MARCH 9 — I know you guys freaking out now with the recent upsurge in local cases.

And the lousy numbers coming out from Italy and Iran.

Iran and Italy had several issues bro!

Don’t lump us with them la!

1. Both were late to diagnose index Covid-19 cases.

2. The 1st index case in Italy was not diagnosed until 6 days later. He presented three times to the hospital with flu like symptoms.

3. And he behaved like a "super-spreader” infecting at least 13 people including his pregnant wife, two doctors and one geriatric lady who eventually succumbed :(

4. They both undertook minimal Covid-19 testing. Few done in Iran due to embargo.

5. MOH ID HOD, Dr Suresh said we generously tested to cast our net as wide as possible to understand the extent of spread into the community.

6. Our own hospital, KPJ-DSH probably did most in any private facility, 300+ rt-PCR tests altogether. So far all reported results were negative. At our KPJ Update meeting on Friday 6 March 2020, at least another 4 KPJ hospitals in the Klang Valley will also do the testing with Lablink, one of 4 accredited private lab facilities in Malaysia.

7. The US looks headed for a massive outbreak with only 1,200 tested. Even Italy did at least 20,000 tests. What do you expect if the POTUS massively reduced spending on its health budget?

8. If anything we need to:

i. Scale up testing to best estimate SARS-CoV2 presence in our community

ii. Begin to prepare our hospitals early (Suresh says MOH is ok and I rationalized similarly for management of Covid-19 patients only in dedicated ID hospitals)

iii. Craft and blast smart public health messaging

9. Biology of the virus makes it very difficult to contain.

10. It is a smarty pants virus:

i. Virulently transmissible — high Ro (2.0)

ii. Not too high CFR (2 per cent) unlike SARS (10 per cent) or MERS (35 per cent)

iii. Because if it kills its human host it (SARS-CoV2) will also die la!

iv. It selects and kill especially the old/high risk guys with co-morbidities/smokers

v. And sticks around to live another day and become endemic

vi. Prof Nichols in HK university, founder of SARS-CoV1, thinks it will be endemic like NL63 seasonal CoV 

11. Like some other guys (good that I have ID maestro Prof Datuk Dr Adeeba on my side) I think MOH needs to move on from containment to mitigation phase.

12. The recent hike in cases is not unexpected since it is possible to spread the virus even before symptoms appear.

13. This plus its high Ro and 2 per cent CFR (flu is 0.1 per cent) is a sure recipe for an outbreak to become ...a pandemic (WHO don’t wanna use this dirty word ma).

14. How to slow the spread of SARS-CoV2? Among others it is the well proven ID culture of #SocialDistancing. It worked in cities that practiced it during the Spanish Flu Pandemic in 1918 when 1/5 world citizen were infected and 50 million deaths.

15. In the 1918 pandemic (Ro 2.0), no single intervention was sufficient.

i. Some were more useful than others. Closing schools, churches, and theatres appeared to be among the most effective measures. Four or more such interventions implemented at the same time were more effective than only one or two and were more effective than multiple interventions started at different times. Timing was especially critical. They were far more effective if applied early and maintained as long as possible.

ii. We need to pick and choose according to our 2020 social, technological and globalised era e.g.

iii. Work from home

iv. Cancel group events

v. Stay at home for high risk groups eg pregnant people, geriatrics, those with underlying health conditions

vi. Staying home when unwell

vii. Best practices hygiene measures

viii. Avoid large crowds

ix. No handshakes, hugs, kisses, high 5, fist bumps

x. Practice #hola #namaste #eyvallah dll

16. Even the children were informed. They played skip rope to the tune:

I had a bird

Its name is Enza

I opened the window

And In-Flu-Enza :)

17. Despite the difficulties, non-pharmaceutical interventions can fulfill lifesaving objectives.

18. Flattening the epidemic curve could reduce the burden on healthcare institutions and essential services.

19. A critical purpose of these interventions would be to reduce the effects of the pandemic as much as possible until anti-viral agents and a vaccine could be produced INSHALLAH.

20. So guys #StayCool and #ChillOut

#DoNotBeFearful

Fear is the path to the Dark Side. Fear leads to Anger. Anger leads to Hate. Hate leads to Suffering (Yoda) and #maytheFORCEbewithyou.

* This is the personal opinion of the writer or publication and does not necessarily represent the views of Malay Mail.