Vaccination reduces risk of long Covid, even when people are infected, UK study indicates

‘People who are fully vaccinated against Covid-19 appear to have a much lower likelihood of developing long Covid than unvaccinated people even when they contract the coronavirus, a study published Wednesday indicated. The research is among the earliest evidence that immunization substantially decreases the risk of long Covid even when a breakthrough infection occurs. Already, researchers had said that by preventing many infections entirely, vaccines would reduce the number of cases of long Covid, but it wasn’t clear what the risk would be for people who still got infected after vaccination.’

Read here (STAT, Sept 1, 2021)

These charts show that Covid-19 vaccines are doing their job

‘While the vaccines don’t protect against infection as well as they do against severe disease, the shots are keeping people off ventilators and from dying, Kathryn Edwards, an infectious disease pediatrician at Vanderbilt University School of Medicine in Nashville, said August 26 in a news briefing sponsored by the Infectious Diseases Society of America. “We cannot lose the forest for the trees.”

Read here (ScienceNews, Aug 31, 2021)

How long does immunity last after Covid vaccination? Do we need booster shots? 2 immunology experts explain

‘As the rollout of COVID-19 vaccines continues, public attention is increasingly turning to booster shots, which aim to top up immunity if it wanes. But is a third dose needed? And if so, when? Let’s take a look at what the data tell us so far about how long immunity from COVID-19 vaccines might last.

• First, what about immunity following COVID-19 infection?
• How long does immunity from vaccines last?
• What about Delta?
• OK, so what now?

Read here (The Conversation, Aug 30, 2021)

Covid-19, post-Muhyiddin – P Gunasegaram

‘A curious thing happened after Tan Sri Muhyiddin Yassin resigned on August 16 and became the caretaker prime minister, during which period, he should not make any major decisions, but wait for the next prime minister to do so.

‘But that was not to be. He made a major decision to roll back movement controls, relaxing the standard operating procedures for those who have been fully vaccinated allowing them to dine in, and other associated measures. These were announced on August 19, to take effect the following day, when the palace announced that it had picked Datuk Seri Ismail Sabri Yaakob as the new prime minister.

‘What was the great hurry for Muhyiddin? Did he want to steal a little bit of thunder in his last days as prime minister? He should have let his successor make the decision, considering that his handling of Covid-19 was one of the reasons MPs lost confidence in his leadership.’

Read here (The Vibes, August 26, 2021)

The coronavirus could get worse

‘In the worst-case scenario, a variant could arise that would “make it like the vaccines did not exist,” Hanage [Bill Hanage, an epidemiologist at the Harvard School of Public Health] said. But at the moment, “there is no such variant like that.” And it would probably be extraordinarily difficult for one to manifest. Even the most evasive variants we know of—the ones that have stumped certain antibodies—aren’t fully duping vaccinated bodies, which harbor a slew of other immunological guards. Hanage also pointed out that many people’s immune systems have been trained on different triggers—distinct brands of vaccines, unique variants, or some combination thereof. A new version of SARS-CoV-2 would find skirting all of those blockades at once to be nearly impossible.

‘Viruses aren’t infinitely mutable; sometimes, to keep themselves in contention, they must make sacrifices. Several experts told me they’re hopeful that the coronavirus might struggle to max out both transmission and immune evasion at once, requiring some sort of trade-off between the two. Some of the most powerful anti-coronavirus antibodies target SARS-CoV-2’s spike protein, which the virus uses to unlock and enter our cells. If the virus altered the protein to sidestep those antibodies, it might make itself less recognizable to the immune system. But it could also hurt its ability to infect us at all.’

Read here (The Atlantic, Aug 25, 2021)

Ventilation for residential buildings: Critical assessment of standard requirements in the Covid-19 pandemic context

‘After the arrival of a new airborne virus to the world, science is aiming to develop solutions to withstand the spread and contagion of SARS-CoV-2. The most severe among the adopted measures is to remain in home isolation for a significant number of hours per day, to avoid the spreading of the infection in an uncontrolled way through public spaces. Recent literature showed that the primary route of transmission is via aerosols, especially produced in poorly ventilated inner spaces. Spain has reached very high levels concerning contagion rates, accumulated incidence, or number of hospitalizations due to COVID-19. Therefore, this article aims to develop a quantitative and qualitative analysis of the requirements established in Spain, with respect to the European framework in reference to ventilation parameters indoors. The different parameters that serve as calculation for the ventilation flow in homes are analyzed to this aim. Results show that the criteria established in the applicable regulations are insufficient to ensure health and avoid contagion by aerosols indoors.’

Read here (Frontiers in Built Environment, August 24, 2021)

Privatised health services worsen pandemic

‘Decades of public health cuts have quietly taken a huge human toll, now even more pronounced with the pandemic. Austerity programmes, by the International Monetary Fund (IMF) and World Bank, have forced countries to cut public spending, including health provisioning.’

This story is well argued and contains several relevant and informative links under the following subheadings:

• ‘Government is the problem’
• Neoliberal reforms worse
• Unhealthy reforms
• Austerity kills
• Government not main problem

Read here (IPS News, Aug 24, 2021) 

Prioritising profits reversed health progress

‘Instead of a health system striving to provide universal healthcare, a fragmented, profit-driven market ‘non-system’ has emerged. The 1980s’ neo-liberal counter-revolution against the historic 1978 Alma-Ata Declaration is responsible.’

This story is well argued and contains several relevant and informative links under the following subheadings:

• Alma-Ata a big step forward
• Primary healthcare
• Lalonde Report turning point
• Neo-liberal ascendance
• Healthcare financing key
• Philanthropy rules

Read here (IPS News, Aug 24, 2021)

When will the Covid-19 pandemic end? McKinsey & Co update August 2021

‘This article updates our perspectives on when the coronavirus pandemic will end to reflect the latest information on vaccine rollout, variants of concern, and disease progression. Among high-income countries, cases caused by the Delta variant reversed the transition toward normalcy first in the United Kingdom, during June and July of 2021, and subsequently in the United States and elsewhere. Our own analysis supports the view of others that the Delta variant has effectively moved overall herd immunity out of reach in most countries for the time being. The United Kingdom’s experience nevertheless suggests that once a country has weathered a wave of Delta-driven cases, it may be able to resume the transition toward normalcy. Beyond that, a more realistic epidemiological endpoint might arrive not when herd immunity is achieved but when COVID-19 can be managed as an endemic disease. The biggest overall risk would likely then be the emergence of a significant new variant.’

Read here (McKinsey & Co, August 23, 2021)

Singapore SARS survivors yield hope for Covid super vaccine

‘Survivors who lived through the SARS crisis in Singapore nearly two decades ago may yield hope for the development of a super vaccine to combat potent Covid-19 variants and even other coronaviruses, new research shows.

‘Scientists from the city-state’s Duke-NUS Medical School and National Centre for Infectious Diseases (NCID) have found “highly potent functional antibodies” in people who had severe acute respiratory syndrome and were vaccinated with Pfizer-BioNTech’s shots for Covid-19.’

Read here (Free Malaysia Today, August 21, 2021)

Highly vaccinated Israel is seeing a dramatic surge in new Covid Cases. Here's why

‘Israel was the first country on Earth to fully vaccinate a majority of its citizens against COVID-19. Now it has one of the world's highest daily infection rates — an average of nearly 7,500 confirmed cases a day, double what it was two weeks ago. Nearly one in every 150 people in Israel today has the virus.

‘What happened, and what can be learned about the vaccine's impact on a highly vaccinated country? Here are six lessons learned — and one looming question for the future of the pandemic.’

1. Immunity from the vaccine dips over time.
2. The delta variant broke through the vaccine's waning protection.
3. If you get infected, being vaccinated helps.
4. Israel's high vaccination rate isn't high enough.
5. Vaccinations are key, but they are not enough.
6. Booster shots offer more protection — if you are one of the world's lucky few to get them.

Looming question: Will we need COVID-19 vaccines every several months? We don't know.

Read here (NPR, August 20, 2021)

Delta has changed the pandemic risk calculus

‘Vaccination was a reprieve from this calculus of personal danger, at least for a while—get vaccinated, get your family and friends vaccinated, get back to a far more normal version of life. To a certain extent, that logic holds: The vaccines are still doing a fantastic job preventing hospitalization and death from the coronavirus’s far-more-transmissible Delta variant. But as COVID-19 cases and hospitalizations have roared back, concerns about breakthrough cases among the vaccinated and increased transmissibility among kids have muddied a lot of people’s ability to gauge their own day-to-day risk, just as they’d begun to venture back out into the world and hug, eat, and laugh in the same airspace together again. In some ways, pandemic life is more confusing than ever.’

Read here (The Atlantic, August 19, 2021)

Covid-19: What is coming our way? — Dr Amar-Singh HSS

‘We have all been occupied by the political situation in the country, but the Covid-19 virus is not. It is continuing its relentless march forward, whether we are focused on it or not. While an efficient government that deals with the pandemic decisively is crucial for the country, Malaysians need to be prepared for what is coming our way. I would like to share with you some possible scenarios for the coming weeks and months, and some thoughts and opinions based on current data.

• Continued recovery in the Greater Klang Valley
• Worsening crisis outside the Klang Valley
• Infections in children the next wave?
• Resolving Sinovac vaccine efficacy issues
• The myth of herd immunity and a resurgence of Delta as immunity wanes?

