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Dr Gabriel Choi, president of the Hong Kong Medical Association

2021-05-09

Dr Gabriel Choi, president of the Hong Kong Medical Association

2021-05-09

Hi Matthew, how are things in Toronto? I heard that the epidemic is still pretty scary down there.  Be healthy and safe and stick with hand washing, safe distancing, and masking. Say hello to my daughter-in-law and my grandson and I hope to see them soon.
 
During the recent holiday, I was watching re-runs of the movie series Resident Evil.  You may remember this action-horror movie series based on the Japanese video game franchise named also as Biohazard by Capcom. The first of the series was released on 2002 and ended with the 5th movie, The Final Chapter, in 2016.
 
The films follow Alice, a former security specialist who battles the Umbrella Corporation, whose bio-weapons have triggered a zombie apocalypse.  The Hive is the secret laboratory under Racoon City from which the deadly T-virus was released by an artificial intelligence, the Red Queen. Despite various attempts to contain the virus including nuclear bombing the city, the T-virus spread and human race is on the verge of extinction.  The earth is wasted but for zombies and mutated animals.  Alice had numerous near misses before finally releasing the anti-virus to eliminate all infected monsters and save the world.
 
In one of the Resident Evil movies towards the finishing scene, hundreds of zombies and mutated animals were scaling the walls of the city with the remaining human race hiding inside and protected by high walls and gunfire.  This was an impasse, a lock down, and dead-end unless the human can with kill off all the infected creatures..
 
I reflected to find the similarity between T-virus and Covid-19 striking.  The latter is caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus strain.  It is an enveloped virus with a fragile outer membrane. The first human cases were first reported by officials in Wuhan, in December 2019.  
 
Like the T-virus, Covid-19 spread widely infecting 155 million and took 3.2 million lives.  In America, 32.6 million were infected with 579,000 deaths.  India has 21.1 Million infected with 230,000 deaths.  Brazil with 14.9 Million in with 414,000 killed. Of course the mortality rate of T-virus in the movie is even higher with the human race near extinction, but who can tell for sure when the virus is on the rampage in India and the health facilities are inadequate there as well as in Africa and when the variant strains are lurking around us.  Further mutations are expected which may be more infectious and more deadly.
 
N501Y mutation can be found in the three variants of concern first identified in Britain, South Africa and Brazil, it is absent in the B.1.617 variant from India.  The India variant is found in 10 HK Covid-19 cases and 7 arrived on a flight from New Delhi on 4 April. 
 
Without frank admission of where the infected person hanged out prior to being discovered to have the infection, the team tracing the contacts will have a hard time to detect the other infected in time to prevent another spread of a local wave. This type of deceit must be taken seriously. 
 
The medical profession is on the defensive.  Border Lock down had not been complete and the faux-pas led to several of the ‘waves’ of attack here in Hong Kong.  Without the ultimate weapon like the one Alice had, we may soon learn that the pandemic is not going to disappear like the last time with SARS, and that it will stay on world-wide even after global vaccination is achieved and we may have to add annual vaccine to our list of MUST in the years to come.
 
Science and technology are making rapid progress in the treatment of Covid-19.  New medications are on the horizon to effectively treat the infection and prevent morbidity and mortality.  Over half a dozen vaccines are on the market from various countries to prevent infection.  Despite the announced side-effects, the results of vaccination in various countries have been convincing.  For countries like Israel, USA, UK the slope of the prevalence of disease has flattened and lockdowns lifted.  For countries where distancing and masking and various social and preventive measures are not practiced, and where vaccination is not popularized, the rate of infection and death continues to rise, like in India.
 
It has always been suggested that a 70% population vaccination rate is required for herd immunity.  Despite Israel (62.4%), UK (50.4%) and USA (43%) are heading in that direction, the world is not.  Only 8% of the world population received at least one dose of vaccine.  7.1% of India’s population received at least one shot and 11.1% of Brazilians have at least one shot. Hong Kong can only boast that over one million or 12.7% of the population received at least one shot.  The low vaccination rate is due to poverty in some countries and to mistrust in others..
 
As clinicians, we have witnessed the succeeding waves in Hong Kong due to failure of lockdown and surveillance and mistakes in swabbing and testing.  Unlike the T-virus in Resident Evil, there is no antiviral to kill the Covid-19 virus in totality. Our only hopes are the safe and efficient vaccines which we have up-to-date.  Although pushed through for emergency use within a year of the pandemic, some of the vaccines have been used on millions of people and almost all side-effects made known for health authorities to consider its safety for use in the emergency situation.
 
Trust of the authority is an issue which dictates whether the citizens will want to get vaccinated or not.  Despite various expert panels being formed, there have been inadequate convincing statements from the groups to convince the public of the importance and safety of the vaccines.  Various measures to entice vaccination are devised so that citizens can eat in restaurants in bigger groups and for longer periods, or for citizens to go on trips or get across the border with shorter quarantine time. Unfortunately, the schemes are complicated and not tempting enough to lure citizens to get vaccinated. 
 
As doctors, we support mass vaccination to create herd immunity in Hong Kong so that life and business can return to normal.  Even with herd immunity through vaccination, variant strains pose a knife over our heads if border control is not well kept and surveillance and follow-up is inadequate  We can only advice our patients based on the current data and set good examples for our fellow citizens to follow.

Letter To Hong Kong

                                                               
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