Wednesday, September 8, 2021

One Minute Sit To Stand Test


 

The normal oxygen saturation or SpO2 of a healthy person is 95 – 100 %.  These numbers generally stay unchanged during moderate intensity exercises and may even increase a little, because one is breathing faster and deeper, resulting in better lung ventilation. 

During vigorous short-term exercise, like in soccer, you may notice a small drop in blood oxygen saturation of about 1 – 2 %. When you stop exercising, the SpO2 will return to your baseline reading quickly.

When a person complains of shortness of breath, the doctor will take down a medical history, perform a physical examination and may order some tests.  Diseases of the heart, lungs, kidneys or liver may present with shortness of breath. 

The most common functional impairment in patients with lung disease is impaired gas exchange. In the early stages of many lung diseases, the oxygen saturation is maintained or is normal at rest, but when the lung is challenged with increasing demand, like during exercise, the oxygen saturation may drop.

The 6MWT is used to assess the functional capacity of a person.  The 6MWT is also a simple test to evaluate gas exchange impairment during exercise.  It is widely used, and is considered the gold standard, to evaluate patients with chronic respiratory disorders like COPD and ILD.  However, it is not feasible to perform the 6MWT in many office-based practices, which generally, do not have the flat, straight 30-m corridor required for the test.

There is evidence in the literature, suggesting that the 1MSTST be used as an alternative to the 6MWT for measuring a person’s functional capacity and in detecting exercise induced gas exchange impairment.  Both tests have a good correlation, and the advantage of the 1MSTST is that it causes less hemodynamic stress for patients than the 6MWT. The 1MSTST is well tolerated, easy to perform, understood, and interpreted; and does not require special hardware.  The mean number of 1MSTST repetitions reported in the literature achieved ranged from 8 repetitions (patients with stroke) to 50 repetitions (young men). 

The 1MSTST has been validated for use in COPD and ILD of various aetiologies. 

There are many uses for the 1MSTST: 

The 1MSTST is used to identify subjects with low exercise capacity or preserved exercise capacity.

The 1MSTST is used to detect exercise-induced gas exchange impairment early in the course of ILD, before changes in resting DLco and PaO2, hence making the early clinical diagnosis of ILD possible.  The resting DLco is a specific but an insensitive predictor of abnormal gas exchange during exercise. The DLco is the diffusing capacity of lung for carbon monoxide is a measure of the efficiency of lung gas transfer.

The 1MSTST is used to measure the effectiveness of a pulmonary rehabilitation programme as an improvement of three repetitions is consistent with physical benefits.

 A doctor or nurse should be present during the 1MSTST. 

To perform the 1MSTST place a chair of standard height (46 cm), without arm rests, against a wall to prevent the chair moving and person falling during the test. Seat the person upright on the chair with knees and hips flexed at 90°, feet placed flat on the floor and a hip-wide apart, with arms held stationary by placing the hands on the hips. The person is asked to perform repetitions of standing upright and then sitting down in the same position at a self-paced speed, safely and comfortably, as many times as possible for 1 minute. The person should not use the arms for support while rising or sitting. The person is permitted to rest during the one-minute period. 

The patient is given the following instructions:

“The purpose of the test is to assess your exercise capacity and leg muscle strength. The movement required is to get up from this chair with the legs straight and sit back continuing the repetitions as fast as possible within one minute. I will give you the countdown ‘3, 2, 1 Go’ as an indication to start and I will tell you when we are at the 15 remaining seconds. If required, you can make a break and resume the test as soon as possible”.

The patient should be able to perform a minimum of 5 repetitions.

The SpO2 and heart rate are noted before and immediately after the 1-minute test.  The SpO2 and hear rate are noted for a further 1 minute following the test, during recovery, as oxygen desaturation can continue for up to a minute after stopping the test.  The number of sit-stand repetitions are recorded for the first 1 minute of the test.

In early lung disease, a person at rest, may have a normal SpO2 of 95 – 100 %.  However, during exercise the SpO2 may drop because of increased oxygen demand and the presence of impaired gas exchange in the diseased lungs. 

POSITIVE TEST.  A SpO2 drop of 3% or more is considered a positive test.  A positive test may indicate the presence of lung disease which requires medical attention.

DO NOT perform the 1MSTST in the following situations.

