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?