Although 2020 was the year of the Covid-19 pandemic, we are only just beginning to appreciate its impact on Malaysia’s finite healthcare resources.
A silver lining is that we also know a lot more about the disease, and we now have a new weapon in our war against the SARS-CoV-2 virus in the form of multiple vaccine choices.
We are also battling an infodemic, of which not all available information out there is reliable.
In today’s column, I will share the answers to questions that are commonly asked of me as a respiratory physician:
Yes. No. Maybe.
Unfortunately, there is no way to be 100% sure of whether or not you have Covid-19 based on symptoms alone.
The symptoms related to the disease – fever, sore throat, cough, lethargy, headache and loss of smell, to name a few – are not specific to Covid-19 and can be due to any viral infection, or indeed, other respiratory tract diseases.
Antigen and viral PCR (polymerase chain reaction) swab tests can help confirm the presence of the SARS-CoV-2 virus.
The threshold to send for testing should be lower for those who have symptoms and those who have risk factors.
Individuals who have a higher risk of complications from Covid-19 include those above the age of 50 and those with underlying medical conditions such as diabetes, high blood pressure, heart failure, kidney failure and obesity.
Patients with Covid-19 are categorised according to their symptoms and need for support as follows:
- Category 1: No symptoms
- Category 2: With symptoms, but lungs not affected
- Category 3: Evidence of pneumonia on chest X-ray
- Category 4: Need oxygen to help breathe
- Category 5: Many organs affected
If deemed appropriate, Category 1 and 2 patients can be isolated at home.
The ease in which this can be done will differ depending on each individual’s circumstances, as will the duration (usually 10-14 days).
These measures should be taken, whenever possible:
- Stay in a separate room with an en-suite bathroom
- The house should have regular and proper ventilation
- Strictly no visitors allowed to the house
- Restrict interaction with other members of the household (e.g. food can be left at the door)
- Avoid sharing personal household items
- If common areas are used (e.g. a shared bathroom), always sterilise/wipe it down after use by the patient
- Care should be provided by only one family member.
During interactions, a suitable distance of more than one metre should be maintained if possible and face masks must be used alongside handwashing by both patient and carer
- Ensure that the patient has a means of communication with others (e.g. mobile phone)
If you are a patient isolating yourself at home, the presence of any of the following symptoms must be alerted to the relevant clinic, hospital or Covid-19 Assessment Centre:
- Worsening fever
- Chest pain
- Unable to eat or drink properly
- Worsening lethargy e.g. unable to get out of bed
- Unable to get up without assistance
- Persistent symptoms that are getting worse, such as cough, nausea, vomiting or diarrhoea
- Reduced consciousness
- Reduced urine frequency and/or volume within a 24-hour period
It will not only protect me as an individual on the frontlines, but will also allow me to reduce the risk of transmitting the virus to my patients, colleagues, loved ones and society in general, especially the more vulnerable.
The vaccines based on mRNA (messenger ribonucleic acid) technology do not change our DNA (deoxyribonucleic acid) sequence.
It also stays in our cell’s cytoplasm and does not go to the nucleus (where the DNA is).
In other words, the mRNA vaccine does not get into contact with our genome.
All vaccines run the risk of causing side effects – there is no such thing as a medicine or vaccine that is 100% safe for everyone all the time.
What’s important is to balance the benefits versus the risks.
Vaccines can cause a fever and discomfort at the area of injection.
At the time of writing, data for the Moderna vaccine identified 10 cases of severe allergic reactions out of 4,014,396 shots, which is 2.5 per million or 0.0002% of cases, with zero deaths.
The risk of being struck by lightning is higher.
The US Centers for Disease Control and Prevention (CDC) has reported that allergic reactions to the Pfizer/BioNTech vaccine occur in approximately 11 people for every one million vaccinations.
Compare this with the death rate of Covid-19 in Malaysia, i.e. four in every 1,000 infections.
And this does not include those who have survived, but have to live with long-term organ damage and lung fibrosis.
No. It will take time for everyone to be inoculated, and not everyone will be able to receive the vaccine (e.g. pregnant women and children).
At this point in time, we also do not know the impact new strains of the SARS-CoV-2 virus might have on the vaccine’s efficacy.
We also do not know if repeated or booster shots of the vaccine will be required.
Ultimately, the vaccine will help lower transmission and the risk of disease, but it is NOT a panacea and will not completely stop the pandemic.
The “new normal” of mask-wearing, handwashing and physical distancing, as well as avoiding congested, crowded and poorly-ventilated areas should not change anytime soon.
Dr Helmy Haja Mydin is a respiratory physician and chief executive officer of the Social & Economic Research Initiative, a thinktank dedicated to evidence-based policies. For further information, email email@example.com. The information provided is for educational and communication purposes only. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.