Adapting to Challenges of COVID-19: A Facebook Live Session

In light of the COVID-19 pandemic, Malaysia is facing numerous issues that may cripple its socio-economic growth if not handled properly. Therefore, ASM has conducted a Facebook Live with the Ministry of Science, Technology, and Innovation (MOSTI) titled Penyesuaian Terhadap Cabaran COVID-19 (Adapting to Challenges of COVID-19).

The Facebook Live Session featured MOSTI Minister YB Khairy Jamaluddin as the moderator. Three ASM Fellows were invited to share their expert knowledge and opinions: Professor Datuk Dr Awg Bulgiba Awg Mahmud FASc, Professor Dr Mahendhiran Nair FASc and Professor Dr Shamala Devi K.C. Sekaran FASc.

Note to Readers: COVID-19 is the term given to the disease, while SARS-CoV-2 is the name of the virus. (Source)

Following a brief introduction by YB Khairy, Professor Dr Shamala Devi K.C. Sekaran FASc, an expert on immunology  and virology commenced her presentation. Professor Shamala started by providing an introduction on how the name “coronavirus” came to be. The word comes from the Latin word corona, meaning garland or crown, which the virus resembles. The virus has a sticky lipid outer cover that enables it to cling on surfaces for a certain period of time. It is transmitted between humans via droplets either by talking, coughing, or sneezing. When it is transmitted, its sticky outer lipid layer enables it to cling on surfaces for a period of time.

Source: New Scientist

Professor Shamala went on to state that SARS-CoV-2 (the virus that causes the disease) is a novel virus; this means that this is the first time we are exposed to it. Despite the similar name, SARS-CoV-2 is not the same as the one identified during the SARS outbreak, which is named SARS-CoV-1. Professor Shamala has highlighted that there are reports stating that the virus can stay up to 30 days in the human body. Therefore, quarantine and self-isolation is important to limit transmission.

Professor Shamala highlighted the reverse transcription polymerase chain reaction (RT-PCR) test as a gold standard in COVID-19 testing. This test is a nuclear-derived method for detecting the presence of specific genetic material from any pathogen, including a virus such as SARS-CoV-2. Originally, the method used radioactive isotope markers to detect targeted genetic materials, but subsequent refining has led to the replacement of the isotopic labelling with special markers, most frequently fluorescent dyes. There are may other test kits to detect infection, but proper validation by medical professional is always required.

Continuing on the topic of effective testing, Professor Shamala noted that one negative test is not enough; she recommends returning for another test in five to seven days to ensure it is a true negative. ASM has produced a Fact Sheet featuring Professor Shamala and Professor Datuk Dr Asma Ismail FASc on the importance of obtaining a true negative through double testing.

According to Professor Shamala, everyone is equally susceptible to COVID-19 because it is a new virus; no one has developed natural immunity to it yet. What differs is the ability to recover from it. A younger person may stand a better chance of recovering from COVID-19, unless they have a pre-existing health condition such as diabetes or heart disease. In that case, they may also be stricken with a more severe case of COVID-19.

When asked whether all infected patients require a ventilator if they are admitted for COVID-19, Professor Shamala stated that only a small portion of the patients will experience the critical stage of COVID-19 that necessitates a ventilator; most will only experience a mild form of the infection.

YB Khairy inquired on the possible cause of high death rate in Italy. Professor Shamala explained that Italy is an ageing population and when viewed in detail, most of the deceased patients in Italy are in the older demographic.

Next, YB Khairy engaged Professor Datuk Dr Awg Bulgiba Awg Mahmud FASc, an expert on clinical epidemiology, medical statistics, and health informatics. Professor Awg Bulgiba started off with a quick introduction to who an epidemiologist is. An epidemiologist not only counts the number of patients stricken with a disease, but also studies the distribution of a disease (e.g. demographic, location, and other factors) as well as finding the source or cause of the disease. They also strive to reduce the disease’s effects on the human population.

When asked about supposed “cures” for COVID-19, such as hydroxychloroquine and a traditional remedy using daun semambu (neem),  Professors Awg Bulgiba and Shamala both agree that clinical trials are the way to go in determining the actual efficacy of these supposed “cures”. Clinical trials are standardised testing methods that determine whether the components are instrumental in curing COVID-19. Without proper testing, it cannot be ascertained that these “cures” worked against the virus. Maybe a strong immune system or a healthy diet were the actual factors for recovery from COVID-19.