Read here (Code Blue, August 19, 2021)

The origins of SARS-CoV-2: A critical review

Since the first reports of a novel severe acute respiratory syndrome (SARS)-like coronavirus in December 2019 in Wuhan, China, there has been intense interest in understanding how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in the human population. Recent debate has coalesced around two competing ideas: a “laboratory escape” scenario and zoonotic emergence. Here, we critically review the current scientific evidence that may help clarify the origin of SARS-CoV-2.

We contend that although the animal reservoir for SARS-CoV-2 has not been identified and the key species may not have been tested, in contrast to other scenarios there is substantial body of scientific evidence supporting a zoonotic origin. Although the possibility of a laboratory accident cannot be entirely dismissed, and may be near impossible to falsify, this conduit for emergence is highly unlikely relative to the numerous and repeated human-animal contacts that occur routinely in the wildlife trade. Failure to comprehensively investigate the zoonotic origin through collaborative and carefully coordinated studies would leave the world vulnerable to future pandemics arising from the same human activities that have repeatedly put us on a collision course with novel viruses.

Read here (Cell, Aug 18, 2021). Download PDF here

If you’re going to mandate Covid vaccination at your workplace, here’s how to do it ethically

‘Maintaining and promoting trust is important when it comes to vaccine mandates. It matters to people subject to mandates and it matters to the public more broadly because mutual trust is a cornerstone of effective public health engagement. People should feel supported in their health decision making and they should trust and feel respected by their employers. We’re seeing increasing politicisation about COVID public health measures, in Australia and internationally. This is a social harm we should avoid.’

Read here (The Conversation, August 18, 2021)

How the pandemic now ends: Ed Yong

‘Pandemics end. But this one is not yet over, and especially not globally. Just 16 percent of the world’s population is fully vaccinated. Many countries, where barely 1 percent of people have received a single dose, are “in for a tough year of either lockdowns or catastrophic epidemics,” Adam Kucharski, the infectious-disease modeler, told me. The U.S. and the U.K. are further along the path to endemicity, “but they’re not there yet, and that last slog is often the toughest,” he added. “I have limited sympathy for people who are arguing over small measures in rich countries when we have uncontrolled epidemics in large parts of the world.”

‘Eventually, humanity will enter into a tenuous peace with the coronavirus. COVID-19 outbreaks will be rarer and smaller, but could still occur once enough immunologically naive babies are born. Adults might need boosters once immunity wanes substantially, but based on current data, that won’t happen for at least two years. And even then, “I have a lot of faith in the immune system,” Marion Pepper, the immunologist, said. “People may get colds, but we’ll have enough redundancies that we’ll still be largely protected against severe disease.” The bigger concern is that new variants might evolve that can escape our current immune defenses—an event that becomes more likely the more the coronavirus is allowed to spread. “That’s what keeps me up at night,” Georgetown’s Shweta Bansal told me.

‘To guard against that possibility, the world needs to stay alert. Regular testing of healthy people can tell us where the virus might be surging back.’

Read here (The Atlantic, August 12, 2021)

Delta variant: Everything you need to know -- Tomas Pueyo

‘Delta is a deadly variant. It spreads like wildfire and kills efficiently. We need to be careful.

If you’re an individual

‘If you’re vaccinated, you’re mostly safe, especially with mRNA vaccines. Keep your guard up for now, avoid events that might become super-spreaders, but you don’t need to worry much more than that. If you’re not vaccinated though, this is a much more dangerous time than March 2020. The transmission rate is higher than it used to be, and if you catch Delta, you’re much more likely to die—or get Long COVID. You should be extra careful, only hang out with other vaccinated people, and avoid dangerous events.’

If you’re a community leader

‘If you’re in charge of a community, you have two goals:

1. ‘Vaccinate, vaccinate, vaccinate. The lives of your community depend on it. Any vaccine that works is better than none. If people are opting out, try to lure them in. Most are not anti-vaxxers, but rather they’re on the fence, or simply don’t see the benefit worth the cost. So change their calculation. Create lotteries. The Ohio one, among the first, probably didn’t work, but the cost is paltry compared to the cost of deaths and closing the economy this Fall.
2. ‘Keep Delta at bay as much as you can while vaccinations proceed. An elimination strategy will be best. Good border fences and test-trace-isolate programs are your best tools. Super-spreader events should still be avoided. Masks indoors and in crowds should be mandatory. Great ventilation is a must. 

‘However, if you have vaccinated everybody that wants to be vaccinated, and the rest simply doesn’t want to get vaccinated, then the calculation changes drastically. If your location values the freedom of its people to make the wrong decisions (as long as they don’t impact others), then you might consider opening up the economy. Delta will tear through those unvaccinated, but that’s their prerogative. Maybe the reality will hit better then.

‘But it really depends on each society. Opening up without full vaccination would infect some of those vaccinated, about 10% of them would get long COVID7, and about 0.3% of them would die8.

‘So here each society needs to decide. Say 40% don’t want to vaccinate. Is the freedom of 40% to not vaccinate worth the deaths and Long COVID of those vaccinated? Otherwise, are you willing to force people to vaccinate? Are you going to keep the country closed until there’s a booster vaccine? Will you be able to get your fences and test-trace-isolate programs to work?’

If you’re in charge of vaccine policy

‘An R0 of 8 is bad news for herd immunity. It puts its threshold at ~90% of people protected, which is impossible to reach if vaccines are only 65% protective of infection. Booster shots are necessary. Let’s accelerate their testing, approval, release, and deployment.

‘Also, support vaccine mix-and-match. In most countries, today, if you need a boost you are forced to take the same vaccine. But mixing types likely protects you better and is as safe as using the same type.’

If you’re in a developing country

‘We don’t pay enough attention to developing countries. Most of the science and media focuses where the money is, in developed economies. But Delta is very hard in developing countries, especially in dense urban areas where the poor are forced to work but live in close quarters with many others. India, Argentina, Tunisia, South Africa, and Indonesia are very sad examples of this. 

‘Unfortunately, there’s not many special tricks that poor countries can pull. They tend to have a younger population, which helps. The one thing they have going on for them is that they tend to be warmer and more humid, which helps against COVID. Also, thanks to a warmer weather, they can have more events outdoors. This is the one thing they can leverage: have as many of your gatherings outside, while you do everything you can to vaccinate your population, and delay as much as you can the arrival of Delta with strong fences. 

‘Let’s hope vaccine production keeps growing and people the world over can get vaccinated before the fall.’

Read here (Uncharted Waters, Aug 11, 2021)

Covid FAQ Summer 2021, Part 1: Tomas Pueyo

‘You shared the last article about the Delta Variant so much that nearly 400,000 people read it. Thanks for spreading the word on something so important. You also asked so many good questions that I have tried to answer as many as I could in this article. It’s so long that I split it in two pieces. This 1st piece covers these questions:

1. What’s the update on the Delta variant and cases worldwide?
2. Am I safe if I’m vaccinated? What activities can I go to? Why are there still cases in very vaccinated countries?
3. I’m vaxxed. Can I go to an indoor event if I get masked?
4. When will we leave this behind? when we’re all vaccinated?
5. Can vaccines stop the pandemic?
6. Do we know more about vaccine effectiveness?
7. Should vaccines be fractionalized?
8. Should I get a booster shot?
9. Should I mix-and-match?

Read here (Uncharted Territories, Aug 11, 2021)

Note: Part 2 is only premier, paid subscribers

China takes the lead at international forum tackling Covid-19 vaccine inequality

‘Foreign Minister Wang Yi pledges more technology transfers and production agreements to get vaccines to developing countries. The UN estimates 11 billion more doses are needed to vaccinate 70 per cent of the world’s population against the disease.’

Read here (South China Morning Post, August 6, 2021)

Long Covid in adults discharged from UK hospitals after Covid-19: A prospective, multicentre cohort study using the ISARIC WHO Clinical Characterisation Protocol

‘Survivors of Covid-19 experienced long-term symptoms, new disability, increased breathlessness, and reduced quality of life. These findings were present in young, previously healthy working age adults, and were most common in younger females.’

Findings

‘55% of participants reported not feeling fully recovered. 93% reported persistent symptoms, with fatigue the most common (83%), followed by breathlessness (54%). 47% reported an increase in MRC dyspnoea scale of at least one grade. New or worse disability was reported by 24% of participants. The EQ5D-5L summary index was significantly worse following acute illness (median difference 0.1 points on a scale of 0 to 1, IQR: -0.2 to 0.0). Females under the age of 50 years were five times less likely to report feeling recovered (adjusted OR 5.09, 95% CI 1.64 to 15.74), were more likely to have greater disability (adjusted OR 4.22, 95% CI 1.12 to 15.94), twice as likely to report worse fatigue (adjusted OR 2.06, 95% CI 0.81 to 3.31) and seven times more likely to become more breathless (adjusted OR 7.15, 95% CI 2.24 to 22.83) than men of the same age.’

Read here (The Lancet, August 5, 2021)

Central banks must address pandemic challenges

‘Hopes for an inclusive global economic recovery are fast fading. As rich countries have done little to ensure poor countries’ access to vaccines and fiscal resources, North-South “fault lines” will certainly widen.’

