December 2021 Vol 1 No 4

Your Editor, Jamari Mohtar, is downed with a very bad cough and so is in need of a much needed rest at home somewhere in KL …

 

  • Soon after Vol 1 No 3 of Let’s Talk! was released, your editor, all of a sudden, was afflicted with a very bad cough. The first thing that came to his mind then was the knowledge that cough is one of the common symptoms of Covid-19.
  • Being cool, calm and analytical, he decided there was no cause for alarm because he can’t remember the last time he had a very bad cough, and at the same time he clearly remembered during Year 1 of the pandemic (the whole of 2020) and most of Year 2, he didn’t suffer from any cough – good, bad, ugly or otherwise.
  • But these alone are not sufficient to draw the conclusion that everything is all right especially in time of pandemic.
  • In line with the adage that prevention is better than cure, his cautious antennae went up by analysing why cough is related to Covid-19, and under what circumstances are a cough is just an ordinary cough that does not spell the harbinger of a serious ailment.
  • It was then he realised the first organ targeted by the Covid-19 virus is the lung causing those who were infected by it to have difficulty in breathing.
  • Once you have difficulty in breathing but still can breathe on your own and tested positive for Covid-19, you’re a Category 3 patient in a normal ward of a hospital.
  • If your condition regresses to a situation where you can’t breathe on your own and need an oxygen tank to assist you in breathing, your status goes one notch up to Category 4 of the intensive care unit (ICU).
  • By the time oxygen-tank assisted breathing becomes useless, you’ll need a ventilator to help you breathe – a very painful process physically that comes along with a painful classification of Category 5 in the ICU, where there’s no more upward classification if your condition continues to regress because you’ll soon be visited by the Angel of Death.
  • Equipped with this knowledge, your editor monitored his breathing and found there were no chest pain and no difficulty in breathing each time he coughed. It’s just the uncomfy sensation in the throat area that he experienced with the cough.
  • So, like a doctor who is not a doctor, he diagnosed himself as having a normal cough, and went down to the convenient store on the seventh floor of his residence to buy his favourite off-the-shelf cough mixture and a packet of black Hacks sweets for soothing his throat which for him works better than the lozenges a doctor who is a doctor gave him each time he had a cough that is accompanied by a sore throat.
  • Family support came into play when his dear significant other recommended the use of a pulse oximeter, which she had bought earlier, to check on his oxygen level, to which he responded with “Good Idea!”
  • A pulse oximeter is a device that is usually placed on a fingertip. It uses light beams to estimate the oxygen saturation of the blood and the pulse rate.
  • Oxygen saturation gives information about the amount of oxygen carried in the blood. The pulse oximeter can estimate the amount of oxygen in the blood without having to draw a blood sample.
  • Most pulse oximeters show two or three numbers, with the most important number, oxygen saturation level, usually abbreviated SpO2, and is presented as a percentage. The pulse rate (similar to heart rate) is abbreviated PR, and sometimes there is a third number for strength of the signal.
  • Oxygen saturation values are between 95% and 100% for most healthy individuals, but sometimes can be lower in people with lung problems.
  • “I was so delighted that each time I used the device the readings were between 96% and 100%,” he excitedly informed his wife.
  • Another support came from their daughter, Haneesa, who gave the tips to drink more warm, plain water and to give the body and soul a much needed rest (which your editor, rightly or wrongly, interpreted it as the need for more sleep).
  • Other family members chipped in with their doa (prayer) of shifa (healing) and a speedy recovery, and in no time after two days of taking the cough mixture, black Hacks sweets, monitoring with oximeter, drinking plenty of warm, plain water and many restful sleep, the cough and sore throat started to abate by the third day and were completely gone by the fourth day, Alhamdulillah!
  • As soon as he recovered, the story of a new variant of Covid-19 named as Omicron began to hit the headlines of the world media.
  • Just like the other variants of the Covid-19, we can use the polymerase chain reaction (PCR) test on whether one is infected with the Omicron variant.
  • PCR is a test to detect genetic material from a specific organism, such as a virus. The test detects the presence of a virus if you have the virus at the time of the test.
  • The nucleocapsid and RNA dependent polymerase genes, which do not change much, can be monitored through this test.
  • In one PCR test, three different genes are monitored. However, one of the S-gene targets is not detected due to multiple mutations that the variant has undergone. This is called S-gene dropout or S-gene target failure (SGTF).
  • The S-gene encodes a surface protein, the spike protein, which is a homotrimeric glycoprotein complex essential for infectivity.