1.      When the resting SpO2 is already abnormal at 94% or less.

2.      When the person is immobile or using walking aids.

3.      During advanced pregnancy.

4.      Following recent abdominal surgery or heart attack.Fo

F    STOP the 1MSTST when you notice the following:

1.      Feeling faint or giddy.

2.      Vision becoming dim or blur. 

3.      SpO2 falling more than 3% from baseline.  (Calculate the value before starting the test.  Example: when the resting SpO2 is 96%, stop the test when the SpO2 fall to 93% or lower.)

4.      Sensation of breathlessness which is severe or unbearable. 

5.      Occurrence of chest pain

You MUST CONSULT a doctor when the test is positive.

The 1MSTST is currently being evaluated for use in respiratory illnesses other than COPD and ILD. 

The IMSTST is being used in some EDs or emergency departments to quickly identify exercise induced oxygen desaturation caused by lung disease, so a decision can be made regarding patient discharge, with or without enhanced monitoring, or hospitalisation. 

 


Wednesday, July 28, 2021

Life After Death - some questions and answers




Video Transcript:

                                      Is There Life after Death?

Hello. I am Dr Leong a consultant chest physician.

Is there life after death?  This is a very pertinent question, as death is the only thing that is guaranteed in life.  Many of my patients are concerned but will not bring up the matter to discuss.

Investigating this subject often leads to the discovery of spiritual truths.  I found my answer in the Bible and the answer is unique. 

Today I wish to share with you my answer.   

Let’s begin.

IS THERE LIFE AFTER DEATH?

The answer is Yes. 

HOW DO I KNOW?

I have seen people in trance.  I have seen a person in his 50’s dance, summersault and behave like a monkey.  I have seen people walk on fire.  I have seen people having their mouths, bodies pierced by sharp objects.  While in trance, a person is influenced and empowered by spirits.  

I have heard of ghost stories from close friends who had seen and heard the voices of spirits. 

There are published photos of ghosts which had been scrutinised and certified authentic.  

There are people who had near-death experiences describing out of body experiences.  They recall hearing and seeing doctors and nurses doing resuscitation on them.  

There are clairvoyants who are able to communicate with spirits.    

While in school, I experienced the ouija board where invited spirits can move objects on the board and answer questions.  

I hear of exorcism by priests.  I have heard how a person’s life has been turned around after the departure of evil spirits.    

The supernatural exists whether we want to believe it or not.  Medical science has difficulty disproving it.  The Bible says spirits exist.   

WHAT IS LIFE AND WHAT IS DEATH?

A person is alive when he is breathing and has a heartbeat. And a person is considered dead when the heart has stopped beating and he is no longer breathing. 

HOW DID LIFE COME ABOUT?  DID SOMEONE CREATE LIFE? 

I am inclined to believe that man is created by a superior being. 

The Big Bang theory attempts to explain the creation of the universe and evolution. But the theory is not able to explain how humans get their first DNA sequence and how the first living cell came about.  

I believe man is created by God for eternity. Yes, created for eternity.

WHAT IS THE PURPOSE OF LIFE ON EARTH?

Most of us journey through life with the purpose of sustaining our own lives. We work hard, make money to purchase what we need like shelter, food, security and health. With extra money we purchase what we want too. 

My purpose in life is to worship and maintain a relationship with God while also caring for the earth and fellow human beings by using my talents and gifts.  In turn, God will provide the ways and means of sustaining my life. 

God loves us.  We need not worry too much about the future as He is in control of our final destiny. 

IS LIFE BOTH PHYSICAL AND SPIRITUAL?

I have both a physical body and a spirit living inside me.  When I die it is my physical body that goes into decay, whereas the spirit lives on. When Jesus, my saviour, comes the second time my spirit will inherit a new resurrected body. 

2000 plus years ago, Jesus was crucified on a cross and died.  On the 3rd day he rose from the dead.  Jesus conquered death. He was seen with a resurrected body that can go through walls.  He was on earth for 40 days before his ascension to heaven. 

Jesus sets the eternal hope for believers.  A future without pain, sorrow and disease. 

WHAT WILL HAPPEN AT THE MOMENT OF DEATH?

My body will fail and stop working one day from illness, a fatal accident or old age.  My soul and spirit will separate from my body and live on.  They will be lodged in a place known as the “realm of the dead” which is neither heaven nor hell. While at this place the experiences between Jesus believers and non-believers are different. One is pleasant, like in paradise, while the other is not.  My spirit will await the Rapture or the Second Coming of Christ when I shall be restored with a glorified resurrected body. 

