed Forces hospitals (24 per cent). These facilities are underutilised and could increase their capacity up to 100 per cent to achieve the daily test target.’

Read here (Malay Mail, Feb 7, 2021)

Vaccine strategy needs rethink after resistant variants emerge, say scientists

‘Leading vaccine scientists are calling for a rethink of the goals of vaccination programmes, saying that herd immunity through vaccination is unlikely to be possible because of the emergence of variants like that in South Africa. The comments came as the University of Oxford and AstraZeneca acknowledged that their vaccine will not protect people against mild to moderate Covid illness caused by the South African variant. The Oxford vaccine is the mainstay of the UK’s immunisation programme and vitally important around the world because of its low cost and ease of use.

‘The findings came from a study involving more than 2,000 people in South Africa. They followed results from two vaccines, from Novavax and Janssen, which were trialled there in recent months and were found to have much reduced protection against the variant – at about 60%. Pfizer/BioNTech and Moderna have also said the variant affects the efficacy of their vaccines, although on the basis of lab studies only.

‘All the vaccines, however, have been found to protect against the most severe disease, hospitalisation and death.’

Read here (The Guardian, Feb 7, 2021)

Fighting vaccine hesitancy with information, trust

‘It appears that vaccine hesitancy is due to lack of information and trust. Despite the government's assurances about Covid-19 vaccines, which include repeated television announcements by Special Adviser to the Prime Minister on Public Health Tan Sri Dr Jemilah Mahmood, many people are still hesitant to get inoculated, with some cynically telling their friends and relatives: "It's not that I don't trust the vaccines, but let's wait and see what happens to the people who will get their shots first."

‘Since efforts to build trust in public institutions, such as the Health Ministry, have been made, we need more sound bites, including building a more credible perception of the vaccines' safety and effectiveness. Hence it is good to ensure that politicians from both sides of the divide, officials and prominent figures, are among the first to be vaccinated. Leading by example, the prime minister would be among the first to be immunised when the National Immunisation Plan gets underway by the end of this month.

‘The authorities must boost public awareness of vaccine development and production, as well as their importance during a pandemic, and at the same, debunk myths. They must explain that the vaccines will not make the virus disappear since it is already too wide spread. They should also tell the public that the vaccines could prevent its spread and reduce its severity.’

Read here (New Straits Times, Feb 7, 2021) 

Approve Ivermectin as Plan B for vaccination

‘On Jan 22, it was announced that the Ministry of Health (MOH) would be conducting clinical trials for two medicines, Ivermectin and Favipiravi, to determine their efficacy in treating Covid-19. Health Director-General Tan Sri Dr Noor Hisham Abdullah has acknowledged that Ivermectin "is cheap, easily available and safe for use." But in Malaysia, it is only licensed for use in animals...

‘In view of the worsening case on Covid-19 infections in our country, many unanswered questions and lack of data on the long term safety aspects of the Pfizer experimental mRNA vaccine (which our country has already been ordered) and the current production problems faced by vaccine manufacturers overseas (with the possibility of delays), the government here should have a "PLAN B".

‘It should quickly approve Ivermectin to provide a safe, cheap and effective "weapon" against Covid-19. The clinical trials by MOH on the efficacy of Ivermectin can continue but we should not need to wait (and let many more people suffer and die from Covid-19 in the meantime) since Ivermectin has ALREADY been PROVEN to be VERY SAFE over the last 30 years or so.

‘What have we got to lose by approving Ivermectin today in Malaysia as an option for doctors to prescribe against Covid-19?’

Read here (New Straits Times, Feb 7, 2021)

Lancet editor says inequality and Covid-19 have converged to create a ‘syndemic’

‘In his new book "The COVID-19 Catastrophe: What's Gone Wrong and How to Stop It Happening Again," Dr. Richard Horton does more than trace the history of the COVID-19 pandemic and explain how we should listen to scientific experts in confronting this global scourge.

‘He does this, of course, but Horton is more ambitious than that. As editor-in-chief of "The Lancet" — one of the world's oldest, most famous and most prestigious medical journals — Horton has overseen the publication of countless articles on a variety of medical subjects. Hence, one can sense in his book a desire to apply the full breadth of his knowledge and experience to this problem. His conclusion is both fascinating and extremely relevant, even urgent.

‘As Horton explains, the COVID-19 pandemic was unnecessarily worsened by deeper social problems, from economic policies that left millions upon millions of people especially vulnerable to Western governments who made political assumptions about the virus that proved to be gravely mistaken. Speaking with Salon, Horton discussed everything from President Donald Trump's failure to address the pandemic (as well as President Joe Biden's early successes) to an intriguing thought experiment on what would have happened if the governments the world could have simply paid people to stay home.’

Read here (Salon, Feb 6, 2021)

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

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

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

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

Read here (Malaysiakini, Feb 6, 2021)

Pfizer withdraws vaccine application in India [after failing to present needed information to experts]

‘Pfizer Inc says it has withdrawn its application for emergency use of its COVID-19 vaccine in India. The company said Friday that it participated in a meeting of experts of the drug regulator on Feb. 3. Based on the deliberation of that meeting and “our understanding of additional information that the regulator may need, the company has decided to withdraw its application at this time,” it said in a statement.

‘The company was the first to approach the Indian regulator in December for its messenger RNA vaccine that it has developed with Germany’s BioNTech. They were closely followed by applications for two other vaccines --- a version of the AstraZeneca made by Serum Institute of India and another by Indian company Bharat Biotech -- which eventually got the nod for emergency use on Jan. 3. However, India’s Health Ministry has said that Pfizer hadn’t made its presentation to experts who needed to clear the vaccine, before the regulator could green-light its use in India.’

