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Thursday, 28 January 2021

China needs to lead global vaccinations


 
COVID-19 pandemic: From 1 to 100 million
 


https://youtu.be/_D4d9OXz8V8


As of Wednesday Beijing time, over 100 million people around the world have been infected with COVID-19, with over 2.15 million deaths. The severest pandemic since the beginning of the 21st century has brought great sufferings to the people and incurred huge losses. It has provided lessons.

As World Health Organization Director-General Tedros Adhanom Ghebreyesus wrote on Twitter, "Numbers can make us numb to what they represent: every death is someone's parent, someone's partner, someone's child, someone's friend." After all, humanity shouldn't be numb. We must keep the thirst for humanitarianism and always spare no efforts. Humanity must not connive in the growing number of deaths - it is a shame of the modern civilization.

Many lessons can be drawn from the COVID-19 pandemic that manages to rage across the globe. The biggest one is that we humans should have made full use of the capabilities to contain the pandemic, but the interference of politics with science and the resulting disunity among major countries have allowed the coronavirus to take advantage. What was supposed to be a unified war against the epidemic has become separate wars within different countries and regions. The problem is clear for all to see, but we have not yet been able to mend the fold quickly enough to build the collective human solidarity that was so badly needed.

Within many countries, too, it has been difficult to forge consensus and solidarity around the pandemic prevention routes. How to coordinate the fight against the epidemic and to boost economic recovery has become a common question. In this process, the opinions of scientists are often marginalized, and some influential politicians put non-scientific considerations first at the critical moment, leading the fight against the pandemic to go astray.

The ravaging epidemic has also exposed the fragility of economic activity and the way human society is organized. Most societies in general are poor in vigilance to disasters with a lack of mobilization, and dependent too much on fair weather for prosperity. The pandemic this time showed the destructive power of a public health crisis at a time when the world's population is growing and more socially intense. Human society must increase its investment in public safety.

After a terrible year, we are now at a new stage of the pandemic. Vaccines at this stage have the potential to revolutionize the fight against the pandemic and reshape the global structure.

China is a large populous country. It has achieved outstanding success in the last round of the epidemic fight, laying a sound foundation for the next stage of the war against the coronavirus. The country is also at the forefront of vaccine research and development. Next, we must create the fastest vaccination rate and stand at the front ranks on the herd immunity list. This is a new test for China.

We contained the epidemic without vaccines in the last round of the virus fight. We cannot continue such an advantage. The speed of vaccine promotion will greatly affect the opening-up of all societies in the future. The US and European societies suffered heavy losses last year, but at the same time they have developed relatively strong endurance toward the pandemic. If their vaccination is fast, this will promote mutual opening-up among them, which will exert pressure on countries which are slow in vaccination.

Only by getting vaccination rates in China roughly on par with the rates in the US and European countries, along with keeping the social distancing capabilities we already have, can China continue to lead in being open in the future and further provide the greatest impetus for the recovery of the global economy.

Before the next winter comes, China needs to strive to get the majority of the vulnerable and high-risk groups vaccinated and to expand the vaccination coverage to the general population. We need to guarantee the total number of people vaccinated in China several times higher than the number in the US.

China also needs to provide large quantities of vaccines to developing countries, and the total number of vaccines exported should be the largest. This is the role China should play as a major manufacturing country, and this is what is expected of China.

To accomplish these tasks at the same time, China's vaccine production must speed up as soon as possible. We don't have time to celebrate our past achievements. We need to move forward and focus on the future

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Regardless of whether Europeans use Chinese vaccines, it is evident that Chinese vaccines have played an important role to protect their interests.

 

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Wednesday, 27 January 2021

The different types of Covid-19 tests




  Health authorities worldwide use either RT-PCR or RTK-Ag to test the virus

 There are two known popular Covid-19 tests available and used by the health authorities worldwide to detect the virus.

The two tests – reverse transcription polymerase chain reaction (RT-PCR) and antigen rapid test kit (RTK-Ag) – require nasal or throat swab samples.

RT-PCR is considered the gold standard in diagnosing the Covid-19 virus.

It can detect if an individual has an active Covid-19 infection and the test has typically high sensitivity rates, though this also means the sample has to be carefully prepared to avoid contamination.<

RT-PCR is a molecular test that is able to detect minute quantities of Covid-19 virus’s ribonucleic acid (RNA) in the nasal or throat swab sample taken from an individual.

Chemicals are used on the swab to remove other substances and extract only the RNA in the sample.

The RNA is converted to DNA through the “reverse transcription” process, and extra short fragments of DNA are added by scientists to build DNA strands and to add marker labels to them to detect the virus.