HOW IS SIN AND SPIRITUAL DEATH RELATED? 

Sin came about because the first man disobeyed God by eating the forbidden fruit from the Tree of Knowledge of good and evil.  When a man with unforgiven sin dies, his spirit is destined to die. However, hell was initially created by God for Satan and the fallen angels and not for man.  

God loves us so much that he continues to try all possible ways to win us back to him.  His way of saving us is spelt out in the Gospel message. Jesus conquered death and gives the hope of eternal life to all who believes in Him.  

My sins are forgiven when I accepted Jesus Christ as my Lord and Saviour.  This gift of love, grace and mercy from God is made possible through faith in Jesus Christ.  This gift is free.  Salvation is not a reward earned by doing good or charitable works.   

IS ETERNAL LIFE A CHOICE THEN?

Man’s eternal destination is either heaven or hell.  This destination decision is made while we are physically alive on earth. There is no second chance for the spirit to change its mind after physical death. 

God seeks justice for all the wrongs I have done in my life.  However, He is graceful and merciful and allows me to choose my destiny when I am alive. By putting my faith in Jesus, he forgave my sins, and justified me into righteousness.  He redeemed me from spiritual death.  

His work of redemption for believers was completed at the Cross. He carried our sins, sacrificed himself at the Cross and cleansed us of sins.   He has justified us into righteousness, freeing our spirits from death.  

HOW WILL SOMEONE BE JUDGED AT THE END?

Bodily resurrection will occur for both believers and non-believers of Jesus some time in future.  Then the final judgement follows. 

The believers in Christ will have their names written in the Book of Life.  Their judgement will be on good works and rewards but not spiritual death.  The new heaven and new earth will be revealed. 

Those whose names are not in the Book of Life will undergo the Great White Throne judgement when the Second Death will be announced.  Hell is envisioned like a lake of fire.    

WHAT DID I DO TO FOLLOW CHRIST?

I first studied intently about Jesus, looking at the evidence of his death and resurrection. When it became clear that the Gospel story is true, I did the following:

Acknowledge myself as a sinner deserving to go to hell.

Believe that Jesus Christ, the Son of God, came to die for my sins.

Confess my sins and believe that Jesus Christ is the only saviour.

Understand I am saved by His grace and not by works.

Believe by faith in the resurrection of Jesus Christ who is alive today.

And receive him into my life and let him be my Lord and Saviour.

WHAT SHALL I DO BEFORE I DIE?

Be sure I am saved by continuing to believe in Jesus Christ

Obey God and be ready and live a holy life.

Worship God and accept His salvation with gratitude.

Proclaim the Gospel of Jesus Christ to the world.

Carry out God’s will by serving others in need.  

WHAT IS THE ADVICE FOR ANY PERSON PREPARING FOR THE FINAL EVENT?

Make sure one is saved for eternity and not fear death.  

Do away with anything that promotes mental images of scary things e.g. horror movies, occult practices, etc.

If fear persists, get professional help.

Draw up a will.

Consider advance planning and have advance directives.

Meet up with family members and friends. 

The saved have the Holy Spirit, comforter, in their hearts. God has assuring words and is faithful. Understand that God is sovereign and in control of everything. 

THANK YOU.

This is how I view life and death as a doctor after discovering my faith in Jesus.

Thank you.

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 Bible References:


Then the Lord God formed a man from the dust of the ground and breathed into his nostrils the breath of life, and the man became a living being.     Genesis 2:7
The Lord God took the man and put him in the Garden of Eden to work it and take care of it. 16 And the Lord God commanded the man, “You are free to eat from any tree in the garden; 17 but you must not eat from the tree of the knowledge of good and evil, for when you eat from it you will certainly die.”     Genesis 2:15-17 
“For God knows that when you eat from it your eyes will be opened, and you will be like God, knowing good and evil.”   Genesis 3:5

By the sweat of your brow you will eat your food until you return to the ground, since from it you were taken; for dust you are and to dust you will return.”   Genesis 3:19
For the wages of sin is death, but the gift of God is eternal life in Christ Jesus our Lord.   Romans 6:23

For we must all appear before the judgment seat of Christ, so that each of us may receive what is due us for the things done while in the body, whether good or bad. – 2 Corinthians 5:10

