Amar Warns Of Covid-19 Rise In Children, 1% Hospitalisation

Dr Amar-Singh expects the pandemic of the unvaccinated population to last for at least six to nine months.

KUALA LUMPUR, Oct 22 — Coronavirus cases among children aged 11 and below, who form a large fraction of the unvaccinated population, will likely increase as Malaysia transitions into a Covid-19 endemic phase, said Dr Amar-Singh HSS.

The consultant paediatrician projected that one in 100 paediatric Covid-19 cases may be hospitalised and one in 5,000 to 10,000 cases will die.

“That can be even higher if there is congestion in paediatric ICUs. One in 10 will get long Covid,” Dr Amar said in a forum titled “Covid-19: Achieving Herd Immunity and the Way Forward” on October 7.

He said that the pandemic of the unvaccinated population will last for at least six to nine months. Malaysia has not yet approved Covid-19 vaccines for children aged under 12 years old.

Approximately 10 per cent of hospital admissions will comprise Covid-19 patients next year if there are no new variants, said Dr Amar. That is when 80 per cent of the total population is fully vaccinated against the coronavirus.

“With an approximate of one breakthrough case among three fully vaccinated people, we might see 8.5 million Covid-19 infections among the vaccinated next year, including 85,333 hospital admissions,” Dr Amar said.

Of the 32-million total population, if there are 20 per cent unvaccinated people, then the country might see 6.4 million new Covid-19 infections among the unvaccinated.

“The number is lower than the vaccinated because the unvaccinated proportion is lower. But there’ll be more hospitalisations among them. Maybe 128,000 of them will be hospitalised in a year due to Covid-19.

“So if there is no new variant and only Delta with the given vaccination estimation, approximately there’ll be 10 per cent Covid-19 hospital admissions next year.”

Everyone Will Be Exposed Or Contract Covid-19

Patients and frontliners at the Covid-19 integrated quarantine and treatment centre (PKRC) 2.0 at the Malaysia Agro Exposition Park Serdang (MAEPS) on May 20, 2021. Picture from Ministry of Health Twitter.

The Peter Doherty Institute for Infection and Immunity in Australia estimated that the country will report a total of 385,983 symptomatic coronavirus cases and 1,457 deaths in six months after the country opens up at 70 per cent adult vaccination coverage.

The institute highlighted public health measures – test, trace, isolate and quarantine – should be in place to keep the virus’ reproduction number below one.

“But as vaccination rates increase, we’ll be able to ease up further and it is unlikely that we will need generalised lockdowns,” Doherty Institute mentioned in a Tweet on August 23.

Dr Amar, who echoed the same idea, emphasised that Malaysia should aim to achieve three indicators to manage the pandemic:

  • Reduce the viral load by providing a good face mask or face shield to reduce the risk of exposure to the coronavirus.
  • Reduce severity of Covid-19 infection by not only through vaccination measures, but also identifying Covid-19 infections earlier and provide necessary support.
  • Reduce community spread by implementing effective contact tracing measures, boosting Covid-19 testing measures, and providing enough ventilation support in closed premises.

“We need to realise that all of us will be exposed or will have Covid-19 in the future, even if you are vaccinated.”

More Covid-19 Deaths With Delta

A Covid-19 death in Labuan. Picture from Labuan state health director Ismuni Bohari’s Facebook page. Picture dated May 31, 2021.

Dr Amar said that the emergence of the Delta variant has caused 76 per cent of Covid-19 deaths in the country. As of October 20, more than 28,000 people in Malaysia succumbed to the disease.

From July to September, Malaysia reported a total of 17,843 Covid-19 deaths; half of them were young people.

During that period of time, the country reported 8.1 Covid-19 deaths every hour, including 21 per cent brought-in-dead (BID) cases. About 85 per cent of Covid-19 fatalities from July to September involved Malaysians.

However, these deaths do not include mortality among Covid-19 patients after they are discharged from the hospital.