Read here (The Independent, Feb 6, 2021)

Explainer: How ministry decides between RT-PCR and RTK to test for Covid-19

‘Health Ministry experts have explained their rationale for choosing between RT-PCR tests and antigen-based rapid test kits (RTK-Ag) for detecting Covid-19 cases.

‘The RT-PCR is more accurate but takes longer to process, and is preferred for confirming Covid-19 infections. It can be used for mass testing using the “pool testing” method but only where virus prevalence was low.

‘The RTK-Ag is useful as a mass screening tool due to its far shorter turnaround time. Even with lower accuracy, it can be used as a confirmatory test if a patient has a high probability of being infected.’

Read here (Malaysiakini,  Feb 6, 2021)

Covid-19 and the convergence of nations

‘Few, if any [government], have set out recovery strategies that include the goal to reduce inequalities as part of future pandemic preparedness. Yet an essential truth of this emergency is that stronger security depends on fairer societies. But that is not the whole story...

‘In a working paper published last week by the US National Bureau of Economic Research, the Nobel economist Angus Deaton concludes that, at least in terms of global income, inequalities have decreased. He claims that the views of several respected authorities, ranging from fellow Nobel laureate Joseph Stiglitz to the UN Development Programme, are plain wrong. His argument is that high-income nations have suffered higher rates of mortality than low-income and middle-income countries. These higher mortality rates have translated into larger falls in wealth. This is an important observation...

‘The reality is that health and prosperity go hand-in-hand. During this pandemic, the smaller the number of deaths, the larger the income of a nation. The result has been that incomes per person in wealthier countries have fallen more than those in low-income countries. International income inequalities have therefore decreased. Nations have converged, not diverged. As Deaton notes, the pandemic “has brought countries closer together, not further apart”.

Read here (The Lancet, Feb 6, 2021)

Experimental cancer drug could help hospitalised coronavirus patients recover within five days, Israeli trial claims

‘An experimental cancer drug could help hospitalised coronavirus recover quicker, researchers believe. Israeli academics today claimed 29 of 30 patients with moderate to severe case of Covid treated with EXO-CD24 made a full recovery within five days. 

‘Further human trials are now needed to prove that the inhaled drug - designed as a medication to fight ovarian cancer - actually works. The study did not compare the drug to a placebo, meaning scientists cannot say for certain that the medicine was behind the patients' speedy recovery.’

Read here (The Mail Online, Feb 5, 2021)

More Covid vaccine choices mean new equity challenges

‘More questions about priority are likely as the distribution effort matures, says Julie Swann, a vaccine supply chain expert at North Carolina State University. Soon, there should be more than three vaccines—shots from AstraZeneca and Novavax are likely next—and each will come with pros and cons. Even if shots are eventually targeted for one group or another, transparency will be key, she notes. “You can tell people that one is less effective but you wouldn’t have to come back, and the other is more effective but you need a second dose,” she says. Some people may have preferences between one or the other. Maybe some will seek out a different shot elsewhere. Maybe some will wait. But most, she hopes, will see little choice in the range of good options. In the middle of a crisis, a shot is a shot.’

Read here (Wired, Feb 5, 2021)

Vaccines are curbing Covid: Data from Israel show drop in infections

‘Close to 90% of people aged 60 and older in the country have received their first dose of Pfizer’s 2-dose vaccine so far. Now, data collected by Israel’s Ministry of Health show that there was a 41% drop in confirmed COVID-19 infections in that age group, and a 31% drop in hospitalizations from mid-January to early February. In comparison, for people aged 59 and younger — of which just more than 30% have been vaccinated — cases dropped by only 12% and hospitalizations by 5% over the same time. The figures are based on analysis of roughly a quarter of a million COVID-19 infections.’

Read here (Nature, Feb 5, 2021)

Matt Hancock orders third review on link between vitamin D and Covid

‘A third review into the link between vitamin D and Covid has been ordered by the UK health secretary as more studies suggest that having low levels of the “sunshine hormone” raises the risk of death.

‘Matt Hancock has again asked the National Institute for Health and Care Excellence (Nice), which sets NHS England clinical guidelines, and Public Health England (PHE) to “re-review” their prior appraisals, after the authorities began “encouraging” people to take vitamin D supplements rather than merely “advising” it.

‘Nice has twice said there was not sufficient causal evidence to support the use of vitamin D in high doses in hospitals to treat or prevent the respiratory illness. However, recent pilot and observational studies have suggested positive effects. A Queen Mary University of London study recently found that high-dose vitamin D supplementation significantly protects against respiratory illness.’

Read here (The Guardian, Feb 5, 2021)

It’s time to trust China’s and Russia’s vaccines

‘The fact is that no Covid-19 vaccine has been developed or released as transparently as it should have been. And while China and Russia may have botched their rollouts more than some Western companies, that doesn’t necessarily mean their vaccines are shoddy. The mounting evidence showing that the Chinese and Russian vaccines are reliable should be taken seriously, and fast, especially considering supply issues throughout the world...

‘What’s more, most big pharmaceutical companies in the West have resisted licensing their vaccines to non-Western manufacturers, and several wealthy countries are blocking a proposal by India and South Africa that the World Trade Organization temporarily suspend some intellectual property protections for Covid-19-related vaccines and treatments.

