Topic: COVID protocols followed by various countries

8th January, 2022, Saturday

9.30am-11am

• Singapore: There are 2522 omicron cases in the country as of 6^th January, 2022. This is because the country is opening up through VTL (vaccine travel lanes) with several countries including Europe. Out of these, only three required oxygen; no patient is in ICU. Compared to delta, where 30 would require oxygen, in ICU or died. The vaccination Differentiated Safe Management Measures (VDS) is starting from 14^th February, 2022. If somebody has not taken the booster, then he/she is given 5 to 9 months after the second dose, to take the booster. Health protocols have been defined for three groups: unwell, well but test positive and identified by MOH as close contact of an infected person. If well but test positive, self-isolate at home. Repeat RAT after 3 days, if negative, then self-isolation can be discontinued. If unwell, get tested and if positive self-isolate at home for 10 days if vaccinated and 14 days if unvaccinated or partially vaccinated. A close contact of an infected person is required to take RAT and upload results on the website. Repeat RAT and go out only if negative. If negative after 7 days then no further test needed. Around 11% of children aged 5-11 years have taken their first dose of Covid-19 vaccine. The Pfizer vaccine has been authorised for use in this age group. For those who have taken Sinopharm and Sinovac vaccines, three doses of the same are considered as the primary complete vaccine course in Singapore.
• Malaysia: Omicron is in the country, but the cases are not so rampant as the delta variant. Yesterday, there were 3381 new cases. Out of these, 98.9% were category 1 cases and 1.1% were in categories 3 to 5. Saliva test kit is now available, the price of which is regulated by the government. If positive, then to be confirmed with RAT/RT PCR. Category 1-3 patients can remain at home and if negative, then they can go out. There are SOPs like face masks, hand wash, social distancing and the government is encouraging people to follow these SOPs. The vaccination program is going on and there is lot of hesitancy about booster. People are apprehensive about mix and match of vaccine. All children aged 12-17 are all vaccinated with 2 doses, but vaccination for the 5-11-year age group is not started yet. 
• Pakistan: The country is in the fifth wave. Self-care is priority. After exposure to Covid-19, it is advised to get RT PCR done as no home test kits are available. If positive, they are advised to stay at home and self-isolate and follow SOPs like masks and handwashing. Repeat test after 3 days, if negative then come out of the isolation. In the hospitals, treatment protocols are in place. The telehealth system is working very effectively in Sind province. Positive cases are monitored by telehealth. 73 million (32%) people have had both vaccine doses and 99 million have taken the first dose. Booster dose has been authorized for ≥30 years. Pfizer vaccine is used as booster. Children older than 12 years are being offered vaccination in their schools, but parents are hesitant. Cases are increasing. In the last 24 hours, there were 1292 new cases, 6 deaths, 1.2 million have recovered. People are not following SOPs. The spread of Omicron is slow. There are 372 omicron cases. The NCOC (National Command Operation Center) meets every two weeks. 
• USA: There is a rapid surge in cases across the country. The Pfizer vaccine is approved for booster in children aged 12-15 years. Flurona has been reported. Total cases are 59,846,235 cases, of which 900,000 are new cases today; 2645 deaths, over 3 million tests and 5000 were hospitalized and 409 were in ICU. This week the CDC reduced the isolation time from 10 days to 5 days. There is shortage of home test kits. Isolation has been reduced to five days after a positive Covid test. Testing has not been included in the CDC recommendations on return to work/school. There is an increase in pediatric cases and  hospitalizations. For the week ending Dec. 30^th, more than 325,000 pediatric cases were reported indicating a 64% increase over the 199,000 cases reported in the week ending Dec. 23^rd. Pfizer vaccine has been approved as booster for 12-15 years. Sotrovimab has been found to be effective in treating the Omicron variant. Paxlovid and molnupiravir are to be used in the outpatient setting only. Cases of Flurona (concurrent influenza infection and SARS-CoV-2) have been reported.
• Australia: There are no cases in Western Australia, but cases are rapidly increasing in the states of Victoria and New South Wales. A major problem is the impact on the work force. The supply chain is affected. The gap for the booster has been reduced to 4 months from the last (second) dose and from the end of this month, a 3-month gap will be required. Vaccination for children aged 5 years will start from Monday. Pfizer and Moderna vaccines are given as booster. Because of inadequate supply of RT PCR, RATs have now been opened up. If a person tests positive on RAT, then start isolation and mandatory reporting of RATs is required. Restrictions are coming back and masks are mandatory except in Western Australia. Cases in NSW are expected to peak in first week of February. 