“One in 10 patients die in the United Kingdom after leaving ICU,” said Dr Amar.

“But in Malaysia, I suspect two in 10 might have died after leaving the ICU. There are a lot more deaths for Covid-19 that are not counted.”

At the same time, Dr Amar mentioned that although one or more of three fully vaccinated people might get the infection, these breakthrough cases will have milder disease and are less contagious.

Dr Amar, who cited several international studies involving Pfizer and AstraZeneca vaccines, said that the risks of Covid-19 deaths and hospitalisations are reduced 10 times among fully vaccinated individuals.

Nevertheless, Dr Amar mentioned that there are not enough real-world studies to know more about the effectiveness of the Sinovac vaccine during the emergence of the Delta variant.

He highlighted the spike in Covid-19 cases in Sarawak, where almost 80 per cent of the adults there were inoculated with the Sinovac vaccine.

“Looking at the international studies and data, we should be asking if there is a larger breakthrough among the Sinovac recipients than others.”

CodeBlue recently reported that Sinovac comprised 59 per cent of 76,186 breakthrough infections among fully vaccinated people nationwide from September 28 to October 11. In that period, just 38 per cent of fully inoculated individuals received the inactivated vaccine.

No Evidence For Widespread Boosters

A health workers prepares Covid-19 vaccine dose at Sunway Medical Centre in Petaling Jaya, Selangor. Photo provided by Sunway Medical Centre on June 2, 2021.

Dr Amar said that studies on waning antibodies are not sufficient to advocate the necessity of booster shots, as longer-term cellular immunity should be taken into consideration too.

“There is no real evidence from anywhere in the world right now for routine boosters.”

However, Dr Amar said that immunocompromised people should take a third shot of the Covid-19 vaccine.

The government will expand from today the Covid-19 booster vaccination programme to senior citizens aged 60 years and older who received two Sinovac doses, who will be offered a booster with Pfizer’s vaccine via off-label use.

Pfizer boosters are also offered to health and security frontline workers, individuals aged 60 years and above, and those with comorbidities who were fully inoculated with the same mRNA vaccine.

Hospital Admissions Best Metric To Track Covid-19

A Covid-19 intensive care unit (ICU) in a public hospital in Malaysia. Picture dated May 7, 2021, from Facebook @DGHisham.

Dr Amar said that new hospital admissions is the best metric to measure the severity of the Covid-19 epidemic in Malaysia.

“We shouldn’t look at new cases. Of course new cases will happen. We expect that a lot of people will still be affected, especially among the fully vaccinated people,” said the paediatrician.

“But for the severity of cases, we have to look at new hospital admissions.”

He added that the intensive care unit (ICU) occupancy rate is not a good indicator to monitor the evolving effects of Covid-19 epidemic as ICUs have a fixed number of beds.

“If we look at the data during the height of the pandemic, only 25 per cent of people were sent to the real ICU and another 25 per cent were sent to a repurposed ICU. Some of them were not sent because perhaps they are too old.”

Dr Amar pointed out that several states in Malaysia have stopped testing asymptomatic people infected with Covid-19, which partly contributed to the decrease in official cases. Thus, the reported decrease in Covid-19 cases is not the “real decline” and all public health measures should be strengthened to prevent another new coronavirus wave.

He also highlighted the probability of unvaccinated people to be affected by Covid-19 with the emergence of the Delta variant.

“For a hundred individuals who are not vaccinated, one in ten will be hospitalised and half of them might end up in the ICU. One to two people will die because when the ICUs are full, there’ll be more deaths. Two to three people will be suffering from long Covid. Possibly even higher.”

Dr Amar mentioned that approximately 10 to 30 per cent of Covid-19 patients will experience persistent symptoms from the coronavirus, called long Covid. Since Malaysia has no strong studies and data on long-term Covid-19 effects, Dr Amar insisted that the government should focus more on long Covid.

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