‘On the other hand, according to our latest analysis of data provided by the analytics firm Airfinity, Sinovac has already signed deals to export this year more than 350 million doses of its vaccine to 12 countries; Sinopharm, around 194 million doses to 11 countries; Sputnik V, about 400 million doses to 17 countries. All three manufacturers have stated publicly that they will have the capacity to produce up to 1 billion doses each in 2021. And all three have licensed their vaccines to local manufacturers in several countries.’

Read here (New York Times, Feb 5, 2021)

The play cure: In a clinical setting, playful activities are not distractions; they take patients deep into trauma – and out the other side...

‘Take a pen. Place it on the paper. Draw wherever you want. However you want. You know, Paul Klee said: “Drawing is like taking a line for a walk.”’ In the hospital workshop, I turn towards a patient, smile and continue: ‘So, let’s draw together. We could draw houses, and draw a path between our homes. Let’s grab paints. Turn the paper around. Upside down. If you don’t mind, I can paint your sky and you can paint mine… We can play and make…’

‘For more than 20 years, I’ve been saying these sentences, playing and making, as a clinical arts therapist, specialising in mental health, and as a lecturer and consultant using creative techniques with doctors, hospital directors, nursing managers and entrepreneurs. Guided by artists such as Louise Bourgeois and Jackson Pollock, and by Plato, I spend my days tapping into what the phenomenologist and philosopher of play Eugen Fink calls the ‘peach skin of things’. It glows.’

Two paragraphs that may interest you to read the whole story

• ‘Play, as Fink writes, unites ‘the highest desire and the deepest suffering’. For years, I worked with teenagers diagnosed with psychosis. A highlight of our work was a short surrealist play, ‘The Lost Potato Masher’, which they devised based around kitchen objects. The main roles were taken by a fridge, a cupboard, a toaster, a cooker, a table and chairs, and the lost potato masher. The text dealt with parental abandonment, despair, solitude, violence, fate and hope. In a training context, a hospital manager, in an improvisation, once acted the role of the file of a dead patient that had been thrown into a bin. Both of these examples show the cathartic effect of play, allowing us to sit with our shadows...
• ‘A recent study by the psychologists Maja Stanko-Kaczmarek and Lukasz Kaczmarek at the Adam Mickiewicz University in Poland found that the tactile sensations of finger-painting provoked a state of mindfulness connected with wellbeing. As we paint, we’re present in the moment, and we have a broader attention. This can be contrasted with the ‘mindlessness’ state, often a symptom of mental illness, characterised by past or future ruminations. The physical nature of play and making locates us in the here and now: it centres us in ourselves, mobilising an embodied cognition that’s important in skill learning. At all stages of life, Lego-making, knitting, embroidery and painting can contribute to psychological wellbeing.’

Read here (Aeon, Feb 4, 2021)

How to heal the 'mass trauma' of Covid-19

‘When the pandemic is over, how should we process the memories of what happened? Ed Prideaux discovers counter-intuitive answers from the science of trauma... 

• What happens when trauma goes viral
• How trauma affects groups and individuals
• The problem of forgetting

‘Covid-19 is a mass trauma the likes of which we've never seen before. Our most complex social extensions, and the building-blocks of our personal realities, have been coloured indelibly. The ways we live and work together, and view each other as common citizens: everything means something different in the viral era, and with potentially traumatic effect. 

‘All pandemics end, however. And this one will. But to forget the trauma, move on, and pay it no mind, won't help. It'd be a disservice to history and our own minds. Maybe to the future, too. ’

Read here (BBC, Feb 4, 2021) 

Covid-19: Social murder, they wrote — elected, unaccountable, and unrepentant

‘After two million deaths, we must have redress for mishandling the pandemic... Murder is an emotive word. In law, it requires premeditation. Death must be deemed to be unlawful. How could “murder” apply to failures of a pandemic response? Perhaps it can’t, and never will, but it is worth considering. When politicians and experts say that they are willing to allow tens of thousands of premature deaths for the sake of population immunity or in the hope of propping up the economy, is that not premeditated and reckless indifference to human life? If policy failures lead to recurrent and mistimed lockdowns, who is responsible for the resulting non-covid excess deaths? When politicians wilfully neglect scientific advice, international and historical experience, and their own alarming statistics and modelling because to act goes against their political strategy or ideology, is that lawful? Is inaction, action?1 How big an omission is not acting immediately after the World Health Organization declared a public health emergency of international concern on 30 January 2020?

‘At the very least, covid-19 might be classified as “social murder,” as recently explained by two professors of criminology. The philosopher Friedrich Engels coined the phrase when describing the political and social power held by the ruling elite over the working classes in 19th century England. His argument was that the conditions created by privileged classes inevitably led to premature and “unnatural” death among the poorest classes. In The Road to Wigan Pier, George Orwell echoed these themes in describing the life and living conditions of working class people in England’s industrial north. Today, “social murder” may describe the lack of political attention to social determinants and inequities that exacerbate the pandemic. Michael Marmot argues that as we emerge from covid-19 we must build back fairer...

Getting redress

‘Where then should citizens turn for accountability, if they don’t find it in their leaders and feel unsupported by experts and the media? The law remains one form of redress, and indeed some legal avenues, including criminal negligence and misconduct in public office, are being explored, although proving any such claims will be difficult and drawn out. But the notion of murder, at least “social murder,” is hard to shake emotionally, and strengthens with every denial of responsibility and every refusal to be held accountable or to change course.

