Infections and deaths from Covid-19 continue to happen daily.
We know the pandemic is not over and we have no idea when it will be, if ever.
Since the majority of our population have been vaccinated, with 50% (as of April 9) having received their first booster shot, we have become more complacent.
After all, we’ve been told to learn to live with the SARS-CoV-2 virus and think of it as the common cold.
But, the statistics are still worrying.
According to the World Health Organization (WHO), globally, nearly 3.3 million new cases and over 23,000 deaths were reported in the last 28 days (March 6 to April 2, 2023), a decrease of 28% and 30%, respectively, compared to the previous 28 days.
The South-East Asia region alone reported over 46,000 new cases, a 289% increase as compared to the previous 28-day period, and a 36% increase in deaths.
Malaysia’s two-week trend (as of April 1) showed there was a 55.2% increase in the number of cases nationwide, with 10.4% requiring hospitalisation. There were 10 deaths during this period.
These numbers may be an underestimation due to the reduction in testing and delay in reporting in many countries.
Is anyone concerned?
“They ought to be, especially high-risk individuals. People forget very fast but the fight is not over,” says infectious disease physician and former Health deputy director general Datuk Dr Christopher Lee.
Common sense precautions such as masking up in crowded or confined spaces, staying up-to-date with vaccinations, isolating when you test positive (or develop symptoms) and seeking early treatment, are still essential to curb the spread of the infection.
To educate the masses on the importance of curbing Covid-19, the Malaysian Society of Infection Control and Infectious Diseases (MyICID) in collaboration with the Family Medicine Association Malaysia and Malaysian Medical Association, have kicked off an educational campaign themed Covid-19: Quickly Test and Treat.
Dr Lee, who is MyICID’s patron, answers some questions here.
Q: Should everyone get booster shots?
A: When my infectious disease colleagues and virologists look at the data, it clearly shows the benefits of the first booster.
For those who are more vulnerable i.e. people like me who are above 60 or people with other diseases e.g. diabetics or kidney failure, they will definitely benefit.
As for second booster, yes, there is a low take-up rate (only 2.5% as of April 1). Data shows it works better for older age and vulnerable groups, but the benefit is not as much as the first booster although it still helps in reducing disease severity and hospitalisation.
So, for the younger chaps, maybe it is not necessary.
Rather than fighting this vaccine and Covid-19 fatigue, let’s get our older parents or grandparents boosted.
Q: People are wary about getting boosters, especially after the Health Ministry (MOH) announced it was extending the shelf life of the Covid-19 vaccines. How can you assuage our fears that we are not getting an expired vaccine?
A: This is not the first time we are extending the shelf life of critical medicines.
We look at data to see how long vaccines will last; if the manufacturer says six months, MOH is often more conservative and usually cuts the time back a little bit more so they might say three months.
Of course, the data is not as robust as the new vaccines that are coming out from the manufacturers.
Companies are commercial entities – they want to make money but MOH does look at data.
The issue here is about trusting MOH.
Yes, the bivalent vaccines are better but we don’t know when it is arriving so don’t wait for it.
Q: The number of Covid-19 deaths among those who were vaccinated has risen in the United States. In the fall of 2021, about three in 10 adults dying of Covid-19 were vaccinated or boosted. By January 2022, about four in 10 deaths were vaccinated or boosted. But by April 2022, the Centers for Disease Control and Prevention (CDC) data shows that about six in 10 adults dying of Covid-19 were vaccinated or boosted. How can you explain this?
A: The deaths may not be directly from Covid-19 but from co-morbidities or other causes.
Or for example, you get knocked down by a car and when we swab you, you’re positive. We will consider it a death but not caused by Covid-19. Every country reports death differently.
A lot of people who are infected now are asymptomatic – that’s why we are asking people to self-test, isolate and treat.
We don’t know for a fact when someone catches Covid-19, how long was it after vaccination as vaccines wane over time.
So, I’m not concerned about getting infected because vaccines don’t prevent or protect me from infection but from severe disease.
Q: How accurate is the self-testing Rapid Test Kit (RTK) since these were manufactured prior to the Omicron variant invasion, and are now available for less than RM1 per kit? Many have reported having symptoms but are still testing negative while others are positive but asymptomatic and roaming free.
A: Whatever is being sold has to be of a certain standard and approved by the Medical Device Authority – we have to control the market.
The Omicron variant has been a problem – it’s very clever and has learnt to avoid detection and vaccine protection.
So, the testing kits now may not be as accurate as earlier testing hence it’s best to just isolate yourself if you develop symptoms. The false negatives are more problematic.
If in doubt, test yourself. Even if the kit is not so accurate, it’s better than not testing at all if you have symptoms.
If you’re attending a big gathering where older people will be present, get tested and mask up.
Don’t worry about masking at the pasar malam as it is in an open air environment.
Some people test once a week but you can do it at your own comfort level since these kits are cheap and accessible.
If your fear is the virus itself rather than getting infected, then mask up despite what the guidelines say.
Q: The oral antiviral drug Paxlovid has been available in Malaysia since April 2022 to treat patients with mild to moderate symptoms, and who have an increased risk for progression to severe Covid-19; yet, many don’t know about it or where to get it and there is little information from MOH. How effective is it?
A: The initial data shows that Paxlovid shortens the duration of a Covid-19 infection if taken within the first five days of symptoms.
Subsequent data shows that the benefits are greater among those who were unvaccinated or under-vaccinated. But it can take a few days for you to start feeling better.
You have to be assessed by a doctor to see if you are suitable for it. Paxlovid is free and available (for those above 17) in most government and private hospitals, and clinics.
Yes, your antibodies (from vaccines and infection) wane over time but your immune system still retains the memory.
While our B-cells produce antibodies to fight infection, the T-cells have the memory to protect people from getting infected by destroying cells.
So, even if your antibodies are low, the immune system’s memory is still there and it can respond.
Q: People with long Covid-19 have survived the infection but have persistent symptoms such as shortness of breath, fatigue, headaches, palpitations, and impairments in mental health and cognition. How do we address this?
A: You may have a mild infection but your long Covid-19 could be more troublesome.
A significant portion of long Covid is complicated because medical tests don’t show anything – it’s objective versus subjective – we don’t know when long Covid actually kicks in.
Then again, if your boss gives you a shelling today, you will be tired at the end of the day so is this long Covid fatigue?
When I was in Hospital Sungai Buloh at the height of the pandemic, my longest patient was there for four months and he went home with a walking stick. It took him a year to be close to where he was. He was 45 and fell into depression.
As a doctor, I felt helpless.
Many get post-traumatic stress disorder after being hospitalised – it is also traumatic for doctors to see this.
Long Covid can be very frustrating and unfortunately, we still don’t have answers.