Covid 19 risk com part2

Prepared by:
Tengku Hanidza Tengku Ismail, PhD.
COVID-19
RISK MANAGEMENT AND RISK
COMMUNICATION- What we know and what we
don’t know
Part II
COVID-19 RISK COMM2/TENGKU HANIDZA 1

Scientific findings and
knowledge
on COVID-19

Global debate of wearing mask
To wear or not to wear?
New research
suggests that
coughs and
sneezes may
project particles
much further into
the air than
previously thought
— six meters for a
cough and up to
eight meters for a
sneeze.

Australians were advised not to wear
face masks if they aren’t infected
by COVID-19

Previously the WHO advised that only individuals with symptoms or those taking care of at-
risk people should use masks (April 4, 2020)

• New Singapore study shows early immune system response in Covid-
19 patients could cause respiratory distress, such as breathlessness.
• If the immune system kicks into overdrive, for instance, it could
stimulate the over-production of proteins called cytokines, which can
cause inflammation.
• one particular cytokine called Interleukin-1 was produced even before
the patient showed clinical deterioration.
• The study was published in the scientific journal Cell Host and
Microbe.
Immune system too efficient backfires in corona infection

The work was posted on the
preprint server bioRxiv on March 14
in a paper titled, “Reinfection could
not occur in SARS-CoV-2 infected
rhesus macaques.” Their
conclusion: there may be no reason
to worry about reinfection.

Men are at a significantly higher risk of having severe
symptoms and dying when compared to women. Men are at
a significantly higher risk of having severe symptoms and
dying when compared to women. Medical experts have long
known men can be more susceptible to viruses than women.
Women generally tend to have stronger immune responses
to viruses, though the reason for that is still up for debate.
Genetic and hormonal differences may play a role, while
environmental factors could also contribute to a stronger
immune system. Still, while women tend to have stronger
immune systems, over 80 percent of all autoimmune
diseases are attributed to women. These occur when an
immune response is so strong, it targets and deteriorates
organs in the body.

Why Italy is the hot spot in Europe, outside China?
In 2018, 22.6 % of
its population was
65 or over, among
the highest
proportions in
Europe.
Social culture:
close proximity,
hugs and cheek-
kissing among
families and
friends
Dense
population. Two-
thirds live in
urban areas, eg.
Rome, Milan
International
business hub:
Northern Italy
home for
multinational
companies.
Close business
relation with
China
Lack of
emergency
management:
They are not
prepared for the
crisis

The effect of travel restrictions on the spread of the 2019 novel coronavirus (COVID-19) outbreak. M. Chinazzi et al.,
Science 10.1126/science.aba9757 (Mar 6, 2020).

Phylogenetic network analysis of SARS-CoV-2 genomes Peter Forster, Lucy Forster , Colin Renfrewb,and Michael Forster, Apr 8, 2020.
Proceedings of the National Academy of Sciences of the USA. https://www.pnas.org/lookup/suppl/ doi:10.1073/pnas.2004999117
Abstract
In a phylogenetic network analysis of 160 complete human
severe acute respiratory syndrome coronavirus 2 (SARS-
Cov-2) genomes, we find three central variants
distinguished by amino acid changes, which we have
named A, B, and C, with A being the ancestral type
according to the bat outgroup coronavirus. The A and
C types are found in significant proportions outside
East Asia, that is, in Europeans and Americans. In
contrast, the B type is the most common type in East
Asia, and its ancestral genome appears not to have
spread outside East Asia without first mutating into
derived B types, pointing to founder effects or
immunological or environmental resistance against this
type outside Asia. The network faithfully traces routes of
infections for documented coronavirus disease 2019
(COVID-19) cases, indicating that phylogenetic networks
can likewise be successfully used to help trace
undocumented COVID-19 infection sources, which can
then be quarantined to prevent recurrent spread of the
disease worldwide.

A ‘dark milestone’: ONE million mark

‘New York is the canary in the coal mine”
(NY City Mayor Cuomo, 31 March)
He was referring to Covid-19 hot spots
warning signal to the US. Now USA is the
latest epicentre, surpassing China and Italy.
New COVID-19 Epicenter:
USA

Health expert says "not every American is
following" social distancing guidelines (April 2,
2020)
“Just to everybody out there across the country
— when we say no gatherings of 10, we want
to be clear — if you have a family of 10, we
don’t want you to be split up,” Birx said, while
noting that the guidelines mean people should
be having “no dinner parties, no cocktail
parties.”
Corona,
come and
get me if you
dare!
Social distancing: Aren’t we
serious yet?

Where America Didn’t Stay Home
Even as the Virus Spread
California, New York and Washington, which were the first
to experience large outbreaks. Most people have
essentially stopped traveling in those places for weeks,
the data show, a sign that they are taking the measures
seriously.