With all wisdom and understanding, 9 he made known to us the mystery of his will according to his good pleasure, which he purposed in Christ, 10 to be put into effect when the times reach their fulfilment—to bring unity to all things in heaven and on earth under Christ. – Ephesians 1: 9-10

‘I am the God of Abraham, the God of Isaac, and the God of Jacob? He is not the God of the dead but of the living.”   Matthew 22:32  
He is not the God of the dead, but of the living. You are badly mistaken!”   Mark 12:27
He is not the God of the dead, but of the living, for to him all are alive.”  Luke 20:38

Let no one be found among you who sacrifices their son or daughter in the fire, who practices divination or sorcery, interprets omens, engages in witchcraft, 11 or casts spells, or who is a medium or spiritist or who consults the dead.     Deuteronomy 18:10

22 “The time came when the beggar died and the angels carried him to Abraham’s side. The rich man also died and was buried. 23 In Hades, where he was in torment, he looked up and saw Abraham far away, with Lazarus by his side. 24 So he called to him, ‘Father Abraham, have pity on me and send Lazarus to dip the tip of his finger in water and cool my tongue, because I am in agony in this fire.’
25 “But Abraham replied, ‘Son, remember that in your lifetime you received your good things, while Lazarus received bad things, but now he is comforted here and you are in agony. 26 And besides all this, between us and you a great chasm has been set in place, so that those who want to go from here to you cannot, nor can anyone cross over from there to us.’      Luke 16:19-26

41 So they took away the stone. Then Jesus looked up and said, “Father, I thank you that you have heard me. 42 I knew that you always hear me, but I said this for the benefit of the people standing here, that they may believe that you sent me.” 43 When he had said this, Jesus called in a loud voice, “Lazarus, come out!” 44 The dead man came out, his hands and feet wrapped with strips of linen, and a cloth around his face.    John 11:41-44

39 Look at my hands and my feet. It is I myself! Touch me and see; a ghost does not have flesh and bones, as you see I have.”

42 So will it be with the resurrection of the dead. The body that is sown is perishable, it is raised imperishable; 43 it is sown in dishonour, it is raised in glory; it is sown in weakness, it is raised in power; 44 it is sown a natural body, it is raised a spiritual body.  1 Corinthians 15:42-44

If there is a natural body, there is also a spiritual body. 45 So it is written: “The first man Adam became a living being”; the last Adam, a life-giving spirit. 46 The spiritual did not come first, but the natural, and after that the spiritual. 47 The first man was of the dust of the earth; the second man is of heaven. 48 As was the earthly man, so are those who are of the earth; and as is the heavenly man, so also are those who are of heaven. 49 And just as we have borne the image of the earthly man, so shall we bear the image of the heavenly man. 1 Corinthians 15: 45-49

15 According to the Lord’s word, we tell you that we who are still alive, who are left until the coming of the Lord, will certainly not precede those who have fallen asleep. 16 For the Lord himself will come down from heaven, with a loud command, with the voice of the archangel and with the trumpet call of God, and the dead in Christ will rise first. 17 After that, we who are still alive and are left will be caught up together with them in the clouds to meet the Lord in the air. And so we will be with the Lord forever.   1 Thessalonians 15-17
28 “Do not be amazed at this, for a time is coming when all who are in their graves will hear his voice 29 and come out—those who have done what is good will rise to live, and those who have done what is evil will rise to be condemned.   John 5:28-29

12 Whoever has the Son has life; whoever does not have the Son of God does not have life.   1 John 5:12
51 Listen, I tell you a mystery: We will not all sleep, but we will all be changed 52 in a flash, in the twinkling of an eye, at the last trumpet. For the trumpet will sound, the dead will be raised imperishable, and we will be changed. 53 For the perishable must clothe itself with the imperishable, and the mortal with immortality. 54 When the perishable has been clothed with the imperishable, and the mortal with immortality, then the saying that is written will come true: “Death has been swallowed up in victory.”  1 Corinthians 15:51-54

25 Jesus said to her, “I am the resurrection and the life. The one who believes in me will live, even though they die; 26 and whoever lives by believing in me will never die. Do you believe this?”  John 11:25
2 Dear friends, now we are children of God, and what we will be has not yet been made known. But we know that when Christ appears,[a] we shall be like him, for we shall see him as he is. 3 All who have this hope in him purify themselves, just as he is pure. 1 John 3:2-3