• Japan: The country is in the midst of the sixth wave. Okinawa US base is the epicentre 2000 out of 100,000 tested positive in last 7 days. There are no deaths and no patient in ICU/ventilator. 80% have received two doses. Booster for medical staff and elderly has started. For symptomatic, 10 days quarantine, close contacts for 14 days quarantine. There is a mild lockdown in some cities.
• South Africa: There are no restrictions on movement from 31^st of December. Wearing a mask is compulsory. There is emphasis on social distancing, handwashing, avoiding crowds. Children >12 years are being vaccinated. We saw a very fast spread of the infection. The numbers came down as fast as they went up. Omicron is a mild disease. No differentiation between vaccinated and unvaccinated cases in mild disease, but difference is seen in hospital cases, where the majority are unvaccinated. The number of patients ventilated (304) has remained constant over the last few days. Patients on oxygen  1300; new cases in the last 24 hours 9260, deaths 140, positivity rate was 20.2%.
• 361 admissions in the last 24 hours. The unvaccinated and 50+ patients are likely to have severe disease.  Treatment protocol includes dexamethasone for patients requiring oxygen supplementation or mechanical ventilation, heparin prophylaxis is given. However, chloroquine, HCQ, Ritonavir+ lopinavir, colchicine, azithromycin and NSAIDs are not recommended for Covid management. No contact tracing is done now. Isolation has been shortened. Lockdown has been lifted. Omicron is still treated as a mild disease.
• Philippines: Last week there were less than 400 cases per day. But starting January, there is a surge in cases due to Omicron. Yesterday, there were 21,819 new cases and 129 deaths, 77,369 active cases. Total number of cases is 2.9 million and total deaths are 51,871 in number. From January 3, the alert level has been increased from Level 2 to Level 3 until the end of January. Under the new quarantine guidelines issued by the Dept. of Health, the fully vaccinated persons must quarantine themselves after exposure for 7 days, while the unvaccinated persons must quarantine for 14 days. For confirmed cases, the mild to moderate patients must isolate for 10 days from the time of onset of symptoms. Asymptomatic persons must isolate for 10 days from the time of testing. Cases are increasing in children. The vaccination for 5-11-year age group will commence in February. So far, 51 million people have been vaccinated, the target is 70-80 million.
• India: We are slowly moving towards the third wave is now here. In the last week of December there were around 8000 cases, but within a week, the numbers have spiralled and now there are up to 1.4 lakh daily new cases. The total number of Omicron cases as of today is around 4000 and two deaths have been reported. So far, Omicron is characterised as a mild disease. 94% have taken the first dose, while 64% are fully vaccinated with two doses. Children aged 15-18 years are now eligible for vaccination with Covaxin. From 15^th, booster dose will be available to healthcare workers and the elderly and those with comorbidities. The same vaccine as the primary vaccine will be given as booster. There is no mix and match of vaccines. The test positivity is 7.6%. Hospital admissions have reduced from 10% to 8%, while ICU admission rate is 0.8% of all admissions. The number of cases is increasing, but mortality and severity are not increasing. Night restrictions and weekend curfew are in place in some cities. The number of persons in indoor gathering is limited to <100. Seven-day quarantine with RAT is required for international travelers. Category A (mild) patients can self-isolate at home. But if symptoms increase then they are required to report to dedicated hospitals. Category B patients include patients > 65 years even with mild symptoms and those with comorbidities. Category C patients are those with severe symptoms. The first line of management is monoclonal antibodies cocktail given as day care. Molnupiravir has been granted EUA, but is not available yet.

Participants

Member National Medical Associations

Dr Yeh Woei Chong, Singapore, Chair CMAAO 

Dr Marthanda Pillai, India Member World Medical Council, Advisor CMAAO

Dr Wasiq Qazi, Pakistan, President-elect CMAAO

Dr Ravi Naidu, Malaysia

Dr Angelique Coetzee, South Africa

Dr Akhtar Hussain, South Africa

Dr Benito Atienza, Philippines 

Dr Salma Kundi, Pakistan

Dr Qaiser Sajjad, Pakistan 

Dr Md Jamaluddin Chowdhury, Bangladesh 

Dr Marie Uzawa Urabe, Japan

Invitees

Dr Russell D’Souza, Australia UNESCO Chair in Bioethics

Dr Monica Vasudev, USA

Dr Mulazim Hussain Bukhari, Pakistan

Dr Anita Dhar, India

Dr Arun Jamkar, India

Dr S Sharma, Editor IJCP Group

Moderator

Mr Saurabh Aggarwal