November 2021 Vol 1 No 3

Your Editor, Jamari Mohtar, is in grab car to accompany his significant other for a booster jab at a polyclinic somewhere in Desa Pandan, KL …

  • The day before, I had my booster jab at a polyclinic near Mid Valley mall accompanied by my 30 years old son, Abdul Haq, as my significant other had to attend a Board meeting.
  • I have always felt going for a jab in this time of pandemic, it is always a good practice to be accompanied by one other person so that in case of unforeseen circumstance, someone close is always there to give a helping hand.
  • Although the venue for my booster jab was a private polyclinic, it is very spacious and has the air and ambience of a mega PPV (vaccination centre or in Malay, Pusat Pemberian Vaksin), which I’m so very familiar with, after getting my first two jabs.
  • The whole process of getting my booster shot was very fast and efficient, similar to the first two jabs at a mega PPV.
  • However, the one that I accompanied wifey for her booster shot was a small polyclinic located at a row of shophouses. Yet, I witnessed the same fast and efficient process.
  • This is all the result of scheduling and timing that the committee on vaccination had meticulously planned with the participating polyclinics, which all began for me with a notification on my MySejahtera app indicating an appointment for a booster jab at a specified venue and time.
  • Now back to the day when I accompanied my wife for her booster jab … when the Grab car arrived, and we were inside the car, the driver didn’t immediately drive his car.
  • He waited for us to scan the QR code at the back of the front passenger seat, and once we have scanned indicating we are checked-in for the grab drive, the driver insisted on seeing our vaccination status and risk profile on our MySejahtera.
  • “I have to do this because if you’re not fully vaccinated or your profile isn’t a low risk one, then I’m afraid I cannot take both of you for a drive to your destination. This is the standard operating procedure (SOP). I hope you understand,” the driver explained.
  • Both of us told him of our support for what he did, and I went on to narrate the day before when I also took a Grab car for my booster jab appointment, the driver just told me to scan the QR code and started driving immediately without bothering to check whether I’m fully vaccinated and/or have a low-risk profile.
  • I was even afraid then to insist that the driver checked my status on my MySejahtera app because of the fear when he turned his head to look at my smartphone, it may cause an accident, as he was driving.
  • “It was very good of you to start driving only once you are satisfied that your passengers are fully vaccinated and have a low-risk profile unlike the driver who just started driving off after asking his passenger to scan the QR code without bordering to check their vaccination status and Covid-19 risk profile.
  • “You are helping in breaking down the rate of transmission of the disease and that’s the reason why the authority has imposed such an SOP on e-hailing vehicles,” I complimented him.
  • And the driver seemed to be aware too that the potential loss of income from rejecting one ride with passengers who are not fully vaccinated and/or have a high risk profile is worth it because with a new wave, his livelihood, and hence his income will be affected BIG time.
  • Way back on Oct 10 on the eve of Malaysia lifting the interstate travel ban the following day, flamboyant Health Minister Khairy Jamaluddin made a wise remark in urging Malaysians to travel safe because he cannot rule out another Covid-19 wave.
  • “I know everyone is going to be rushing to the borders tomorrow but in the back of my mind as the Health Minister, my biggest worry is another wave and that’s not something that is out of the realm of possibility,” he said back then.
  • If the system can’t handle the surge, ICU cases, ventilators, oxygenated beds and admissions into hospitals, then it will put a tremendous stress not only on the public healthcare infrastructure but also on our frontliners.
  • We can’t afford that anymore. With the Health Ministry, I have made early preparations to ensure we can deal with the surge if it happens, but we don’t want to deal with a surge
  • Today of all days, on Doctors’ Day, we ask Malaysians to be responsible and if you really value and appreciate what the frontliners have been doing for the past one-and-a-half years, you will be responsible, you will be self-aware and take care of your own health and health status to ensure that a surge does not happen,” said Khairy during the Doctors’ Day celebration organised by the Malaysian Medical Association (MMA) on Oct 10.
  • Meanwhile on Nov 12, the Director-General of Health, Tan Sri Dr Noor Hisham Abdullah revealed the infectivity rate otherwise known as the R- naught has increased to 1.0 on Nov 11, about five weeks after the ban on interstate travel was lifted. And this was just 17 days when it was at 0.88 on Oct 25 as mentioned in a Let’s Talk! op-ed on Oct 29 (see Sustaining endemicity in pre-endemic time).