  • The absence of the S-gene or SGTF is actually helpful and is diagnostic of Omicron, as its absence is a marker to identify the Omicron variant.
  • Sample with SGFT should be send on a priority basis for gene sequencing studies, as sequencing efforts should also be encouraged to better understand this variant and guard against further changes.
  • Moreover, while these tests will confirm the presence of Covid-19, the variant will be identified only through genome sequencing and through SGFT.
  • It is therefore imperative to have a balanced approach. On the one hand, very little is known regarding this Omicron strain, as there are only a handful of identified infections worldwide, and scientifically sound data is lacking on transmissibility, disease severity and current vaccine effectiveness against this strain.
  • On the other hand, it is important to be vigilant in gathering critical clinical information and planning for redesigning vaccines in the event the Omicron mutations diminish current vaccine effectiveness.
  • In the meantime, what can be done to come to term with the Omicron variant pending more accurate information on transmissibility, disease severity and current vaccine effectiveness?
  • It’s back to basics – enhance public health preventive measures such as mask wearing, personal hygiene and social distancing, and speed up the number of people that are fully vaccinated, and intensifying booster jab among the fully vaccinated.
  • No matter how menacing a mutated strain is, if it is deprived of its human hosts through public health measures that aimed at curbing its transmission, there is not much damage a mutated strain can do.
  • It’s like you are giving nil opportunity for a top-notch criminal to find his victims, and being deprived of human hosts for quite some time, hopefully the mutated strain becomes a dormant virus, and thus a footnote similar to the Delta Plus variant.
  • As for a full vaccination, even if it fails to prevent you from being infected, that infection is usually mild and don’t result in severe illness.
  • The point is whatever strain, even a virulent one that is attacking you, you’ll be relatively in a much better position with the high immunity that a double vaccination gives you compared to a low (one dose) or no immunity (nil vaccination) at all.
  • Thus far, most Covid-19 vaccines have remained effective in preventing severe Covid-19, hospitalisation, and death, for all previous variants, despite its waning immunity over time.
  • In fact, this waning immunity can be restored back to high immunity with a booster jab (See Booster jabs to prevent another lockdown!).
  • The immunity provided by the two primary doses begins to wane over time because antibodies the body produces after the vaccination to protect itself against the virus naturally decrease over time.
  • But antibodies are not the body’s only defence against the virus. There are also certain immune cells for example the T-cells that prepare the body to fight off pathogens. And those may not be waning.
  • Others posited that despite waning immunity, the Covid vaccines are still effective against severe illness, hospitalisation and deaths because this effectiveness might be more dependent on T-cell immune response than antibodies.
  • So, to prepare for the challenges that might be posed by the Omicron variant, for the sake of a relatively higher immunity, those who are unvaccinated should immediately go for their first primary dose, those already having their first dose, should step up and go for being fully vaccinated, and those fully vaccinated should go for their booster jab.
  • And since to rely on vaccinations alone is like putting all your eggs in one basket, very importantly, existing public health preventive measures (mask wearing, physical distancing, avoidance of enclosed spaces, outdoor preference, and hand hygiene) that have remained effective against past variants should be observed and remain just as effective in meeting the challenges against the Omicron variant.
  • As for the SOPs and travel policies pertaining to the Omicron variant, we’ll just leave it in the good hands of the Health supremo and all his sidekicks in the Health Ministry and give our wholehearted support to him and his team.
  • Khairy has made the right moves – in asking the public to remain calm, monitored closely the first Omicron case in Malaysia who together with her seven close contacts are now negative-tested on Dec 3, announcing travellers from high-risk countries must wear digital tracking device following the first detection of Omicron in Malaysia, and continuing with the Malaysia-Singapore Vaccinated Travel Lane (VTL) by land and air despite two cases of the Omicron variant being detected in Singapore, after speaking to his Singapore counterpart.
  • He does not even leave the Sarawak state election to chance when in light of the Omicron variant detected in Malaysia, the Health Ministry will tighten further the SOP for the election.
  • The Sarawak election will be held on Dec 18 with Nomination Day on Dec 6, and early voting on Dec 14.
Read more on Omicron as a variant of concern, PCR kits able to detect Omicron, and SOPs for Omicron:WHO classification of Omicron