‘That leaves three options. The first is to push for a public inquiry, as The BMJ and others argued for in the summer of 2020—a rapid, forward looking review rather than an exercise in apportioning blame that will identify lessons and save lives. The second is to vote out elected leaders and governments that avoid accountability and remain unrepentant. The US showed that a political reckoning is possible, and perhaps a legal one can follow, although research suggests that mishandling a pandemic may not lose votes.21 The third is for mechanisms of global governance, such as the International Criminal Court, to be broadened to cover state failings in pandemics...

‘The “social murder” of populations is more than a relic of a bygone age. It is very real today, exposed and magnified by covid-19. It cannot be ignored or spun away. Politicians must be held to account by legal and electoral means, indeed by any national and international constitutional means necessary. State failures that led us to two million deaths are “actions” and “inactions” that should shame us all.’

Read here (British Medical Journal, Feb 4, 2021)

Merck statement on ivermectin use during the Covid-19 pandemic

‘Merck, known as MSD outside the United States and Canada, today affirmed its position regarding use of ivermectin during the COVID-19 pandemic. Company scientists continue to carefully examine the findings of all available and emerging studies of ivermectin for the treatment of COVID-19 for evidence of efficacy and safety. It is important to note that, to-date, our analysis has identified:

• No scientific basis for a potential therapeutic effect against COVID-19 from pre-clinical studies; 
• No meaningful evidence for clinical activity or clinical efficacy in patients with COVID-19 disease, and; 
• A concerning lack of safety data in the majority of studies.

We do not believe that the data available support the safety and efficacy of ivermectin beyond the doses and populations indicated in the regulatory agency-approved prescribing information.

Read here (Merck press statement, Feb 4, 2021)

The vaccine alternatives for people with compromised immune systems

‘While the exact number of the immunocompromised worldwide is unknown, estimates suggest that about 10 million live in the U.S. alone, or around 3 percent of the national population. The number encompasses a diverse range of vulnerabilities, including rare genetic immune deficiencies, chronic illnesses that impair the immune system such as rheumatoid arthritis, and cancer and organ-transplant patients who must take immune-suppressing medications.

‘For them, vaccines will not be effective, because they are incapable of making their own antibodies to neutralize the SARS-CoV-2 virus. Instead, pharmaceutical companies around the world are racing to develop alternative treatments that bypass the immune system altogether.

‘The most common option is called monoclonal antibody treatments. These artificially generated antibodies mimic the body’s natural immune response by binding to key sites on the virus’ spike protein, preventing it entering cells and reproducing. Companies including AstraZeneca, Regeneron, and Eli Lilly are currently testing whether monoclonal antibodies can protect immunocompromised people from SARS-CoV-2.’

Read here (National Geographic, Feb 4, 2021)

The ‘vaccine passport’: Answers to your questions

‘In the near future, travel may require digital documentation showing that passengers have been vaccinated or tested for the coronavirus. Answers to your questions:

• What is a vaccine pass or passport?
• Why would I need a vaccine pass or passport?
• Has this been done before?
• Do vaccine passports have to be digital?
• What are the objections to vaccine passports?
• What are the challenges to creating these digital passes?

Read here (New York Times, Feb 4, 2021)

The Covid-19 disinformation divide: Understanding vaccine attitudes

‘Scientists have developed COVID-19 vaccines so rapidly it has exacerbated existing mistrust proliferated by social media. New research by Edelman Data & Intelligence (DxI) aims to examine and understand the psychological motivations driving attitudes at both ends of the spectrum – from vaccine resistors to vaccine adopters. By understanding the concerns and sensitivities of each group, the scientific community can tailor messaging to improve vaccine uptake.’

Read here (World Economic Forum, Feb 4, 2021)

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

‘It is important to note that all the severe Covid-19 cases were in the placebo group, which suggests that mRNA-1273 is likely to have an effect on preventing severe illness, which is the major cause of health care utilization, complications, and death. The finding of fewer occurrences of symptomatic SARS-CoV-2 infection after a single dose of mRNA-1273 is encouraging; however, the trial was not designed to evaluate the efficacy of a single dose, and additional evaluation is warranted.

‘Overall, the safety of the mRNA-1273 vaccine regimen and platform is reassuring; no unexpected patterns of concern were identified. The reactogenicity associated with immunization with mRNA-1273 in this trial is similar to that in the phase 1 data reported previously. Overall, the local reactions to vaccination were mild; however, moderate-to-severe systemic side effects, such as fatigue, myalgia, arthralgia, and headache, were noted in about 50% of participants in the mRNA-1273 group after the second dose. These side effects were transient, starting about 15 hours after vaccination and resolving in most participants by day 2, without sequelae.’

Read here (New England Journal of Medicine, Feb 4, 2020)

A new vaccine to battle Covid-19 -- NEJM editorial

‘That the mRNA-1273 Covid-19 and the BNT162b2 Covid-19 vaccines protect with near-identical 94 to 95% vaccine efficacies — and that both vaccines were developed and tested in less than a year — are extraordinary scientific and medical triumphs. This happened because the scientific community was prepared from years of technology development for other vaccines, such as those against HIV, influenza, respiratory syncytial virus, and Zika, and because clinical trials consortia were established that rapidly carried out Covid-19 efficacy trials. If mRNA-LNP vaccines significantly contribute to control of the pandemic, mRNA technology has the potential to radically change vaccine design for future viral outbreaks.

