Report For May 2021

 

19 May 

First Day of FHBL 

It was the first day of FHBL for all government schools and higher learning in Singapore. People logging into SLS experienced slow connectivity which was resolved later in the morning. 

A student of mine actually emailed me to ask me whether I could rectify the problem. 

I was on duty watching over three lower primary students. There was Nathaniel, a P2 boy, who has a keen interest in Alaskan King Crabs. 

What is the better face mask? 

It is recommended to go with the 3-ply surgical mask for its greater filtration capabilities. Avoid those with vents that filter incoming air but not the exhaled air. There was a video that circulated showing a man blowing out a flame of a lighter with a different type of face mask. The surgical mask and N95 mask did not allow air to pass through and thus the flame could not be extinguished. 

Efficacy of the Covid-19 vaccines 

The vaccines are known to create antibodies that are good for 2-3 months after the first dose. 

It was also shown in studies that the vaccines can be used on 12 to 15-year-olds. Singapore will soon start inoculated this age group. 

 According to Dr Fischer, Singapore’s moderately high vaccination rate of over 30 per cent of the population, which includes those who have already received their first jab, is a game changer in helping the nation avoid another circuit breaker.

Vaccinations are a more sustainable way of protecting the population, though the current slew of Covid-19 curbs - while fairly aggressive – are necessary, experts said. 

The experts took a deeper look at current restrictions – such as the complete shift to home-based learning (HBL) in schools – which have been disruptive.

HBL was done as a precautionary measure, given that the B1617 variant is more likely to infect children. Prof Teo said HBL is not a long-term strategy.

Instead, vaccination of children, where those aged 12 to 15 can now get the Pfizer-BioNTech shot in Singapore, will be a more sustainable way of protecting children in the long run.

Home-based learning and school closures increase inequity because families that are more able to cope will do better, while other parents may struggle to make sure their children can keep up with the curriculum, as well as to supervise them.

“HBL is just a way for us to tap the brakes, learn a bit more about the chains of transmission that are happening in schools, but it is not going to be a long-term strategy,” Prof Teo said.

Other strategies, such as rostered routine testing, are also not part of a viable long-term strategy because of the tremendous costs, inconvenience and low yield, Prof Hsu added.

“But as a way of preventing transmission to more vulnerable members of the community and providing assurance that measures are in place, it sends a good message.

“But in the long run, we will probably not be able to sustain it,” Prof Hsu said. 

When asked if Singapore should adopt a zero-tolerance approach to Covid-19 or learn to live with it as an endemic disease, the panel felt that the endpoint of this pandemic will realistically see Covid-19 becoming an endemic disease.

“Vaccination was designed to minimise serious symptoms and side effects but not meant to completely block the risk of infection.

“If we are vaccinated, then get infected and are asymptomatic, and do not have a risk of going to the hospital or suffer from a serious side effect – that looks like one of the ways of living with the disease in the long term,” Prof Teo said.

Prof Hsu pointed out that in the history of human diseases, such as measles and tuberculosis, mankind has learnt to live with them, with the help of vaccination.

Scientists in Britain have estimated the B1617 variant as being 70 per cent more transmissible than the B117 variant, which originated in Britain.

But for the vast majority of cases, the virus spreads through droplets. Hence, conventional surgical masks will continue to serve us well. There are exceptions, of course, such as in a poorly ventilated area, where aerosols that contain the virus are more likely to spread infection.

It is important to highlight Pfizer's study of about 2,200 children aged 12 to 15 in the United States. In the trial, 18 cases of Covid-19 were observed in the placebo group, which consisted of around 1,100 children, versus no cases of Covid-19 in the vaccinated group, which also had around 1,100 children.

Pfizer said the children in this group had robust antibody responses and that the vaccine was 100 per cent effective.

The trial also showed that the vaccine was safe for that group. The jab was well tolerated, with side effects generally consistent with those observed in trial participants from the 16 to 25 age group.

Closing of the borders

This would have affected the Singapore economy particularly Food and Beverage, Construction and Cleaning industries. In the construction sector, project completion was delayed up to 12 months. Currently, the government has stopped the flow of workers from South Asia because of the record number of infections and deaths in that region. 

But there were still gaps in its vaccine playbook, and by late May, Singapore's Changi Airport - which also boasts a popular shopping centre - had turned into the country's biggest Covid cluster this year.

Authorities later found out that a number of infected airport staff had been working in a zone that received travellers from high-risk countries, including those in South Asia.

