RETURNING TO WORK IN THE OMICRON WAVE FOR COVID CLOSE CONTACT

Datuk Dr Suresh, ID Physician of Hospital Sungai Buloh has given a very insightful webinar organized by the Malaysia Medical Association on 16/2/22 concerning the Omicron wave. Here are some take home messages which are useful and practical for us:

1. A sharp spike of Omicron cases is expected. However after we have reached the peak, there will be a sharp drop in cases as well.
2. Be prepared for episodic spikes every now and then. We will have to manage with Omicron amongst us (towards endemicity).
3. Omicron has taken over Delta. Although Omicron spreads faster, it causes less hospitalization and ICU admissions compared to Delta variant.
4. Omicron spreads much faster than the Wuhan or Delta variant because of the shorter incubation period (about 3 days). It also takes approximately 2-3 days for a person who started to have covid symptoms to cause another person to start having covid symptoms as well.
5. There is no perfect covid test. A highly sensitive test like PCR can cause unnecessary quarantine for people with low viral load who are not infectious. A less sensitive test like RTK-Ag (swab or salive self-test kit) might miss some positive cases with high viral load (yet below the detection threshold), thus escaping quarantine. Therefore close contact history and symptoms evolution must be considered also in making sense of the test results.
6. Although Omicron has proven to be less aggressive than Delta variant, the highest risk group for severe outcome are:
• ≥ 40 years old with comorbid, unvaccinated
• ≥ 60 years old with comorbid irrespective of vaccine status

As many people will be tested positive for covid in the coming weeks, many more will be having close contacts with a positive covid source person knowingly or unknowingly. Here are the latest guidelines from the Malaysia Ministry of Health (updated on 15 Feb 2022) on the requirements for returning to work for health care workers (HCW) who are CLOSE CONTACTS. I personally think this guideline is relevant to other sectors as well. We cannot afford to have too many workers away for quarantine jeopardizing operations, yet we have to keep the risk of transmission to the minimum.

LOW RISK CLOSE CONTACT

This algorithm applies to HCW who had covid infection before and now fully recovered.  A healthcare worker who does not have symptoms within 90 days after recovery from covid infection can continue to work without restrictions and does not require testing after low risk close contact. This is because the HCW's neutralizing antibodies are presumably high post covid infection within the first 90 days.

LOW RISK close contact is if both you and the source person are WEARING MASKS. A source person is someone who is confirmed positive for COVID-19.

IF YOU DO NOT HAVE SYMPTOMS:

• You do not require RTK-Ag testing to return to work.
• However, you are required to self-monitor for the next 14 days.
• At any point within the 14 days period if symptoms develop, do an RTK-Ag test.

WHEN YOU HAVE SYMPTOMS:

• Do RTK-Ag test immediately.
• You can return to work if your RTK-Ag is NEGATIVE.
• If required, continue re-evaluating symptoms to decide if medical leave is required until symptoms resolve or go for further testing ie PCR to have a conclusive diagnosis.
• A 14-day duration for self-monitoring of symptoms is required.

HIGH RISK CLOSE CONTACT

HIGH RISK close contact is if both you and the source person with positive covid are NOT WEARING MASKS.

IF YOU DO NOT HAVE SYMPTOMS:

• You need to do RTK-Ag as soon as you are aware of such exposure.
• If your test result is NEGATIVE, then you can return to work.
• DAILY RTK-Ag TESTING is required until Day 5 post exposure for those fully vaccinated or until Day 7 post exposure for those partially/unvaccinated. You can work as long as you are tested negative.
• Continue self-monitoring for symptoms until Day 14.

WHEN YOU HAVE SYMPTOMS:

• You should not go to work yet. Do RTK-Ag test immediately AND at Day 3 post exposure.
• If at Day 3 RTK-Ag test is NEGATIVE and SYMPTOMS RESOLVE, then only you can return to work.
• If symptoms persist till Day 3 but RTK-Ag is negative, then do a PCR before returning to work.
• DAILY RTK-Ag TESTING is required until Day 5 post exposure for those fully vaccinated or until Day 7 post exposure for those partially/unvaccinated. You can work as long as you are tested negative.
• Continue self-monitoring for symptoms until Day 14.