‘Although the Covid-19 pandemic is currently raging, the prospects for control of this and future pandemics are bright. The recent FDA issuance of EUAs for these extraordinarily protective vaccines provide us with much-needed hope at a time when so many are suffering. The next challenge is to get these and the next Covid-19 vaccines to the people most at risk as quickly as possible.’

Read here (New England Journal of Medicine, Feb 4, 2020)

Sinovac applies for conditional approval of Covid-19 vaccine in China

‘China's medicine regulator is reviewing a second domestically developed COVID-19 vaccine for conditional approval. The CoronaVac inoculation, developed by Sinovac Biotech, has been given to tens of thousands of people in China under an emergency use program launched in July targeting specific groups with high infection risks. Regulators are also reviewing for approval a similar vaccine created by state-owned China National Pharmaceutical Group, known as Sinopharm...

‘China's COVID-19 vaccines have won approval in a dozen countries for emergency use, but the failure to publish detailed trial data could undermine public trust, a leading Chinese researcher said in a recent interview.

‘Ding Sheng, dean of Tsinghua University's School of Pharmaceutical Sciences and director of the Global Health Drug Discovery Institute (GHDDI), called for the original clinical trial data from Chinese experimental vaccines to be made public so that experts can better assess their efficacy and eliminate lingering safety concerns in China and abroad.’

Read here (Nikkei, Feb 4, 2021)

Can you still transmit Covid-19 after vaccination?

‘In fact, most vaccines don't fully protect against infection, even if they can block symptoms from appearing. As a result, vaccinated people can unknowingly carry and spread pathogens. Occasionally, they can even start epidemics. 

"Effective" or "sterilising" immunity: There are two main types of immunity you can achieve with vaccines. One is so-called "effective" immunity, which can prevent a pathogen from causing serious disease, but can't stop it from entering the body or making more copies of itself. The other is "sterilising immunity", which can thwart infections entirely, and even prevent asymptomatic cases. The latter is the aspiration of all vaccine research, but surprisingly rarely achieved.

What type of immunity do the Covid-19 vaccines provide? "In a nutshell we don't know, because they’re too new," says Neal. So far, the available Covid-19 vaccines have not been judged primarily on their ability to prevent transmission – though this is now being evaluated as a secondary endpoint for many of them. Instead, their efficacy was assessed by whether they could prevent symptoms from developing. "This means that we set our targets kind of pragmatically," says Danny Altmann, professor of immunology at Imperial College London.’

Read here (BBC, Feb 4, 2021)

Could mixing Covid vaccines boost immune response?

‘Vaccine developers often combine two vaccines to combat the same pathogen, and researchers are keen to deploy the strategy — known as a heterologous prime-boost — against the coronavirus. A heterologous prime-boost combination was approved last year by European regulators to protect against Ebola, and experimental HIV vaccines often rely on the strategy, says Dan Barouch, director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center in Boston, Massachusetts. But it has yet to be tested for vaccines against COVID-19, which are typically given as a repeat injection of the same vaccine.

‘The ability to mix and match vaccines could make vaccination programmes more flexible: it would speed up the process and reduce the impact of any supply-chain disruptions. “It really makes the implementation much more simple,” said Mary Ramsay, head of immunization at Public Health England, at a press briefing on 3 February.’

Read here (Nature, Feb 4, 2021)

Covid has a dramatic impact on children

‘It was in December that Axel Gerschlauer noticed the crisis within the crisis. In the last three weeks before Christmas, the pediatrician found himself treating three minors who had slashed their lower arms. Three youths in three weeks — Gerschlauer says he usually sees this sort of thing about once every three to six months. "This kind of frequency,” he says, "brought the scale of the problem home to me."

‘And this at a time when Gerschlauer is not even getting to see all his regular patients. Some are avoiding his practice altogether for fear of infection. His phone, meanwhile, has hardly stopped ringing, as desperate parents seek his advice. "There has been a shift of emphasis towards psychological issues, ranging from anxieties to concentration disorders to sleep disorders. In recent months, mental health issues have increased massively."

Read here (DW, Feb 4, 2021)

Pregnant during pandemic: The bump that no one saw

‘Sometimes I’m grateful for the isolation. I got to endure nausea in private, be exhausted in private and work from my couch on the days when it felt too hard to stand. Luckily for me, I had a job that allowed me to work from home. Luckily for me, I had a job at all. And as others also reported in a 2020 survey of 70 pregnant women in Ireland, taking a break from life’s fast pace while I grew another life did, at times, bring me peace.

‘My challenge instead has been letting go of the picture I had in my head of what pregnancy was “supposed” to look like. Gone is the fantasy of the Good Samaritan on the crowded bus giving up his seat for me or of colleagues in the hall asking how I’m doing. Also gone are the strangers trying to touch my belly or giving me unsolicited advice. Sometimes, without that constant feedback, I forget I’m pregnant. At other times, the aches and pains I feel in isolation seem stronger than they would be if someone was around to provide distraction.’

Read here (Scientific American, Feb 4, 2021)

Political warfare, inequity, and insufficient data in coverage of the vaccine rollout

‘Ellen Ruppel Shell, a professor of science journalism at Boston University, told me yesterday that vaccine framing can be “schizophrenic—alarmism followed by sometimes misleading reassurance.” This is true, for example, of many stories warning about vaccines’ possible reduced efficacy against new variants of the virus, whose scary headlines often belie more nuanced expert assessments and key questions that have yet to be answered...

