Covid-19 now pandemic of the unimmunised

 

Red flags were raised when 204 out of 453 personnel at the Ideal Convention Centre vaccination centre (PPV) in Shah Alam were infected with Covid-19. Some 88 percent of them were reported to be vaccinated. 

Many of the concerns would have been immediately allayed if the minister had informed that none, or a minuscule few of them, suffered from Covid-19 severe enough to be hospitalised. And that all of the personnel had very low virus counts in their upper airways, therefore they were virtually non-infectious.

Instead, the minister chose to be medically savvy and said that the Cycle Threshold (CT) values were above 35 and that the viral load was low.

For the less informed (which I suspect includes all of the lay public and a considerable proportion of healthcare workers) CT values above 30 are associated with a low viral load and the person is considered as non-infectious. 

The caveat being a proportion of infected persons in the early phase of the illness, who are asymptomatic or pre-symptomatic, only exhibiting signs later and become infectious. So all the reasons for them to be quarantined to protect against this potential eventuality.

I hope the authorities would be wiser and smarter in their management and risk communication of the more recent outbreak at the Setia City Convention Centre (SCCC) mega vaccination site (PPV) in Shah Alam. 

A friend and his immune-compromised spouse who were at the SCCC PPV were very concerned. Since they were there for their second AstraZeneca shot, I reassured them with the following messages.

Since you would very likely practise the standard operating procedures (SOPs), you are at virtually zero risk! It is the PPV personnel who are at the highest risk since they are more likely to be closer together, eat, chat, smoke and some of them may actually be unvaccinated.

Your first AstraZeneca dose would confer the both of you (maybe less so for your spouse):

• 85 percent protection against being hospitalised with Alpha Covid-19
• 83 percent protection against being hospitalised with Beta and Gamma variants

The data against the Delta strain hospitalisation is mixed. UK data reports only 33 percent protection whilst the Canadian data reports 88 percent protection. 

Isn’t this after all the raison d’etre of the Covid-19 vaccines? The vaccines were designed to prevent serious illnesses, hospitalisations, admissions into the Intensive Care Unit (ICU) and deaths. These are the very sequelae of serious Covid-19 that would fill our hospital and ICU beds and overwhelm our health care capacity.

This was borne out in the Health Ministry report on breakthrough infections. Only 3,106 (1.26 percent) of the 245,932 healthcare workers who mostly received the Pfizer vaccines, were infected. The majority of these were Category 1 and 2 infections, asymptomatic or mild symptoms. There were three cases each in Category 3 and 4 requiring hospital care (0.2 percent). And there were no Category 5 cases nor any deaths reported.

All of our 751 staff members in our hospital were immunised with the Pfizer vaccine. There were 13 breakthrough infections (1.73 percent). All of them were Category 2 and none required hospitalisation.

A total of 10,262 (0.01 percent) vaccine breakthrough infections had been reported in the US as of April 30. Approximately 101 million persons in the US had been fully vaccinated against Covid-19. 

Unlike the Health Ministry or our hospital which picks up virtually all cases of breakthrough infections, the US numbers would be significantly under-reported since the national surveillance system depends on passive and voluntary reporting. 

Preliminary data showed that 2,725 (27 percent) of the breakthrough infections were asymptomatic. Some 995 (10 percent) patients were known to be hospitalised. Among them, 289 (29 percent) were asymptomatic or hospitalised for a reason unrelated to Covid-19.

Some 160 (2 percent) patients died, 28 (18 percent) of these were asymptomatic or died from a cause unrelated to Covid-19. The median age of patients who died was 82 years.

Genomic sequences were available from 555 (5 percent) cases with 356 (64 percent) identified as variants of concern (VOC).

The Singapore Health Ministry reported that for those fully vaccinated, 158 persons had been infected. Two (1.3 percent) of them, both with pre-existing illnesses, required oxygen supplementation and none required ICU care.

In Thailand, 618 (0.09 percent) out of 677,348 healthcare workers who received two doses of Sinovac, became infected. The news report only mentioned the death of a nurse and another healthcare worker was in critical condition. 

These data emphasise the fact that vaccines are effective. The rates of Covid-19 have declined among those vaccinated. Virtually all of those hospitalised for Covid-19 or succumbed to it were among the unimmunised.

There is a powerful message here for all Malaysians, notably those who are vaccine-hesitant. The overwhelming majority of the Covid-19 cases are now seen among the unvaccinated. Covid-19 has now become the pandemic of the unimmunised. - Mkini

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DR MUSA MOHD NORDIN is a paediatrician and chairperson of the Federation of Islamic Medical Associations advisory council.

The views expressed here are those of the author/contributor and do not necessarily represent the views of MMKtT.