CMAAO CORONA FACTS and MYTH COVID Informed Consent : Dr K K Aggarwal

Minutes of Virtual Meeting of CMAAO NMAs on “Asian Countries Update – Part 1”- 1^st August, 2020

9.30am-10.30am, Dr K Aggarwal , President CMAAO

With inputs from Dr Monica Vasudev

Participants

Member NMAs

Dr KK Aggarwal, President CMAAO

Dr Yeh Woei Chong, Singapore Chair CMAAO

Dr Marthanda Pillai, Member World Medical Council

Dr Alvin Yee-Shing Chan, Hong Kong

Dr Subramaniam Muniandy, Malaysia

Dr Marie Uzawa Urabe, Japan

Dr Ashraf Nizami, Pakistan

Dr Prakash Budhathoky, Nepal

Invitees

Dr Russell D’Souza, UNESCO Chair in Bioethics, Australia

Dr S Sharma, Editor IJCP Group

Dr Marthanda Pillai spoke about Covid situation in the Gulf countries. Dr KK Aggarwal analysed the Covid data in South Asia and Dr Yeh Woei Chong gave an update on Covid in China, South Korea and Singapore. Dr Alvin Yee-Shing Chan spoke on the current scenario of Covid in Hong Kong.

Covid in Gulf countries

Dr Marthanda Pillai

Many of Gulf countries have been proactive in response to Covid-19 launching tremendous efforts to control the infection prior to detecting the first case.
Iran was the first country to be affected; it continues to be a hotspot.
Saudi Arabia: Spread from Iran; disease detected in Jan/Feb, quick to implement measures to control the infection.
UAE reported four cases on 29^th January. Subsequently, Bahrain, Kuwait, Oman, Iraq and Qatar reported their first case in late February. These cases were either Iranians or citizens of Gulf countries who had recently visited Iran.
Lockdown has been implemented, schools/religious places have been closed, no public transport in operation.
There is a good system of testing.
The entire treatment is free, especially Covid-19 treatment, for all citizens.
Overall, total cases are around 2.3 lakh; the cure rate is around 45-50%. Mortality is less than 1% except in Iran, where mortality is 3.2%.
Non-Covid patients are restricted; e prescriptions are being given, which has helped to control the infection.
Restrictions are in place; there is no international travel except chartered flights for people who wish to go back to their country of origin. Their status is checked.
The status of these countries has an indirect impact on the situation in our countries.

Covid-19 in South Asia

Dr KK Aggarwal

The south Asian region includes 8 countries: Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka.
If the population density is more, the number of cases will be more in the first wave. If density is more than 1000, the number of cases is higher. Among the 5 countries, Bangladesh is the most densely populated at 1174/sq km. In all the rest, the density varies between 200 and 400.
India has the maximum number of cases in the South Asia region.
India, Pakistan and Bangladesh are almost the same in terms of total deaths per million population (20-25) and also same case fatality rate, which is around 2%. The total deaths per million population is 2 in Nepal; this may be because Nepal is yet to peak and spread is not yet seen.
The situation in Sri Lanka is however different despite similar population density. The case fatality rate is low (1%) as is the total number of cases.
Analysis of the indicators of health infrastructure shows that all five countries have almost similar number of physicians per 1000 people. But in terms of hospital beds per 1000 population, Sri Lanka has the highest number (3.6); in India, Pakistan, Nepal and Bangladesh, this number if 0.5-0.8.
Sri Lanka and India reported their first case of Covid-19 at nearly the same time; 27^th January and 30^th January, respectively.
All five countries implemented lockdown around the same time, but Sri Lanka extended the lockdown much longer.
More than 10% positive rate practically means community transmission and if less than 5%, then lockdown can be lifted. India, Pakistan and Bangladesh have more than 10% positivity rate
Reasons for low mortality in Sri Lanka: First in the region to eliminate malaria, better hygiene index, educated population, better infrastructure, extended lockdown.
Kerala has similar mortality as that of Sri Lanka (0.3%); total cases are 23,000 cases and only 74 deaths. The seroprevalence is less than 10%. The seroprevalence in Delhi and Mumbai and Pakistan is around 20-30%. In Bangalore, seroprevalence is 10-12%.

Covid-19 in China, South Korea & Singapore

Dr Yeh Woei Chong

China: Confirmed cases 84292 (discharged 78974, deaths 4634); cases have been rising from last one week. From 11^th June to 23^rd June, there were 256 cases in Beijing. Prior to this, there were no cases for 55 days. The trigger is a seafood market like in Wuhan and the source of infection apparently is contaminated chopping boards. China has a huge testing capacity; it is testing people in large numbers – half million tests daily. Outbreaks in Dalian and Xinjiang in the last week; the new outbreak in Dalian has been linked to a seafood company and contamination from packaging is suspected. On 30^th July, there were 11 cases in Dalian and 112 in Xinjiang.
South Korea: There are more than 14,000 confirmed cases; 13183 have been discharged and around 300 have died due to the infection. There is a second wave in South Korea. The number of cases is increasing. There were 113 cases on 30^th July (Friday). South Korea has done 1563796 tests. Their clusters are nightclubs, door to door sales, churches, ports, and nursing homes.
Singapore: There are around 52,000 cases. Majority of cases in the country are in dormitories housing migrant workers (around 50,000), while the community are only around 2000 cases. Last week there were 400 cases in dormitories and 5 in the community. Around 5400 cases are in isolation. Since February, there are 128 ICU cases; this number has been zero since last 2 weeks. Number of tests performed is 1.23 million. There are 323,000 migrant workers in dormitories. Of these, 262,000 have recovered or cleared of the virus. Efforts are on to clear all the dormitories of Covid-19 by 7th August. Migrant workers are swabbed every month towards this end. 975 factory dorms + 64 blocks in 17 purpose built dorms have been cleared. Everybody is swabbed and if there are any cases, swabbed again after a week. 13000 swab tests are done in a day.

Hong Kong Update

Dr Alvin Yee-Shing Chan

Hong Kong is experiencing the third wave (July) with 3271 cases and 27 deaths, which is serious; up to end of June, there were 1200 cases and 8 deaths; in 2^nd wave in April, the maximum number was only 65.
Origin of the third wave is from sea men and air crew who were exempted from quarantine and routine testing together with relaxation of rules of social gathering and fatigue set in.
No capacity for en masse testing ; bottleneck of testing 13,000 daily; now screening started for high risk groups – people working in restaurants, catering, sellers etc. No exemption now from testing and quarantine.
Manpower is adequate; 6219 doctors in public hospitals, only half of public hospital beds are occupied in the past two months as all elective surgeries have been postponed in public hospitals.
T614 gene mutation was found in cluster of sailors entering Hong Kong from Kazakhstan and Philippines; this DNA expression is similar to that seen in many people in Hong Kong infected in the third wave. Patients became more serious and more infectious.
Virology Dept in the University of Hong Kong is working on research to produce a vaccine against Covid-19.
Holiday homes/villages/resorts have been modified as isolation and quarantine centers for mild cases to prevent cross infection to family members.

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