This story is well argued and contains several relevant and informative links under the following subheadings:

• Enhancing relief, recovery, transformation
• Macroeconomic policy coordination
• Central banks’ developmental role
• Supporting transformation
• Bolder actions needed

Read here (IPS News, Aug 3, 2021)

Include migrant workers in Covid-19 vaccination or face disaster – P Gunasegaram

‘A decades-old problem studiously ignored by successive governments – despite so many articles written and questions raised in Parliament and elsewhere – is going to come back and bite us on our backsides as we desperately deal with increasing numbers of infections and deaths from the Covid-19 pandemic.

‘Unless and until the problem of migrants – specifically migrant workers, both documented and undocumented – is properly considered and included in any Covid-19 mitigation programme, things will continue to get worse even as more people are vaccinated. And there is no telling how long the problem will be around us.

‘The only way to overcome this major roadblock is to simply remove it and wholeheartedly include as many as six million migrant workers (which is about a third of the documented and undocumented workforce of an estimated 18 to 19 million) into the vaccination programme – the only workable solution right now to mitigate the pandemic and get back to some form of normalcy.’

Read here (The Vibes, July 29, 2021)

Containing Covid-19’s impact on the Klang Valley's healthcare system: Chong Chee Keong

‘It has been just over two weeks since we have formed the Greater Klang Valley Special Task Force (GKV STF) to deal with the huge Covid-19 outbreak in the region. The GKV STF has a good team from the Health Ministry (MOH), the Army and experts from outside the MOH. We have been working continually to put into place measures to contain the impact of the outbreak - saving lives is our priority.

‘The rising numbers of infections and deaths indicates the dire situation, one that is very evident to the public. Covid-19 infections are very widespread in the community and our hospital capacity in the Greater Klang Valley, including intensive care unit (ICU), is stretched to the maximum.

Why are numbers still rising in the Greater Klang Valley despite the vaccination ramp-up?

‘Many are asking this question. It is important to appreciate that the size of the outbreak is far larger than the numbers detected each day. Many asymptomatic or pre-symptomatic individuals, who are not aware of their infection, are spreading the virus. Remember that the vaccine effectiveness is best two weeks after the second dose, so this takes time. An important contribution is the Delta variant that has a high infectivity rate. In addition, we recognise, from the experience and data of nations with high vaccination rates, that infections can still occur due to the Delta variant although the hospitalisation and severe infections are significantly reduced.’

What are the key measures we are taking to stem the outbreak?

‘The GKV STF has put in place a number of strategic measures to optimise care services, reduce virus transmission and support the community and health staff. Given the current situation, outbreak management interventions have shifted from containment to mitigation efforts with the objective of preventing death and minimising the spread of disease. Some of the key initiatives include:

1. Increased capacity of beds, ICU care, oxygen supply, manpower deployment and use of volunteers. Moving non-Covid-19 patients to the private sector is also helping to free up beds. The help from our army colleagues has been invaluable in logistic and manpower support;
2. Strengthen Covid-19 Assessment Centres (CAC) by offering a virtual CAC for asymptomatic and mildly symptomatic patients and enhanced home monitoring management;
3. We hope to offer more RTK-Ag tests to health clinics and general practitioners via sales of MDA approved test kits to allow for wider testing. Home saliva test kits for self-testing are also available in pharmacies for the public to purchase and test themselves;
4. Improving support for frontliners, both hospital and health, as well as strengthening the social and emotional support systems for the public;
5. Acquiring and allocating funding for the purpose of procuring additional medical equipment and medication; and
6. We are also attempting to improve our communication with the public on critical issues and to keep the people updated.

‘Our staff from the hospitals, health facilities and management areas are exhausted but we are still here for the people and will continue to work to overcome this crisis.’

What can the public do?

‘We would like to thank the members of the public that have cooperated in this emergency by limiting their social contact and following standard operating procedures (SOPs). There are some key measures you can take to help yourself, your family, the community and the health services listed below. The key message is to help us break the transmission of this virus to others:

1. At this time if you are in the Greater Klang Valley and have any symptoms of Covid-19 you should consider yourself as possibly infected and get tested;
2. Once you are confirmed positive, please home isolate, notify yourself and do self-monitoring frequently through the MySejahtera application. Home isolation is for asymptomatic and mildly symptomatic patients who do not need hospitalisation and will recover. We do not want to congest hospitals with mild cases so that treatment for the severe patient can be prioritised. Our staff will contact those that are “red-flagged” as high risk and request them to come to the nearest CAC or hospital;
3. If you are positive, please inform all those you have been in contact with to quarantine for 10 days. Testing is not necessary unless they develop symptoms. What is important is to stay at home and monitor your condition daily;
4. Members of the public who think they have been exposed but are not identified as close contacts are encouraged to test at private health facilities; this may include doing a saliva-based self-test;
5. Vaccination will greatly reduce the risk of infection, so register and get vaccinated as soon as you get an appointment. Those who are contacts of positive cases should defer vaccination for at least 10 days;
6. We appeal to the community to support us. Some can volunteer to help in the health system at the CAC, health centres or hospitals. Others can volunteer to help boost the social and emotional support systems for the public.

‘As we encourage more self-testing and RTK-Ag use, we can expect the number of cases to rise in the next few days. Do not be alarmed by this; we need to identify as many cases as possible to reduce transmission in the community. As more of these positive cases and their contacts are isolated and quarantined, cases will start to gradually come down in the weeks to come. Once that happens, the testing will be restrategised to ensure effective detection of cases for isolation and monitoring.

‘This crisis has been the worst that we have faced as a community and health service in our generation. We have not given up and will persevere to offer the best that we can. We thank you for understanding our limitations and for the enormous ground swell of support that we have seen.’

Dr Chong Chee Kheong is MOH deputy director of health and this statement was issued on behalf of the Greater Klang Valley Special Task Force.

Read here (Malaysiakini, July 28, 2021)

Urgent proactive steps needed to manage Covid-19 surge: Jeyakumar Devaraj

 This article is reproduced in full, in the public interest, here because the original is behind a pay wall...

There is light at the end of the tunnel. Our vaccination programme has accelerated to more than 400,000 shots per day, and already around 5 million Malaysians have received both shots and another 5 million have taken their first. Credit should be given to the ministries that have procured and are delivering these vaccines to our population. They are doing a good job in ramping up the vaccination exercise. This is a good sign for the nation – it means that we have the institutional capacity to design and deliver effective programmes when the cabinet commits to these programmes.

However, the end of the tunnel – the attainment of 80 percent vaccination cover for our population - is still several months away. (80 percent of 38 million is 30.4 million – the virus does not discern between citizens and the 6 million migrant workers in the country.) There is therefore the very real possibility that we will witness more surges of Covid infections in places outside the Klang Valley in the next few months as we have not achieved the vaccine coverage level we need to prevent explosive growth of clusters. The genie is out of the bottle, and our current movement control orders (MCOs) are not going to be able to put it back in. It will take a much stricter and prolonged MCO to achieve that, but that would adversely impact the economy and the livelihoods of many Malaysians. We do not have the social capital to embark on such a course. People are already quite irate.

The high number of “sporadic” cases is a clear indication that the virus is circulating in the community. As bringing down the daily infection rate to two-digit figures is not within our reach, the general population must continue to strictly observe physical distancing, double masking and avoidance of crowds for a few more months until we get 30.4 million people vaccinated. Interstate travel should be avoided. This is certainly not the time to let our guard down.

The attempt by the MOH to paint a rosy picture by breaking down newly diagnosed cases by clinical categories is also poorly conceived. A person who is Category 1 on the day of diagnosis could quite easily deteriorate to Category 4 by the end of that week and to Category 5 by midway through the second week of symptomatic illness. It would be more beneficial to the public if the MOH were to include a breakdown by category of the cohort of patients diagnosed three weeks prior as part of the statistics released daily. That would give the truer extent of the problem and motivate people to observe the safety precautions. My assessment is that about 20 percent of cases go into category 4 and require oxygen, 4 percent progress to category 5 and about 1.5 percent die.

So, as the spectre of future spikes is still high, all our states need to prepare for the very real possibility that they might suddenly be beset by a surge in cases.

The phases of Covid-19 infection

To prepare for the proper care of Covid-19 patients in the event of a surge, we first need to understand how the disease unfolds in infected persons and how best to curtail morbidity and deaths. There are two distinct phases in the first three weeks of Covid 19 infection – the first phase is when the virus multiplies in the body, causing fever, headache, cough, body aches and several other symptoms. This “viraemic” phase lasts for about five days before the patient’s immune system produces the antibodies and the killer lymphocytes that attack and smother the virus particles, thus blocking the virus from infecting new cells. In about 80 percent of the cases, the illness ends here, and the patient begins to recover.

However, in about 20 percent of the cases, the patient goes into the second phase – his/her immune system goes into overdrive (the “cytokine storm”) and this overreaction causes damage to the patient’s vital organs – lungs, heart, kidneys and brain. We are still not too sure why this happens, but the effects of immunological “exuberance” can be worse than the initial damage by the virus itself. The overactive immune system also disrupts the normal clotting mechanism in the patient resulting in multiple small clots forming in many organs, causing further damage to these organs.