Rosmah, Rosmah … what telah happened…

  • When a Court has granted you leave to have your passport back to go overseas and be back in the country by a certain date, you should jolly well abide by the condition imposed on you for the sake of the rule of law.
  • Otherwise, a penalty for this breach of condition will be imposed on you for taking lightly the leave granted by the court.
  • This is what happened to Datin Seri Rosmah Mansor when on Oct 15, the Court allowed her applicationfor the temporary release of her passport to visit her daughter in Singapore who was expecting her second child.
  • The application was allowed on condition that Rosmah returned to the country on or before Nov 21 and return the passport by Dec 6, and the prosecution raised no objections as long as the move would not interfere with her court dates.
  • But not only was she not back on or before Nov 21, there was a no-show on her part on Dec 2 for the hearing of her bid to disqualify former judge Datuk Seri Gopal Sri Ram as lead prosecutor in her corruption case involving a solar hybrid project in Sarawak
  • Sri Ram had applied for the court to issue a warrant of arrest against Rosmah for failing to appear, and also asked it to revoke her bail for breaching the court order.
  • “If this had been a case of a normal citizen, an Ahmad Abdul, Muniandy or Ah Chong, it would have been different. I don’t know why it should be different with Rosmah Mansor and not Ahmad Abdul.
  • “We have to be guided by the court order. If people are going to ignore this then what is the point of making these orders? The natural order is a warrant of arrest must be issued and bail must be cancelled,” he said, adding that Rosmah should not be treated differently from other accused persons otherwise the public would lose confidence in the courts.
  • It was very fortunate of her to escape arrest after the Judge took into account the submission by her lawyer that she had never failed to turn up in court before, once her lawyer acknowledged her no-show in court on Dec 2 was in breach of the High Court’s order on Oct 15.
  • She duly appeared in Court on Dec 6.

Let’s Talk Op-Ed

Let’s Talk! PRESENTS: There was much alarm when a new variant of Covid-19, Omicron made its appearance last month culminating in the first index case in Malaysia early this month. But in the good hands of Malaysian Health supremo, Khairy Jamaluddin, and his team at the Ministry of Health, the issue was managed with calm and cautious approach. As JAMARI MOHTAR finds out mutation of a virus, even a virulent one, is as natural as the air we breathe and there’s nothing much we can do to stop the mutation other than cushioning its adverse impact by going back to basics – preventive health measures, vaccination and booster jab.

Handling Omicron: Back to the basics of preventive measures, vaccination and booster jab 

