THE National Recovery Plan (NRP) phase transition indicators has been reported as daily hospital admissions for the total number of patient cases in category 3 and above, nationwide threshold value of symptomatic daily cases, and utilisation capacity of intensive care units (ICUs).
The reason for this is likely due to the fact that current data (against current variants) indicate significant impact of vaccination in reducing severe cases, hospitalizations, and death. However, effectiveness against infections - particularly the Delta variant - is lower. In other words, the landscape has shifted and number of cases become relatively less important.
But breakthrough infections and future variants could pose a real threat to recovery, and we could be underestimating vaccination targets.
It has to be noted that studies on breakthrough cases are recent, not easily compared and some findings appear contrasting to one another. Some studies point to low breakthrough incidence, and others appear to point to higher rates. Either way, it poses the question on vaccine effectiveness, which may impact the indicators used towards gradual re-opening of the economy and increased freedom of movement.
A report from the Kaiser Family Foundation (KFF) points to the rarity of breakthrough cases when it found that the incidence in fully vaccinated individuals to be “well below 1% in all reporting states, ranging from 0.01% in Connecticut to 0.29% in Alaska”.
This is consistent with the Centers for Disease Control and Prevention (CDC) slides published by The Washington Post that there are 35 000 weekly symptomatic infections from the 162 million vaccinated Americans, which is an incidence rate of about 0.02%.
Notwithstanding the fact that comparisons are not “apple-to-apples”, Code Blue showed that breakthrough infections for Malaysia from July 26 to August 2 was 15.6% of (20,684 out of a total 132,748 cases). Removing Category 1 cases from this data means 19,859 symptomatic cases from 132,748 cases i.e.,14.9% of symptomatic breakthrough cases.
Is this showing Malaysia’s breakthrough case rate to be hundreds of times bigger than the cases reported by the CDC and the KFF? If so, what could be driving it? Could this be related to different vaccine types?
Even if the figure appears large, it appears to be well below the figures reported in a recent release by the CDC which found 74% of the 469 people infected in Massachusetts (due to an outbreak whereby 90% is Delta infections) were among those fully vaccinated. Furthermore, among these, 79% reported symptoms. The good news is that there were only four hospital admission and zero deaths.
This supports the effectiveness of vaccines in preventing severe disease, but the high percentage of symptomatic cases among the fully vaccinated (even if not hospitalised) could affect the symptomatic daily cases indicator (“nationwide threshold values”) of the NRP.
EMIR Research warned in its article “Are we easing movement restrictions a little too soon?” dated July 21 that a significant portion of the population could have a relatively significantly lower antibody level. Although memory immunity cells may retain information, it could be for the “wrong” type of antibodies).
We also mentioned potentially uneven levels of protection due to inoculation with different types of vaccines that could be unprepared to take on the rising spread of virus, particularly from what is now dominant Delta variant.
It was reported that the decision to use these indicators was based on the experience in Sarawak and Labuan whereby the risk of infection, rate of symptomatic cases and need for ICU treatment saw a significant reduction after the vaccination rate reached 50% in July.
As of August 8, only 37.7% of the Klang Valley population has been fully vaccinated, with clear vaccine disparity as nine other states have fully vaccinated population well below 25%.
We have to keep in mind that the protective impact of a certain percentage of vaccinated population is directly tied to the effectiveness of the vaccines as well as infectivity rate.
Breakthrough cases and high infectivity rate of variant Delta could mean that the “50%” assumption is underestimated and that a much bigger vaccinated population target may be required prior to Phase transition and easing restrictions.
Growing evidence that vaccinated people may also carry and transmit means the traditional herd immunity definition is no longer valid. The future definition here should therefore, be herd immunity against severe disease. But breakthrough infections and future variants could threaten even this outlook.
The CDC slides also pointed to published studies that indicating Delta to be clearly more infectious and likely to cause more severe disease than Alpha when comparing vaccinated versus unvaccinated group.
The CDC also referred to studies indicating that for those fully vaccinated, effectiveness in preventing infection and symptomatic disease is lower for Delta compared to Alpha, but similar for hospitalisations and deaths (although this may differ between different vaccines types).
Thus, the indicator of the number of patients in severe categories and ICU admissions may be affected as well, though to a lesser degree than the indicator for daily cases.
The use of such indicator reemphasises the importance of managing disease progression, whereby large-scale early intervention is key. We refer back to our suggestions outline under “Reinventing Covid-19 pandemic management: speed and scale” dated July 27. Additionally, we should expand this into other drugs, and not put all our options in one vaccine basket.