Doctors treating Covid-19 cases have found that early treatment can limit the damage caused by the immunological phase of infection. Steroids can dampen down the “cytokine storm” and low molecular weight heparin can reduce the tendency to form clots in the blood vessels. However, these interventions have to be given before multiple organs have been damaged. You have got to catch the “cytokine storm” early and nip it in the bud.

Early intervention will reduce the need for ICU admission. Waiting for the patient to develop oxygen desaturation before initiating steroids and heparin is rather late. For the best results, we need to look for the early signs of the cytokine storm and abnormal clotting – and these can be found via blood tests. The cytokine storm will consume cytokines (obviously) – and the levels of a group of substances in the blood – the complements – will drop. Similarly disseminated clotting all over the place will consume platelets and clotting factors such as prothrombin and result in elevated D Dimers (a breakdown product arising from clots within the bloodstream).

You might wonder why not start the steroids and the heparin the moment Covid-19 is diagnosed. We can’t, because we need the immune system to bring the viraemic phase under control. And also in 80 percent of cases, the body knows when to stop. So our strategy should be to identify as early as possible the 20 percent of cases who go on to the second phase – the immunological phase of the illness.

The immunological overreaction usually kicks in about one week after the start of the viraemic phase, but we cannot use the date of onset of symptoms to determine when the viraemic phase started. Some people have very minor symptoms during the viraemic phase and then develop devastating complications in the subsequent immunological phase. This, I think, is the reason behind the spate of brought-in-dead cases. Their immunological overreaction caused a life-threatening complication such as a heart attack, or pulmonary embolism although their initial illness was relatively mild. The incidence of this phenomenon seems to be higher with the current Covid-19 variants in the population.

We have to arrange for the management of any future surge in Covid 19 infections based on this understanding of the natural history of the illness, and the fact that when a surge occurs, admitting every case to hospital is not an option as we would be out of hospital beds very soon.

The action plan

First of all, we need to build capacity for outpatient screening for Covid-19. This should be by a drive-through method as that will reduce exposure of other people to suspected cases. People who suspect they have Covid-19 infection should call their nearest Covid-19 Assessment Centre (CAC) to get an appointment to come for a drive-through nasal swab test or a saliva antigen test. If they do not have their own transport, then the CAC should send a mobile lab team to collect the sample. I would think that the rapid antigen test that looks for specific Covid-19 antigens is good enough to make the diagnosis in this pandemic setting. The RNA PCR test (which has a mechanism to multiply the viral RNA) is more sensitive, but takes far longer (24 to 48 hours compared to 4 to 6 hours for the antigen test) for the result to be known.

Ideally, all diagnosed cases should have a blood test done to assess complement levels, platelet counts, prothrombin time as well as D Dimer levels. As we do not want these patients to come to hospital for their tests, we need to send properly attired mobile units that can go to their homes, draw their blood as well as take nasal swabs for household contacts, and teach them how to take their own pulse rate. Personal protective equipment is of crucial importance here, because this is the phase when Covid-19 patients are most infectious. By the time patients develop immunological overreaction and get admitted to hospital, their viral load is much lower and they are far less likely to transmit the infection to others.

Those who are asymptomatic or minimally symptomatic can be allowed to quarantine at home together with their household contacts. Theoretically, it would be ideal to quarantine all the household contacts separately but that would require a lot of resources, and it is uncertain how helpful such a practice would be in reducing intra-household transmission. It appears that Covid-19 patients start emitting the virus about 24 hours before the onset of symptoms. And it usually takes another 24 hours or more after the onset of symptoms before the diagnosis is confirmed by tests.

This means that household contacts are exposed to the virus for more than 48 hours prior to any attempt to isolate the index case in that household. Is isolating family members separately worth the effort? MOH data comparing the rate of household transmission in patients who were removed to quarantine centres with that of patients asked to quarantine at home would be useful in deciding this issue. Can we get some epidemiologists in our universities to look through MOH data to quickly throw some light on this issue? We should be guided by the empirical data for this. My gut feeling is that separate isolation of household contacts will not reduce transmission rates to household members significantly. Perhaps we should still offer older family members who are not fully vaccinated the option of a single-room hotel stay for a week.

The Covid 19 Assessment Centres (CAC) should follow up on the home quarantining patients everyday via phone calls. The CACs should set up teams including general practitioners, retired doctors and nurses who would each be assigned 10 to 20 patients to follow up every day via phone calls. The caller should screen for danger signals – shortness of breath, heart rate of over 110/min, confusion and/or persistence of symptoms for more than a week. The caller should also ask regarding the situation of other family members in the household and whether any essential provisions are needed, for example, long-term medicines that family members are already on. There must be a simple format to report back to the coordinator of the home quarantine programme at the CAC. There should also be a mechanism set up where essential provisions are delivered to the homes of the quarantining patients if required – perhaps Rela or even the army can be involved in this. If the patient being monitored at home develops any of the danger signs he/she needs to be brought to the next level of care for assessment.

The next level of care would be the make-shift hospitals that have been set up in convention halls, schools and stadiums. More such venues should be readied in other states. Here, clinical examination, pulse oximetry, blood tests (including those mentioned above) and if warranted, a chest XRay would help ascertain whether they have pneumonia (which would make them category 3). The National TB Control programme had a number of mobile XRay units mounted in specially designed ambulances. We should quickly procure a few of these to serve the field hospitals. Category 3 cases can be managed as inpatients in the makeshift hospital.

If the patient has low oxygen saturation (hence qualifying for Category 4) or any laboratory evidence of immunological overreaction, he/she will require immediate commencement of treatment at the field hospital itself – oxygen therapy, steroids and low molecular weight heparin as indicated, while admission to a hospital is arranged.

Being prepared for possible surges

I think it would not be an overreaction on the part of the authorities to make the preparations that I have sketched out above. A lot of effort would be required to ramp up the capacity of the CACs. More staff would need to be hired to handle each of its various responsibilities as described above.

Current SOPs will have to be upgraded to meet the new responsibilities of the CACs. The aim is to move a large part of Covid-19 management out of the hospitals so that the hospitals can concentrate on the more ill patients. This strategy also is aimed at catching the deteriorating patients early so that their slide to a more critical stage of the illness can be arrested.

We need to develop these capacities now so that if a surge were to happen, we have the ability to handle it. Our case fatality rate (CFR) for Covid-19 has soared from 0.38 percent in 2020 to about 1.8 percent currently. CFR refers to the percentage of diagnosed Covid-19 patients who die. Part of the reason for the higher CFR now could be that the current strains are more vicious. But the fact that our hospitals are overloaded and treatment to dampen the cytokine storm is not started soon enough is also a factor.

Let’s take all the steps we can to reduce ICU admissions and to bring the CFR down to lower than where it was in 2020. The government has shown that it can implement programmes effectively if it sets its mind to it – witness the vaccination programme. Let’s hope some of the above suggestions are acted upon, they would save us a lot of pain.

Dr Jeyakumar Devaraj is Parti Sosialis Malaysia chairperson.

Source: Malaysiakini, July 23, 2021. Read here

Physical activity and the risk of SARS-CoV-2 infection, severe Covid-19 illness and Covid-19 related mortality in South Korea: A nationwide cohort study

What are the findings?

‘Our results indicated that those who engaged in both aerobic and muscle strengthening activity according to 2018 exercise guidelines had a lower risk of SARS-CoV-2 infection (adjusted relative risk (aRR), 0.85; 95% CI 0.72 to 0.96), severe COVID-19 illness (aRR 0.42; 95% CI 0.19 to 0.91) and COVID-19 related death (aRR, 0.24; 95% CI 0.05 to 0.99) than those who did not.

‘Our findings reported that the recommended key target range of metabolic equivalent task (MET; 500–1000 MET min/week) was associated with the maximum beneficial effect size for reduced the risk of SARS-CoV-2 infection (aRR 0.78; 95% CI 0.66 to 0.92), severe COVID-19 illness (aRR 0.62; 95% CI 0.43 to 0.90) and COVID-19 related death (aRR 0.17; 95% CI 0.07 to 0.98). The length of stay in hospital was shortened about approximately 2 days in patients with both aerobic and muscle strengthening or with 500–1000 MET min/week.’

How might it impact on clinical practice in the future?

‘The findings of the study suggest that public health policies and strategies to increase physical activity at the population level may reduce the risk of SARS-CoV-2 infection and minimise adverse consequences in patients with COVID-19.

‘Encouraging individuals to have active level of physical activity during the COVID-19 pandemic should be promptly and actively considered at the public health level.’

Read here (BMJ British Journal of Sports Medicine, July 22, 2021)

10 Covid-19 vaccine vexations to ponder on – P Gunasegaram

‘It’s a rather trying time for all of us, and many are the aspects of the pandemic in Malaysia that remain unanswered despite frequent questions from the public. Today, we will focus on 10 Covid-19 vaccination vexations. There are more, but the 10 main ones will do for now.

1. Why were we late to vaccinate people?
2. What will be the total cost of vaccination?
3. Is there a breakdown?
4. Are middlemen involved, and who are they?
5. Are mega vaccination centres necessary, how much do they cost, and are they sources of infection?
6. Are there alternative distribution channels, and why were they not used?
7. Are migrant workers being vaccinated?
8. What about undocumented workers?
9. Is there a black market for vaccines?
10. Why are people getting blank jabs?

