With input from Dr Monica Vasudev

27^th March, Saturday, 9.30am-10.30am

Participants: Member NMAs: Dr KK Aggarwal, President CMAAO; Dr Yeh Woei Chong, Singapore Chair CMAAO; Dr Alvin Yee-Shing Chan, Hong Kong, Treasurer, CMAAO; Dr Ravi Naidu, Malaysia Immediate Past President CMAAO; Dr Marthanda Pillai, India, Member World Medical Council; Dr Prakash Budhakoty, Nepal Medical Association; Dr Marie Uzawa Urabe, Japan Medical Association; Dr Md Jamaluddin Chowdhury, Bangladesh Medical Association; Dr Qaiser Sajjad, Secretary General, Pakistan Medical Association; Dr Akhtar Hussain, South African Medical Association

Invitees: Dr Russell D’Souza, Australia UNESCO Chair in Bioethics; Dr S Sharma, Editor IJCP Group

Key points from the discussion

• Nucleotides are the basic substances that make up the RNA and DNA. RNA is single stranded, DNA is double stranded. The uracil in RNA (CGAU) is replaced by thymine in DNA (CGAT).
• There are three types of RNA: mRNA (carries information from DNA in the nucleus to ribosomes in the cytoplasm), ribosomal RNA (rRNA – structural component of ribosomes) and transfer RNA (tRNA carries amino acids to the ribosome during translation to help build an amino acid chain).
• The sequence of RNA/DNA determines the protein sequence. The amino acids can be in different combinations and make polypeptide. In RNA, three amino acids will form a base pair, while in DNA, two amino acids form a base pair.
• Copying of nucleotide sequence from DNA to RNA is transcription (the first step in decoding genetic messages) and RNA to polypeptide is translation. Translation occurs in cytoplasm.
• Amino acids join together to form a protein; this is the next step. The order in which the amino acids are joined together determines the shape, properties and function of a protein.
• RNA is converted to DNA in RT PCR and in AstraZeneca vaccine (reverse transcription).
• The genetic code is read in three-base words called codons. Codon is a sequence of three nucleotides that corresponds with a specific amino acid or stop/start signal during translation.
• Mutation is a change in genetic sequence. They occur in nucleotides. Mutations allow for evolution. In silent mutations, there is no change in phenotype. Irrelevant mutations or friendly mutations are insignificant.
• The SARS-CoV-2 virus has 30,000 base pairs. ORF 1a/b have 16 non-structural proteins (NSPs).
• 12-16 NSPs are responsible for proof reading. Mutation in NSP14 will take away the proof reading ability.
• Currently, the focus is on S protein and not the other parts of the virus. In addition to S protein, mutations are also occurring in other parts of the virus.
• There is a new double mutant in India (E484Q and L452R), which is causing the second wave of infection. Mainly four states in the country are contributing almost 80% of total cases. The rate of spread of the mutant virus is 2.54 times higher. Immunization is progressing rapidly. It has the highest number of people vaccinated, but in terms of percentage of population immunized, there is still a long way to go. The only way out is to vaccinate as many people as possible. From 1^stApril, persons older than 45 years will be eligible for vaccination. The second wave will be faster and stronger than the first wave. The new phenotype is causing more diarrhea.
• In South Africa, there are 1000-1500 new cases and 65-90 deaths daily. The number has not touched zero since the second wave started. Few superspreaders are expected during the Easter weekend. The vaccination (J&J) is slow. About 500,000 doses have been procured and only 230,000 healthcare workers have been vaccinated so far. Six million J&J doses have been procured for the second phase, which will begin in April.
• In Nepal, cases are increasing from double digits to three digits. Health workers have been alerted and are not sanctioned leave. New vaccination stopped due to shortage, but continues for the second dose.
• In Hong Kong, the fourth wave has come down to single digit new confirmed cases. From 1-2 days, there have been no cases of unknown origin. Till last week, people were infected in clusters (gyms, public restaurants). Places which were superspreading infection were found to be due to lack of ventilation. It was suggested to the government that there should be rules stating that these places should have ventilation 6 times of circulation per minute or they should not allow aerobic exercises. The government has also been urged to have very stringent quarantine and contact tracing. Some cases of variants of virus have been reported, although only in single digits. But they could still pose a risk.
• In Bangladesh, the second wave is on the rise. There have been more than 3500 new cases; deaths are a cause of concern. There is no new variant. The new cases have been because of lack of adherence to social distancing and masking. The vaccine is imported from India (Covishield); it has been stopped, which is worrying. The second dose is not started yet.
• Singapore has not reported any new case since last 1-2 weeks. 8.3 million swabs have been tested at the rate of 36,000 per day. The immunization rate is 40 thousand per day; 1.07 million vaccines have been given; 300,000 have completed two doses. Now the vaccine is being extended to those aged 45-59 years. The total number of cases are 60,000 (2300 community and the rest in dormitory infections); there have been 30 deaths. The main cases in the last few months are imported cases, which were under quarantine when diagnosed, so did not pose much threat to the community. One case yesterday (imported) of a domestic help from Myanmar.
• In Japan, 20,000 people have had the vaccine; there have been minor side effects. One death 4 days after the vaccination has been reported, that of a 62-year-old woman who developed brain hemorrhage. The relationship with the vaccine is not yet clear. There are about 2000-3000 new cases and 30 deaths daily. The lockdown has been opened. Although there is a concern about an impending third wave.
• In Malaysia, the total cases reported so far is 323,925; the number of deaths is 1249. Around 1275 new cases were reported yesterday. The total vaccines given are 536,681. The vaccination progress is very limited. The SOPs are followed very strictly as the penalty for not wearing a mask or observing social distancing is up to a maximum of 10,000 Malaysian Ringgits. 

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA