– Vol 1 No 4

Talk of the Week

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.

We all know that the pandemic has taken a toll on the livelihoods of many Malaysians. With the lockdown (a.k.a. MCO or Movement Control Order in Malaysia) lifted for inter-district and inter-state travels, and with domestic tourism in full swing since the success of the pilot project on the Langkawi travel bubble, rays of hope are in the offing for the economy to be healed, and we can therefore expect a good fourth quarter GDP growth that will propel the economy to perform better and better, albeit gradually.

But as in the nature of things, there will be a delayed effect in that some rakyats will continue to suffer from the economic impact of the pandemic in the sense that for them, especially for the vulnerable group, things will get worse before they get better. The Government, to its credit, is reaching out to this vulnerable group by pumping in more financial assistance, aiming to make Malaysia an attractive destination for foreign investors and to increase high value-added employment.

Some from the vulnerable group are enterprising enough to embrace the challenge by taking advantage of the burgeoning digital platforms where people are more and more beginning to do all sorts of things online (your Editor is no exception), including setting up businesses and working from their mobile phones, in order to make ends meet.

With this in mind, LET’S Talk! is dishing out free advertisements to assist these people based on the recommendations of their clients/ customers that their products/ services are indeed excellent!

Our 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 Outbreak, 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.
Each time a new variant of Covid-19 makes an early appearance, its enhanced transmissibility and virulence are often implied quite early on in news reports in the face of insufficient evidence that a subtle dire doomsday scenario is predicated on the premise of a failing public health measures.
But the fact is individual mutations is as natural an aspect of life for an RNA virus, as much as breathing is natural 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.
In fact, these constraints causes 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.
Although according to scientists, the spectre of a ‘super killer’ virus is baseless, the claim a virus will mutate to become more virulent during an outbreak is still pervasive when in reality this is a highly complex topic that has inspired extensive research on evolutionary theory and debate.
Mutations actually can go both way in making a virus either more 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.
It is also hypothesized that mutations in highly pathogenic avian influenza A (H5N1) could lead toward more efficient human-to-human transmission, although thankfully this has yet to occur.
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, which has become the fifth variant of concern.
Sometime back when your editor wrote about the emergence of the variant Delta Plus, he cautioned the public to be calm but cautious and alert, in the face of insufficient data.
Apparently, that variant is now a footnote and it is its mother, the Delta variant that still remains relevant, dominant and vociferously transmissible up till today.

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 Outbreak, 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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