Read here (The Vibes, July 22, 2021)

How the Delta variant achieves its ultrafast spread

‘Viral load is roughly 1,000 times higher in people infected with the Delta variant than those infected with the original coronavirus strain, according to a study in China...

‘The combination of a high number of viruses and a short incubation period makes sense as an explanation for Delta’s heightened transmissibility, says epidemiologist Benjamin Cowling at the University of Hong Kong. The sheer amount of virus in the respiratory tract means that superspreading events are likely to infect even more people, and that people might begin spreading the virus earlier after they become infected.

‘And the short incubation makes contact tracing more difficult in countries such as China, which systematically tracks each infected person’s contacts and require them to quarantine. “Putting it all together, Delta’s really difficult to stop,” Cowling says.’

Read here (Nature, July 21, 2021)

European duplicity undermines anti-pandemic efforts

‘Despite facing the world’s worst pandemic of the last century, rich countries in the World Trade Organization (WTO) have blocked efforts to enable more affordable access to the means to fight the pandemic. Everyone knows access for all to the means for testing, treatment and prevention – including diagnostic tests, therapeutic medicines, personal protective equipment and vaccines – is crucial.’

This story is well argued and contains several relevant and informative links under the following subheadings:

• European deceit
• Big Pharma law
• European deceptions
• Inflexible ‘flexibilities’
• Bogus claims

Read here (IPS News, Jul 20, 2021)

A new norm needed to fight Covid-19 – P Gunasegaram

‘It’s a dire situation that needs to be handled now through concrete measures instead of repeated platitudes of how we are pressing forward with vaccinations after that late start, for which the only satisfying explanation we have is that vaccine supply was limited then.

‘On the health front, the numbers are going to rise further given the high infectivity rate and the inefficacy of lockdowns – so give the resources needed to hospitals. Extra beds, field hospitals, enlisting the help of private hospitals, changing public facilities to temporary health facilities, increasing the number of ventilators, etc.

‘All the powers are at the disposal of authorities, not just because of the emergency, but under long-standing health laws that have been in the statute books for decades. Use them judiciously but do not be afraid to make bold moves if that is what is necessary.’

Read here (The Vibes, July 20, 2021)

Three new estimates of India’s all-cause excess mortality during the Covid-19 pandemic

‘India lacks an authoritative estimate of the death toll from the COVID-19 pandemic. We report excess mortality estimates from three different data sources from the pandemic’s start through June 2021. 

‘First, extrapolation of state-level civil registration from seven states suggests 3.4 million excess deaths. Second, applying international estimates of age-specific infection fatality rates (IFR) to Indian seroprevalence data implies a higher toll of around 4 million. Third, our analysis of the Consumer Pyramid Household Survey, a longitudinal panel of over 800,000 individuals across all states, yields an estimate of 4.9 million excess deaths. 

‘Each of these estimates has shortcomings and they also diverge in the pattern of deaths between the two waves of the pandemic. Estimating COVID-deaths with statistical confidence may prove elusive. But all estimates suggest that the death toll from the pandemic is likely to be an order of magnitude greater than the official count of 400,000; they also suggest that the first wave was more lethal than is believed. Understanding and engaging with the data-based estimates is necessary because in this horrific tragedy the counting—and the attendant accountability—will count for now but also the future.’

Read here (Centre for Global Development, Jul 20, 2021)

There are few good Covid antivirals, but that could be changing

‘The COVID pandemic has now made new antiviral treatments a priority. But generating these therapies—especially direct-acting, orally administered drugs that inactivate viruses—is time-consuming. The reason monoclonal antibodies came along first is that scientists could simply follow the immune system’s lead and create synthetic versions of the natural antibodies that deflect the novel coronavirus, or SARS-CoV-2, from its host cell receptor in recovered patients. The goal of an antiviral pill is to stop the pathogen from replicating, but finding drugs that can do that without injuring the infected human cell is no easy task. Scientists start by screening thousands of compounds for their efficacy in targeting SARS-CoV-2 in cell culture. Promising candidates are then tested in animals—both to ensure that the drugs are not toxic and that they are not immediately destroyed in the body and reach tissues in the lungs and other organs in sufficient amounts. All this work takes place in high-level biosafety laboratories staffed by skilled workers, who are in short supply.’

Read here (Scientific American, July 15, 2021)

Rich country hypocrisy exposed by vaccine inequities

‘No one is protected from the global pandemic until everyone is’ has become a popular mantra. But vaccine apartheid worldwide, due to rich countries’ policies, has made COVID-19 a developing country pandemic, delaying its end and global economic recovery.

This story is well argued and contains several relevant and informative links under the following subheadings:

• Systemic inequities
• Leftovers now charity
• European hypocrisy
• New North-South divide
• Reject new apartheid, cooperate

Read here (IPS News, Jul 13, 2021)

A much-needed RM52 bil Covid-19 relief plan for Parliament to pass – P Gunasegaram

‘A RM50 billion injection of aid by giving cash to the most needy sections of society and an RM2 billion immediate injection to help hospitals in the Klang Valley cope with large numbers of Covid-19 cases are probably the most urgent things to do now.

‘This will alleviate the needless suffering of large numbers of people in the current environment who have to literally beg for food by flying white flags and rely on volunteers and non-governmental organisation to help them while the government should be at the forefront of such efforts.

‘But how would the government raise that RM52 billion, you ask. It can be done through multipartisan efforts by political units to raise the debt ceiling. And this can be done by calling for an urgent meeting of Parliament. But first, let’s lay out the problems and solutions.’

Read here (The Vibes, July 13, 2021)

What we should do to get a good grip on Covid-19 – P Gunasegaram

‘Can the reported number of Covid-19 cases be manipulated? Is it being done? The short answer to the first question is, yes. For the second question, you get to decide after looking at the data. But whichever way you vote, there can be no argument against keeping politics out of Covid-19 – that is absolutely essential for success in beating back the pandemic.

‘Given the constantly high number of daily Covid-19 cases, it is not at all surprising that the movement control order (MCO) has been extended. But what is surprising is that the numbers have stayed steadily well above 5,000 infections per day despite a lockdown of nearly four weeks. Why is that?

‘What the strict MCO over four weeks has done is severely restrict movement within the community, but daily infections are still resistant to moving below the 5,000 figure. That is a clear indication that the source is elsewhere than the broad community – perhaps factories and the manufacturing sector, which are still allowed to operate? Some are pointing to easy approvals for some industries to open.’

Read here (The Vibes, July 8, 2021)

Mystery of rising Covid-19 cases in Selangor, KL – P Gunasegaram

‘On Tuesday, new Covid-19 infections in Malaysia numbered 7,654, the first time the daily tally crossed the 7,000 mark in a month. The Klang Valley contributed more than 60 of each 100 cases that day. Selangor logged 3,260 cases, while Kuala Lumpur had 1,550, bringing the total in these two areas to 4,819, or 63% of the Tuesday caseload.

‘But, the population of Selangor and KL stands at 8.3 million – 26%, or slightly over a quarter, of the Malaysian population. That works out to this: the area’s contribution to the national Covid-19 rate is some 2½ times its population share. Why? We need to know the answer to that if we are to deal with the latest coronavirus problem.‘

Read here (The Vibes, July 8, 2021)

Developing country solidarity needed to overcome pandemic

‘As rich countries have delayed contagion containment, including mass vaccination, in developing countries, much weaker fiscal efforts in the South have worsened the growing world pandemic apartheid.’

This story is well argued and contains several relevant and informative links under the following subheadings:

• Lessons from first wave
• Sustaining businesses, nurturing economies
• One size cannot fit all
• Who can we count on?
• Relief, recovery, reform

Read here (IPS News, Jul 6, 2021)

Beware the fifth wave of Covid-19 — Amar-Singh HSS

‘On 8th May 2021 I wrote about how to “Avoid a Covid-19 Disaster in Malaysia”. This crisis has washed over us and the toll in deaths and loss of livelihood has been and continues to be significant. I am now writing about the impending, massive fifth wave. This wave may be so big as to make the current one look pale in contrast. In a sense we have, in the fourth wave, experienced what Italy did last year. Now the fear is that we may experience what India, Peru and some other countries in South America are experiencing.

‘Some of our leaders seem to live in denial of the reality; one even saying that the pandemic in Malaysia is under control. Others have set a value of '4000 cases' as a benchmark to use, but in the face of a high positivity and limited testing this is fraught with problems. A good look at the data and trends suggest that the worst may be yet to come.’

Read here (The Malay Mail, June 25, 2021)

Should we vaccinate our children against Covid-19 in Malaysia? — Amar-Singh HSS

While we take every protective measure to prevent children from getting infected, we need to ask ourselves if we should consider vaccinating children against Covid-19. Some issues to consider the risk and the benefit are discussed below.

• How severe is Covid-19 in children? Will vaccines benefit children?
• Are Covid-19 vaccines safe to use in children?
• Are there benefits to the family and society?
• Remember that children cannot be a priority for vaccination until we first vaccinate all adults that are keen. This includes the elderly, those with chronic illness, younger adults who comprise our workforce and our migrant workers.
• What are other nations doing?

Summary

‘The pandemic impacts all of us, even those not infected. We will have to grapple with these issues as parents and a society as we decide about Covid-19 vaccination for children. How effectively we control the outbreak locally and the spread and impact of variants (mutations) will also determine our response and decision regarding this issue.

