TR EMERITUS

Epidemiologists estimated the basic reproductive number R0 of the original Covid-19 virus is about 3. This means in a population where none has any immunity to the disease, the average number of people a single infectious person will infect is 3. It is estimated the British Alpha variant (Pango classification: B.1.1.7) is twice as infectious and the Indian Delta variant (Pango classification: B.1.617.2; AY.1; AY.2; AY.3; and AY.3.1) is twice as infectious as the Alpha variant. Effectively, the R0 of the Delta variant is 12: a single infected person will on average infect 12 persons (The Washington Post estimated the R0 of the Delta variant to be between 6 and 9). It is not too difficult to see the monumental task the authorities are up against containing a virulent virus as infectious as the Delta variant, even assuming a lower R0 number between 6 and 9. The WHO tracks SARS-CoV-2 variant when it becomes Variants of Concern (VOC) demonstrating: • Increase in transmissibility or detrimental change in COVID-19 epidemiology; OR • Increase in virulence or change in clinical disease presentation; OR • Decrease in effectiveness of public health and social measures or available diagnostics, vaccines, therapeutics. Before a variant becomes concerning, the WHO will first designate it as a Variant of Interest (VOI). The working definition of a SARS-CoV-2 VOI is one: • with genetic changes that are predicted or known to affect virus characteristics such as transmissibility, disease severity, immune escape, diagnostic or therapeutic escape; AND • identified to cause significant community transmission or multiple COVID-19 clusters, in multiple countries with increasing relative prevalence alongside increasing number of cases over time, or other apparent epidemiological impacts to suggest an emerging risk to global public health. Even before we can contain the Delta VOC, the WHO has raised four VOIs: (1) Eta (B.1.525) (2) Iota (B.1.526) (3) Kappa (B.1.617.1) (4) Lamada (C.37) Clearly, it is looking like a tall order attempting to contain the pandemic. In a recent article, SCMP said the same, citing world renowned epidemiologist Larry Brilliant’s “The Forever Virus”, an ominously titled article: “It is time to say it out loud: the virus behind the COVID-19 pandemic is not going away. SARS-CoV-2 cannot be eradicated, since it is already growing in more than a dozen different animal species. Among humans, global herd immunity, once promoted as a singular solution, is unreachable.” Larry Brilliant added: “More recently, epidemiologists were debating what percentage of a population had to be vaccinated to reach herd immunity and when that threshold would be reached. But now it is becoming clear that the world cannot wait for herd immunity to contain the pandemic. For one thing, vaccination is proceeding too slowly. It is taking too long to produce and deliver sufficient supplies of vaccines, and a sizable global anti-vaccine movement is dampening demand for them. For another thing, there has been a constant flow of new variants of the virus, threatening the progress that has been made with vaccines and diagnostics.” “Variants are an unavoidable byproduct of the pandemic’s exponential growth. Variants are an unavoidable byproduct of the pandemic’s exponential growth. More than half a million new cases of COVID-19 are reported every day. Each infected person harbors hundreds of billions of virus particles, all of which are constantly reproducing. Each round of replication of every viral particle yields an average of 30 mutations. The vast majority of mutations do not make the virus more transmissible or deadly. But with an astronomical number of mutations happening every day across the globe, there is an ever-growing risk that some of them will result in more dangerous viruses, becoming what epidemiologists call “variants of concern.” According to Larry Brilliant: (1) Most countries simply don’t have enough vaccines to go around, and even in the lucky few with an ample supply, too many people are refusing to get the shot. (2) As a result, the world will not reach the point where enough people are immune to stop the virus’s spread before the emergence of dangerous variants — ones that are more transmissible, vaccine resistant, and even able to evade current diagnostic tests. (3) Such supervariants could bring the world back to square one. It might be 2020 all over again. He added: “Part of what makes COVID-19 so difficult to combat is that it is an airborne illness with so much asymptomatic transmission.” The more ominous part is the human to animal and animal to human transmissions: “Over a year and a half into the pandemic, it has become clear that the race to contain the virus is simultaneously a sprint and a marathon. Yes, the world needs to vaccinate