Some of these workers then went on to have their meals in the airport's food courts - which are open to members of the public - further spreading the virus.

Singapore has now closed its passenger terminals to members of the public temporarily as a result.

Many of the infected were later found to have a highly contagious variant that first surfaced in India - known as B1617.

Singapore has now also announced that it would segregate flights and passengers from high-risk countries and regions from those arriving from lower-risk places. Staff will also be ring-fenced and segregated by zones.

Some online are asking why such measures were not taken earlier, noting potential loopholes were pointed out up to a month ago.

But one expert said he thinks it was "inevitable" that the new variant would have found its way into Singapore.

"I understand why people are feeling frustrated because the majority of Singaporeans have been extremely compliant," said Prof Teo Yik Ying, Dean of the NUS School of Public Health.

"But we are not like China which can keep its borders completely shut. Our reputation as a country, our economy, is linked to our position as a trade hub.

"[Also] if we look at the US last year, its worst virus cases came in not from China, but from travelers that went to Europe. So how many countries can Singapore close its borders to? We have to understand it's never just closing off one country." 

But Prof Cook says the country is still in a "very good position" to rein in its outbreak.

"I'm hesitant to say that things went wrong, since Singapore is still, despite the stepping up of measures, in a very good position," he said.

"If we compare it to the UK, the typical daily cases is around 10% of the UK's level after adjusting for population size. In other words, Singapore is tightening measures to pre-empt getting to a point where the virus can run amok." - https://www.bbc.com/news/world-asia-57153195

The Pandemic in America - What could have been? 

A group of health officials in California, etc whose warnings were ignored resulted in USA being hit hard by the pandemic. 

Michael Lewis chose this title The Premonition because, he explains, “to control a virus you have to see around corners”. What he means by that is that if you wait for sufficient evidence to establish that a pandemic is underway, it’s already too late to stop it.

In the pandemic prevention business, you need to see the future before it arrives and, as it turns out, there were a number of people who had anticipated precisely where things were heading. One of them was the deputy public health officer, Charity Dean,  for the state of California. 

The irony, as Lewis notes, is that in a pre-pandemic assessment of those nations best prepared to deal with a global contagion, the US was ranked top and the UK second.

Lewis details the recruitment of a group of medical mavericks, led by a couple of southern doctors, one a poet-administrator named Richard Hatchett and the other Carter Mecher, a sublimely focused problem-solver with highly evolved people skills (Tom Hanks would have to play him in a movie). They were charged with breaking away from received thinking and looking at radical ways of dealing with a pandemic.

Three years earlier, a 13-year-old girl called Laura had entered a school science fair in Albuquerque with a project she’d been working on: a computer model to predict the spread of a virus. She was helped by her scientist father, Bob Glass. The senior Glass soon became obsessed by the project, long after his daughter moved on to other interests, and he tried without success to engage the attention of the academic science world with his findings. No one was interested. But eventually Hatchett and Mecher were and they used his model, first developed with his daughter, to come up with a comprehensive plan for limiting the spread of a virus: closing down schools and colleges, social distancing, mask wearing.

“It’s a novella,” Lewis says of the Bob and Laura Glass story. “It could be written as fiction. I went and saw Bob Glass in Albuquerque. He reminded me of me. He’s much smarter than I am but his feelings about his daughter’s science projects are exactly the feelings I have about my daughters’ softball careers.”

Drawing on Glass’s work, Hatchett, Mecher and several others were brought into the White House in the Bush years and some stayed on during the Obama administration. But when it really mattered, they found themselves outside the decision-making process, unable to get through to those in power. The book follows the pioneering strides made in federal pandemic planning and then the gradual and then abrupt dismantling of their work.

For all Hatchett’s and Mecher’s painstaking efforts, perhaps the real hero or heroine of the book is Dean. As deputy public health officer of California, her warnings were ignored by her boss and the state governor’s administration. When she protested, she was frozen out of meetings and silenced. But rather than buckle, she fought back, finding any way she could to get the message out, until finally the state administration, reeling from the virus, was compelled to backtrack and adopt Dean’s plan, although without publicly recognising her input.

We see her first as the public health officer for Santa Barbara, where she gained a fierce reputation for battling a tuberculosis outbreak. In a scene that must surely feature in any prospective film, Dean is forced to conduct a postmortem in a mortuary car park with a pair of garden shears because the local coroner is too scared to extract a lung that might be infected with TB.

“Men like that always underestimate me,” she tells Lewis. “They think my spirit animal is a bunny. And it’s a fucking dragon.”