It was reported that Singaporean researchers using an artificial intelligence platform had identified antiviral drug remdesivir, together with lopinavir and ritonavir as the “cocktail” to treat Covid-19 patients with mild to moderate disease and that it has also shown promising results in terms of effectiveness against the Beta and Delta variants of the virus.
Malaysia’s current protocol have already considered these exact drugs, though Remdesivir is not available yet in Malaysia. We should speed up and scale up on-going clinical trials (such as Ivermectin) and other drugs, especially for early intervention, and not simply wait until we’ve exhausted all already-approved methods.
Increased freedom for those fully-vaccinated
Fully vaccinated individuals in Phase 2 are also said to be allowed to cross-district, dine-in, and even engage in same-state tourism as long as one has a digital certificate of Covid vaccination.
On one hand, we have authorities saying that antibody measurements are not recommended as there are no guidelines for public use yet. But on the other hand, the policy trusts fully that vaccination certificates equal immunity passport, despite all the uncertainties mentioned earlier.
EMIR Research would like to reiterate that there are immunological and virological uncertainties. In addition to potential difference in the level of protection by different vaccines, not all those vaccinated may be immunised and there is risk of waning immunity.
We mentioned before that fully vaccinated people can be carriers too, especially in the absence/insufficient mucosal immunity. If they are exposed to non-protected individuals, they could be sparking sporadic and cluster cases in unprotected communities.
Recent findings by the Public Health England (PHE) and CDC greatly support this postulation when they found that the PCR cycle-threshold for both unvaccinated and vaccinated people are similar, which has been inferred to mean both are carrying similar virus loads and therefore, similar level of virus transmissibility.
Consultant Paediatrician Datuk Dr Amar-Singh HSS had warned that other states with relatively lower vaccination rate than Greater Klang Valley may face a Delta outbreak and undergo a potentially worse situation. We are still firefighting in Klang Valley. Allowing fully vaccinated people to cross states with lower vaccination rates is not advisable.
In summary, we have to be on the side of caution until a higher percentage of vaccinated population is achieved (which should be reflected by the careful movements of vaccinated people), focus on increasing vaccination rates, enhance containment of virus spread in communities with low vaccination rate by increasing Find-Test-Trace-Isolate-Support (FTTIS) strategy (effective contact tracing, ability to do tests at home and self-quarantine could be a significant measures), and prevention of disease progression through large scale early interventions.
*Ameen Kamal is the Head of Science & Technology at EMIR Research, an independent think tank focused on strategic policy recommendations based on rigorous research.
**The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the position of Astro AWANI.
Ameen Kamal
Tue Aug 10 2021
As of August 8, only 37.7% of the Klang Valley population has been fully vaccinated, with clear vaccine disparity as nine other states have fully vaccinated population well below 25%. - Photo/ Bernama
Freedom Flotilla to Gaza: Guinea-Bissau akur kepada Israel, tidak beri kebenaran guna bendera bagi misi pelayaran
Kerajaan Republik Guinea-Bissau dilaporkan tunduk dan akur kepada gesaan Israel untuk tidak membenarkan misi pelayaran Break The Siege: Freedom Flotilla to Gaza menggunakan bendera mereka.
Penyakit berkaitan haba dikhuatiri meningkat di Gaza
Penularan penyakit berkaitan haba panas menjadi kebimbangan terbaharu di Gaza selepas suhu luar jangka melampau melanda wilayah itu setiap hari. Ia sudah semestinya diburukkan lagi dengan kekurangan air bersih dan ketiadaan sistem pembuangan sisa pepejal yang sepatutnya wujud di sesebuah kawasan didiami manusia.
Ilhan Omar melawat peserta tunjuk perasaan
Wakil Dewan Perwakilan Amerika Syarikat (AS) Ilhan Omar mengadakan lawatan di kampus penyokong Pro Palestin di Universiti Columbia New York pada Khamis.
Dua lelaki didakwa jadi 'tali barut' kepada China
Dua lelaki yang mana salah seorangnya pernah bertugas di Parlimen United Kingdom (UK) enjalani proses perbicaraan di mahkamah London pada Jumaat selepas didakwa menjadi tali barut menyalurkan maklumat sulit kerajaan kepada negara tembok besar itu.
Polis serbu pejabat 'Save the Children' di Guatemala
Polis Guatemala melakukan serbuan mengejut ke atas pejabat-pejabat Pertubuhan Save the Children di pelbagai lokasi di negara itu. Ia bagi mencari bukti dakwaan pertubuhan yang memperjuangkan kebajikan kanak-kanak itu, terlibat dalam jenayah penderaan terhadap golongan itu.