as many people as possible as quickly as possible to slow the spread of the virus. But if every human on the planet were vaccinated tomorrow, SARS CoV-2 would still live on in multiple animal species, including monkeys, cats, and deer. In Denmark, more than 200 people contracted COVID-19 from minks. Although there is no evidence yet of sustained transmission from humans to animals and then back to humans, the discovery of SARS-CoV-2 in so many species means that it is not just plausible but probable.” Importantly, “Conquering a pandemic is not only about money and resources; it is also about ideas and strategy,” said Larry Brilliant. “The key lies in treating vaccines as transferable resources that can be rapidly deployed where they are needed most: to hot spots where infection rates are high and vaccine supplies are low,” he added. Larry Brilliant cited the work of epidemiologist William Foege, working in a hospital in Nigeria, and not allocated enough vaccines to vaccinate everyone and had to pioneered a new way of using vaccines, focusing not on volunteers or the well-connected but on the people most at risk of getting the disease next. It was through this strategy that smallpox was eradicated in India and ultimately the world. It was first called “surveillance and containment” and later “ring vaccination”. Although Larry Brilliant was part of a team that had success in eradicating smallpox, his recent article is doing damage to his reputation as a scientist with his demonisation of China in the handling of the pandemic. It is difficult to solve problems when they are viewed with jaundiced eyes. Larry Brilliant seemed to assign the major part of the blame for the pandemic to China asserting: “Even setting aside the question of whether the virus jumped to humans as a result of a lab accident or animal spillover, Beijing was less than forthright in sharing information about the scale of the problem in its early days. And although it may never be clear what Chinese decision-makers knew when, it was nonetheless irresponsible of them to allow international travel in and out of an epidemic area during a period of intense holiday travel — a decision that possibly created a superspreader event.” The United States never banned travel out of the country at any time at all. Even today, when the U.S. is among the highest in daily infections, Larry Brilliant didn’t specifically call it out as a super spreader. In his own words Larry Brilliant acknowledged but downplayed the role of U.S. as a super spreader country: “The United States, for its part, disregarded early warnings from dozens of epidemiological Cassandras and denied the gravity of the emerging crisis.” Larry Brilliant also didn’t call out European countries despite acknowledging they are spreading the virus through travels: “The U.S. government . . . waited way too long to control travel from Europe…” In shilling for western vaccines, Larry Brilliant sounded like a shrill shill rather than epidemiologist. He bragged the U.S. won the race to be first: “Everyone should be grateful for the remarkable vaccines that won the race to be first.” He added: “Vaccine development has been one of the few bright spots in this pandemic. Pharmaceutical and biotechnology companies worked hand in hand with governments to make powerful new vaccines in record time. The two vaccines based on messenger RNA, or mRNA — the Moderna and Pfizer-BioNTech ones — moved lightning fast. Just two months after the genetic sequence of SARS-CoV-2 was published, the Moderna vaccine was being tested in a Phase I clinical trial, and not long after, it moved on to Phase II. At the same time, a number of actors — the Coalition for Epidemic Preparedness Innovations; Gavi, the Vaccine Alliance; the WHO; and many governments, companies, and philanthropies — were investing massively in manufacturing capacity. As a result, the companies behind the two vaccines were able to rapidly scale up production and conduct Phase III trials over the summer. The trials demonstrated that the Moderna and Pfizer-BioNTech vaccines were not just safe but also far more effective than many had thought, and by the end of 2020, regulatory agencies around the world had authorized them for emergency use. Vaccines based on a modified adenovirus also moved quickly. The United Kingdom authorized the Oxford-AstraZeneca vaccine in December 2020, and the United States did the same for the singledose Johnson & Johnson vaccine in February 2021.” Conveniently, Larry Brilliant politicised the pandemic and failed to acknowledge the contributions of China: The genetic sequence of SARS-CoV-2 was published by China on 10th January 2020 — ten days after China notified WHO an unknown virus of concern was circulating in China. Not only Larry Brilliant didn’t credit China