THE HEALTH | MARCH-APRIL , 2022
| Column |
EMIR-SING
BY AMEEN KAMAL
IN MALAYSIA , Omicron appears to be less severe , with most cases reportedly in Category 1 and 2 , and only about 0.5 per cent are in Category 3 and above . This is consistent with global observations . Although this is a good mutational trajectory relative to variant Delta , Omicron ’ s high transmissibility makes it a game of time and numbers . The number of cases in all categories , however small percentage-wise , will expand relative to the number of cases . Therefore , there is still a real urgency to minimise the rate of transmission , even if we cannot stop it entirely .
For example , 0.5 per cent of Category 3 and above cases out of 20,000 daily cases means 100 people that may need to be hospitalised , be put in intensive care units ( ICUs ), and / or require ventilation daily .
Of course , it is said that Omicroncaused cases tend to resolve faster than Delta , which means that the daily 100 moderate to severe cases is unlikely to mean 3,000 hospitalisations per month . Even if the duration is shorter , say , between 7 – 15 days , the number can still be significant if the total number of cases is too high , over a short period .
According to data gathered in the CovidNow portal , hospitalisation rates have been increasing since the end of January this year , coinciding with the rise in cases that started in early and mid-January . As of Feb 9 , the hospital utilisation rate was at 77.4 per cent ( nationwide ), with 52.3 per cent and 33.7 per cent ICU and ventilator utilisation rates respectively . These figures have been steadily rising .
Keep in mind these figures include non-Covid cases , and it could be said that these utilisation rates came about when Malaysia is just at the beginning of its Omicron wave . In other words , this provides a snapshot of the state of the public healthcare system which clearly needs to be on high-alert mode , and emergency capacities ( beds , ventilators , medications , healthcare workers , etc .) need to be expanded immediately for the eventual surge .
People and businesses must do their part
As mentioned earlier , Omicron ’ s threat is not so much in its disease severity , but in the speed it spreads . If it reaches many vulnerable groups faster than the healthcare system can handle , our healthcare system may be overrun .
Note that old people and people with underlying diseases are still considered high-risk categories even against Omicron .
So , people who are always in close contact with elderlies and people with comorbidities should be extra vigilant .
Navigating the Omicron wave
Public healthcare capacity and readiness , minimisation of transmission , proper self-management , new technologies and personal interventions are key in navigating the surge in Omicron cases
They should refrain from crowds and test themselves more frequently . As we know , even fully vaccinated healthy adults can become asymptomatic carriers and can still transmit the virus to these vulnerable groups .
That is why the health minister recommends working from home . Industries ( such as manufacturing and construction ) need to ensure a high testing frequency and ensure adherence to safety and health protocols at sites .
We can ’ t afford another total lockdown , but we will be forced to consider drastic or radical measures if our public healthcare system is pushed to the brink again .
As it is right now , likely , Omicron cannot be stopped entirely , but gradual transmission spread over time is more manageable by the healthcare system . Therefore , mass gatherings should be minimised to avoid an explosion of cases and the number of clusters spiking .
Proper self-isolation and self-management
Though the health minister provided guidelines on the isolation period for exposure to the virus ( which varies depending on vaccination status ), there are anecdotal reports of where home test kits showed negative for the whole five days of isolation among boosted individuals , only for tests to turn out positive by day seven onwards .
Guidelines provided by the government are data-driven policies which makes them reliable . But as with any statistical data , outlier cases happen , and things are never static . Over time , what may be uncommon now could become the average .
Since there is no upside ( from the public health perspective ) to the premature release of a self-isolating individual into the community , it ’ s best to be on the side of caution for one ’ s own sake and others .
Remember , Omicron wave is a time and numbers game so the objective of self-isolation and management is to ensure we detect it whilst in isolation . False negatives and premature release of virus carriers into the community defeat the entire purpose of isolation in the first place .
There is a smaller window for the rapid tests to detect the virus , compared to PCR tests accurately . Therefore , multiple self-tests throughout the duration of isolation are ideal .
Not all fully vaccinated individuals have the same level of protection , and not everyone who received booster shots is guaranteed to be boosted effectively .
Furthermore , people get infected with different levels of viral loads and people ’ s immune systems may differ greatly .
Thus , the infection profile and the time for isolation and time for symptoms to manifest can differ greatly
Ameen Kamal is the Head of Science & Technology at EMIR Research , an independent think tank focused on strategic policy recommendations based on rigorous research . and vary from the guidelines provided . For the same reasons , it ’ s best to follow stricter protocols , if possible .
Also , on a related note , people may not know how to use rapid home tests correctly , which can give false-negative results - defeating the purpose of self-isolation and management .
The saliva / mucous must be from deep within the throat , and this can only be done through deep coughing , and better yet , to do multiple replicates to reduce chances of random errors .
If PCR tests require those thin swabs to reach deeply into our nose and throat , the home tests kits also need samples from the same area . Mouth saliva may not suffice to provide accurate readings .
With the importance of self-testing becoming more evident , it is expected that people may stock up on home test kits . One must be aware of the expiration date , which is usually printed on the box . As a rule of thumb , one should always assume that any results from an expired kit are false .
Furthermore , the type of test kit , timing , temperature , and even what you consume or put in your mouth before the test may affect the results . For example , it is known that using mouthwash could temporarily remove some viruses and give false-negative results .
New technology interventions
Omicron ’ s characteristic is an expected mutational trajectory , and probably a welcomed change , relative to Delta . It is already displacing Delta as the dominant variant , and a report suggests that natural immunity in vaccinated individuals may provide protection even from the Delta variant . As suggested by other experts , and aligned with the approach to empower the people to make their own choices , the MySJ Trace feature of MySejahtera should be tied to an early warning and prevention system so that people can avoid high-risk places . In other words , it ’ s a wider proximity alert , instead of alerting historical close contact .
Perhaps this can be done as a revival of the Hotspots Identification for Dynamic Engagement ( HIDE ) system , where real-time hotspot locations are updated in MySejahtera so that people don ’ t need to be in a certain proximity to avoid the area .
In previous years , we have also mentioned that it looks like the vaccinevirus “ cat and mouse ” game is likely to be an annual affair , based on current designs . A good situation for some , but unsustainable for many .
Vaccine designs should be improved to induce mucosal and systemic immunity and provide a balanced target ( antigen ) for our immune system to deal with future variants .
Virus mutations aren ’ t new , and our immune system is a wonderful system with mechanisms to deal with mutations – provided that it ’ s given a sufficient amount of information to deal with potential variability in the future .
As for medications , it is good to know that the Government is procuring Covid-19 pills to address disease progression and possibly shorten the time to recovery , which are crucial factors in alleviating the public healthcare burden .
Moving on from pills for the masses , there needs to be a study on why some people get severe disease to develop tailored interventions . — The Health