But not everybody has been staying home. Florida waited so long to
shut down travel that it
will struggle to control
local outbreaks even if
people immediately
change their behavior
significantly,
In New Orleans, where more
than 2,000 people have been
infected, travel was not
reduced significantly until
March 20, weeks after Mardi
Gras brought huge crowds
together.
Gov. Kay Ivey of Alabama
resisted issuing a stay-at-home
order as the outbreak appeared
more acute and immediate in
other states. “We are not
California,” she said. “We're not
New York. We aren't even
Louisiana

In the list of exempted activities --
religious services (essential business), --
no more than 10 people can gather
(Alabama, Florida).
AL
Lessons not learned from Korea and
Malaysia. The virus is non religious
friendly
FL

Second stage of MCO (April 1-14).

Phase 1: Slow the spread
Phase 2: Reopen, state by state
Phase 3: Establish protection,
then lift all restrictions
Phase 4: Rebuild our readiness
for the next pandemic
Malaysia is near
completion of
Phase 1 as of
Apr 4

New cases vs recovered and discharged during MCO 1 & 2
(Data from DOSM)

Covid-19: Second stage of MCO (April 1-14). The Prevention and Control of
Infectious Diseases (Measures within Infected Local Areas (No. 2)
(Regulation) 2020
• All business premises selling daily essentials (supermarkets, petrol
stations, stalls, restaurants, food delivery services) are allowed to
operate from 8am to 8pm only.
• Movement is within 10 km radius from one’s residence to travel to
buy food and necessities and must not be accompanied unless it is
reasonably necessary

Source: NST
6/4/20

Lessons not learned:
A 3-day event held on Feb 26.
82 positive cases (2 deaths)

The index case did not reveal
that she has recently returned
from Italy (Europe hot spot).
She went to work without
complying to the 14-day home
isolation.
This resulted in 37 positive
cases, including 5 deaths and 1
in ICU
New and sub
clusters

A wedding on Feb 26.
88 positive cases (I ICU)
New and sub
clusters

New and sub
clusters
Lessons not leaned:
The outbreak originated from a
meeting that was held in a school
attended by an index case (Case
448), who was a participant in the Sri
Petaling event.
There were also visits of unhealthy
relatives at their homes, despite the
Movement Control Order (MCO).

1. Public
surveillance

Phones Could Track the Spread of Covid-19. Is It a Good Idea? Does it do more harm than good?
ILLUSTRATION: ELENA LACEY; GETTY IMAGES
Such tools might enable unwanted corporate
or government surveillance?
China and South Korea used smartphone
apps to monitor people with the disease.
But Americans have different views of privacy
and data collection.
Contact tracing to slow spread of corona
virus

2. Continuous practice of
social distancing OR NOT!
Barr (US AG) calls
coronavirus
restrictions
'draconian' while
health experts say
they're helping lower
death projections.
"I would hate to see
restrictions on
religion continue
longer than they're
strictly necessary,"
Texas pastors demand a
“religious liberty” exemption
to coronavirus stay-at-home
orders

1. Italian cluster (3
generations)
- 37 infections, including 5
deaths and 1 in ICU
2. Tabligh cluster (5
generations)
-1624 infections (711
index case) (April 6)
Updates: 19,032 tabligh participants had been screened so far with 15,970 samples
taken (Apr 3). 3000 yet to be screened. They have gone abroad and not returned home
Cluster contained due to immediate reporting, continous screening, active surveillance of
contacts, home isolation).

MCO/Stay at Home
Orders violators
Malaysia: Regulations 2020, which provides for a fine of up to
RM1,000, jail of up to six months or both.
Singapore: starting April 17, anyone who commits the first offence
(against such order) will face a fine of S$10,000, while for the
second offence, $20,000.
Michigan (USA): Stay-at-home order could face up to a US$1,000
civil fine, a $500 criminal fine and 90 days in jail together.
Korea: Giving false or deceptive information during the
coronavirus investigation can result in up to one year of jail
time or 10 million won in fines,” said Korea Centers for
Disease Prevention and Control Vice Director Kwon Jun-
wook in a press briefing. “Violating a quarantine order can
lead to similar penalties per laws on infectious disease
control.” (The Korean Herald)
Draconian?
Totalitarianism?
Dictatorship?
Hardship to poor
communities?
Infringement on human rights?
Authoritarian gov?

The nine MOH hospitals:
• Tuanku Fauziah Hospital
• Sultanah Bahiyah Hospital
• Pulau Pinang Hospital
• Sungai Buloh Hospital
• Kuala Lumpur Hospital
• Melaka Hospital
• Tengku Ampuan Afzan Hospital
• Sarawak General Hospital
• Queen Elizabeth Hospital
"WHO is focusing on what it says are the four most
promising therapies: an experimental antiviral compound
called remdesivir; the malaria medications chloroquine
and hydroxychloroquine; a combination of two HIV drugs,
lopinavir and ritonavir; and that same combination plus
interferon-beta, an immune system messenger that can
help cripple viruses,“ (DG. MOH Malaysia)
3. COVID-19 Treatment

The social cost of COVID-19
They’re apt to be long-lasting,
hard to measure, and heavy.

End of MCO 2

World status: Approaching 2 M mark

Covid 19 risk com part2

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