‘In Malaysia we have yet to make a serious impact on vaccination rates for those at high risk of severe illness and death (the elderly and those with chronic illnesses). No matter how much we want to support children, it is imperative that we push for those at highest risk to be vaccinated before we vaccinate children. In addition, it is vital to vaccinate young adults who are working and mobile as they are important drivers of the pandemic. However we should consider selectively vaccinating children with severe disabilities in residential care, especially if at high risk of exposure to Covid-19.

‘My personal preference would be not to subject our children to mass vaccination against Covid-19 however to control Covid-19 in the community we may have to vaccinate children aged 12-17 years. The recovery of our nation from Covid-19 means the recovery of our children from the severe mental strain that currently impacts them daily. Lives are currently being lived on a ‘pause button’ and vaccination is an important measure to return our society to a semblance of normality.’

Read here (The Malay Mail, June 6, 2021)

Pandemic relief policies need more resources, better design

‘Pandemic relief measures in developing countries have been limited by modest resources, fear of financial market discipline and policy mimicry. COVID-19 has triggered not only an international public health emergency, but also a global economic crisis, setting back decades of uneven progress, especially in developing countries.’

This story is well argued and contains several relevant and informative links under the following subheadings:

• Struggling to cope
• Urgent financing needs
• COVID-19 recessions different
• Government as ‘payer-of-last-resort’
• Policy blind spots
• Diverging recoveries
• Appropriate relief measures
• Recoveries threatened

Read here (IPS News, Jun 1, 2021)

 

Suggest pragmatic steps in handling Covid-19 nightmare: Jeyakumar Devaraj

‘We (in Malaysia and in the world) are now facing the biggest crisis faced by humankind since the Second World War. We need our government to do the right thing to steer us out of this combined health and economic crisis. The government has to:

1. Implement movement restrictions as and when required to keep the incidence of new cases from overwhelming the capacity of our hospitals;
2. Ensure that the vaccination programme reaches 80 percent of our population (26 million) as soon as possible. As of date, only 11 million Malaysians have signed up. The rest remain unconvinced, and the anti-vaxxers are not helping the situation;
3. Ensure that those whose incomes have collapsed because of the MCOs are identified and supported; and
4. Raise the funds necessary to do all of the above without compromising Malaysia’s credit ratings in the financial markets.

‘The government needs the support and trust of the people in order to carry out the above measures. I would submit that unfairly running the government down and undermining its credibility does not help in handling the Covid-19 nightmare. 

‘Do criticise if there are shortcomings and if possible, suggest pragmatic steps that can be taken to overcome these. But disparaging everything the government is doing on the basis they are an “illegitimate backdoor government” and therefore everything they do must be faulty, is not helping the situation. Let’s leave partisan politicking aside for now and focus on navigating safely through the Covid-19-induced health/economic storm.’

Read here (Malaysiakini, May 27, 2021)

Developing countries desperately need Covid-19 financing

‘Failure to sufficiently accelerate comprehensive efforts to contain COVID-19 contagion has greatly worsened the catastrophe in developing countries. Grossly inadequate financing of relief, recovery and reform efforts has also further set back progress, including sustainable development.’

This story is well argued and contains several relevant and informative links under the following subheadings:

• Uncertain and unequal recovery
• Global disparities
• Insufficient international support
• Leveraging the new SDRs
• Financing options for developing countries

Read here (IPS News, May 25, 2021)

The mental pitfalls of Covid: Tomas Pueyo

‘If a handful of governments had failed, it would be easy to single them out. Instead, the failure was widespread. Most Western governments failed to contain the virus. When so many humans fail, they are not at fault. Politicians are humans. They’re flawed, biased, like you and me. Their failures are understandable.

‘What failed is the system. Systems should be designed to eliminate human failure. Here, they didn’t. Why have western democracies been so bad at incorporating information quickly? Why was decision-making so poor? Why were they so bad at coordinating citizens, which at the end of it is their sole function?

‘Covid is bad, but thankfully its Infection Fatality Rate is not civilization-threatening. Many upcoming challenges will threaten the collapse of our civilizations, from Global Warming to low fertility, inequality or AI. If our governments have been exposed to be incapable of solving even COVID, what will they do about these more important problems?’

Also discussed why politicians made the errors they made, and what that tells us about ourselves and how to prepare for the future: 

1. Not doing a cost-benefit analysis
2. Not accounting for confidence
3. Dogmatism
4. Social proof
5. Availability bias
6. Authority
7. Escalation of commitment & confirmation bias
8. Reinventing the wheel
9. Desensitization (and hedonic adaptation, framing, storytelling, and anchoring)

Read here (Uncharted Territories, May 25, 2021)

Some personal insights into the Covid-19 situation in Malaysia — Amar-Singh HSS

‘This article offers some personal insights into the Covid-19 situation in the country. One concern is that the public in some states behave as though the worsening outbreak is confined to the Klang Valley, or only to selected states. This is a dangerous assumption as the situation is worsening in the whole nation. The lack of adequate data hampers the public’s appropriate response to the deepening crisis.’

The following matters are discussed:

• ICUs bed occupancy is at critical levels nationwide
• Mortality rate is rising
• Younger persons are dying and mutations spreading
• When will the current outbreak peak?
• What are the implications of these trends?
• What is possibly going to happen?
• What can we do as the general public?’

Read here (The Malay Mail, May 23, 2021)

Put people before profits for progress

‘Millions of people are expected to die due to delayed and unaffordable access to COVID-19 tests, treatment, personal protective equipment and vaccines. Urgent cooperation is desperately needed to save lives and livelihoods for all.’

This story is well argued and contains several relevant and informative links under the following subheadings:

• Vaccine apartheid
• Pfizer profits
• What the pandemic demands
• Technology transfer needed
• What the world needs now

Read here (IPS News, May 18, 2021)

Investigate the origins of Covid-19: ‘Take hypotheses about both natural and laboratory spillovers seriously’

‘As scientists with relevant expertise, we agree with the WHO director-general, the United States and 13 other countries, and the European Union that greater clarity about the origins of this pandemic is necessary and feasible to achieve. We must take hypotheses about both natural and laboratory spillovers seriously until we have sufficient data. A proper investigation should be transparent, objective, data-driven, inclusive of broad expertise, subject to independent oversight, and responsibly managed to minimize the impact of conflicts of interest. Public health agencies and research laboratories alike need to open their records to the public. Investigators should document the veracity and provenance of data from which analyses are conducted and conclusions drawn, so that analyses are reproducible by independent experts.’

Read here (Science, May 14, 2021)

How China used the media to spread its Covid narrative — and win friends around the world

‘Over half of the 50 nations surveyed at the end of 2020 reported coverage of China had become more positive in their national media since the onset of the pandemic, while less than a quarter reported it had become increasingly negative.

‘The change was most favorable in Europe, which scored 6.3 on a scale of one to ten, where one is the most negative and ten is the most positive. China’s image plummeted in North America, coming in at 3.5.

‘The overall increase in positivity coincided with an uptick in Chinese outreach. Three-quarters of the journalists we surveyed said China had a visible presence in their national media, compared to 64% in a previous survey we conducted for IFJ in 2019.’

Read here (Nieman Lab, May 14, 2021)

Wider vaccination, herd immunity vital to recovery — Moody's Analytics

‘A stronger push towards wider vaccination and herd immunity will be key to domestic recovery and should facilitate an economic rebound as emergence of new Covid-19 variants poses high risk, Moody's Analytics economist Sonia Zhu said. Malaysia's economy contracted by 0.5% year-on-year in the March quarter, following a 3.4% slump in the fourth quarter of 2020.

"Despite a gradual easing of gross domestic product (GDP) contractions, conditions will likely stay weak in the coming quarter due to the latest Movement Control Order (MCO)," she said in a statement today... "Hence, a stronger push towards wider vaccination is key," she said, adding that at present, only 3.4% of Malaysia's total population has received at least one dose of a vaccine.

‘The slow vaccination rate casts doubt on the ability to reach herd immunity target by the end of 2021, tilting the balance of risks to the downside for the subsequent quarter, opined Zhu.’

Read here (The Edge, May 14, 2021)

The top 25 mistakes of Covid mismanagement: Tomas Pueyo

We need to learn the lessons so that these widespread governmental failures don’t happen again. Here are the top 25 mistakes of COVID management I see so far, from least important to most.

25. Infection parties
24. Immunity passports
23. Not knowing who to trust
22. Underestimating people’s willingness to do the right thing
21. Lying to the public
20. PCR test management
19. Letting states fend for themselves
18. Forgetting that good fences make good neighbors
17. Storytelling against reality
16. Not adapting to lower income areas
15. Missing that the virus would mutate
14. Not understanding exponentials
13. Not realizing the value of time has changed
12. Be unable to make decisions under uncertainty
11. Misunderstanding individual freedom
10. Making privacy sacred
9. Challenge trials
8. Seeing nails everywhere
7. Aerosols, outdoors, masks, and superspreaders
6. Regionalism
5. Applying developed country logic to emerging economies
4. Not understanding that rapid tests were a game changer
3. Vaccine management
2. Failing at test-trace-isolate
1. Not learning fast enough

Read here (Read here (Uncharted Waters, May 13, 2021)

The AstraZeneca vaccination system must be scrapped – P Gunasegaram

‘The original proposal for Covid-19 vaccinations was a good one but concerns over the AstraZeneca vaccine have elicited a wrong response from the government, leading to a system that enabled jumping a queue that already exists.