Professor Awg Bulgiba emphasised the importance of quarantining in reducing the transmission rate of the SARS-CoV-2 virus. COVID-19 is a novel infectious disease with no known cure; therefore, epidemiologist have recommended quarantining as a solution. Social distancing is a form of quarantining, which has its roots in history. The method of isolation was not ideated in modern times; the Muslim polymath Ibnu Sina (980-1037) has been credited with the development of quarantine as a method of controlling the spread of disease. The logic behind it is if we are not close to an infected person, our chances of contracting the disease is greatly reduced. The reduced transmission rate also provides a window of opportunity for countries to develop a vaccine and flatten the curve.

When asked about how soon will the MCO be lifted, Professor Awg Bulgiba provided his view: before the MCO can be lifted, experts need to look into when the disease curve reaches the peak; then we need to see whether the peak will descend afterwards in a downward trend. That shows that the disease is slowing down. However, daily numbers cannot be used to gauge the downward curve; numbers need to be observed for at least seven to 14 days to see whether the number is actually descending or not. Even when a downward trend in the disease curve is observed, Professor Awg Bulgiba does not rule out the possibility of COVID-19 returning even after said reduction. Therefore, a measure of precaution must still be observed.

Continuing the session, YB Khairy presented the oft-asked question: why don’t we just allow people to live freely to get herd immunity? Prof Awg Bulgiba explained that herd immunity is when 95% of the population has immunity to a certain disease. SARS-CoV-2 is a novel virus; it is not sure whether someone infected normally (not via vaccination) can develop natural immunity in time. If we were sure and the virus is not lethal, letting people go about their daily business would be okay. However, according to current statistics, about 1% of the population dies from COVID-19; it would be unacceptable to attempt developing herd immunity this way.

YB Khairy asked Professor Awg Bulgiba about the implications to the health and medical system when the curve gets too high. Professor Awg Bulgiba explains that without suppression system, the number of infected persons would increase exponentially. Considering the current availability of facilities as well as other patients with other health conditions that need care, that would overwhelm the system as there would be not enough facilities to cater to all patients. A suppression strategy such as social distancing is put in place to allow some space and time for efforts such as vaccine development that will hopefully develop resistance and cure COVID-19.

Also present in the Facebook Live Session was Professor Dr Mahendhiran Sanggaran Nair FASc, an expert on data science, and statistical & econometrics methods.

According to Professor Mahendhiran, modern technology is widely available nowadays, but the capabilities vary with each country. He cited South Korea as an example: in a society as highly connected as South Korea’s, it is easily to track the population over time via technology; it is a practice widely carried out by consumer companies for a while now. However, issues arise when the topic of data privacy is brought up. Therefore, to mitigate this, some countries are revisiting how they look at data privacy and under what conditions they are allowed to use these data. Malaysia may have the technology, but we may not have the regulatory architecture.

Apps can be an integral part in the effort to curb COVID-19,
but without proper regulatory framework and architecture, it will not be as effective.

YB Khairy brought up a new app developed by the Singapore’s Government Technology Agency (GovTech) and the Singaporean Ministry of Health that enables authorities to identify those who have been exposed to people infected with coronavirus as part of efforts to curb the spread of the disease. He asked Dr Mahendhiran’s opinion on the app’s effectiveness and importance in the Malaysian context. Undoubtedly the app has its benefits, but without proper regulatory architecture and framework in place to determine who gets to view and see the data collected, it would do no good to quell the population’s concerns about the constant monitoring. Aside from possessing the architecture, educating the population on the value of the data and how to use it is equally important.

YB Khairy asked Professor Mahendhiran on Malaysia’s ability to apply existing technology and innovation to repurpose its industrial capacity to create products necessary in battling COVID-19, such as face masks and gloves. Professor Mahendhiran mentioned the importance of agility of industries in adapting to face challenges. When the Industry 4.0 Plan was launched, a segment called Smart Factories entailed using new technologies that grants agility in production processes. Many of these technologies that are available these days are relatively affordable, enabling industries to change up their business models and adopt more autonomous systems and processes, and data analytics.

Approaching the end of the Facebook Live Session, YB Khairy asked Professor Mahendhiran how businesses will adapt to the “new normal”. Professor Mahendhiran provides a short- and long-term perspective on the matter: in the short term, micro and small businesses may be able to sustain themselves; the government can support them in the interim via financial adis such as loans and grants. However, moving towards a more technology-based platform would be beneficial in the long run. The Government’s support for them to adapt to the digital economy is really necessary such as providing ICT support for SMEs and promoting ICT literacy. Intensifying Industry 4.0 technology is important to set the tone for long-term development.

YB Khairy concluded the session by stating that the Facebook Live Session is an effort by MOSTI to show that all government decisions for the nation are based on science. He hoped that this session would help inform the nation with the right information. YB Khairy also reassures that Malaysia is approaching this challenge to fight COVID-19 with scientific facts and we will get through this together.