The mixture is placed in a machine that creates copies of the viral DNA, during which the marker labels release a fluorescent dye that is measured by a computer.

Depending on the lab and logistics, results can be obtained in two hours, or up to several days if the sample needs to be shipped across distances.

The RTK-Ag test, on the other hand, is faster than the RT-PCR test, as it can generate results within 15 to 30 minutes.

As such, RTK-Ag has the advantage of detecting Covid-19 outbreaks quickly and in large quantities, but its accuracy is lower than the RT-PCR test and it may produce false-negative results (leading to a false sense of security).

The Health Ministry uses the RTK-Ag as an alternative to the RT-PCR in certain situations, in order to obtain test results within a shorter time in circumstances where molecular testing is not available.

Antigen tests work by detecting specific proteins on the surface of the virus, as opposed to the RT-PCR test which detects the virus’s genetic material.

Yet another Covid-19 test is the antibody test, which unlike the RT-PCR and RTK-Ag tests, is detected through a blood sample. Samples are obtained via pricking the finger or drawing of blood, and results can be obtained within a few days.

However, the antibody test is not suitable to be used to detect active Covid-19 infections as it can only show that a person has been (or never been) infected by the virus in the past.

The test picks up on antibodies, which are proteins created by a person’s immune system after they have been infected or vaccinated.

According to the US Centers for Disease Control and Prevention, it will take one to three weeks after infection for a person’s body to produce antibodies.

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MANY individuals and groups have shared suggestions of how to manage the Covid-19 pandemic. Allow me to summarise five key measures we critically need to take to manage the crisis.

Test extensively:

Ramping up our PCR (reverse transcription polymerase chain reaction) tests to 100,000 a day is insufficient. PCR tests are labour intensive and results are usually delayed. If it takes three to five days to get a result, this limits the value of the testing.

We need hundreds of thousands of RTK-Ag (antigen rapid test kit) tests on the ground. With a one- hour result time they offer rapid response and action when positive.

Even if they are only 75% sensitive, it significantly mutes the pandemic. Equivocal results can be sent for PCR testing. We should keep PCR tests for patients requiring admission and testing of high risk symptomatic persons (over 60 years with major comorbidities).

Restore contact tracing:

Contact tracing activities have been swamped by the huge numbers and have currently failed. We must learn from other nations.

Rapidly employ the more than 10,000 retrenched non-medical professionals, train and use them to re-establish contact tracing in all states. This will also free healthcare staff to do more vital tasks.

We must dramatically improve our handphone applications to allow for seamless contact tracing and notification of the public.

Support Health Ministry staff

Our Health Ministry staff are long past burnout. The burden of excessive work, long hours wearing PPE (personal protective equipment), fears of contracting Covid-19 and lack of adequate emotional support have wrought havoc on a healthcare system that was always fragile and inadequate.

We must immediately offer permanent jobs to all Health Ministry staff on contract, as well as hire all available doctors, pharmacists and nurses waiting for jobs. Also consider graduating all final year doctors, pharmacists and nurses, using their continued formative assessments and prior examination results as a proxy indicator of performance.

Improve home quarantine

Home quarantine is useful for Covid-19 individuals who are well and healthy. However, maintaining home quarantine for large numbers is a challenge. There are numerous reports of those who are supposed to be under home quarantine, either because they are positive or have been in close contact with a confirmed case, travelling outside their home to get food or visit a doctor.

In addition, many people are at a loss about what to do at home and are waiting for days for Health Ministry personnel to contact them. There must be a mechanism to improve current home quarantine conditions.

We should hire and train retrenched non-medical professionals and use them to monitor and support these individuals.

It may be important for the Health Ministry to offer hospitalised quarantine for those over 60 years of age with major comorbidities, as they are at high risk for death.

Widen pick up services:

 Individuals who are found to be Covd-19 positive and require hospitalisation should not have to wait. We hear many anecdotal reports of such persons waiting for days to be admitted.

We recognise that the Health Ministry’s ambulance services are overwhelmed. We need to urgently widen the pick-up services. We can train and use private ambulance services, especially for those who are really ill.

For those who are mildly ill and require hospitalisation, we could work with established transport services (taxis, Grab, etc) to provide a dedicated pick up service with good PPE and protection for the drivers.

When there is a huge fire raging in a large region, using hand-held fire extinguishers will not work. We cannot continue with the same initiatives we have practised thus far to control the vast local outbreak.

Using imaginative, out-of-the box strategies are necessary. No one person or organisation has all the solutions or answers. Listening to diverse views is critical.

DATUK DR AMAR-SINGH HSS , Senior Consultant Paediatrician

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