Red flags were raised when 204 out of 453 personnel at the Ideal Convention Centre vaccination centre (PPV) in Shah Alam were infected with COVID-19.
88% of them were reported to be vaccinated. [1]
Many of the concerns would be immediately allayed if the minister had informed that none or miniscule few of them suffered from COVID-19 severe enough to require to be hospitalized. And that all of the personnel had very low virus counts in their upper airways and were therefore virtually non-infectious.
Instead he chose to be medically savvy and said that the CT (Cycle Threshold) values were above 35 and that the viral load was low. [2]
For the less informed (which I suspect includes all of the lay public and a considerable proportion of Health Care Workers) CT values above 30 are associated with a low viral load and the person is considered as non-infectious.
The caveat being a proportion of infected persons who are in the early phase of the illness, and who are asymptomatic or pre-symptomatic, only to exhibit signs later and become infectious. So all the reason for them to be quarantined to protect against this potential eventuality.
I hope the authorities would be wiser and smarter in their management and risk communication of the more recent outbreak at the Setia City Convention Centre mega vaccination site (PPV) in Shah Alam. [3]
A friend and his immune-compromised spouse who were at the SCCC PPV were very concerned. Since they were there for their second AstraZeneca shot, I reassured them with the following messages.
Since you would very likely practice your SOPs, you guys are virtually zero risk! It is the PPV personel who are at highest at risk since they are more likely to be closer together, eat, chat, smoke and some of them maybe actually be unvaccinated.
Your first AstraZeneca dose would confer you both (maybe less so for your spouse):
85% protection against being hospitalized with Alpha COVID-19
83% protection against being hospitalized with Beta and Gamma COVID-19
The data against Delta COVID-19 hospitalization is mixed. The UK data reports only 33% protection whilst the Canadian data reports 88% protection [4,5]
Isn’t this after all the raison d’etre of the COVID-19 vaccines? The vaccines were designed to prevent serious illnesses, hospitalizations, admissions in the ICUs and deaths. These are the very sequelae of serious COVID-19 that would fill our hospital and ICU beds and overwhelm our health care capacity.
This was borne out in the KKM report on breakthrough infections. Only 3,106 (1.26%) of the 245,932 HCW who had mostly received Pfizer vaccines, were infected. The majority of these were Category 1 and 2 infections, asymptomatic or mild symptoms. There were 3 cases each in Category 3 and 4 requiring hospital care (0.2%). And there were no Category 5 cases nor any deaths reported.
All of our 751 staff in our hospital were immunized with the Pfizer vaccine. There were 13 breakthrough infections (1.73%). All of them were Category 2 and none required to be hospitalized.
A total of 10,262 (0.01%) vaccine breakthrough infections had been reported in the US as of 30 April 2021. Approximately 101 million persons in the US had been fully vaccinated against COVID-19. Unlike the MOH or our hospital which picks up virtually all cases of breakthrough infections, the US numbers would be significantly under-reported since the national surveillance system depends on passive and voluntary reporting. [6]
Preliminary data showed that 2,725 (27%) of the breakthrough infections were asymptomatic. 995 (10%) patients were known to be hospitalized. Among these, 289 (29%) were asymptomatic or hospitalized for a reason unrelated to COVID-19.
160 (2%) patients died. 28 (18%) of these were asymptomatic or died from a cause unrelated to COVID-19. The median age of patients who died was 82 years.
Genomic sequences were available from 555 (5%) cases. 356 (64%) were identified as variants of concern (VOC).
The Singapore MOH reported that for those fully vaccinated, 158 persons had been infected. Two (1.3%) of them, both with pre-existing illnesses, required oxygen supplementation and none required ICU care. [7]
In Thailand, 618 (0.09%) out of 677,348 HCW who received two doses of Sinovac, became infected. The news report only mentioned a death in a nurse and another HCW was in critical condition. [8]
All of these data emphasize the fact that the vaccines are effective. The rates of COVID-19 have declined among those vaccinated. Virtually all of those hospitalized for COVID-19 or succumbing to it are among the unimmunized. [9,10]
There is a powerful message here for all Malaysians, notably those who are vaccine hesitant or reluctant. The overwhelming majority of the COVID-19 cases are now seen among the unvaccinated. COVID-19 has now become the pandemic of the unimmunized.
References:
- https://www.nst.com.my/news/nation/2021/07/709161/release-data-covid-19-infections
- https://www.nst.com.my/news/nation/2021/07/707810/204-idcc-ppv-workers-contracted-covid-19-nsttv
- https://codeblue.galencentre.org/2021/07/18/volunteers-claim-selangor-ppv-hid-covid-19-cases-no-mass-testing-or-sop/
- https://www.nature.com/articles/d41586-021-01696-3
- https://www.medrxiv.org/content/10.1101/2021.06.28.21259420v1.full.pdf
- https://www.cdc.gov/mmwr/volumes/70/wr/mm7021e3.htm
- https://www.straitstimes.com/singapore/study-of-29000-people-on-quarantine-in-spore-shows-vaccines-can-prevent-infection-and
- https://www.scmp.com/news/asia/southeast-asia/article/3140651/coronavirus-thailand-tightens-curbs-virus-hotspots-deaths
- https://www.nbcnews.com/health/health-news/virtually-all-hospitalized-covid-patients-have-one-thing-common-they-n1270482
- https://apnews.com/article/coronavirus-pandemic-health-941fcf43d9731c76c16e7354f5d5e187
Dr Musa Mohd Nordin
19 July 2021
