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1049: Minutes of Virtual Meeting of CMAAO NMAs on “Asian countries update – part 2”
8th August 2020, Saturday, 9.30am-10.30am
Participants Member NMAs: Dr KK Aggarwal, President CMAAO, Dr Yeh Woei Chong, Singapore Chair CMAAO, Prof Ashraf Nizami, Pakistan, First Vice President CMAAO, Dr N Ganabaskaran, President Malaysian Medical Association, Dr Marthanda Pillai, Member World Medical Council, Dr Alvin Yee-Shing Chan, Hong Kong, Dr Marie Uzawa Urabe, Japan, Dr Ashraf Nizami, Pakistan, Dr Sajjad Qaisar, Pakistan, Dr Md Jamaluddin Chowdhury, Bangladesh, Dr Prakash Budhathoky, Nepal, Dr Lochan Karki, Nepal
Invitees: Dr Russell D’Souza, UNESCO Chair in Bioethics, Australia; Dr Zion Hagay, Israel Medical Association; Dr S Sharma, Editor IJCP Group
Key points from the discussion
- The correct interpretation of RT PCR test, done with 2 antigens, same reagent, same lab results is important.
- Rising Ct (cycle threshold) value means that the viral load is reducing.
- After nine days, the virus is detectable but does not replicate and is non-culturable.
- COVID-19 is an “acute immunoinflammatory manageable viral illness with post viral phase”.
- Singapore is reaching the tail end of the epidemic. Swabbing of all migrant workers (330,000) has been completed and large numbers of them have returned to work. Community cases remain 1-2 per day.
- Malaysia is concerned about the issue of illegal immigrants
- In Indonesia, testing is inadequate; they are using luminosity to find out the situation, i.e., they send a satellite at night and measure the light pattern all over the country and compare with base data from previous years and estimate the amount of COVID cases from satellite images.
- In Bangladesh, tests are limited (12-13,000/day), 4-25% are positive, mostly the young have the infection, people are losing interest.
- In Pakistan, people are not following SOPs to prevent the infection; they don’t use mask or observe social distancing.
- In Nepal, when the infection first came in, the cases were asymptomatic; after lockdown relaxed, the cases have again started to increase. Most cases now are symptomatic. This may be due to a new mutation of the virus.
- Prevent the infection as much as you can; if you can’t, then manage it. If positivity rate is >10%, then strict precautions need to be taken; if it is less than 5%, then let the infection happen. If 25% of population is infected, then the first wave is likely to be over. This is herd immunity for the first wave.
- There are six strains of the coronavirus: L strain (original strain in Wuhan), strains S, V, G, GR, and GH.
- Multiflanged approach to reduce the infection: state, society and the individual.
- RT PCR detects viral antigens (E, S, M, ORF 1a, 1b, NS, RdRp); if E antigen is negative, no corona. If the kits test for multiple antigens, the sensitivity of the test is higher. For doctors, a policy recommendation can be made that minimum 2-3 antigen tests must be done; this will reduce the chances of false negative result.
- After 10 days, the virus is nonreplicable, so test is not required after 10 days. The person can move out and after 14 days, can resume work.
- The government of Bangladesh is considering a new order regarding duty hours of doctors. Earlier, 7 days’ work and 14 days’ quarantine (7 days at home) and then resume work. Now the Bangladesh government has changed this to 14 days work and 14 days quarantine (no home stay).
- The participating NMAs were of the opinion that working for 14 days straight is not a very sensible recommendation as fatigue sets in. Not allowing doctors to go home to their families may result in mental health problems. Working hours should also be reduced to reduce viral load. However, this could lead to shortage of manpower.
- A resolution was passed to be sent to Dr Md Jamaluddin Chowdhury, representing the Bangladesh Medical Association for discussion with the government.“In a CMAAO meeting today, 8th of August 2020, it was resolved unanimously that COVID-19 duties for medical staff should not exceed more than 7 days at a stretch and the daily shift should not exceed 8 hours.”
- Dr Alvin raised the issue of resident doctors’ strike in South Korea, who are protesting the government’s decision to increase the number of medical students in the country to meet the shortage. CMAAO would try to reach out to South Korea to see if they need any kind of assistance.
· Death in symptomatic cases: less than 1% (with best of care). Therefore, deaths x100 = expected number of symptomatic cases
· Cases after 7 days: Cases today x 2 (based on doubling time 7; this will vary from country to country)
· Cases expected in the community: Get the number of deaths occurring in a 5-day period; estimate the number of infections required to generate these deaths based on the country or area case fatality rate; compare that to the number of new cases actually detected in the 5-day period. This can give an estimate of the total number of cases (confirmed or unconfirmed)
· Lockdown effect = Reduction in number of cases after average incubation period (5 days)
· Lockdown effect in reduction in deaths: Reduction in number of deaths on day 14 (average time to death of that country)
· Requirement of ventilators on day 9: 1-3% of number of new cases detected
· Requirement of future oxygen on day 7: 10% of total cases detected today
· Requirement of ventilators: 1-3% of number of cases admitted 7-9 days back
· Requirement of oxygen beds today: 10% of total cases admitted 7 days back
· Case fatality rate: Number of total deaths as on date/number of total RT PCR positive cases as on today
· Infection fatality rate: Number of total deaths as on date/number of total calculated cases as on today
· Number of people which can be managed at home care: 90% of number of cases today
· Number of reported deaths: Number of confirmed deaths x 2
· Number of asymptomatic cases: For 6 symptomatic cases, 200 asymptomatic cases
· Number of unreported or untested cases = Number of reported cases x 10-30 depending on the country
Dr KK Aggarwal
President CMAAO, HCFI and Past National President IMA