‘It’s hard to generalize, obviously, but it’s increasingly clear that much vaccine coverage is stuck in conventional journalistic rhythms that don’t serve the story well. Given that the pandemic is a “once-in-a-hundred-years event, it’s time for journalists to step back and think about what our priorities need to be,” Shell told me. “We don’t just take notes and put them out there. Almost every piece should have some analysis in it.” In the course of this reflection, we need to reckon, too, with the idea that vaccines may not be a magic bullet. Elena Conis, a science historian and journalism professor at Berkeley, told me yesterday that her biggest concern with vaccine framing is that “we have rushed to cover, talk, and think about vaccination all while failing to have much harder conversations about other things we can do to keep this epidemic in check.”

Read here (Columbia Journalism Review, Feb 3, 2021)

Domestic violence is a pandemic within the Covid-19 pandemic

‘Growing evidence shows the pandemic has made intimate partner violence more common—and often more severe. “COVID doesn’t make an abuser,” says Jacky Mulveen, project manager of Women’s Empowerment and Recovery Educators (WE:ARE), an advocacy and support group in Birmingham, England. “But COVID exacerbates it. It gives them more tools, more chances to control you. The abuser says, ‘You can’t go out; you’re not going anywhere,’ and the government also is saying, ‘You have to stay in.'”

‘Surveys around the world have shown domestic abuse spiking since January of 2020—jumping markedly year over year compared to the same period in 2019. According to the American Journal of Emergency Medicine and the United Nations group U.N. Women, when the pandemic began, incidents of domestic violence increased 300% in Hubei, China; 25% in Argentina, 30% in Cyprus, 33% in Singapore and 50% in Brazil.’ 

Read here (Time, Feb 3, 2021)

Caught in tangled web of vaccine nationalism -- Jomo Kwame Sundaram

‘As known COVID-19 infections exceed 100 million internationally, with more than two million lives lost, rich countries are now quarrelling publicly over access to limited vaccine supplies. With ‘vaccine nationalism’ widespread, multilateral arrangements have not been able to address current challenges well. 

‘Vaccine nationalism has meant that the rich and powerful come first, not only in societies, but also in the world, making a mockery of the ‘No one left behind’ slogan embraced by the international community.  Many developing countries and most of their people will have to wait for access to vaccines while the powerful and better off secure prior access regardless of need or urgency. Vaccine nationalism and the prospect of more profits by not scaling up output to induce scarcity may thus cause more losses of both lives and livelihoods, causing economies to slow further.’

Read here (ksjomo.org, Feb 2, 2021)

Why has Britain failed on Covid? | Richard Horton, editor, The Lancet

‘A year after the World Health Organisation declared Covid-19 a pandemic, with Britain enduring more than a 100,000 deaths since, a number of major questions remain unanswered. Why was the response of the UK among the worst in the world? How is it possible that the death toll of countries in Europe and North America is so much higher than poorer countries in Asia such as Thailand and Vietnam? And when will things go ‘back to normal’? Discussing that, and more, is Richard Horton – editor of the prestigious medical journal The Lancet and author of ‘The Covid-19 catastrophe, what’s gone wrong and how to stop it happening again’.

View here (Novara Media, Feb 2, 2021)

The second Covid-19 shot is a rude reawakening for immune cells

‘Side effects are just a sign that protection is kicking in as it should...

‘At about 2 a.m. on Thursday morning, I woke to find my husband shivering beside me. For hours, he had been tossing in bed, exhausted but unable to sleep, nursing chills, a fever, and an agonizingly sore left arm. His teeth chattered. His forehead was freckled with sweat. And as I lay next to him, cinching blanket after blanket around his arms, I felt an immense sense of relief. All this misery was a sign that the immune cells in his body had been riled up by the second shot of a COVID-19 vaccine, and were well on their way to guarding him from future disease.

‘Side effects are a natural part of the vaccination process, as my colleague Sarah Zhang has written. Not everyone will experience them. But the two COVID-19 vaccines cleared for emergency use in the United States, made by Pfizer/BioNTech and Moderna, already have reputations for raising the hackles of the immune system: In both companies’ clinical trials, at least a third of the volunteers ended up with symptoms such as headaches and fatigue; fevers like my husband’s were less common.

‘Dose No. 2 is more likely to pack a punch—in large part because the effects of the second shot build iteratively on the first. My husband, who’s a neurologist at Yale New Haven Hospital, is one of many who had a worse experience with his second shot than his first.’

Read here (The Atlantic, Feb 2, 2021)

Viral loads, including in asymptomatic cases, a key factor in transmission

‘The scientific community is still uncovering the full picture of SARS-CoV-2 transmission dynamics. A study published in The Lancet: Infectious Diseases analyzed SARS-CoV-2 transmission among clusters in Catalonia, Spain, to understand the relationship between viral load and transmission risk. The researchers utilized participant data from a previous clinical trial, and they identified 314 COVID-19 patients that met their inclusion criteria. Among those patients, 282 had at least 1 contact (753 total contacts). The index patients infected 125 secondary cases, corresponding to a secondary attack rate of 17%. 

‘The researchers identified a statistically significant association between viral load in the index patients and the subsequent secondary attack rate. Among index patients with the lowest viral load, index patients exhibited a secondary attack rate of 12%, compared to 24% among the highest group. The researchers estimate that the odds of secondary transmission increase 30% for every log(10) increase in viral load. Additionally, the study found increased likelihood that secondary cases would develop COVID-19 symptoms associated with increased viral load in the index patients (aHR of 1.12 per log(10) increase in viral load). While further research is needed to more fully characterize the factors associated with transmission, this study provides evidence that the index patient’s viral load could be a major driver of secondary transmission risk and potentially disease severity in secondary cases.’ (Source: Updates on the COVID-19 pandemic from the Johns Hopkins Center for Health Security.)