28 Do not be afraid of those who kill the body but cannot kill the soul. Rather, be afraid of the One who can destroy both soul and body in hell.  Matthew 10:28
41 “Then he will say to those on his left, ‘Depart from me, you who are cursed, into the eternal fire prepared for the devil and his angels.  Matthew 25:41
11 Say to them, ‘As surely as I live, declares the Sovereign Lord, I take no pleasure in the death of the wicked, but rather that they turn from their ways and live.  Ezekiel 33:11
32 For I take no pleasure in the death of anyone, declares the Sovereign Lord. Repent and live!  Ezekiel 18:32

Let the wicked forsake their ways and the unrighteous their thoughts. Let them turn to the Lord, and he will have mercy on them, and to our God, for he will freely pardon.  Isaiah 55:7
14 Then death and Hades were thrown into the lake of fire. The lake of fire is the second death. 15 Anyone whose name was not found written in the book of life was thrown into the lake of fire.  Revelation 20:14
But the wicked will perish:  Though the Lord’s enemies are like the flowers of the field, they will be consumed, they will go up in smoke.    Psalm 37:20

9 They marched across the breadth of the earth and surrounded the camp of God’s people, the city he loves. But fire came down from heaven and devoured them. 10 And the devil, who deceived them, was thrown into the lake of burning sulfur, where the beast and the false prophet had been thrown. They will be tormented day and night for ever and ever.    Revelation 20:9
Surely the day is coming; it will burn like a furnace. All the arrogant and every evildoer will be stubble, and the day that is coming will set them on fire,” says the Lord Almighty. “Not a root or a branch will be left to them.   Malachi 4:1

3 Then you will trample on the wicked; they will be ashes under the soles of your feet on the day when I act,” says the Lord Almighty.  Malachi 4:3
By your many sins and dishonest trade you have desecrated your sanctuaries.  So I made a fire come out from you, and it consumed you,  and I reduced you to ashes on the ground in the sight of all who were watching.  Ezekial 28:18
But the day of the Lord will come like a thief. The heavens will disappear with a roar; the elements will be destroyed by fire, and the earth and everything done in it will be laid bare.   2 Peter 3:10

But do not forget this one thing, dear friends: With the Lord a day is like a thousand years, and a thousand years are like a day. 9 The Lord is not slow in keeping his promise, as some understand slowness. Instead he is patient with you, not wanting anyone to perish, but everyone to come to repentance.  2 Peter 3:9
28 “Do not be amazed at this, for a time is coming when all who are in their graves will hear his voice 29 and come out—those who have done what is good will rise to live, and those who have done what is evil will rise to be condemned.   John 5:29

And these will go away into eternal punishment, but the righteous into eternal life.   Matthew 25:46
And the devil who had deceived them was thrown into the lake of fire and sulfur where the beast and the false prophet were, and they will be tormented day and night forever and ever.   Revelation 20:10

Then I saw “a new heaven and a new earth,”[a] for the first heaven and the first earth had passed away, and there was no longer any sea. 2 I saw the Holy City, the new Jerusalem, coming down out of heaven from God, prepared as a bride beautifully dressed for her husband. 3 And I heard a loud voice from the throne saying, “Look! God’s dwelling place is now among the people, and he will dwell with them. They will be his people, and God himself will be with them and be their God. 4 ‘He will wipe every tear from their eyes. There will be no more death’ or mourning or crying or pain, for the old order of things has passed away.”   Revelation 21:1-4

Sunday, July 4, 2021

Lavender




 

Bought this lovely Lavendar plant with purple flowers.  Had no idea how to grow and maintain it.  Wish to share with you what I found out about the plant in the web. Thought I would produce a short video too and here it is.  Really trying out how difficult or easy is to produce a short YouTube video.  

Monday, June 28, 2021

COVID-19 Quick Facts

COVID-19 Quick Facts



Video Script:

Hello I'm Dr Leong.  Today's talk will be on COVID-19.

A Suspected Case of COVID-19 needs to fulfil 2 criteria. One is the Clinical Criteria and the other is the Epidemiological Criteria.  In the clinical criteria one has to have an acute fever and cough OR an acute illness with two or more of the following:  fever, cough, general malaise, fatique, headache, myalgia, sore throat, coryza, dyspnea, anorexia, nausea, vomiting, diarrhea or altered mental status.

