I spoke about how increasing the RM1 in our HC fees is a terrible way to increase funding somewhere end of last year. And that wasn’t the first time either. Feels like we need a biannual conversation for it 😂 So this isn’t the first time & it won’t be the last time (though putting it in a white paper might be a first). It will take an incredible amount of bipartisan support to switch our HC financing system now, more than the tobacco issue. A bit skeptical it will happen.

Some thoughts on the whole ‘transition to endemicity’ thingy.

I don’t necessarily disagree with the concept or goal but I think some parts can be better executed or at least thought through better. 1/n For eg, opening borders w/out quarantine for fully vaxxed is ok but perhaps do it in stages. Select a few countries for a period of time to load test our system of RTK surveillance to see if there are any stress, especially on local healthcare capacity. 2/n

It’s very tempting to scratch that itch, to refute every argument but if we are not careful or not trained, it’s a rabbit hole & we will trip sooner or later. The more effective way is to provide the correct information. Science denialism is rooted in a few characteristics. If u really want to engage, u need to identify which area the denier is using.

Wrote a little something on the latest Covid-19 buzz phrase: living with the virus. Plenty of (better) articles on how do we shift to an endemic mindset, but though I’ll just chip in as well.

link.medium.com/BnQD5GJx7jb I started by discussing the timing, preparation & transition to an endemic. The timing will require sound judgement, preparation will need foresight & transition some courage.

link.medium.com/BnQD5GJx7jb

Catching up on some lunchtime reading; In 2019 there was a Reddit post of a boy named Ethan Lindenberger who turned 18 & asked where to get vaccinated because his mom wouldn’t let him previously.

He is now a pro science advocate & said this during the Global Vaccine Summit 2019. The current vaccine messaging is being drowned out by Covid19, vaccine restrictions, etc. While we struggle to get on with our lives, perhaps we need to look a little deeper & understand the layers underneath.

Gone are the days where folks just listen to doctors w/out questions.

Quite a few vaccine hesitant folks using the increasing numbers of breakthrough infections as ‘evidence’ the vaccine is not working.

But the b/through infection numbers also need context. As vaccination % increase, only natural that the % of b/through will increase as well.

https://twitter.com/codebluenews/status/1432167001271775238

But we know b/through infection will occur. More importantly, b/through disease & death remain low for the vaccinated population.

Only <2% in this b/through group need hospitalisation.

https://twitter.com/codebluenews/status/1432167135246123013

Similar to the UK PHE technical briefing, studies show viral loads in vaccinated vs unvaccinated are the same.

But it’s not a straightforward comparison & needs some context /continued

https://twitter.com/NewsBFM/status/1428517196188110851

Vaccinated ppl will have 2 advantages even tho they can get C19:

1. Time for viral shedding is less = less chance to infect others
2. Virus will be covered with neutralising Ab, rendering it less/non viable

Preprint fr SG show viral load clears faster.

medrxiv.org/content/10.110…

My thoughts after today on #HartalDoktorKontrak

I think what our remarkable young doctors have shown today is maturity beyond their age & experience. They’ve demonstrated a strike can be held safely without compromising patient care. They’ve managed to voice out on very important issues regarding their employment, the system they are trapped in & ultimately our public health system.

Been seeing few folks promoting or doing C19 antibody testing, presumably to ‘check’ whether they received the vaccine in light of the empty syringes reports. Not gonna go into that, but thought I’d elaborate on how our immune response work, in a simplest way possible. /continue 1st of all, the immune response post vax is not just generating antibodies (Ab) & they standby forever waiting for the virus to come.

While the presence of neutralising Ab is a direct response to the antigen introduced by the vax, it’s not the measure of long term immunity.

Seems one of the debate last few days is whether factory clusters r causing the high C19 numbers in S’gor or it’s mostly community cases now. My thoughts in this thread & will try to correct some misconceptions too.

Also, because @nadsjalil ask to. She ask, u dont say no 😂 1st of all, categorising betw factory vs sporadic cases is wrong. Sporadic ≠ community cases. Sporadic simply means unlinked, where the source of infection cant be determined. So sporadic cases could mean from community or from factory clusters.

I still see ppl claiming having vaccine side effects or reactions is a sign of the vaccine ‘working’. This is false, please do not cause unnecessary worry to those who did not experience any side effects.

Let me try & explain. /continue The immune system respond to the vaccine (or any foreign pathogen) by 2 ways.