Source: Adapted from KKM COVID-19 Guidelines (Annex 21a)

WHAT TO DO IF YOU ARE COVID POSITIVE OR CLOSE CONTACT (Updates Feb 2022)

In view of the recent spike of covid cases, here are the latest info obtained from the Malaysia Ministry of Health portal which may be relevant to many now. As positive covid cases rise, there will be more people wondering if they are considered a close contact.

GET THE DEFINITIONS RIGHT first. Are you a close contact? The person you are in contact with is a covid positive suspect if proven by RTK-Ag test (self test kit or professional) with symptoms and confirmed covid positive with RT-PCR (professional).

What should you do if you are a CLOSE CONTACT?

How things are different if you are a close contact WITH OR WITHOUT SYMPTOMS? Here are what you should do depending on symptoms:

How do I report my close contact status in MySejahtera?

When should I check for covid actually?

How do I report my covid self-test kit results in MySejahtera?

What happens if I am found positive later?

WHERE SHOULD I GO FOR QUARANTINE if I am covid positive?

How do I know which CATEGORY of covid I have?

So what do I do after I am confirmed covid positive?

I was in close contact with someone before I knew I was covid positive. How can I inform MySejahtera about this so that my close contacts will be alerted for further action?

IN SUMMARY

Please click here to download the source PDF for your reference:

#1 National COVID-19 Testing Strategy

#2 COVID INFO 2022

BOOSTER DOSE VACCINATION FOR COVID-19 AND COVID-19 ANTIBODIES

Ministry of Health Malaysia has rolled out the 3rd Dose (Booster Vaccination) for COVID-19. Many people will be asking these questions:

Q: Who should get it first?

A: Frontliners; Senior citizens (>60 years old); High risk patients with co-morbidities.

Q: When should I get it?

A: After at least 6 months from your 2nd dose Covid-19 vaccination or as soon as it is offered to you if you are in the susceptible group.

Q: How do I know if I am in the susceptible group?

A: The older you are the more susceptible you are, the more medical conditions you have ie Diabetes mellitus, hypertension, heart disease, kidney disease etc. the more susceptible you are. The lower your Covid-19 neutralizing antibodies below the cut off point, the more likely you will get infected with Covid-19.

The general guiding principles on whether or not you should be getting your booster dose for Covid-19 vaccination are:

• Covid-19 vaccination benefits far outweigh the risks. It is generally safe and efficacious for the vast majority. So, if  you have no doubts or reservations toward the vaccine, then go ahead and get it the booster shots.
• If you have issues or concerns about getting the booster vaccination, then prove that you really do not need it, then there is no urgency or compulsion for you to get it.
• If you want to reject the Booster Dose (Covid-19 Vaccination), you better have a solid good reason for doing so. Otherwise you are putting yourself and others at risk of getting Covid-19 infection and its complications.

This is the conclusion that I derived from Dr Timothy's post advising doctors on Covid-19 vaccination booster dose. He is the Consultant Infectious Disease Specialist of Gleneagles Hospital Kota Kinabalu. Below is the verbatim transcript of his post:

Q: What if a patient would rather have a Sinovac booster instead of a Pfizer booster? (Those who had 2 previous Pfizer or 2 previous Sinovac)

A: Take the Pfizer, but if the patient is still worried then take the Sinovac anyway. (Any booster is) better than not having a booster shot.

Q: What is the level of antibodies that is adequate to give protection against Covid-19? 

A: We don't really know what is the level of antibodies that are needed to reduce the risk of severe disease ie a cutoff point although it is written in the lab form. However, the higher the better. Low titres also does not mean the person does not have any immunity.

 

Q: If the antibody levels are high, should we advice a high risk person ie older age group or those with co morbidities, to still take the booster dose? 

A: No harm taking but I would not push for them to take it.

 

Q: In that case should we then advice people to do antibody levels before advising them to take the booster? 

