Topic: COVID update, New Norms and lockdown situation in each country

26th February, 2021, Saturday

9.30am-11am

• South Africa Update: Many restrictions have been eased including for gatherings outside and in closed spaces. Mask is mandatory. Schools have been opened fully. The number of vaccinated people, including those taking the booster dose is going up, though not as much as anticipated. Till now a homologous booster is being used, but recently the National Department of Health announced that hetero booster doses will be now allowed. The country is now open for travellers. New cases in the last 24 hours are 2101 and 127 deaths. The last 7-day average is 1500 to 3000. Total deaths since Covid started are 99,145. Total cases so far are 3.6 million, 34,000 active cases. The week between 13^th February and 19^th February, the positivity rate was 10.2%. It is around 8.1% since the last two days. 3028 patients were admitted in the 666 hospitals in the country, both public and private. Out of this 278 are ICU admissions and 99 are on ventilator. Among those fully vaccinated, only those with comorbidities were hospitalized. The duration of hospital stay was 1.5 to 2 days; some with chronic complications had longer stay. Omicron is being missed because of mild symptoms. Every patient coming in for any upper respiratory tract complaints should be tested. Those who have had previous Covid or vaccinated more than 4 months back should also be tested because breakthrough infections are quite prevalent. Lot of patients with BA.2 have tachycardia with pulse up to 120 and fatigue.
• India Update: The infection is easing out. The number of daily cases are 11,000 and they are mostly from southern states, which have been chronically having large number of cases. Covid is almost negligible in most northern states of the country. There is easing of restrictions and life is returning to normal. There are no quarantine now for international travelers; RTPCR is not done now as a routine for all travelers; it’s done only for those with symptoms. Schools are opening up. Online classes are now becoming less in number. Restaurant restrictions are less, cinema halls are also open but with restricted attendance. Interstate travel is now allowed. Now testing is not mandatory now for hospital admission. But most hospitals still do RT PCR before any surgery is done. 176 crore doses of vaccine have been administered, almost the entire eligible population has received one dose and most of them have received two doses. Booster dose has started for those >65 years and with comorbid conditions; 15-18 years vaccination is being given. Booster is same as the primary vaccine (Covaxin and Covishield). Emphasis is still on covid-appropriate behavior. The active case load stands at 1,34,235 (0.31%); the recovery rate is 98.49%; 26,988 recoveries in the last 24 hours takes the total recoveries to 4.22,46,384. 13,166 new cases have been added. The daily positivity rate is 1.28%, the weekly positivity rate is 1.48%. 76.45 crore tests are done;10,30,016 tests are conducted in last 24 hours.
• Australia Update: The country is opening up. Masks are mandatory in old age homes, hospitals, primary schools. Cases continue to occur with some deaths every day mainly from the geriatric population. Overall, the hospital admissions have opened up for elective surgeries. Work from home is being relooked at. Western Australia is about to open. They had a surge of 1000 odd cases, going to open on 4^th/5^th March. Last Monday, Australia opened its borders where fully vaccinated do not need RT PCR. Each state has different rules for travelers. Victoria had 6000 positive cases, but the number does not impact on hospital admissions. 95% population has taken both vaccine doses. Victoria is >50% for three doses. All 5-11-year-olds have had their first dose. Secondary schools no masks. No schools closed, students have to do two rapid tests in a week and send to the education department. If tested positive the child will not come to school for 4-5 days, but schools are not closed now.  
• Japan Update: The sixth wave is decreasing caused by Omicron. There is another seventh wave in Okinawa prefecture probably caused by the BA.2 variant. Hence, movement of people testing positive is being looked at very carefully.
• Pakistan Update: Situation is easing up in the country. Schools and markets are opening up, including international travel. In the last 24 hours, there were only 14 deaths reported. The positivity rate has come down to less than 3%. About 125 million have received the first dose and 96 million are fully vaccinated; 4 million people have got their booster dose. New daily cases are about 1200; no pressure on the hospitals, 1100 critical cases in the last 24 hours. Though people are educated about masks, only few people wear masks.