Any author would kill for that kind of dialogue. As is often the case with Lewis’s books, I wonder how he manages to find people who speak in such gloriously vivid language. Is it a factor of America culture, steeped as it is in cinematic ways of talking, or is he just lucky?

If Dean and Mecher are the good guys, there are no shortage of baddies. Chief among these, perhaps surprisingly, is the Centers for Disease Control and Prevention, better known as the CDC. It’s an American federal institution with an international reputation.

In the book, they are mostly not doing very much and a lot of their energy seems to go into preventing others from doing anything either. Back in the 1970s, the then head of the CDC, David Sencer, called for nationwide vaccination after a swine flu outbreak. Two hundred million doses of vaccine were ordered and 45m administered, only for the outbreak not to materialise. Sencer was blamed for overreacting and sacked. Henceforth, the CDC tended to err on the side of cautious inaction. “I think the CDC had virtues but it was not battlefield command. It had become a place where the generals had no experience fighting a war,” says Lewis.

The official within the Trump administration whom he does identify as a major culprit is the former national security adviser John Bolton, who now does the media rounds as a voluble Trump critic. The day after he was appointed to the position in April 2018, Bolton sacked Tom Bossert, a veteran of the Bush administration. Bossert was the homeland security adviser who oversaw the biological threat team that was even then still influenced by the Hatchet and Mecher pandemic plan.

“From that moment on,” Lewis writes, “the Trump White House lived by the tacit rule last observed by the Reagan administration: the only serious threat to the American way of life came from other nation states.” So ingrained was this perspective within the administration that when he finally began to acknowledge the danger that Covid presented to America, Trump could only speak of it in nationalistic or xenophobic terms, continually referring to the “China virus”. Yet Lewis believes there was an opportunity for Trump to have been seen as the saviour of the day.

Bossert told Lewis that had he survived he thinks he would have been able to persuade Trump to give him a chance of implementing the pandemic plan, on the basis that if it didn’t work, he could fire and blame him and, if it did work, he could take all the credit.

“Trump would have loved that,” says Lewis. “All it would have taken is a couple of months with the United States doing well in relation to other people. That could have got Trump re-elected. The fact that Bolton cut that tie – that probably cost hundreds of thousands of lives. It prevented all the knowledge that had been accumulated from ever getting into the response. There’s an alternative history there. Maybe John Bolton is the reason Donald Trump didn’t get elected.”

For many observers, not only did the Trump administration fail the United States, it also vacated its long-established position as world leader. Had the US set the kind of example seen in Japan and South Korea, it’s not hard to imagine that the UK and the EU would have been more inclined to follow suit.

If The Premonition is an avowedly character-driven book, it also seeks to cast a critical light on the workings of America’s mammoth industrial-medical complex. One point that repeatedly emerges is that lacking any kind of national coordination, it is fundamentally ill-prepared to deal with national crises. That said, the UK does have a national health service, but it didn’t stop us from being among the nations with the highest per capita death rate from Covid. “The existence of an actual national system is not a sufficient solution,” acknowledges Lewis, “but it’s necessary. There’s no way you can run a coordinated response without a system.”

On a more profound level, the book also examines the backward priorities in health, how we are geared up to treat illness rather than to stop it from occurring. The paradox of medical science is that the better you are at avoiding a problem, the less likely that anyone will notice your efforts. And if they do, it will probably be to complain of a needless overreaction.

“There is no incentive to prevent things,” he says. “If you look at what our two societies have in common, we’ve given ourselves over to markets in a way that’s pretty extreme. Which is to say, we strongly encourage things that pay and we give correspondingly less attention to things that don’t pay. Prevention does not pay. Disease pays. It pays when Covid is all over society and corporations get to make a lot of money testing for it. It doesn’t pay just to shut it down up front. And if there’s food for thought, it’s that we were essentially incentivised to have a bad pandemic response.”

The lesson of the book is that there are people who spend their lives readying those in power for bad outcomes. Rather than being treated as tiresome Cassandras, simply because bad outcomes more often than not don’t occur, they ought to be involved at the centre of decision-making, not just for strategic purposes but economic ones. Most of the damage done to the economies of the US and UK was due to the fact that neither country acted early enough. Each saw themselves as the so well prepared that they had no need to worry about it. And so they didn’t.

Source:https://www.theguardian.com/books/2021/may/09/michael-lewis-the-premonition-covid-response-the-big-short-interview 

20 May 2021

Is there a Singapore variant of Covid-19? 