with generously sharing the genetic sequence SARS-CoV-2, he also deliberately ignored China’s vaccines Sinovac and Sinopharm in his article. It was as if they didn’t exist. To add insults to injury, Larry Brilliant chose to cast aspersions on the efficacy of Chinese vaccines: “For instance, China has exported more than 200 million doses of four homegrown vaccines — more than any other country — and yet there is disturbingly little transparent data on the Chinese vaccines’ safety. Anecdotal reports from Brazil, Chile, and the Seychelles have raised doubts about their efficacy.” It is quite surprising that for a man of science Larry Brilliant chose to cite and give prominence to anecdotal evidence: this speaks volume. Although Larry Brilliant made many useful observations about the pandemic, it is tainted by his prejudice against China: it is to such an extent the names Sinovac and Sinopharm are anathema to him.   APolitical   Reference: (1) https://www.who.int/en/activities/tracking-SARS-CoV-2-variants/ (2) https://www.scmp.com/magazines/post-magazine/article/3144486/larry-brilliant-eradicator-smallpoxproposes-ring (3) https://www.foreignaffairs.com/articles/united-states/2021-06-08/coronavirus-strategy-forever-virus (4) https://www.washingtonpost.com/outlook/coronavirus-vaccine-booster-shots/2021/08/11/aefec5dcfae0-11eb-9c0e-97e29906a970_story.html    Read More →

Call it a series of coincidences but several things happened that led to this blog post. First it was a WhatsApp conversation with my favourite Young Pork Guzzling Muslim Politician (“YPGMP”) on why people in Myanmar should not have been protesting military rule. Then, over the weekend, India celebrated 75-years of Independence from British Rule. Say what you like about India and Indian nationals but as anyone who has seen the movie Gandhi will tell you, was a hard-fought battle and despite the attempts of being “non-violent,” you had some unforgettably violent moments like the partition between India and Pakistan. Without the struggles of Mahatma Gandhi and Nehru, Lee Kuan Yew and his Gang would have had a much harder fight on their hands. Then, I started binge watching Fauda, an Israeli drama about a unit that infiltrates the Palestinian territories and finally, there was the conquest of Kabul by the Taliban. All these events got me thinking of one key question. – Why do people fight and protest, particularly when they’re on the side that will most likely lose? As the famous military saying goes “God is on the side of the Big Battalions,” which meant that the bigger force inevitably wins the wars. In a confrontation, the bigger guy inevitably crushes the small guy. Size, as they say matters. Hence, big animals like elephants don’t have predators and combat sports like boxing are inevitably separated into weight categories. The only time in recorded history when a small guy went ahead to take on a giant was when David took on Goliath and he only did so because he had someone bigger in his corner (God). Nature has shown consistently that the guy with the greater force inevitably wins and the small guy either flees or learns to cooperate with the big guy. Take the basics of Singapore politics. We had Lee Kuan Yew who branded himself as God within Singapore. However, if you read his biography, you’ll notice that the late Mr. Lee’s greatest skill was being an insect that could work with bigger animals. In the early days, he was careful to stay on the good side of the British. Then as the Americans became more prominent, he’d rush to Washington to be the regional consultant to US Presidents. When China started coming up, he ran off to Beijing to become their development consultant. The plan was simple, it was to ensure that all the big animals of the geopolitical jungle had a stake of sorts in keeping Singapore safe and sound. However, Mr. Lee made one crucial mistake. Whilst he was busy showing the beast of the geopolitical jungle that Singapore was a valuable insect, he also went out of his way to remind his people that they were nothing more than insects that could be crushed should they get any pesky ideas. Mr. Lee then sold the Singaporean worker to the multinationals as being wonderfully compliant. The selling point was not so much the fact that our workforce was well educated but that it would never go on strike. In his book, Mr. Lee attributes to fall of the British to strikes. To be fair, Mr. Lee’s initial strategy was successful and made Singapore a wonderfully prosperous place. However, there was one problem. Mr. Lee drilled it into us that all forms of protest and civic participation was bad. If you talk to enough Singaporeans, you’ll notice that they have a chronic inability to understand why people from other parts of the world would ever risk things like protest and