1. Innate immunity: this is the initial response where all the white cells come out & play, trying to clear the body from the foreign particles. The physical manifestations r fever, body ache etc.

Govt not wasting the school holidays. Kids >12 years old can to register for vaccination tmrw onwards. Adults <40 to start mid June.

https://twitter.com/channelnewsasia/status/1399278576893976577

Removing barriers is important to achieve high uptake. System should always be optimised to cater to the least privileged.

https://twitter.com/channelnewsasia/status/1399278945523040262

Had a couple of days to think about the option of choosing vaccines in the mainstream PICK, so here are my thoughts:

These tweets are not really about whether it is a right decision but more of a ‘why’ & ‘how’ about it. Whether it is the right call, I think only time can tell. Vaccine preference, whether we want to admit, do play a part in vaccine uptake. We always assume all who want to get vaccinated wont mind which type we get, but that’s not entirely true. I wrote about it little here:

medium.com/@Yoongkhean/co…

Been answering Qs for the most part of the day, found out some misconception re: AZ vaccine or C19 vaccines in general. Would like to address these concerns/misconception.

Just to give everyone more in depth information that could help u understand more. 1. Blood disorders e.g Thalassemia, G6PD deficiency.

In general, this group mostly have no problems w receiving the vaccine. Even Haemophilia, platelet function disorders. Only consideration is if u are on treatment for these diseases, then u should consult your doctor.

Not going to repeat the ultra low incidence of blood clots in the AZ vaccines, think we’ve established that the benefits far outweigh the risks now.

But since tmrw is the big day, would like to offer some thoughts on other data, re: risk factors for the clots. Most news sites will mention incidence is higher in younger age group & mostly women. However, European regulators does not mention this two groups are a risk factor, merely ‘incidence occurring higher in this 2 groups’.

Why?

I’m all for getting jabs in to arms & highly recommend everyone to get any approved vaccine but funnelling all the traffic to 1 website for 260k shots will be messy.

Building a system to vaccinate the whole country is a very complicated task but there has to be a simpler way.

https://twitter.com/malaymail/status/1388374637742936065

Some initial thoughts re: this parallel AZ track is how about those w/out internet/smartphone/laptop access?

While trying to increase no. of ppl vaccinated is the ultimate goal, the system cannot widen the inequity gap further.

Some info on vaccine efficacy. We tend to make the mistake of 95% efficacy (Pfizer) being 95 out of 100 is protected from the disease while 5 out of 100 will get infected/succumb to disease.

But that’s not how vaccine efficacy works. So how did we get that 95%? Consider these numbers. The Pfizer P3 trial had 43,661 participants.

Total was split into half, each group received the placebo or the vaccine. The placebo group had 162 symptomatic infection & the vaccine group had 8.

We then can calculate the infection risk. 0.74% vs 0.04%.

We shouldn’t be too fixated on vaccine efficacy. What ultimately is important (& I suspect most of us are talking about) is vaccine effectiveness (VE).

Vaccine efficacy is % of reduction of disease in a vaccinated vs unvaccinated group in a trial.

VE is the real world impact. V.efficacy measures individual protection in a controlled environment while VE looks at how protected is a population after vaccination. There is a whole host of factors influencing it.

And not necessarily v.efficacy is directly proportional to VE.

Always amusing to see men (or rather boys) trying to use declining fertility of women by showing fertility rates to justify that women should marry young.

Firstly, reproduction is not the only purpose in life or partnerships/marriage.

Secondly, they are reading the data wrong. Fertility rates (broadly) is defined as avg number of children born by a woman in her reproductive years over her lifetime. It measure a period, not the cohort’s metric.

And number of children born means u need the man as well, so the equal & opposite cohort to see is the men.

The person interviewed is no doubt severely misinformed (or ignorant) so no need to amplify her.

But it gives us an opportunity to reexamine what is UHC for us and how effective is the index. (This thread might be #unpopularopinion 😅)

https://twitter.com/malaymail/status/1323025910707089408

WHO defines UHC as equitable access to HC without financial hardship. Some fancy math done & the index for us & neighbours are:

Malaysia 70
Indonesia 60
Singapore, Brunei & Thailand >80
Vietnam 73
Philippines & Myanmar 50

We are somewhere in the middle amongst SEA countries.

Lol apa anakku buat ni I am getting bombarded by WhatsApp stickers 🤦🏻‍♂️ #OhEmmaku