Covid-19 virus is here to stay; it will come back in waves

The Covid-19 virus is here to stay and it will come back in waves; experts of 19 countries agreed at the Confederation of National Medical Associations in Asia and Oceania (CMAAO) meeting earlier today. At a virtual meeting, CMAAO experts talked about the long term effects of Covid-19. Current situations at various countries were discussed along with trends emerging from the different countries were shared.

CMAAO experts believe that we must prepare for post-lockdown situation. Recommendations such as precautions (personal lockdown) should continue for at least 2 years; emerged from the discussion. Experts believe the new trends like pre-operative testing, which also includes Covid-19 in addition to HIV, Hepatitis B & C, will become a norm. Social distancing will be the new norm, even for doctors. Companies should plan for social distancing at offices.They recommended that AII rooms must be introduced in hospitals; if not possible, then rooms must have air purifiers with HEPA filters and exchange rate of 12 per hour.

Besides, airlines will not be fully operational for at least 2 years; may resume travel to lowest risk areas, and monitor it further.

The meeting was presided by Dr KK Aggarwal, President CMAAO and experts from Australia, Japan, Hong Kong, Malaysia, India and Singapore attended the meeting.

Updates from Different Countries

Malaysia Update

Malaysia had 88 cases yesterday; total active cases are 1932; 363 (64%) patients have been treated and discharged. At presented total cases reported are 5691.

• The 3^rd phase of the MCO has been extended.
• Launched an app “MySejahtera” meaning “My Wellbeing” has been launched; details about your health can be put in the app and there is a symptom checker, which will give results and tell you if you are at risk. We can also check the area we are in (Red, yellow or Green zone) based on our location.
• The government is rolling out a return to work policy. It is planning to roll out RTPCR test for the first 100,000 workers in the next couple of days followed by antibody testing for surveillance of those returning to work.
• The exit strategy for MCO will be rolled out slowly.
• Malaysia has a sizeable migrant worker population, which is an area of concern. There might be clusters.

Singapore Update

• There has been an explosion of cases in migrant workers, but we still have a very low death rate. One of the reasons for this is that migrants are mostly under 30 years of age. Our local data shows that if you are under 30, only half (0.5%) will need oxygen; the remaining 99.5% are just lying in bed, we test them, if they are negative then they go home. So, fortunately the disease is very mild in our migrant population.
• Migrant population have been moved out of their dormitories and put in temporary isolation centers. Only about 10% rooms are infected i.e. there are clusters within the dorms (the whole dorm is not affected).
• The lockdown has been extended to the 1^st of June.
• The lockdown has started to some effects; there are less and less community cases.
• In future, the pandemic will come back in waves.
• Singapore is facing both 2^nd and 3^rd waves together. 2^nd wave due to people returning back, especially from the UK; the 3^rd wave is the migrant population.
• Run your own local tests. We used antibody tests that came from China, which had 90-99% sensitivity and specificity, but our local tests showed that it was only 30%.

India Update

We are more or less keeping the rate of growth of infection under control. The doubling time has improved to 6.5 days from 3.5 days.

• The increase is only linear; there is no exponential increase in the number of cases.
• Because of shortage of PPE kits, we have started manufacturing (good standard) them locally.
• The situation varies from state to state. Every district has been divided into 3 zones – red, yellow and green depending upon the number of Covid-positive cases.
• Antiviral drugs are being tried as treatment; convalescent plasma therapy has been successful in at least one patient.
• Vaccine trials are going on at ICMR level and the National Institute of Virology (NIV), Pune.
• The lockdown is complete; we are slowly trying to release the lockdown for economic and social reasons.
• Pre-operative test for Covid-19 should be routine for all surgeries, even elective procedures. This has medicolegal and safety concerns.
• Decontamination of clinics is a viable option.
• The quality of kits is very important. Kits from China have also failed in India.
• The govt. of India has brought in an ordinance to amend the Epidemic Diseases Act, 1897 incorporating stringent provisions against people who commit violence against doctors, nurses and paramedical workers. Attacks on doctors, paramedic staff have been made non-bailable offences punishable with up to 7 years imprisonment. We hope that the govt. will extend this law even when there is no epidemic and we will have this as a regular law.

Australia Update

• There are very good reports from Australia.
• Australia is in the midst of stage 3 lockdown. New Zealand is in stage 4 lockdown.
• The lockdown in Australia could be lifted in three weeks, in a gradual manner. Schools will restart.

Japan Update

• We are now improving but it is still not controlled since there are few patients with serious illness.
• We have tried to prepare ICU into a full negative pressure room to reduce the use of PPE.

 Hong Kong Update

• The number of confirmed cases has been less than 10 each day. This number has been nil for the last 2 days now.
• We have practiced absolute quarantine for those coming back to Hong Kong; moving them to hotels designated for quarantine. There is no contact between people coming back from overseas and the local people.
• People have been using face masks voluntarily. We have advised them to not touch face even though wearing a mask; this is a loophole for getting the infection.
• We have kept our confirmed cases to 1036, but this is not the time to be complacent. Next      month, there is a possibility that the border between Hong Kong and mainland China may reopen. We are on our guard.
• Schools are still closed; university entrance examinations started yesterday. Few students had high fever and left the examination room. This has introduced loopholes in the disease transmission.