This is false. There is no new “Singapore” variant of COVID 19. Neither is there evidence of any COVID-19 variant that is ‘extremely dangerous for kids’. The strain that is prevalent in many of the COVID-19 cases detected in Singapore in recent weeks is the B.1.617.2 variant, which originated from India. The existence and spread of the B.1.617.2 variant within India predates the detection of the variant in Singapore, and this has been publicly known and reported by various media sources from as early as 5 May 2021.

Source: https://www.gov.sg/article/factually200521?fbclid=IwAR37jQ_2BRUwPyAMfK6U6aBUDSQhsnmON1x3ktRJqh67Z7Pdqj7TFjaO6Yw

22 May

Found out the first transmission of the Covid-19 virus took place at ACS  Junior. 

I had my first dose of the Pfizer vaccine at Woodlands Galaxy. I was there from 11:40 am-12:30 pm.

Process: Temperature - Check-in - checked about personal health - issued a queue # - checked more thoroughly about health status - cubicle for the vaccination - observation area for 30 mins - received reminder for my next  dose on 13 June & certificate acknowledging my first dose - collected free gifts like medical masks, etc.

I experienced a numbing pain at the site of the injection after about six hours and remained until Sunday morning. 

JEM and Westgate are the first shopping centres to close for 2 weeks - https://www.channelnewsasia.com/news/singapore/jem-westgate-shopping-malls-closed-2-weeks-covid-19-transmission-14865464 

23 May

I went for a 30-minute walk around the block and logged in about 7000 steps one day after the vaccination. I was able to complete 15,000 steps by the end of the day. 

As of 23 May, more than 40 students and pupils from some 30 schools have come down with Covid-19. Reasons: due to the cluster environment, such as a tuition centre or a school bus, said infectious diseases expert Paul Tambyah. 

It seems that the B1617 variant is overall more transmissible than the previous variants - across all age groups - hence affecting more children as well according to Associate Professor Sylvie Alonso, co-director of the NUS Yong Loo Lin School of Medicine’s Infectious Diseases Translational Research Programme. 

However, the risk of severe disease for those under the age of 18 is much lower than for adults.

Children under the age of 12 are also less likely to get infected but children remain a weak link in Singapore’s fight against Covid-19.

Associate Professor Hsu Li Yang, vice-dean of global health at the NUS' Saw Swee Hock School of Public Health said that young children tend not to be able to wear masks or observe safe distancing measures well. So, even though they are individually less at risk of serious illness or spreading the virus, collectively, the risk will add up – particularly at tuition centres and other enrichment classes and play locations, where children from multiple schools typically congregate 

Prof Alonso said children who are infected can also be carriers and transmitters of the virus without realising it because they will be mostly asymptomatic. 

She added that this will be a concern if they transmit the virus to vulnerable people in their household who could develop a severe form of the disease.

Prof Tambyah said that the idea of vaccinating this age group is a way to protect the vulnerable. 

With that in mind, the Health Sciences Authority on Tuesday extended its authorisation for those aged 12 to 15 to receive the Pfizer-BioNTech vaccine. The Health Ministry and Education Ministry will announce when vaccinations will be extended to this age group in due course. 

Source: https://www.straitstimes.com/singapore/children-are-not-more-prone-to-getting-infected-with-covid-19-experts. Dated 23 May 2021 

How kids in other nations are faring during the pandemic 

United States

Collating state data, the American Academy of Paediatrics said that as at May 13, more than 3.9 million child Covid-19 cases were reported. This is 14 per cent of all cases. 
Between 0.1 per cent and 1.9 per cent of all child cases resulted in hospitalisation. 
Children accounted for less than 0.21 per cent of all Covid-19 deaths. About 140 children under four have died. 
The United States last week vaccinated 600,000 teens between 12 and 15 years old with the Pfizer-BioNTech vaccine.

Britain

Since January, about 12 to 15 children aged eight to 14 have been hospitalised every week for post-Covid-19 complications called paediatric inflammatory multisystem syndrome (Pims), official statistics say. 
These complications show up as cough, rashes, fever, low blood pressure and abdominal pain. 
Studies show that 47 per cent of those with Pims – a rare but extreme immune response – were of Afro-Caribbean origin and 28 per cent were of Asian origin.

South Korea

Of the total number of Covid-19 cases as at March 24, 4.19 per cent were children below 10 years old, and 6.76 per cent were aged between 10 and 19. 
But deaths among children are extremely rare, the government has said.