Transmission of COVID-19 in 282 clusters in Catalonia, Spain: a cohort study

Read original here (The Lancet, Feb 2, 2021)

Covid-19 infection rates fall as millions are vaccinated in Britain

‘Infection rates in the over-80s have fallen by 36 per cent this month. Other age groups have seen similar falls. The biggest drop was recorded in people in their 20s. Rates in that age group have halved. Prof Harnden said: “The data we have is still is very early because it only reflects approximately three or four weeks of the program and it’s mainly based on the Pfizer vaccine.”

Read here (News.com, Feb 1, 2021)

Sputnik V ‘91·6% efficacious, well tolerated’: Safety and efficacy of an rAd26 and rAd5 vector-based heterologous prime-boost COVID-19 vaccine: an interim analysis of a randomised controlled phase 3 trial in Russia

‘Our interim results of the phase 3 Gam-COVID-Vac trial show that the vaccine is 91·6% (95% CI 85·6–95·2) efficacious against COVID-19 (from day 21 after first dose, the day of receiving second dose). Our results also showed that the vaccine was 100% (95% CI 94·4–100) efficacious against severe COVID-19, although this was a secondary outcome so the results are preliminary. The vaccine was well tolerated, with 45 (0·3%) of 16 427 participants in the vaccine group reporting serious adverse events, all of which were considered not related to the vaccine... 

‘The vaccine induced robust humoral (n=342) and cellular (n=44) immune responses in all age strata. Notably, there were a few non-responders in the vaccine group (six of 342), possibly due to immunosenescence in older people, individual characteristics of the formation of an immune response, or concomitant immunological disorders.’

Read here (The Lancet, Feb 2, 2021) 

Pregnant women get conflicting advice on Covid-19 vaccines

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

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

Ivermectin may not be the ‘silver bullet’ antiviral against Covid-19 (link to original Medrxiv report included)

‘A team of researchers based in Peru and the US recently examined the role of the anti-parasitic drug ivermectin in treating COVID-19. The team has released their findings on the medRxiv preprint server... (link below).

Study details

‘The researchers included 12 qualitative and five quantitative studies, mostly preprints. These studies originated from all over the world, two being from the U.S., two from Spain, two from South America, one each from Iraq and Iran, and four from Bangladesh.

‘Altogether, there were around 7,400 participants, with a mean age of 47.5 years. About 60% were male. The treatment protocols for all included studies comprised ivermectin either alone or in combination with another anti-inflammatory, antibiotic or blood-thinning drug like azithromycin, hydroxychloroquine, dexamethasone, enoxaparin, aspirin or dicloxacillin...

‘Ivermectin was not significantly associated with a lower mortality or higher recovery of patients in this meta-analysis. However, the majority of studies were preprints, allowing for later changes in the data on which these conclusions are based.’

Read here (Medical News, Feb 1, 2021)

• Outcomes of Ivermectin in the treatment of COVID-19: A systematic review and meta-analysis

Read original study here (Medrxiv, Jan 27, 2021) 

CommuniVax: A coalition to strengthen the community’s involvement in an equitable vaccination rollout

‘CommuniVax is a national alliance of social scientists, public health experts, and community advocates who seek lasting solutions to a serious problem: in the United States, historically underserved Black, Indigenous, and Latino populations have endured negative health and economic impacts from the COVID-19 pandemic at tragic and disproportionate rates. While these communities could benefit greatly from safe and effective COVID-19 vaccines, longstanding biases and barriers hinder their access to and acceptance of vaccination.

‘The coalition is strengthening national and local COVID-19 vaccination efforts in the United States by putting communities of color at the center of those endeavors. The coalition is listening to Black, Indigenous, and Latino/Latinx individuals on how best to promote awareness of, access to, and acceptability of COVID-19 vaccines in their respective communities; and developing longstanding, local governance systems that enable underserved groups to exercise collective agency over their own health and wellness, during this pandemic and going forward. Funding for CommuniVax is provided by the Chan Zuckerberg Initiative.

‘CommuniVax relies on efforts from 3 groups: local teams, a central working group, and national stakeholders.

• Local Teams are composed of resident researchers, grassroots leaders, and public health implementers. They will engage local communities of color to identify improvements needed to vaccine delivery and communication strategies in their communities.
• The Central Working Group includes experts in public health, public policy, medical science, anthropology, and public involvement. With input from diverse stakeholders, the working group will coordinate the local research processes and ensure the implementation of findings nationwide
• National Stakeholders represent groups with political, technical, cultural, and social justice perspectives on vaccine delivery and uptake. These associations will amplify information generated from local teams within their networks and provide feedback to the central working group.

Read here (John Hopkins Center for Health Security, Feb 2021)

A doctor's fight for survival in ICU

‘On Dec 27, 2020, after 23 days in the hospital, I was finally allowed to return home. I was told that my blood parameters and X-ray would only return to normal after many months. All this would not have been possible if not for the prayers and love of my wife, family, friends and God. I was grateful for a strong social support group...

‘It's been a month since I was discharged from the hospital, but my joints still hurt, I suffer from fatigue and shortness of breath when walking far or fast. There is also social stigma as many people won't come near me because I'm a former Covid-19 patient. A friend even declined my small change claiming that the virus would be on it.’