In the Epidemiological Criteria the suspected case needs to have been in the following places within the last 14 days prior to symptoms and signs.  The case needs to have 1. stayed or worked in an area of high risk of transmission like in a close residentials example a nursing home or institutions like prison or immigration detention depot 2. stayed or travelled in an area with community transition or 3. worked in any healthcare setting.

A confirmed case is one who is tested positive RTK- Ag in areas of prevalence greater than 10% or cases tested positive with a molecular test, namely RT-PCR or a rapid molecular test.

This graph shows the probability of detection of SARS CoV2 over time. The incubation period of SARS Co V2 is about 5 days. Most infected persons will show symptoms or signs within 11 days of infection. During the onset of symptoms, RT- PCR testing will usually be positive. Before symptoms onset, RT-PCR testing can be negative even though the person is infective because of viral shedding.  After the onset of symptoms, the RT-PCR test can be positive for up to 3 weeks.  Commonly the infected person will no longer be infective to others after 14 days of symptom onset, even though the RT-PCR is still positive as the nasopharyngeal swabs contain detectable non-viable viral material. The infected person begins to develop antibodies to the virus after a week of symptom onset and the antibodies will be detectable at about the 2nd week.  RT-PCR will likely be negative after the 3rd week of symptom onset.

SARs CoV2 mutation and variants. This chart shows the variants of concern.  The Alpha, Beta, and Delta variants are present in Malaysia. The delta variant is of special concern as there is information suggesting increased transmissibility of the virus. There is also some suggestion of reduced neutralization of the virus by antibodies produced in our bodies by vaccination.  But it is too early to say if vaccines are compromised.

Dr Noor Hisham reported in the Malay Mail that the variants of concern like beta and delta are already present in Malaysia. 

Clinical stages of COVID-19 infection. There are five categories. Category 1 – asymptomatic. Category 2 - symptomatic but no pneumonia. Category3 - symptomatic with pneumonia. Category 4 - symptomatic with pneumonia and requiring oxygen. Category 5 – the critically ill with multi-organ involvement. Persons in Category 1 and 2 maybe opt for home quarantine. Whereas persons in Category 3 to 5 will need hospital admission.

Category 2 can be divided into mild and moderate. The moderate cases who have RED FLAG symptoms may need to be admitted to hospital for observation.  The RED FLAG symptoms are  - persistent or new onset fever, exertional dyspnea, chest pain, unable to tolerate orally, worsening lethargy, unable to ambulate without assistance, worsening or persistent symptoms such as cough, nausea, vomiting, or diarrhea, reduce level of consciousness. or reduced urine output in the last 24 hours.

Confirmed cases of COVID-19 can undergo home quarantine or be admitted to hospital for observation. Persons in Category 1 and 2, with mild symptoms, can undergo home quarantine. However should the Category 2 status change with RED FLAG symptoms they better be observed in  hospital.  Persons in Category 3 - 5 should be admitted to hospitals.

A person may undergo home quarantine if he fulfills the following criteria: For adults the person should be less than 40 years and without comorbidities; like diabetes, cardiovascular disease, chronic lung disease, chronic kidney disease, hypertension, or obesity.  The person needs to be able to ambulate without any assistance and also be able to self-administer medication.  The person should have no ongoing clinical needs, like hemodialysis, not pregnant and is not immunocompromised.

For pediatric patients, who are in Category 1, they should not have any comorbidity and with a suitable caregiver.  Children in Category 2 with mild symptoms should be more than two years old, with no comorbidities and with suitable caregivers.

The home condition should be suitable and the person must be able to adhere strictly to SOP.

Caregivers who are suitable should not be more than 60 years old, are not pregnant, without comorbidities, are not immunocompromised and with no disease considered high risk by health personnel.

The home should be suitable.  A telephone should be available at all times.  The isolation room should preferably have an attached bathroom.  The other occupants in the house are not immunocompromised and appropriate caregivers should be present in the house.

The person should be able to adhere strictly to SOP.  The person should stay at home, maintain physical distance with other household members and there should be no visitors.  The person must wear a mask, wash hands regularly and practice cough etiquette.  The person must be able to report health status to health care providers through MySejahtera App.  The eating utensils, tableware should be used exclusively for the person.

Vaccination

The national COVID-19 immunization program is on a voluntary basis, is free for all Malaysians and non-Malaysian residing in the country.  It is for everyone of age 18 years and above.  Currently the age has been extended to cover 12 years and above using the Pfizer vaccine.  The immunization target is to cover 80% of the Malaysian population.  We are currently in Phase 3 of the program.  The immunization program will be completing sometime at the end of this year. 