By Jamari Mohtar
The Omicron variant’s high number of mutations could be one reason for the alarm and knee-jerk reactions that had even spooked the global financial markets with the appearance of this fifth and latest variant of concern of the Covid-19 pandemic.
Initial genome sequencing studies found more than 30 mutations to its spike proteins alone. This protein allows the virus to infect and take over human cells, and is also the target of most vaccines.
As seen in previous variants such as Delta and Alpha, spike protein mutations are thought to have made the virus more infectious or more likely to evade the immune system and vaccines.
But our layman understanding of mutation – to undergo a significant transformation resulting in the possession of incredible new abilities – is very much derived from the science fiction perspective that it does not do justice to reflect the complexities inherent in an evolutionary theory.
In the entertainment industry, the sensationalization of evolution to portray disease outbreaks is a common trope, as for example, in the sci-fi movie, The Andromeda Strain, based on Michael Crichton’s novel of the same name, in which an extra-terrestrial microorganism continuously ‘mutates’ to acquire new biological properties, including the ability to degrade plastic and escape containment.
Another example is Richard Preston’s 1994 nonfiction book, The Hot Zone, which inspired the 1995 thriller film, in which a fictional Ebola-like virus rapidly mutates into a highly infectious strain capable of aerosolized transmission.
Thus, it is no wonder during a real-life outbreak of virus, journalists and scientists are sometimes predisposed to draw upon these fictional views. But the fact is individual mutations are as natural an aspect of life for an RNA virus, as much as breathing is for humans.
While this natural ability to mutate sparks evolutionary change, most mutations that have an adverse impact on some aspects of virus function are actually removed by natural selection.
Indeed, across a spectrum of viruses, it is unusual to find those that have changed or expanded their mode of transmission over short evolutionary time-scales despite high rates of mutation. These cause uncertainty on what characteristics are favoured by natural selection and how quickly they will spread in a population.
Also, it is difficult to predict the precise part played by natural selection in analysing how virus evolves, which renders problematic any speculation on the evolutionary trajectory of a virus during a nascent outbreak investigation.
Mutations actually can go both ways in either making a virus more virulent or less virulent, with a common assumption that virulence will only change if it increases the transmission rate of the virus, which effectively means an increase in the number of virus ‘offspring’.
Yet high virulence may reduce transmissibility if the host is too sick to expose others. Without information on the precise evolutionary forces and selection pressures in operation, predicting how virulence might evolve is an extremely difficult and perhaps futile task.
However, this does not mean mutations and natural selection don’t happen during a pandemic but it all means it’s difficult to quantitatively specify their epidemiological relevance.
Mutations are bound to happen when the virus changes its host, for instance, when it spreads out from an animal host to humans or takes advantage of an alternate arthropod vector for transmission.
According to scientists, mutations at amino acid 30 in the Gag protein of human immunodeficiency virus-1 (HIV-1) have been proposed as adaptations for the simian immunodeficiency virus (SIV) ancestors in chimpanzees to increase infectivity in humans.
In chikungunya virus, a single mutation (E1-A226V) appearing during epidemics has been suggested as a signature of adaptation to an alternate mosquito vector, Aedes albopictus while a single mutation (GP-A82V) in Ebola virus increased infection of human cells.
Some scientists caution while there are many examples of mutations that alter virulence or cause drug resistance and hence impact human health, speculating about the phenotype (observable traits) of any new mutation can be dangerous during fast-moving outbreaks, as it takes a non-trivial amount of effort to experimentally and epidemiologically verify these phenotypes.
These are all the backdrop that one should take into account when coming to term with the emergence of the Omicron variant which requires us to be calm and not panicky and yet, at the same time very cautious and alert.
It’s good that the Health supremo of the country Khairy Jamaluddin has cautioned the public not to panic as preventive steps and standard operating procedures (SOP) in Malaysia are very stringent. The Health Ministry, he said, is also increasing its genomic surveillance capacity to detect Omicron.
In the meantime, what can be done to come to term with the Omicron variant pending more accurate information on transmissibility, disease severity and current vaccine effectiveness is to go back to basics – enhance public health preventive measures such as mask wearing, personal hygiene and social distancing; speed up the number of people that are fully vaccinated; and intensify booster jab among the fully vaccinated.
No matter how menacing a mutated strain is, if it is deprived of its human hosts through public health measures that aimed at curbing its transmission, there is not much damage a mutated strain can do.
It’s like you are giving nil opportunity for a top-notch criminal to find his victims, and being deprived of human hosts for quite some time, hopefully the mutated strain becomes a dormant virus.
As for a full vaccination, even if it fails to prevent you from being infected, that infection is usually mild and don’t result in severe illness. The point is whatever strain, even a virulent one that is attacking you, you’ll be relatively in a much better position with the high immunity that a double vaccination gives you compared to a low (one dose) or no immunity (nil vaccination) at all.
Thus far, most Covid-19 vaccines have remained effective in preventing severe Covid-19 hospitalisation, and death, for all previous variants, despite its waning immunity over time.
In fact, this waning immunity can be restored back to high immunity with a booster jab (See Booster jabs to prevent another lockdown!)
The immunity provided by the two primary doses begins to wane over time because antibodies the body produces after the vaccination to protect itself against the virus naturally decrease over time.
    But antibodies are not the body’s only defence against the virus. There are also certain immune cells for example the T-cells that prepare the body to fight off pathogens. And those may not be waning.
      Others posited despite waning immunity, the Covid vaccines are still effective against severe illness, hospitalisation and deaths because this effectiveness might be more dependent on T-cell immune response than antibodies.
        So, to prepare for the challenges that might be posed by the Omicron variant, for the sake of a relatively higher immunity, those who are unvaccinated should immediately go for their first primary dose, those already having their first dose, should step up and go for being fully vaccinated, and those fully vaccinated should go for their booster jab.
          And since to rely on vaccinations alone is like putting all your eggs in one basket, very importantly, existing public health preventive measures (mask wearing, physical distancing, avoidance of enclosed spaces, outdoor preference, and hand hygiene) that have remained effective against past variants should be observed and remain just as effective in meeting the challenges against the Omicron variant.
            As for the SOPs and travel policies pertaining to the Omicron variant, we’ll just leave it in the good hands of the Health supremo and all his sidekicks in the Health Ministry and give our wholehearted support to him and his team.
              Regards,
                Jamari Mohtar
                  Editor, Let’s Talk!

                  Let’s Talk! is a free, monthly e-mail service on current happenings in Malaysia brought to you by Usrafalah Sdn Bhd. It is edited and managed by a group of volunteers.

                  It promotes a balanced discourse on news and current affairs to prompt the public to reflect and digest issues in order to understand how their daily lives are affected.

                  Let’s Talk! is edited and managed by a group of volunteers.

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