Israel

More than 50,000 children and teens tested positive in January, more than during the first and second waves of Covid-19 infection, largely because of the more contagious variant first detected in Britain. 
The vaccination drive is now expanded to 12- to 15-year-olds.

Source: https://www.straitstimes.com/singapore/children-are-not-more-prone-to-getting-infected-with-covid-19-experts dated 23 Mary 2021 

Malaysia 

Adding to the grim figures, Senior Minister (Security Cluster) Ismail Sabri Yaakob said more children below the age of 12 have been infected with the coronavirus than in previous months.
There are 41,971 cases involving young children below 12, he said in a statement, including 6,290 babies below 18 months old.
He said the number of people below the age of 20 who have been infected has risen eightfold.
"To date, there are 64,046 children nationwide infected with the coronavirus, compared with 8,369 reported cases throughout 2020," he said. "Previously, it was said that the elderly were at risk of being infected with the virus. Now, it seems that the threat of this virus is contagious to children as well."

Source: https://www.straitstimes.com/asia/se-asia/malaysia-sees-record-high-7289-new-cases dtd 26 May 2021 

26 May 2021 
Pfizer vaccines can be stored in a refrigerator for a month

The Health Sciences Authority (HSA) has given the green light for Pfizer's Covid-19 vaccine to be stored at standard refrigerator temperatures of between 2 deg C and 8 deg C for up to a month. Source: https://www.straitstimes.com/singapore/health/green-light-for-storing-pfizer-shots-at-refrigerator-temperature-for-a-month dtd 26 May 2021 

Possible Mode of Transmission at JEM and Westgate 

The ways in which the Covid-19 virus can be transmitted have come under renewed scrutiny after a 53-year-old cleaner who works at a stay-home notice facility was identified as a possible source of infection that led to the latest community cluster at Westgate and Jem malls in Jurong East.
Infectious diseases expert Paul Tambyah said the cleaner was unlikely to have had direct contact with the stay-home notice visitors, so if she was infected at her workplace, the virus could have somehow been carried to her through the air or via a contaminated surface.
There are three main modes of transmission: airborne - where people are infected over long distances by inhaling very fine respiratory droplets carried by the air and aerosolised particles; through contact with droplets; and the touching of contaminated surfaces.
Most scientists and researchers agree on droplet transmission, but debate surrounds airborne and surface transmission.
An article published by British medical journal The Lancet on May 1 detailed 10 scientific reasons in support of airborne transmission. The World Health Organisation and the United States Centres for Disease Control and Prevention also recently accepted that the coronavirus can spread through the air.
However, some experts whom The Straits Times spoke to felt that droplet and surface transmissions remain the key modes by which the virus spreads, with airborne transmission occurring under more unusual settings such as aerosol-generating environments in hospitals.

Source: https://www.straitstimes.com/singapore/experts-weigh-in-on-mode-of-transmission-at-jem-westgate dtd 26 May 2021

This chart shows how the Covid-19 Virus can be transmitted to strangers, colleagues, friends, family members, relatives, etc.  

Source: https://static.straitstimes.com.sg/s3fs-public/attachments/2021/05/26/st_20210526_wkwest_6569518.pdf dtd 26 May 2021 

Improving ventilation indoors 

Source: https://www.straitstimes.com/singapore/health/no-ventilation-system-in-office-open-windows-turn-off-air-con dated 26 May 2021 

Should Idle Lifts have its door open to reduce transmission of fine respiratory droplets carried by air? 

This was posted by an ST Forum writer - Ryan Yeo Feng Shuo dated 26 May 2021

Singaporeans use lifts on a regular basis. Lifts are enclosed spaces where different people can come into close contact owing to the difficulty in keeping a safe distance from others.

It is an environment in which the coronavirus may spread easily. If an infected person were to sneeze or cough inside a lift, the next person to use it might become infected.

I propose that when a lift is idle, regardless of which floor it is on, its doors should remain open.

Source: https://www.straitstimes.com/opinion/forum/forum-idle-lifts-should-have-doors-open-for-air-to-circulate 

31 June. 

Lee Hsien Loong addressed the nation about the measures to be taken in the fight against Covid-19 

There will be more testing to detect and isolate as many cases as possible. Known as Fast and 

A case in point - 55 000 PCR and ART tests per day in May. That translates to about 76 000 individuals per day. ART or Antigen Rapid Test which takes about 30 minutes. Swabbing just around the nostrils and costs about $10.  

Breath analyser tests developed by NUS and NTU. 

There are Rostered Routine Tests.