  • Dr Noor Hisham also revealed last year it took about five to six weeks after interstate travel ban was lifted on Dec 7 for the daily infection to go on an increasing trend.
  • This is an early reminder for us all to act in ensuring Covid-19 cases won’t increase instantaneously by, among other things, intensifying the administration of booster shots among the population,’’ said the good DG.
  • Malaysia has started giving booster shot in early October after 80% of its adult population has been fully vaccinated on Sept 21.
  • After the DG Health’s statement, the next day on Nov 13, a public health expert Dr Farhan Rusli warned the country could see an increase in Covid-19 cases, which will result in a new wave by the end of the year if many refuse to get their booster shots.
  • The people, he said, should take booster shots seriously because it could give more immunity to them as the immunity afforded by the earlier two primary doses started to wane.
  • Three days later on Nov 16, Dr Azfar Kamal, a medical official at the Sungai Buloh Hospital posted on Twitter to advise Malaysians to be cautious of the next COVID-19 wave in December.
  • According to his tweet, active wards and ICUs at the hospital are occupied by Category 4 and 5 (symptomatic and critically ill) patients.
  • This resulted in a rejoinder by Selangor health director Dr Sha’ari Ngadiman who said the increase in the number of Covid-19 cases at Hospital Sungai Buloh’s ICU is due to it being a full Covid-19 hospital and a reference hospital for the Klang Valley.
  • Sha’ari added Hospital Sungai Buloh received Covid-19 cases from other hospitals so that those hospitals could make more ICU beds available for non-Covid cases.
  • But this does not detract from the fact that we all must be mindful of the important and timely advice given by Dr Farhan and Dr Azfar to be always on guard against an impending wave.
  • In fact, on Nov 18 the DG Health himself said the Covid-19 infectivity rate in Malaysia on Nov 17 stood at 1.03 – from 1.0 on Nov 11, barely a week later.
  • And on that same day, Labuan recorded the highest infectivity rate at 1.29, followed by Putrajaya (1.12), Kuala Lumpur (1.09), Negri Sembilan (1.07), Selangor (1.06), Kelantan (1.05), Pahang (1.03), Kedah and Johor (1.01 each), Perak (0.99), Sabah (0.98), Penang and Melaka (0.95 each), Perlis (0.91) and Sarawak (0.85).
  • The infectivity rate has been on the rise starting Nov 6, five weeks after the government lifted the ban on interstate travel.
  • Dr Noor Hisham had previously said that an infectivity rate above 1.0 indicates the possibility of a new Covid-19 wave, like what Malaysia experienced in the beginning of the third wave.
  • He had since reminded the people to comply with SOPs and told vulnerable groups to immediately get their Covid-19 booster shots when they receive their appointments.
For more on the advice of a new wave:
  • When Covid-19 vaccines made their appearance and were administered to millions of people globally since early this year, the ensuing data worldwide showed the majority of those who were fully vaccinated were spared from Covid-19 infection, while for a small number of those infected known as breakthrough infection, the majority were spared from hospitalisation, and a very small number who were hospitalised were spared from a state of critical illness.
  • The only exception of critical illness and death among the breakthrough infection were the senior citizens whose immunity is low to begin with, and those with comorbidities, defined as a disease or medical condition that is simultaneously present with another or others in a patient.
  • It has since been proven by data worldwide that among Covid deaths, the majority comprises those who were not vaccinated at all and those with only one dose of vaccination, hence the endemic policy of relaxing restrictions only on those who were fully vaccinated.
  • But as with all vaccines, the immunity they afforded wanes over time, and that is why we are beginning to see an increasing number of breakthrough infection being hospitalised, and those hospitalised regressed to critical illness.
  • With the number of severe Covid-19 cases among vaccinated people increasing in Malaysia, Health Minister Khairy Jamaluddin has called on all to take booster shots.
  • He said the effectiveness of vaccines would start to wane after a few months, with the Sinovac vaccine being the quickest to lose its effectiveness.
  • “While Sinovac is effective, there is evidence its effectiveness wanes sooner. That’s why we want you to take whatever booster is on offer,” Khairy tweeted on Nov 20.
  • He further explained the faster waning period is the reason why the interval for Sinovac booster shots is three months, compared with six months for Pfizer and AstraZeneca.