A: There is no recommendation to take the antibody levels before a booster as most will be low unless they had been infected earlier.

 

Q: Is there any situation you would advise taking an antibody level before advising a patient to take a booster? 

A: I would if the patient had severe side effects from the 1st 2 doses.

 

Q: A patient had mild Covid last year, 2020  and now has already completed 2 doses of the vaccine. Should he get a booster? 

A: So this would be the 4th exposure to the Covid Ag. I wont push for it. No harm getting it though.

 

Q: If the patient had 2 doses and then still got the Covid 19 infection (ie breakthrough infection), should the patient get the booster? 

A: I really think this is unnecessary.

These are all my own personal opinions.

 Thank you

 Dr. Timothy William

UPDATES ON COVID-19 BY DR TIMOTHY WILLIAM (INFECTIOUS DISEASE PHYSICIAN, GLENEAGLES KOTA KINABALU)

This live webinar was recorded on the 11th July 2021. 

This event was organized by The Association of Private Practitioners Sabah (APPS) for the benefit of medical practitioners and the general public regarding current issues of COVID-19 as we battle into the second year of this pandemic. 

Various issues of the COVID-19 pandemic are being discussed including new variants of COVID-19 and vaccinating children and adolescents. Get first hand, accurate and reliable information from Dr Timothy William from this webinar.

You can click the time stamp below to go directly to the specific issue of interest:

0:03 Introducing the speaker, Dr Timothy William, Infectious Disease Physician, Gleneagles Hospital Kota Kinabalu 
1:21 Various types of coronaviruses 
2:28 How does COVID-19 transmit?
3:28 Can airborne transmission occur? 
6:42 How about contact transmission of COVID-19? 
7:54 How does COVID-19 cause disease? 
9:41 How long is the incubation period? 
11:42 Spectrum of disease severity 
13:08 Case studies 
15:48 Time course of illness and 'Happy Hypoxia' 
18:10 Asymptomatic Infection 
18:40 Progression of disease and risk factors
21:22 Diagnosis 
21:48 Interpreting diagnostic tests for COVID-19 
23:28 Investigations 
24:49 Management 
25:04 Prognosis 
25:21 Therapeutic management of hospitalized adults with COVID-19 based on disease severity 
27:30 Vaccine update 
28:50 Risk of side effects from COVID-19 vaccines 
32:25 Should we give mRNA vaccines to children/Adolescents? 
34:32 Benefits and risks after 2nd dose of COVID-19 vaccination 
35:46 New variants of COVID-19 
40:35 Mixing vaccines 
42:24 Safety of vaccines in pregnancy and breast feeding mothers 
43:29 Q&A Can Ivermectin be used as an anti-viral drug?
45:13 Q&A Can a person develop covid infection after vaccination? 
45:45 Q&A Is there a role for anti-fungals in preventing mucomycosis? 
46:24 Q&A If the patient dies after vaccination, when will it be considered as the direct cause of death? 
48:18 Q&A Any studies done to investigate levels of antibodies after vaccination or if booster doses are necessary? 
48:54 Q&A What is the maximum interval between dose 1 and dose 2? 
49:35 Q&A Should people buy pulse oxymeter to check their oxygen saturation at home? 
49:49 Q&A Any prohibitions in taking alcohol after vaccination?

COVID-19 in Kota Kinabalu: What you should know about the current situation.

When should you suspect yourself having COVID-19? 

When you develop symptoms of SHORTNESS OF BREATH, COUGH or SORE THROAT with or without fever

+

have been to a PLACE or EVENT with known COVID-19 cluster

OR

CLOSE CONTACT with a person confirmed with COVID-19 in the past 2 weeks

OR

TRAVELING HISTORY to a foreign country before having symptoms in the past 2 weeks

KKM Annex 1: DEFINITION OF PERSON UNDER INVESTIGATION (PUI)

Important!