‘The AstraZeneca vaccination system needs to be scrapped after its first roll-out and amalgamated into the existing one, especially since it was reported that Malaysia is soon to receive a million more doses of AstraZeneca under the Covax facility, which enables countries to get vaccines. It would be a major disaster if this is done through the alternative booking process because it seriously compromises the earlier queuing system.

‘Science, Technology and Innovation Minister Khairy Jamaluddin, who is responsible for the coordination of vaccinations, erred when he allowed a parallel system of vaccination, which is unfair because it bypasses a system already in place which prioritises vaccinations according to need.’

Read here (The Vibes, May 13, 2021)

Indonesia study finds China's Sinovac COVID-19 vaccine effective in medical staff

‘China's Sinovac Biotech COVID-19 vaccine was 98 per cent effective at preventing death and 96 per cent effective at preventing hospitalisation among a group of inoculated Indonesian medical staff, a study conducted by the country's health ministry has found.

‘The findings were based on data from 120,000 healthcare workers in Jakarta who had received the vaccine between January and March this year, lead researcher and health official Pandji Dhewantara told a briefing on Wednesday.’

Read here (Channel News Asia, May 12, 2021)

US support for vaccine waiver welcome, but more needed

‘Thanks to President Biden, the US now supports a suspension of intellectual property (IP) rights to increase vaccine supplies. However, without vaccine developers sharing tacit technical knowledge for safe vaccine mass production, it will be difficult to rapidly scale up vaccine output.’

This story is well argued and contains several relevant and informative links under the following subheadings:

• Waiver delayed is waiver denied
• Foot dragging for profit
• Vaccine monopolies not yet IP dependent
• Vaccine profits kill
• TRIPS discourages knowledge sharing
• Accelerate vaccinations for all

Read here (IPS News, May 11, 2021)

Vaccine hesitancy is nothing new. Here’s the damage it’s done over centuries

“Vaccine hesitancy has less to do with misunderstanding the science and more to do with general mistrust of scientific institutions and government,” says Maya Goldenberg, a philosophy expert at the University of Guelph, Ontario, who studies the phenomenon. Historically, people harmed or oppressed by such institutions are the ones most likely to resist vaccines, adds Agnes Arnold-Forster, a medical historian at the University of Bristol in England.

‘A range of recurring and intersecting themes have fueled hesitancy globally and historically. These include anxiety about unnatural substances in the body, vaccines as government surveillance or weapons, and personal liberty violations. Other concerns relate to parental autonomy, faith-based objections, and worries about infertility, disability or disease. For example, some people oppose vaccines that were grown in cell culture lines that began from aborted fetal cells, or they mistakenly believe vaccines contain fetal cells. One of today’s false beliefs — that COVID-19 vaccines contain a microchip — represents anxiety about both vaccine ingredients and vaccines as a surveillance tool.’

Read here (Science News, May 11, 2021)

Gavi in talks with China's Sinopharm, other vaccine makers for Covax doses

‘The GAVI Vaccine Alliance is in talks with COVID-19 vaccine manufacturers including China's state-owned Sinopharm to expand the COVAX pipeline and secure doses for distribution, a GAVI spokeswoman said on Monday.

‘Sinopharm received emergency use listing from the World Health Organization (WHO) last Friday, making it eligible for the COVAX programme and bolstering Beijing's push for a bigger role in inoculating the world.

‘COVAX, run jointly by GAVI and the WHO to provide doses to the world's poorest people, has hit major supply problems. To date the AstraZeneca (AZN.L) shot made by the Serum Institute of India account for most doses rolled out, but authorities there have restricted exports because of India's massive epidemic.’

Read here (Reuters, May 10, 2021)

Unhide the confusion over HIDE – P Gunasegaram

‘HIDE clearly highlights the amount of confusion that the government’s handling of Covid-19 has raised. There is no coordination, consideration, nor thought given to measures taken, with each leader working in his own silo. Examples of previous gaffes include a botched and questionable roll-out of the AstraZeneca vaccine; conflicting statements over police requirements for interstate travel; the U-turn on exercise requirements during the movement control order; a number of different dates for closure of Ramadan bazaars; etc.

‘The government badly needs to get its act together over the control of Covid-19. It is not an easy task – but it is made much tougher by a lack of coordination and ministers shooting from the hip before moves have been properly considered. There is a crying need for professionals to take over and for politicians to be side-lined – a clear mandate needs to be given to a committee of professionals from various relevant ministries to run the operation to fight Covid-19 and make the needed announcements.

‘Probably the best person to lead this effort is Health Director-General Tan Sri Dr Noor Hisham Abdullah, who has a very good grasp of the problem and who will be able – with the help of other top civil servants and experts from the private sector – to deal with this.’

Read here (The Vibes, May 10, 2021)

Indian Covid mutant more contagious, but not vaccine resistant: Top WHO scientist

“Surge in India increases chances of more dangerous variants emerging. Prelim data shows that Indian variant is more contagious. There is heterogeneity in India in terms of spread of Covid-19. WHO is concerned about number of cases and deaths in India. Globally, cases and deaths have plateaued, not in South Asia. South East Asia is seeing case rise owing to India. Overall numbers hide what is going on, need to go deeper in state, local level data,” she said.

‘Speaking on efficacy of vaccines available in India, she assured, “There is no enough data to show that double mutant is vaccine resistant. All the available vaccines today in India and elsewhere prevent severe disease and death even if you get up the infection. You are not going to end up in the ICU critically ill. The message is take the vaccine whichever is available and you eligible for it. If your turn is there, please take it.”

Read here (Yahoo, May 10, 2021)

Avoid a Covid-19 disaster in Malaysia — Amar-Singh HSS

‘A Covid-19 disaster is looming in Malaysia as we watch the numbers rise. It is semantics to argue if we consider this a fourth wave or a resurgence of the third wave. What we know as a reality is that our control measures are no longer effective, deaths are increasing, younger persons are dying (some with no chronic illnesses) and our intensive care units (ICUs) are getting choked.

‘Our fear is not just death but Long Covid-19; i.e. 10-30 per cent of all adults that get infected, even with a mild illness, may suffer long term damage to organs and be debilitated for many months. It would be foolish to think that we cannot reach a state like India is in today. Don’t forget what happened to Italy early in the pandemic — they have much better health infrastructure compared to us and yet were overrun.’

Read here (The Malay Mail, May 8, 2021)

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

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

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

Read here (The Lancet, May 8, 2021)

Suspend HIDE information announcement immediately, shopping mall operators and retailers tell MOSTI

‘The statement [by The Malaysia Shopping Malls Association, Malaysia Retailers Association and Malaysia Retail Chain Association] claimed that the HIDE assessment is grossly unfair to shopping malls and retailers which have invested so much on safety and control and adhered to Covid-19-driven SOPs as determined by the authorities. "The earnest and diligent adherence to the SOPs at shopping malls would appear to have, unfortunately, back-fired and inadvertently punished the malls. 

"We understand that the national [Covid-19] infection rate is 1.3% and from our own statistics, shopping malls’ infection rate is significantly below the national average,” the statement claimed. Citing data from the Health Ministry, the statement said the ministry’s data shows that factories, communities and construction sites constitute the top three locations where Covid-19 incidence is detected at 48.06%, 12.5% and 11.56% respectively.

‘As the ministry’s data shows that shopping areas only comprises 4.78%, the statement said clarification needs to be accurately provided as to the incidence of Covid-19 infections in shopping malls and areas. "It is obvious the HIDE information is incomplete and skewed and portrays a completely different picture than the real situation. "The information is incomplete as only those premises and operations that diligently comply with the SOPs and MySejahtera recording are data-mined. "Those sectors that do not comply and blatantly flout the SOPs are not evaluated for lack of data and thus do not appear as a hotspot, despite being so,” the statement claimed.’

Read here (The Edge, May 8, 2021)

DCGI approves anti-Covid drug developed by DRDO for emergency use

‘The Drugs Controller General of India (DCGI) has granted permission for emergency use of anti-COVID-19 therapeutic application of the drug 2-deoxy-D-glucose (2-DG) developed by Institute of Nuclear Medicine and Allied Sciences (INMAS), a lab of Defence Research and Development Organisation (DRDO), in collaboration with Dr. Reddy’s Laboratories (DRL),Hyderabad. 

‘In a release issued on Saturday, the Ministry of Defence said that as per the order, emergency use of this drug as adjunct therapy in moderate to severe COVID-19 patients is permitted. It added that being a generic molecule and analogue of glucose, it can be easily produced and made available in plenty in the country. 

‘The drug comes in powder form in sachet, which is taken orally by dissolving it in water. It accumulates in the virus infected cells and prevents virus growth by stopping viral synthesis and energy production. Its selective accumulation in virally infected cells makes this drug unique.

‘Clinical trial results have shown that this molecule helps in faster recovery of hospitalised patients and reduces supplemental oxygen dependence, noted the release.’

Read here (The Hindu, May 8, 2021)

Study: Vitamin D won’t limit risk, severity of Covid-19

‘New Cornell-led research finds “little to no evidence” of a link between a person’s normal blood levels of vitamin D and risk of getting COVID-19, or the severity of an infection, in the most comprehensive study of its kind to date.