  • In his tweet, the Health Minister shared a graph showing data for Covid-19 admissions in Hospital Sungai Buloh in the state of Selangor, which revealed that most of Category 4 and 5 patients are Sinovac recipients.
  • The last epidemiology week (week 45) for instance, saw 165 Sinovac recipients admitted to Hospital Sungai Buloh as Category 4 and 5 patients.
  • Both categories refer to seriously ill patients in intensive care units (ICUs). Patients under Category 4 require oxygen assistance while those under Category 5 need to be ventilated.
  • In comparison, 24 were Pfizer recipients while seven had taken the AstraZeneca vaccine.
  • When the immunity afforded by vaccines starts to wane, it also raises the real possibility of an increase in the transmission of the disease, which means the possibility of a new wave occurring is no longer remote.
  • In recent days we have seen the latest wave of Covid-19 cases hitting Europe with a vengeance.
  • Some countries have responded by imposing partial lockdowns and placing more restrictions on unvaccinated people.
  • Germany, which has declared a state of emergency, shattered a new record on Nov 18, reporting more than 65,000 new cases. Some German health officials are warning that the true number of cases could be two or three times as many.
  • In the neighbouring Netherlands, more than 20,000 new cases were reported on Nov 17,a new record for the third day in a row, and on the same day in France, where a fifth wave of the pandemic is underway, the number of new cases topped 20,000, a level not reached since Aug 25, Reuters reported.
  • So it’s not paranoia when the authorities in Malaysia here is warning about the emergence of a new wave, and the best thing we as responsible citizens of the country should do is to heed the advice to religiously continue observing the SOPs and especially going for a booster shot when your appointment to do so is given on your MySejahtera app.
  • This is the only way to forestall the emergence of a new wave.
  • It is indeed very assuring when on Nov 21, Khairy announced the Health Ministry will introduce a heightened alert system to detect early signs of an increase in Covid-19 cases in the country.
  • Through the system, the MOH proposed that some sectors be tightened if there was an increase in cases, but it would not be a “total lockdown”.
  • “I will announce the matter, including details of the situation on how this system will be applied. Maybe in a week or two. If we can, we want to avoid lockdown because lockdown not only disrupts the economy, but has other effects on family well-being and mental health.”
  • Khairy said so far, the level of MOH’s health system was still under control, but there were early signs of an increase in cases. He reminded the public not to be too complacent when the states transitioned to Phase Four of the National Recovery Plan (NRP).
  • “We are very worried because we have seen the early signs (of rise in cases). However, it has not reached the level of paralysing the health system, but the signs are very clear,” he added.
  • He went on to say his concern was the increase in serious cases requiring hospitalisation, especially critical cases in categories four and five.
  • Citing the situation in Negri Sembilan as an example, he said the number of hospital admissions doubled in a month. From Oct 25, only 35 patients needed oxygen assistance statewide, but yesterday (Nov 20), the figure increased to 70.
  • “If this trend continues, we will have to provide beds for critical treatment such as in the intensive care unit (ICU), and need oxygen supply to treat patients,” he added.
  • On the booster dose, Khairy once again called on the public who had received an appointment for the booster dose to get the jab, and not to choose the type of vaccine given by MOH, as the Ministry would conduct an investigation if there were any serious side effects among recipients.
  • Last week Austria became the first European country to make Covid vaccination a legal requirement, with the law due to take effect in February.
  • Politicians in neighbouring Germany are debating similar measures as intensive care units there fill up and case numbers hit fresh records.
Read more on booster dose, new waves and the worsening state of Covid-19 in Europe:
  • So much about the talk of returning the mandate of the rakyat to the rakyat so as to restore the rakyat’s mandate of GE14 in which Pakatan Harapan (PH) was supposed to be the ruling coalition for five years at the federal level and at the state level in Melaka.
  • Going by the Melaka state election results, where PH was trounced, especially its component party PKR led by Datuk Seri Anwar Ibrahim who’s also the PH president, such a notion is fallacious, because ruling the country for five years after winning a general election is not a GIVEN – that’s what democracy is all about.
  • Before the Melaka state election was held, it was difficult to answer the question, if GE15 is held today which coalition will win?
  • This has caused some die-hard supporters of any political parties/coalitions to take a stance of wait-and-see, and hence hedging their bets until perhaps early next year when the picture becomes a bit clearer.
