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THIS set of notes/ideas is styled as a FAQ and focused on how to understand Covid-19 better, vaccination (boosters, children), ventilation optimisation, improving home & office safety.

Important note: Information regarding Covid-19 changes rapidly and is very fluid. The pandemic is in evolution. Hence what is said today may need to be revised tomorrow. We need to follow ALL of the data, science and evidence; we cannot follow only part of the evidence.

Is the Delta variant more severe?

There is increasing data and clinical experience to suggest that the Delta variant is not just more contagious but more severe than the original Covid-19 virus. There is data from the UK to show that hospital admissions are twice as likely with the Delta variant than with the Alpha variant. A recent study from Canada showed that the Delta variant (compared to non-variants of concern) had a 120% higher risk for hospitalisation, 287% for ICU admission and 137% for death. Unpublished data from Florida showed 3.1-3.8 times higher mortality rates in children and young adults with the Delta variant. Our local data on deaths in Malaysia showed the huge escalation of deaths in the Delta wave – 76% of all deaths so far have occurred from July to September 2021, with one in five dead on arrival, one in three occurring in well persons (no comorbidities) and 45% under 60 years of age.

Remember that this is without vaccination – full vaccination reduces your risk of severe disease or death by 10 times.

Will I get a breakthrough infection after vaccination?

There is still some debate as to whether there is real vaccine waning immunity or if Delta is evading vaccination. There has been increasing data to show that at least one in three persons who are fully vaccinated with mRNA or adenovirus vaccines may get a breakthrough infection5 and that this rate is higher the longer the time from the vaccination date. However, the majority of the data supports that mRNA or adenovirus vaccines are still protective against severe disease and hospitalisation in the range of 85-95%. The data for long-term effectiveness of the Sinovac vaccine is still unclear. There is some suggestion from our local data that the effectiveness of Sinovac at preventing hospitalisation and ICU admissions is not as strong as the Pfizer or AstraZeneca vaccines.

As a higher proportion of the population is infected, we should expect that the majority of cases will begin to appear in the vaccinated (breakthrough) but will generally be mild. Vaccinated individuals clear the infection quicker; vaccinated individuals have milder disease and vaccinated people are less contagious.

This outlines the need for universal masking and maintaining critical SOP even after vaccination. In addition, to monitor the outbreak in Malaysia, we should also move away from looking at new cases to looking at new hospital admissions (see CovidNow website). And especially look at hospitalisation and severe disease in the vaccinated by type of vaccine.


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