• Singapore Update: There is a big Omicron wave. Last week, the number of cases ranged between 13,000 to 25,000 cases (average 20,000 cases per day). In the last one month, 335,000 have been infected versus a total of 679,798 in the last two years. Hospitalizations are 1005, patients on oxygen 211, ICU cases are 46. Total deaths are 1000 in last two years. This is despite having 94% vaccination rate and 67% booster. No lifting of curbs in Singapore. Confinement of 5 persons outside e.g. in restaurants. Every household in Singapore has ART kits and a pulse oximeter distributed by the government. 
• USA Update: Current cases are 80,532,307 cases; 972,200 deaths and 52,866,250 recovered. There has been a dramatic decline in the last 30 days in the number of cases. The number of deaths have also declined. At least 80% of people aged 5 years and older have received at least one dose of the vaccine. There were 73,000 new cases on Feb. 24 with seven-day average of 74,100 illustrating the Omicron surge. The CDC has announced new guidelines allowing unmasking indoors from 25.2.22. however, the immunocompromised or those living with people at high risk of severe disease should continue to take precautions. Under the old guidelines, masks were recommended for people living in communities with high transmission rates. The new mandate allows people to go without masks in public indoor spaces such as restaurants, bars, shopping centers, salons, movie theaters, offices, churches, schools, government buildings. The mask mandates for planes, trains and other modes of public transportation will remain in effect until March 18. There has been a call to end all Covid testing at land crossings. In a recent update, people younger than 40 years and males were at elevated risk for myocarditis/pericarditis in the first week after vaccination with mRNA vaccines. The risk was especially increased after the second dose (preprint study). Another news is that infection with the first circulating variant of Omicron makes it unlikely to be infected with the emerging BA.2 subvariant. A MMWR report published this week found that babies born to pregnant women who had received two doses of an mRNA vaccine were 61% less likely to be hospitalized with a Covid-19 infection. Effectiveness was lower if a woman was vaccinated in early pregnancy(32%)  versus in later pregnancy (80%).
• Philippines Update: There are less than 1500-2000 new cases with a total of 3.5 million positive cases with fewer hospital admissions. The government has moved from Alert 2 to Alert 1. The number of people allowed inside is 50% and outside 75% in Alert 2. Alert 1 is reverse. Classes will soon start when Alert 1. Vaccine roll out for 5-11-year-olds has started. Two million senior citizens unvaccinated. More than 70 million completely vaccinated. The total population of Philippines is 110 million and more than 40 million, including children need to be vaccinated.
• Bangladesh Update: All restrictions have been lifted and only masks are advised. The number of cases is around 1500 per day; 5% tests are positive. Fifty percent of population is fully vaccinated, while nearly 70% have received the first dose. Today about 10 million doses (first) would be administered under a government program.
• Hong Kong Update: The fifth Omicron wave has come like a tsunami. Over 80% population has been vaccinated. Different age groups have different vaccination coverage. In 20-70 age group, over 90%; for 70-80 years, it is less than 70%; in 80 years and above it is only 40%; in 12-20 years it is 70%. Vaccination for 5-11 age group is 25%; vaccination for 3-5 years has just started 10 days ago. Parents are hesitant for vaccination, especially the mRNA vaccine for the very young children because of concerns for the long-term side effects of the vaccine. Many people are now rushing to get vaccinated. There is an exponential increase in daily cases; 10,000 cases in a day, but many people have not been tested because testing services are overwhelmed. Next week it is expected to be 20,000 because of the high transmissibility of Omicron. It is difficult to get hospital beds. There is a policy of two negative RT PCR tests before the patient is discharged from the hospital. Beds are therefore occupied and positive patients isolate themselves at home, where other members of the family may get infected. There will be mandatory community testing (RT PCR) next month.

Participants

Member National Medical Associations

Dr Yeh Woei Chong, Singapore, Chair CMAAO

Dr Alvin Yee-Shing Chan, Hong Kong, Treasurer, CMAAO

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

Dr Wasiq Qazi, Pakistan, President-elect CMAAO

Dr Mvuyisi Mzukwa, South Africa

Dr Angelique Coetzee, South Africa

Dr Akhtar Hussain, South Africa

Dr Benito Atienza, Philippines 

Dr Qaiser Sajjad, Pakistan 

Dr Marie Uzawa Urabe, Japan

Dr Md Jamaluddin Chowdhury, Bangladesh 

Invitees

Dr Russell D’Souza, Australia UNESCO Chair in Bioethics

Dr Monica Vasudev, USA

Dr Patricia La’Brooyi

Dr Wah Seng Chin

Dr EC Ng

Dr Nang Fong Chan

Dr L Soh

Dr Colin Goldberg

Dr S Sharma, Editor IJCP Group

Moderator

Mr Saurabh Aggarwal