  • But with the Melaka state election over, that question can at least be answered with Barisan Nasional (BN) now having the lead and the favourite to win GE15 for its landslide victory in Melaka.
  • No surprise here when BN’s lynchpin Umno is now calling for GE 15 to be held soon despite the warning of a new Covid wave which has already run berserk in Europe.
  • A lasting lesson from the Melaka state election: If you are, rightly or wrongly, obsessed with becoming a chief minister and go to the extent of causing turmoil in your state in order to achieve your ambition for power and position by triggering a dissolution of your state assembly, you’ll find yourself soon in the dustbin of history!

Let’s Talk! PRESENTS: As the situation in Europe shows, the Covid-19 there is running berserk with a new wave in the five digits that has put the healthcare services to the breaking point. As JAMARI MOHTAR finds out, the immunity provided by the first two primary doses have started to wane, and what tilts the balance against Europe is the coming winter season, a fertile breeding ground for the coronavirus to sweep the continent with a new wave. The saving grace for us here in Asia to forestall the new wave is increased immunity via the intensification of booster shots.

Booster jab to prevent another lockdown!

By Jamari Mohtar

    The Pfizer vaccine, based on clinical trials is touted to have a staggering 95% efficacy. But according to the Wall Street Journal, a recent unpublished data from Israel shows the Pfizer vaccine was only 40% effective at reducing the risk of symptomatic Covid-19.
    On Nov 23, the National Security Council posted on its Telegram channel a study by the Real-World Evaluation of Covid-19 Vaccines Under the Malaysia National Covid-19 Immunisation Programme (RECoVaM) and the National Medical Research Register (NMRR) which showed by September, those who were vaccinated in April to June had a lower immunity compared to those who were vaccinated in July to August.
    Using the methodology of negative binomial regression, the study discovered in the case of Pfizer, its effectiveness was reduced from 89% one to two months after vaccination, to 68% three to five months later.
    In light of the above, the relevant question to ask is if the original trial shows high efficacy (95%), why did a large portion of people in the Israel and Malaysia studies get the virus?
    To fathom this dichotomy of 95% efficacy versus 40% effectiveness (Israel) or 68% effectiveness (Malaysia) shown by the Pfizer vaccine, there is a need to understand the difference between efficacy and effectiveness.
    According to experts, vaccine efficacy refers to how well a vaccine performs under ideal, tightly controlled conditions like clinical trials. During trials for Covid-19 for instance, vaccines were given to people on a tight schedule.
    Efficacy also has to do with what the researchers were studying. In the case of the Covid vaccines, they were looking at how well vaccines prevented symptomatic infection in a limited number of people, and NOT on whether they prevented infection altogether or kept people from being contagious.
    Bear in mind too, with Covid-19, it’s possible to be infected and not show symptoms, which means asymptomatic infection wasn’t covered by the researchers.
    In the Pfizer study, the company tested about 44,000 people for symptomatic Covid19 and only 170 developed the disease with at least one symptom. And of those, just 8 have been vaccinated while 162 have got a placebo. This is what added up to that 95% efficacy rate.
    This trial finding is to be read as follows: in a vaccinated population, 95% fewer people will contract the disease when they come in contact with the virus and NOT that each individual is 95% immune to the virus.
    That efficacy rate was calculated then during a specific time and under a specific set of circumstances in which many people were staying at home, avoiding a large gathering, wearing mask and the virus hasn’t mutated as much.
    Vaccine effectiveness on the other hand refers to how well a vaccine works in the real world, outside of clinical settings. The real world is kind of messy in that not everybody get their vaccines at the exact interval or that everybody has the same kind of immune system.
    But as the vaccine was approaching the time for regulatory approval from the authorities, peoples’ behaviour started to change too where in many places, businesses are open and large gatherings are happening again – the reason why efficacy number in trials are often higher than the effectiveness we see in the real world.
    And what makes it all complicated and unfathomable is the virus itself is still evolving. The delta variant has become dominant in many countries and more transmissible than earlier strains of the virus which means more people will come into contact with it.
    And it became dominant months after the vaccines has been authorised and millions of doses have been distributed. That means our current shots were designed from earlier version of the coronavirus and don’t look that good against delta.