‘Multiple studies had suggested an association between vitamin D and COVID-19 risk, raising hopes that vitamin D supplements might help to prevent or minimize infections – speculation that has received widespread media attention and boosted consumer interest.

‘The new study, however, which analyzed a publicly available genomic data bank and 38 different COVID-19 studies worldwide – a total sample including nearly 1.4 million people – does not support those claims.’

Read here (Cornell Chronicle, May 7, 2021)

Next steps for a people’s vaccine

‘The Biden administration’s decision to stop opposing a proposed COVID-19 waiver of certain intellectual-property rights under World Trade Organization rules is a welcome move. But ending the pandemic also requires scaling up knowledge and technology transfer, as well as public production of vaccine supplies.’

Read here (Project Syndicate, May 7, 2021)

Covid in India: Missing facts, misdirected discourse

‘The current stentorian discourse sans facts, which shifts the blame on to the government for the supply chain failures of hospitals, misses a more critical fact. Anticipating a contingency like this, the Modi government had ordered 162 PSA plants at a cost of over Rs 200 crore in October last for government hospitals all over India. This could have produced 80,500 litres of medical oxygen per minute. This translates approximately to one ton of liquid oxygen per day per plant. 

‘But out of plants ordered for 162 hospitals, only 33 got installed. Why? Even state government hospitals thwarted the Centre’s plan for on-the-spot oxygen production facilities. The Print says, orders were placed in December but when vendors reached the hospitals for installation, many “faced resistance” from them, pretending “no space” — the real reason being vested interest to procure oxygen rather than generating the entire requirement onsite. This showed how advance planning for on-the-spot oxygen supply by the Centre was thwarted by even the state-run hospitals. In the contemporary shouting and counter shouting in the media and social media, has anyone heard about this farsighted move of the government, beyond the feeble voice of The Print?’

Read here (New Indian Express, Apr 27, 2021) 

The fail West: They knew. They ignored. The reckoning, One year in. By Tomas Pueyo

‘Soon, over 1.5 million people will have died of Covid in Western countries. 1.5 million futile, needless deaths. 1.5 million wasted lives. Meanwhile, in a block of Asia-Pacific countries with a population over twice as big, they lost 18,000 people. 

‘For today, we’re going to expose the failures, expose the excuses, expose the lies, expose what we knew one year ago that we didn’t learn fast enough, and the true reasons why the West failed.‘

Read here (Uncharted Territories, May 6, 2021)

How a small city in Brazil may reveal how fast vaccines can curb Covid-19

‘The city of Serrana in Brazil is a living experiment. The picturesque place, surrounded by sugarcane fields, is nestled in the southeast of one of the countries hit hardest by COVID-19. By the end of March, daily deaths in Brazil surged to 3,000 on average a day, a high in a pandemic that has claimed more than 405,000 lives there — the second worst death toll of any country in the world behind only the United States. And as vaccines slowly trickle into the country, only about 15 percent of the population has gotten at least one shot.

‘Except in Serrana. There, nearly all the adults have gotten their shots. What happens next in this city could provide a glimpse of what the future of the pandemic could be — not only in Brazil but across the globe as vaccinations pick up.’

Read here (Science News, May 5, 2021)

The origin of Covid: Did people or nature open Pandora’s box at Wuhan?

‘If the case that SARS2 originated in a lab is so substantial, why isn’t this more widely known? As may now be obvious, there are many people who have reason not to talk about it. The list is led, of course, by the Chinese authorities. But virologists in the United States and Europe have no great interest in igniting a public debate about the gain-of-function experiments that their community has been pursuing for years.

‘Nor have other scientists stepped forward to raise the issue. Government research funds are distributed on the advice of committees of scientific experts drawn from universities. Anyone who rocks the boat by raising awkward political issues runs the risk that their grant will not be renewed and their research career will be ended. Maybe good behavior is rewarded with the many perks that slosh around the distribution system. And if you thought that Andersen and Daszak might have blotted their reputation for scientific objectivity after their partisan attacks on the lab escape scenario, look at the second and third names on this list of recipients of an $82 million grant announced by the National Institute of Allergy and Infectious Diseases in August 2020.

‘The US government shares a strange common interest with the Chinese authorities: Neither is keen on drawing attention to the fact that Shi’s coronavirus work was funded by the US National Institutes of Health. One can imagine the behind-the-scenes conversation in which the Chinese government says, “If this research was so dangerous, why did you fund it, and on our territory too?” To which the US side might reply, “Looks like it was you who let it escape. But do we really need to have this discussion in public?”

‘Fauci is a longtime public servant who served with integrity under President Trump and has resumed leadership in the Biden Administration in handling the COVID-19 epidemic. Congress, no doubt understandably, may have little appetite for hauling him over the coals for the apparent lapse of judgment in funding gain-of-function research in Wuhan.

‘To these serried walls of silence must be added that of the mainstream media. To my knowledge, no major newspaper or television network has yet provided readers with an in-depth news story of the lab escape scenario, such as the one you have just read, although some have run brief editorials or opinion pieces. One might think that any plausible origin of a virus that has killed three million people would merit a serious investigation. Or that the wisdom of continuing gain-of-function research, regardless of the virus’s origin, would be worth some probing. Or that the funding of gain-of-function research by the NIH and NIAID during a moratorium on such research would bear investigation. What accounts for the media’s apparent lack of curiosity?

‘The virologists’ omertà is one reason. Science reporters, unlike political reporters, have little innate skepticism of their sources’ motives; most see their role largely as purveying the wisdom of scientists to the unwashed masses. So when their sources won’t help, these journalists are at a loss.

‘Another reason, perhaps, is the migration of much of the media toward the left of the political spectrum. Because President Trump said the virus had escaped from a Wuhan lab, editors gave the idea little credence. They joined the virologists in regarding lab escape as a dismissible conspiracy theory. During the Trump administration, they had no trouble in rejecting the position of the intelligence services that lab escape could not be ruled out. But when Avril Haines, President Biden’s director of national intelligence, said the same thing, she too was largely ignored. This is not to argue that editors should have endorsed the lab escape scenario, merely that they should have explored the possibility fully and fairly.

‘People round the world who have been pretty much confined to their homes for the last year might like a better answer than their media are giving them. Perhaps one will emerge in time. After all, the more months pass without the natural emergence theory gaining a shred of supporting evidence, the less plausible it may seem. Perhaps the international community of virologists will come to be seen as a false and self-interested guide. The common sense perception that a pandemic breaking out in Wuhan might have something to do with a Wuhan lab cooking up novel viruses of maximal danger in unsafe conditions could eventually displace the ideological insistence that whatever Trump said can’t be true.

‘And then let the reckoning begin.’

Read here (Bulletin of the Atomic Scientists, May 5, 2021)

Is the first come first served vaccine rollout scientifically and ethically right? — Dr Musa Mohd Nordin

‘This narrative may not go down very well with the many young Malaysians who have successfully secured their AstraZeneca-University Oxford (AZ) doses. It was a frantic scrambling by the tech savvy for the 268,000 doses of the AZ vaccine. All vaccine doses were snapped within a space of four hours. Now that they have jumped the queue, some of them have even begun to rationalize the legitimacy of the first come first served vaccine roll out!...

‘The risk of being admitted to hospital and of dying from COVID in a 70 year old is 1786 and 906 times respectively, when compared to the risk of suffering from a blood clot.

‘Thus my suggestion to prioritize the AZ vaccine rollout in the high infection rate states, namely Sarawak, Kelantan, KL and Selangor, with the first right of refusal to the groups at the highest risk of severe COVID disease and deaths, i.e. those above 60 years old. Only when these high-risk elders have been protected, then the AZ vaccine can be offered to others. This makes medical sense and it is the ethically right response, within the context of limited vaccine supplies and the presently known risk benefit analysis.’

Read here (The Malay Mail, May 5, 2021)

Millions are saying no to the vaccines. What are they thinking?

‘So what will change their minds? I cannot imagine that any amount of hectoring or shaming, or proclamations from the public-health or Democratic communities, will make much of a difference for this group. “I’ve lost all faith in the media and public-health officials,” Myles Pindus, a 24-year-old in Brooklyn, said. “It might sound crazy, but I’d rather go to Twitter and check out a few people I trust than take guidance from the CDC, or WHO, or Fauci,” Baca, the Colorado truck driver, told me. Other no-vaxxers offered similar appraisals of various Democrats and liberals, but they were typically less printable.

‘From my conversations, I see three ways to persuade no-vaxxers: make it more convenient to get a shot; make it less convenient to not get a shot; or encourage them to think more socially.’

Read here (The Atlantic, May 3, 2021)

Will the pandemic make us nicer people? Probably not. But it might change us in other ways

‘Throughout the pandemic, we’ve been awash in feel-good stories about celebrating essential workers, uplifting local businesses, appreciating what we have — all shining a light on our better angels. A year ago, Kelly Ripa told The Washington Post, “I think we’re all going to be better off for this” because “we’re all being satisfied with less.”

‘But, if experts in history and science are any guide, this altruism is probably not going to last. We are more likely to put this behind us as soon as possible, dive back into life with abandon and push boundaries. If anything, we will probably be less concerned with what other people think. Carpe diem, baby.’

Read here (Washington Post, May 1, 2021)