LIMA '25 dianjurkan pada 20-24 Mei tahun depan
Pameran Maritim dan Aeroangkasa Antarabangsa Langkawi 2025 (LlMA ‘25) akan dianjurkan pada 20 hingga 24 Mei tahun depan bertemakan Innovate Today, Thrive Tomorrow.
Malaysia komited tingkat hubungan dua hala bersama Libya
Malaysia terus komited mempertingkatkan hubungan dua hala yang berterusan bersama Libya demi manfaat bersama dalam pelbagai sektor.
Demi rakyat, Zahid-Muhyiddin henti saman fitnah
Presiden Umno, Datuk Seri Ahmad Zahid Hamidi dan Presiden Bersatu, Tan Sri Muhyiddin Yassin bersepakat untuk menamatkan pertikaian peribadi antara mereka.
Sultan Selangor berangkat ke Majlis Bacaan Yassin di Pangkalan TLDM
Sultan Selangor Sultan Sharafuddin Idris Shah yang juga Kepten Yang Dipertua Tentera Laut Diraja Malaysia (TLDM) berkenan berangkat ke Pangkalan TLDM Lumut di Perak bagi menghadiri Majlis Bacaan Yasin, Tahlil dan Khutbah Khas sempena Sambutan Hari TLDM ke-90.
PM Anwar pulangkan elaun Pengerusi Khazanah
Perdana Menteri Datuk Seri Anwar Ibrahim memaklumkan beliau memulangkan elaun sebagai pengerusi Khazanah Nasional Berhad yang diterimanya dan sekali lagi menegaskan tidak menerima gaji bagi jawatan Perdana Menteri yang disandangnya sejak November 2022.
Kelaparan akut jejaskan 281.6 juta orang tahun lepas - PBB
Tahap bahaya kelaparan akut menjejaskan 281.6 juta orang tahun lepas, tahun kelima berturut-turut bahawa ketakjaminan makanan semakin memburuk.
Hamilton optimis kedudukan lebih baik di GP China
Lewis Hamilton melihat potensi kedudukan yang lebih baik dalam saingan Grand Prix yang kembali ke China buat pertama kali dalam tempoh lima tahun, hujung minggu ini.
'Selfish!' - Fasha Sandha sedih raya di Perlis tak jadi gara-gara dijangkiti COVID-19
Fasha berkata dia mula melakukan pemeriksaan COVID-19 selepas berasa tidak sihat badan dan mengalami bersin tidak henti sejak Raya pertama.
Kes COVID-19 catat penurunan ketara pada ME 14/2024 - KKM
Jumlah kes COVID-19 menurun 97.1 peratus kepada 493 kes pada Minggu Epidemiologi ke-14 (ME 14/2024) iaitu bagi tempoh 31 Mac hingga 6 April lepas berbanding 17,256 kes pada ME 1/2024.
China jadikan pengalaman pencegahan COVID-19 untuk hadapi pandemik masa depan
China akan menjadikan pengalaman dalam pencegahan dan kawalan COVID-19 untuk membuat persediaan yang lebih proaktif untuk menghadapi pandemik masa depan seperti "Penyakit X".
Negara berdepan ketirisan subsidi diesel serius - Amir Hamzah
Negara kini sedang berdepan isu ketirisan subsidi diesel yang serius dan wujud kemungkinan terdapat pihak yang tidak layak masih menikmati subsidi itu, kata Menteri Kewangan II Datuk Seri Amir Hamzah.
Kematian akibat kemalangan jalan raya lebih tinggi daripada COVID-19 - Anthony Loke
PDRM akan mengeluarkan data mengenai kemalangan jalan raya pada setiap hari, bukan setahun sekali seperti diamalkan sebelum ini.
Ismail Sabri ziarah lapan beradik yatim piatu akibat COVID-19
Ismail Sabri tiba kira-kira jam 2 petang di kediaman lapan beradik itu di Taman Adenium, Bukit Beruntung pada Selasa.
Teori konspirasi 'Penyakit X'
Ahli teori konspirasi AS sekali lagi membuat 'keuntungan' selepas PBB memberi amaran tentang wabak lebih berbahaya iaitu 'Penyakit X'.
Reformasi dasar, kukuhkan perlindungan, produktiviti pekerja tidak formal
Reformasi dasar perlu dilakukan dalam usaha meningkatkan perlindungan dan produktiviti pekerja tidak formal di Malaysia.