    This is the reason why we are hearing more about breakthrough cases. In fact health officials expected breakthrough cases were more likely among people who had gotten the vaccine earlier on, in Jan or Feb. This is partly because antibodies, which the body produces after the vaccines to protect itself against the virus naturally decrease over time.
    That, along with the unknown about variants is the big reason why in the US, the Biden Administration announced new vaccine recommendation to stay ahead of the virus in the form of a booster shots programme for fully vaccinated adults 18 years and older.
    What the booster shots programme is trying to achieve is to ensure that immunity is kept high enough, hence increasing the chances that the vaccine would prevent severe illness that could then lead to hospitalisation and deaths.
    In the meantime while breakthrough cases continue to occur, experts say these are usually mild and don’t result in severe illness. And this is proven by both the Israeli and Malaysian data, which showed the vaccine has 91% effectiveness against hospitalisation and death.
    While the Israel study is all about Pfizer, the Malaysia study also includes the vaccine Sinovac, which also exhibits the same pattern in terms of waning effectiveness through time, although in term of both efficacy and waning effectiveness, the Pfizer vaccine performs better.
    All this points to the crucial need for booster jabs to forestall a new Covid wave and avoid a lockdown. In addition to vaccines, experts also recommend preventive measures like mask wearing and social distancing to keep the virus from spreading and mutating further.
    It has since been proven by data worldwide that among Covid deaths, the majority comprises those who were not vaccinated at all and those with only one dose of vaccination, hence the endemic policy of relaxing restrictions only on those who were fully vaccinated.
    With the number of severe Covid-19 cases among vaccinated people increasing in Malaysia, Health Minister Khairy Jamaluddin has called on all to take booster shots.
    He said the effectiveness of vaccines would start to wane after a few months, with the Sinovac vaccine being the quickest to lose its effectiveness.
    “While Sinovac is effective, there is evidence its effectiveness wanes sooner. That’s why we want you to take whatever booster is on offer,” Khairy tweeted on Nov 20.
    He further explained the faster waning period is the reason why the interval for Sinovac booster shots is three months, compared with six months for Pfizer and AstraZeneca.
    In his tweet, the Health Minister shared a graph showing data for Covid-19 admissions in Hospital Sungai Buloh in the state of Selangor, which revealed that most of Category 4 and 5 patients are Sinovac recipients.
    The last epidemiology week (week 45) for instance, saw 165 Sinovac recipients admitted to Hospital Sungai Buloh as Category 4 and 5 patients. In comparison, 24 were Pfizer recipients while seven had taken the AstraZeneca vaccine.
    When the immunity afforded by vaccines starts to wane, it also raises the real possibility of an increase in the transmission of the disease, which means the possibility of a new wave occurring is no longer remote.
    In recent days we have seen the latest wave of Covid-19 cases hitting Europe with a vengeance. Some countries have responded by imposing partial lockdowns and placing more restrictions on unvaccinated people.
    Germany, which has declared a state of emergency, shattered a new record on Nov 18, reporting more than 65,000 new cases. In the Netherlands, more than 20,000 new cases were reported on Nov 17, a new record for the third day in a row, and on the same day in France, where a fifth wave of the pandemic is underway, the number of new cases topped 20,000, a level not reached since Aug 25, Reuters reported.
    So it’s not paranoia when the authorities in Malaysia here is warning about the emergence of a new wave, and the best thing we as responsible citizens of the country should do is to heed the advice to religiously observe the SOPs, and especially going for a booster shot when your appointment to do so is given on your MySejahtera app.
    It is indeed very assuring when on Nov 21, Khairy announced the Health Ministry will introduce a heightened alert system to detect early signs of an increase in Covid-19 cases in the country.
    Through the system, the MOH proposed that some sectors be tightened if there was an increase in cases, but it would not be a “total lockdown”. “If we can, we want to avoid lockdown because lockdown not only disrupts the economy, but has other effects on family well-being and mental health,” said Khairy.
    He also reminded the public not to be too complacent when the states transitioned to Phase Four of the National Recovery Plan. “We are very worried because we have seen the early signs (of rise in cases). However, it has not reached the level of paralysing the health system, but the signs are very clear,” he added.
    Last week Austria became the first European country to make Covid vaccination a legal requirement, with the law due to take effect in February. Politicians in neighbouring Germany are debating similar measures as intensive care units there fill up and case numbers hit fresh records.
    Regards,
    Jamari Mohtar
    Editor, Let’s Talk!

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