[FEATURE] Post COVID-19: Lessons Learnt and the Way Forward

FEATURE ARTICLE

By Elisa Shafiqah Shahrilnizam & Sharumanthi Kavi Rajan

The COVID-19 pandemic is a testament to how important a good healthcare system can lead to a speedy recovery towards the wellbeing of the nation. Undoubtedly, this pandemic has various facets when it comes to impact. Nevertheless, it is significant for us to venture into the realm of the virus and epidemiological measures in curbing the spread of the disease. In this segment of the article, we are tapping into the realm of medicine and see how COVID-19 impacts our healthcare system from the opinions of three experts in the field:

• Datuk Prof Dr Awang Bulgiba Awang Mahmud, Epidemiologist, Universiti Malaya
• Associate Professor Dr Chan Yoke Fun, Head of Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya
• Dr Zuraida Ahmad Sabki, Senior Medical Lecturer at the Department of Psychological Medicine, Faculty of Medicine, UM

WHAT IS COVID-19 AND HOW DOES IT LOOK IF ONE IS INFECTED FROM A VIROLOGIST PERSPECTIVE?

Dr Chan: COVID-19 is a contagious disease caused by severe acute respiratory syndrome coronavirus 2, or more commonly noted among medical practitioners as SARS-CoV-2. Although it is now one of the most studied viruses globally, many things remain unknown such as the origin of the virus, immunity against the virus and how we respond to the COVID-19 vaccines. Symptoms of COVID-19 vary among the patients but often include fever, headache, fatigue, cough, breathing difficulties and loss of smell and taste. Nevertheless, one can be infected with Covid-19 even if they do not show any symptoms. This case is considered asymptomatic and can be very dangerous. In most cases, when such patients have the virus but do not show any symptoms, they can still spread it to others.

WHAT IS THE COVID-19 LAB AND WHY IS IT INITIATED FOR?

Dr Chan: We wanted to grow the SARS-CoV-2 virus. Sadly, we have no funding to build a BSL-3 laboratory. With our knowledge in biosafety, we designed a BSL2+ laboratory to fully comply with the facility design requirements of the WHO biosafety manual 4th edition core requirements with some features for heightened control measures including anteroom, sealed windows, HEPA filtered exhaust air and operate with only trained and vaccinated personnel. This laboratory with optimized resource use is an example of a sustainable and futuristic research model. The lab renovation, equipment and consumables were funded in part by the Faculty of Medicine, Biogenes Technologies Sdn Bhd, Esco Micro (M) Sdn Bhd, Eppendorf Asia Pacific Sdn Bhd and a grant from Fundamental Research Grant Scheme. It is like a virologist’s dream comes true.

MAKING A VACCINE IS COMPLEX. HOW IS A TYPICAL VACCINE MADE AND REGULATED ESPECIALLY DURING THIS PANDEMIC?

Dr Chan: Making and regulating the vaccine goes through a few phases. Vaccines are developed by certain ingredients such as antigen which stimulates the immune response. The first step of a vaccine is to find a good antigen, followed by undergoing a preclinical phase in suitable animal models. If the vaccine is good and safe, the vaccine will be tested in humans via phase 1 to 3 clinical trials. Officials such as U.S. Food Drug and Administration (FDA) and Malaysia National Pharmaceutical Regulatory Agency (NPRA) will then review the vaccine before being able to authorize mass production and usage among the public. Once the green light is given, the public may begin to receive their vaccine The authority should play an active role by disseminating the benefits of vaccines, debunking vaccine myths and monitoring the side- effects of the vaccines, if any.

WHAT PLANS CAN THE GOVERNMENT ADOPT TO PREVENT FUTURE OUTBREAK AND IMPROVE OUR HEALTHCARE SYSTEM OVERALL?

Dr Chan: We should be forward thinkers and invest in talents and technologies. for We need to tackle possible outbreaks of infectious diseases with laboratory preparedness and a good surveillance system. This means the government needs to invest in futuristic and robust technology in order to ensure research and development goes hand-in-hand with saving the lives of the Rakyat. We can learn from this pandemic that diseases are also a threat to our national security – to make it worse, the enemy is invisible. Therefore, the pandemic should be taken seriously by retaining our talents, creating more nationwide laboratories, upgrading the healthcare-related facilities and synergizing collaboration between public health and scientists at the national, regional and global levels. Pandemic is not only a war on the disease but a war on infodemics too. The overabundance of information, both online and offline can lead to misinformation that affects vaccine campaigns.

WHY IS VACCINATION ONE OF THE BEST EPIDEMIOLOGICAL CONTROL MEASURES?