Portfolio of Vaccine in Malaysia are from the following manufacturers:  Pfizer, SinoVac, Astra Zeneca, Johnson and Johnson and CanSino. 

The Pfizer vaccine uses the mRNA technology.  The Astra Zeneca, Jansen, CanSino vaccines use the viral vector technology.  SinoVac is of the inactivated virus technology.

As of June the registration for immunization has reached almost 60% of the population in Malaysia. From the graph you can see the accelerated growth for vaccination.  There is an increase in demand by the population and vaccine roll out by the government.

Selangor, Sarawak, Kuala Lumpur and Putrajaya will reach vaccination target in August.  Labuan will reach vaccination target earlier in July.  Perak will reach the 50% target in September and full target by year end.

Vaccine adverse events are very uncommon. Of note with mRNA vaccines is heart inflammation (myocarditis and pericarditis)  This adverse event occurs several days after vaccination.  It mostly affect males, adolescent and young adults of 16 years and above. The presenting symptoms are chest pain, difficulty breathing and palpitation.  The Pfizer vaccine is a mRNA vaccine.  The occurrence of the adverse event is about 2 per 100,000 population, aged between 16- 39 years.

Another adverse event of concern is Thrombosis with Thrombocytopenia Syndrome. (TTS).  It occurs 4 to 30 days post vaccination.  TTS may present as cerebral venous sinus thrombosis.  The illness presents with severe headache, worse by lying down or bending over, and is associated with blurred vision, nausea and vomiting, difficulty with speech, weakness, drowsiness, or even seizures. 

There may even be unexplained bruising or bleeding.   Some may experience shortness of breath, chest pain, leg swelling or persistent abdominal pain.

The Astra Zeneca and Jansen vaccines are viral vector vaccines.  These adverse events are very rare with 2 - 4 events per million vaccinated.

Recovery Plan

The national recovery plan has 4 Phases.  There are 3 conditions to be met under each phase.  The conditions include 1. the number of daily cases 2. ICU bed availability and 3. The percentage of population vaccinated.

In Phase 1 only essential services are allowed.  In Phase 2, some economic sectors to reopen while the social sector remains closed.  In Phase 3, more economic sectors to reopened, the social sector is reopened gradually, Parliament and schools to reopened as well.  In Phase 4, there is full reopening of the economy.  Phase 4 is projected to occur sometime in November and December this year.

This chart shows the number of observed and forecast cases in the month of April and June. R0 is the basic reproduction number of an infection.  The rate of infection rises when the R0 is greater than 1 and declines when the R0 is less than 1.  We currently have a R0 of less than 1 with declining number of cases.

As you can see from this chart, there has been an increasing number of hospitals managing COVID-19 cases.  The number of ICU beds and ventilators have also increased.   

As such, with deceasing number of cases and increased number of ICU beds we can expect ICU bed utilization will decrease.

More than 10% of the population is already vaccinated.  We shall soon reach our 40% and 60% target soon and will help speed up our National Recovery Plan.

There is a very low risk of viral transmission from surfaces and outdoor activities. However there is a very high risk of viral transmission from gatherings in enclosed spaces,  like in offices, religious places, cinema halls, gyms and theaters.

Infection

The COVID virus is mainly transmitted via droplets and contact routes.  However airborne transmission is possible for example while performing aerosol generating procedures. There has been no report of faecal- oral transmission to date.

A viral dose of about 1000 virus particles is needed before a person becomes infected.  During normal breathing about 20 vp are shed in a minute.  While speaking about 200 vp.  Coughing and sneezing expel about 200 million vp into the air and these vp can remains in the air for hours in poorly ventilated environments.

The infectious dose is dependent on the number of virus particles multiplied by time.   


 

 

 

 

Sunday, June 20, 2021

Kampar House is offering a 20% Discount on All Rooms


 COVID-19 has caused financial problems to many families and students.  Kampar House is offer a 20% discount on all rooms for Year 2021 - 2022.  

ACS Virtual Programme


Gave a short presentation on COVID-19 to my ACS Ipoh schoolmates.  They were so enthusiastic to listen and had so many questions to ask. 
 

Friday, June 18, 2021

Check your blood oxygen level.


 Check your blood oxygen level regularly if you are unwell and under home quarantine for COVID-19 infection.