 

In KK, 91% of cases are not linked to any known clusters, events or history of traveling. People are screened because they only have symptoms. Some of these patients did not even have fever as a symptom. Therefore the temperature check is not going to help much in identifying who to suspect. It means there are many people without symptoms who are potentially infectious still moving around and there is no way we can trace the source of the spreader. This means the more people you meet, the higher the chances of you coming in contact with one of those asymptomatic spreaders. You may even be a spreader without realizing it. THIS IS WORRYING the medical team in Sabah. THIS IS A PRE-MEGA SURGE TREND. We may be heading for 1000 new cases per day by the end of October 2020!

As of now the ICU beds in QEH 1 are already full according to colleagues working there.

If we refer to our national statistics, in order to "flatten the curve", our new cases number from 7-11 October should be below 500 case per day and downward trend. However if you isolate the figures for Sabah in the following graph it reveals a disturbing fact.

As of 11th October 2020, Sabah had a 76% jump to a new high from to 488 cases per day! Our Sabah healthcare system is truly being "tested" as Tan Sri DG puts it. Berita Harian today (12/10/2020) carries the title, "Perang COVID-19 di Sabah sedang mencapai tempoh kritikal" says it all.

 

How is COVID-19 infection confirmed?

1.     Positive RT-PCR (Reverse Transcriptase Polymerase Chain Reaction)- Nasopharyngeal Swab test

2.     2 positive RTK-Ag (Rapid Test Kit- Antigen) 14 days apart- Nasopharyngeal Swab test

 

IF Positive for COVID-19 will I be admitted to the HOSPITAL, sent to QUARANTINE CENTER or given HOME QUARANTINE?

For details refer KKM Annex 2: MANAGEMENT OF PUI AND CONFIRMED COVID-19 CASES

Not all COVID-19 positive patients need to be admitted. In view of the very likely possibility that wards and quarantine centers in KK are full, home quarantine can be done if these requirements at home are fulfilled:

1. Have separate bedroom and bathroom that is not shared with other family members.
2. Have access to food and other necessities.
3. Has access to face masks, gloves and disinfectant at home.
4. Able to seek medical care if necessary and return with own private transport.
5. Able to follow instructions for home surveillance.
6. No family members at home who are considered high risk e.g. elderly, young children, having chronic diseases.

 DO NOT go for RTK-Ab (Rapid Test Kit-Antibody as a confirmatory test or screening method because if it is positive, it does not reflect the current presence or infectious status of the virus. It merely indicates past exposure to COVID-19. If it is negative, it does not mean that the person is not exposed to the virus. It is possible that the antibody to COVID-19 has not developed at the time the test was done and the antibody could develop later and result in a positive result. Therefore, DO NOT DO RTK-Ab test on your own to avoid such diagnostic confusion.

(Click here to watch Tan Sri Dr Noor Hisham's explaination on this issue)

What should you do if you feel unwell?

If you feel unwell (FEVER, COUGH, SORETHROAT, SHORTNESS OF BREATH) and worries about the possibility of getting COVID-19, please do not go for COVID-19 testing immediately. The first thing you should do is to put on a mask, use hand sanitizers or wash your hands before and after you touch anything. Most importantly STAY AT HOME! Do not go anywhere, not even to the clinic yet. Give your doctor a call. Let the doctor talk to you to find out more about your symptoms. If you could video call your doctor even better. Let your doctor decide if the symptoms and history presented are consistent with COVID-19 or not. It could be other diseases e.g. heart attack, lung infection, dengue or other medical conditions that should be managed differently instead of going to the lab to request for a COVID-19 test.

 

After assessing you remotely, if the doctor thinks that you are not so ill to warrant a visit to the hospital or clinic, he might just prescribe you with some medicine to control the symptoms first. Please keep in touch with your doctor to update your condition. If it is just common cold or mild upper respiratory tract infection, you would feel better or at least your symptoms would not worsen. However, if you feel your symptoms worsen especially SHORTNESS OF BREATH, then your doctor may advise you to go to the hospital straight away for further testing to rule out COVID-19.

 

The reason I would prefer patients to home quarantine themselves if they are qualified is because I assume they could rest and be better cared for at home. Bear in mind that if you are not able to physically isolate yourself from other family members, then please consider going to the quarantine center.