Prof Awang: Vaccination allows us to build immunity which reduces the risk of infection. Utilizing this method means we can control, mitigate and prevent the spread of this disease. Hence, it is indeed an excellent measure in ending the pandemic so that we can lead a better quality of life. However, the public’s fears of the side effects of vaccines are understandable. All vaccines have side effects – so do not be afraid. Even with the case of polio and measles, the side effects are not too severe and curable in which it is better to take the jab rather than none.

WHAT ARE THE PUBLIC PERCEPTIONS ON THE CURRENT MALAYSIAN PUBLIC HEALTH POLICIES, ESPECIALLY THE VACCINATION ROLLOUT?

Prof Awang: Going into the third wave of the Movement Control Order (MCO), various policies have been made and our main priority now is on the vaccination rollout. Many outreach programmes have been conducted to aid in the process of registering the national vaccination programme (PICK). As Chairman of Jawatankuasa Penasihat Bebas Vaksinasi COVID-19, I have pushed many pieces of advice to the relevant ministries to implement science or data-based policies, but not all have been implemented. Unfortunately, the public perception has been rather rough – the lack of crisis management from the epidemiology sense is apparent which makes the pandemic harder to tackle. There are blurry lines and double standards when it comes to the implementation of certain SOPs.

HOW CAN SCIENTISTS AND THE COMMUNITY AID IN MINIMIZING THE PUBLIC’S FEARS OF THE SIDE EFFECTS OF VACCINES?

Prof Awang: As the pandemic progresses, we have seen good practices – the do’s and the don’ts. The government should utilise the media and work closely with scientists in promoting vaccine rollout by providing verified information and using influencers to aid such a process too! In order to combat vaccine hesitancy, we need to be proactive in mobilizing proper communications rather than merely responding. A good practice is the United Kingdom’s mode in tackling vaccines via getting more news coverage and mobilizing centres towards the target recipients rather than recipients going to centres which we can opt to push for. Malaysia has already adopted this mode too now, which is good.

THE COVID-19 PANDEMIC HAS IMPACTED EVERYONE MENTALLY AND EMOTIONALLY. HOW SO?

Dr Zuraida: The WHO has issued a statement with regards to the immense direct and indirect ramifications of the COVID-19 pandemic on the psychosocial health of every individual especially the frontline healthcare workers and the vulnerable and high-risk groups such as the elderly, children, B40s and with underlying psychiatric disorders. The extension of MCO imposed by the authority has triggered stress reactions to those having to work from home, long hours of online meeting and teaching leading to zoom fatigue and burnout. Adjusting to the new norms through social distancing and wearing masks may further worsen the feeling of isolation and loneliness that is anxiety-provoking. The protracted nature of the pandemic has created post- pandemic trauma following the sudden death of loved ones, and secondary traumatic stress or compassion fatigue among healthcare workers. Tragically, a surge of cases of suicide reported through social media proved the darkest yet unresolved psychosocial conflict brought about by the pandemic. Therefore, a concerted effort by everyone is crucial to mitigate the various biological and psychosocial crises. This includes accessible psychological interventions, social aid and accelerates the vaccination process.

HOW CAN INDIVIDUALS MONITOR THEIR HEALTH AND ENSURE THEIR HEALTH IS IN GOOD CONDITION?

Dr Zuraida: Fight against COVID-19 is far from over and until there is an effective vaccination strategy, everyone remains at risk. It is important to be aware of a certain level of distress during this pandemic such as feeling anxious, grief due to loss of loved ones, and worry of the uncertainties of the future. The fear of being infected, loss of income, and inability to care for family members will constantly create a vicious cycle between thoughts and emotions. Learning to cope with stress in a healthy way is vital as poor coping can affect one’s body and mind leading to insomnia, smoking or even self-harm. Monitoring one’s mental health requires the awareness of one’s emotion and being mindful about the thoughts that may trigger negative emotions and behaviour. Some useful measures include self-care by practicing breathing and relaxation, creating space for self and exercising. Second, strengthen the aspect of spirituality by being closer to God and finding purpose in a compassionate manner on any particular event. Third, stay connected via phone or online with the family, friends or colleagues by providing emotional support through empathic listening and provide links to any relevant source of social assistance. Learning to cope in a healthy way will make us and those people we care for become more resilient post-pandemic.

Read more about the lessons learnt on other aspects in UM Research Bulletin vol 21 issue 1 here.

**All previous posts about COVID-19 here: https://sciencemediacentremalaysia.com/tag/covid-19/

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Bionotes of expert