Read here (Malaysiakini, Feb 1, 2021)

Efficacy of the AstraZeneca-Oxford University vaccine: A preprint for The Lancet

‘A study (preprint for The Lancet) of data from the Phase 3 clinical trials of the AstraZeneca-Oxford University vaccine evaluated vaccine efficacy after a single dose and for alternate timing for the booster dose. Notably, the UK adapted the timing for the booster dose from 4 weeks after the first dose—which is how the vaccine was designed to be administered and the timing used for clinical trials—to 12 weeks in an effort to provide the first dose to as many people as possible. This study assessed the vaccine’s efficacy in participants who received the 2 doses between 4 and 12 weeks apart.

‘The researchers found that the efficacy after the first dose did not wane in the first 12 weeks. A single dose of the vaccine was 76% efficacious in preventing symptomatic COVID-19 disease in the first 90 days after vaccination, although it was associated with a substantial decrease in efficacy with respect to preventing asymptomatic infection. Notably, however, the additional asymptomatic infections could potentially be among participants who would have otherwise developed COVID-19 symptoms. Additionally, the efficacy in preventing symptomatic disease was higher in participants who received the booster dose later than in those who received it earlier. Vaccine efficacy was 82.4% among participants who received their booster dose 12 weeks or longer after the first dose, compared to 54.9% in those who received their 2 doses less than 6 weeks apart. These results provide support for vaccination plans that delay the booster dose beyond the intended 4 weeks, considering that the immunity conferred after the first dose appears to be relatively stable over the first several months and the overall protection appears to increase with an increased time between the prime and booster doses.

‘The researchers also found that vaccination was associated with an overall reduced risk of infection—54.9% efficacy for 2 doses and 67% efficacy for 1 dose—which provides evidence that the vaccine could also provide protection against SARS-CoV-2 transmission. The role of SARS-CoV-2 vaccines in mitigating transmission risk remains uncertain, but these findings provide a promising indication that vaccination could reduce community spread of the virus, which would be a major tool to bring the pandemic under control.’

**The above summary was contained in an update of Feb 5, 2021, on the COVID-19 pandemic from the Johns Hopkins Center for Health Security 

• Single dose administration, and the influence of the timing of the booster dose on immunogenicity and efficacy of ChAdOx1 nCoV-19 (AZD1222) vaccine

Read here (The Lancet, Feb 1, 2021)

Coronavirus: After Wuhan, it’s time for global response reset, says Covid-19 probe chief

‘Covid-19 has exposed global deficiencies in the response to dangerous infectious diseases and the international system will need to be strengthened to raise alerts and deal with future outbreaks, according to Helen Clark, co-head of an international panel investigating the pandemic.

‘Despite the novel coronavirus emerging in a world with rapid communication services, it was notable how slow the global response to the outbreak was after it was first detected in China, said Clark, a former prime minister of New Zealand and one-time head of the United Nations Development Programme.

“Every day counts if you are trying to stop an infectious disease of unknown origin,” she said in an interview with the South China Morning Post. “There just doesn’t seem to be enough happening quickly enough, from the time of first awareness of the cluster onwards, and here we are.

“The WHO didn’t have all the information it needed, and – let’s be fair here, we are still discovering things about Covid-19 every day, we are on a very steep learning curve – but all the more reason, I would think, for applying a precautionary principle. If it smells bad, it may well be bad,” she said, referring to the early days of the pandemic.’

Read here (South China Morning Post, Feb 1, 2021)

How Singapore picked its Covid-19 vaccines

‘Last June, Singapore sealed its first deal to buy Covid-19 vaccines - before any of the more than 200 vaccine candidates had even started their phase three clinical trials. It decided not to wait for the trials, and even paid a premium on the price, in order to secure some early stock of vaccines for people here at high risk, such as healthcare workers and the elderly. That was for the Moderna mRNA vaccine, which has yet to be approved for use here.

‘Singapore signed two more purchase agreements in August - with Sinovac which produces a traditional vaccine, and Pfizer-BioNTech which also uses mRNA. These purchases should provide sufficient vaccines for the entire adult population. But Singapore is buying more. Dr Benjamin Seet, who chaired the panel that picked the vaccines for Singapore, said several late-stage discussions are still ongoing with a handful of other companies - as part of a contingency plan should there be disruptions in the supply of purchased vaccines, delays in the delivery, or even the need for further booster shots.’

Read here (Straits Times, Feb 1, 2021) 

The mystery of India's plummeting Covid-19 cases

‘Last September, India was confirming nearly 100,000 new coronavirus cases a day. It was on track to overtake the United States to become the country with the highest reported COVID-19 caseload in the world. Hospitals were full. The Indian economy nosedived into an unprecedented recession.

‘But four months later, India's coronavirus numbers have plummeted. Late last month, on Jan. 26, the country's Health Ministry confirmed a record low of about 9,100 new daily cases — in a country of nearly 1.4 billion people. It was India's lowest daily tally in eight months. On Monday, India confirmed about 11,000 cases.

"It's not that India is testing less or things are going underreported," says Jishnu Das, a health economist at Georgetown University. "It's been rising, rising — and now suddenly, it's vanished! I mean, hospital ICU utilization has gone down. Every indicator says the numbers are down." Scientists say it's a mystery. They're probing why India's coronavirus numbers have declined so dramatically — and so suddenly, in September and October, months before any vaccinations began.

‘They're trying to figure out what Indians may be doing right and how to mimic that in other countries that are still suffering.’

Read here (NPR, Feb 1, 2021)