 

The spread of COVID-19 can only be stopped if everyone minimizes their movement and contact with other people. Doing RT-PCR or RTK-Ag alone will not help. STAYING AT HOME WILL HELP to break the chain of infection. This is especially true for asymptomatic spreaders. Everyone must have this mindset that they could potentially be positive therefore they must avoid spreading the virus to other people. Everyone must also assume everybody they meet could potentially be positive therefore do their best to avoid being infected. All these could be easily achieved with faithful adherence to wearing mask, using hand sanitizer and social distancing or just STAYING AT HOME!

 

Our politicians currently have a lot at stake i.e. power struggle, economic recession, political instability. They will always take the middle path or the path with the least resistance to maximize the number of people they will please. The health policy makers and technocrats are also not independent of their political masters. They are not supposed to issue any public statement that would jeopardize the peace and cause society to panic.

 

For us common people, OUR PRIORITY IS TO KEEP OURSELVES AND OUR LOVED ONES SAFE. That is all that matters for the time being. So do what is right. #kitajagakita

HEART ATTACK LEADING CAUSE OF DEATH (Adapted from The Star 31st October 2019)

Heart attack remains the leading cause of death in Malaysia for the 14th year.

Ischaemic heart diseases, which occur when arteries of the heart cannot deliver enough oxygen-rich blood to the heart, continued to be the main cause of death in Malaysia last year with a total of 18,267 deaths or 15.6% of total deaths from various causes, the latest Statistics on Causes of Death in Malaysia released by the Department of Statistics Malaysia (DOSM) revealed.

It was the principal cause of death for males in Malaysia with 12,510 deaths (17.8%) while for females, the principal cause of death was pneumonia with 6,033 deaths (12.8%), it said.

Last year, 172,031 total deaths from various causes were recorded, an increase of 2.3% compared to 168,168 in 2017, it said.

“On average, 50 persons in Malaysia die of ischaemic heart diseases every day,” DOSM said in the statistics released yesterday.

According to the National Heart, Lung and Blood Institute in the United States, the most common type of ischaemic heart diseases is coronary heart disease (also known as coronary artery disease).

It is caused by the build-up of plaque inside the coronary arteries. The build-up can partially or totally block blood flow in the large arteries of the heart. The condition may be caused by disease or injury which affects how the arteries work in the heart.

Coronary microvascular disease is another type of ischaemic heart diseases which occurs when the heart’s tiny arteries do not function normally.

Risk factors include smoking, high blood pressure, high cholesterol, diabetes, being physically inactive, overweight or obese, and family history.

DOSM said ischaemic heart diseases were the principal cause of death in 90 administrative districts in Malaysia and the highest percentage was recorded in Petaling, Selangor (16.3%).

Urban areas recorded 12,101 cases, double that in rural areas (6,166 cases), it said.

Pneumonia was the principal cause of death in 48 administrative districts with the highest percentage recorded in Kota Setar, Kedah (17.8%).

The number of deaths due to ischaemic heart diseases in Malaysia in 2010 was 9,371 and the figures increased gradually through the years. The jump increased more prominently from 2016 to 2017 (13.9%) and from 2017 to 2018 (15.6%).

After ischaemic heart diseases, the second main cause of death last year was pneumonia (11.8%), followed by cerebrovascular diseases (7.8%), transport accidents (3.7%) and chronic lower respiratory diseases (2.6%).
On the main causes of death by age group, 4.8% of those aged 0 to 14 died of pneumonia and 20.4% of those aged 15 to 40 died in transport accidents.

The main cause of death among those above age 40 was ischaemic heart diseases: ages 41 to 59 (19.2%) and ages 60 and above (16.6%). 

Reference: TheStar.com.my

The question now is: CAN WE DO SOMETHING ABOUT THIS SO THAT WE DON'T END UP AS JUST ANOTHER STATISTICS?

The answer is YES, but HOW?

1. Early detection
2. Early intervention
3. Active prevention by modifying risk factors
4. Adopting a healthy lifestyle