confrontation, particularly against a more powerful force. The YPGMP brought this home to me when he started telling me about why he felt that his employer’s workers in their Myanmar outlet should not protest: He dismissed it as people getting involved in things that didn’t involve them. I tried to explain that whilst this may be the case in Singapore, it’s not necessarily in the case elsewhere. He argued that it was the protesters against military rule that were ruining the country, as opposed to military rule itself. According to a friend, who is the marketing director of an insurance company in Myanmar, this attitude is common amongst Singaporeans. He told me of a Singaporean who was the CEO of local Myanmar Bank who tried to explain how the killing of the first protestor was justified and how everything would be fine if people stopped protesting. As far as the late Mr. Lee was concerned, all forms of protest were bad. I take myself as a sad example. I tend to avoid arguments with people like bosses. Answer is simple, what is an argument going to get me. The stress of confrontation is not worth it as long as the money is in my bank account when I expect it to be. However, that’s because I live and operate in the Singapore context. Losing a source of income will be tough and as long as my various employers don’t get involved in dubious stuff, I’m OK. I take care of my family and myself as long as I have a job. So, what do I really have to fight against? Sure, I have difficult days at work and deal with difficult people but that’s about it. This isn’t necessarily the case outside of Singapore. It’s definitely not the case in the Gaza strip or in Kabul or in Myanmar. It’s a case of what is your life worth and an extent, who are you living it for. I worry about making a living and having money to help the kid make her life a little better. However, there are parts of the world where money isn’t the only issue. As much as I might complain about the Singapore government, I don’t worry that some official will one day decide to screw everything up for my kid and her kids. There are, funnily enough, parts of the world where people are screwed for the crime of being born. Parents have the option of trying to flee or trying to change the system even if it costs them their lives. Singaporeans are lucky in the sense that we are nominally a democracy. Hence, we can get heard every so often. However, what’s to stop a rogue from coming into power and making sure that we live through the same situation that the people in Kabul or the Gaza Strip live in? Nobody is asking for a revolution and as long as the people are willing to stand up for themselves and communicate with those in power and those in power are willing to listen, we can ensure that the scenes in Yangon don’t happen here. However, if the people are not heard and made powerless, then who is to say when revolutions become a necessity. Insects when they gather together can make life very uncomfortable for the biggest beast.   Tang Li *Although I’ve been based mainly in Singapore for nearly two decades, I’ve had the privilege of being able meet people who have crossed borders and cultures. I’ve befriended ministers and ambassadors and worked on projects involving a former head of state. Yet, at the same time, I’ve had the privilege of befriending migrant labourers and former convicts. All of them have a story to tell. All of them add to the fabric of life. I hope to express the stories that inspire us to create life as it should be.      Read More →

Many unvaccinated people are unhappy about the restrictions imposed on them from dining in restaurants. They see the restrictions as being discriminatory. They should consider the following facts: 1. The spread of covid is higher for unvaccinated people. If infected, the virus is more harmful for them. 2. Many countries have imposed similar restrictions on unvaccinated people. I do not see this restriction as being discriminatory. It is necessary to minimise the harm from the spread of the virus. I hope that this restriction is temporary and a new arrangement can be put in place soon. The government now allows unvaccinated people to take a rapid covid test on the spot before entering the restaurant. This is troublesome. Most restaurants will not provide this option. I wish to suggest a more practical way. I suggest that the unvaccinated people be allowed to go for a covid test in a designated test center. If the test is negative, the result can be uploaded into the Trace Together app. These tested people will be treated similar to the vaccinated people for a certain duration, maybe 7 days, from the date of the test. After a while, the unvaccinated people may become vaccinated, so there will be no need for this regular test.   Tan Kin Lian      Read More →