COVID-19: ``A More Contagious Coronavirus`` Episode on 19 August 2020

We have seen reports that the COVID-19 strain has mutated and vaccines are underway. We invite back Dr Leong Hoe Nam to share his thoughts on the "more contagious coronavirus".

 

"A More Contagious Coronavirus" Episode with Glenn and The Flying Dutchman
Interview with Dr Leong Hoe Nam, Infectious Disease Specialist from Mount Elizabeth Hospital, Rophi Clinic on 19 August 2020.

[See related episode on 15 April]

 

Transcript

[00:18:05] Glenn & The Flying Dutchman: We’ve seen reports coming out of Malaysia, and then yesterday the Philippines, reports of this mutated COVID-19 bacteria. Has it mutated, what is the significance if it has?

[00:18:29] Dr Leong: It certainly has mutated. If you think about it, it is in the nature of the virus to mutate. Just like us, we are working in a new environment, in a new station, we want to adapt and try to do better at the station. The better you are, the faster you are and you’ll be more efficient in your work, the more productive you will become. Similarly, the virus acts exactly the same. It wants to mutate and adapt so it can affect more people faster and quicker. So it is in the nature of the virus to do it, and if you think about natural selection, the one that adapts fastest to the human body, with a fastest growth, will be the one that succeeds best. In this scenario, you actually have a mutation called D614G which allows the virus to grow faster. I must qualify, this was proven in someone’s scientific laboratory. Under the test tube conditions, they gave the virus compared with the old strain of it (that first surface out of China), and if you look at the cells, the ones where you had the new mutation (D614G), it seems to infect the cells faster - up to 10x faster. So, the virus will try to adapt, it is in the nature of it to try to adapt, just like how you would try to do better at your job.

But, does it mean anything? If you think about it, let’s say there are 2 viruses here. One, there’s mutating to be more efficient in infecting, it will probably outrun that is far behind, so very soon this will take over. While this efficiently mutating and adapting, you come up with a strain that kills immediately, it kills the virus, it kills the host at the same time. Wheares the ones that infect but allows the person well enough to go out to work, continue spreading, that will survive better. The host will pretend and feel he is well and go out to infect others. So give it sufficient time, the one that infects fast, hardly give any symptoms or minimum symptoms, giving the host a false sense of security that he is well - that is the one that succeeds. Most of these then do not cause severe illness. Dr Paul Tambyah said when they actually mutate, they mutate towards a milder form of illness, perhaps more infectious so they can spread quicker, and that will ensure the survival of its progeny.

[00:21:34] Glenn: So that's the thing, as long as people don't get seriously ill, then it’s ok!

[00:21:41] Dr Leong: But what is the true situation on the ground? Look at Italy, when we first started off, we didn't have much of the D614G, but by February, or at least early March, majority of the Italian cases were actually D614G which is the mutated strain, but did Italy come out worse with the D614G? No, it actually came out stronger. Look at the death rates that fell subsequently from April to May, Italy got it under control. But what did Italy do which America couldn't do? The answer is they were doing good social distancing, they were wearing face masks. So, in this instance, where it’s supposed to be mutating faster, it didn’t make a difference in the real sense. It didn’t make a difference when the Italians put on the mask and kept the social distancing. What it means is that, even if D614G were to come to Singapore, Singapore's efforts of working together will block D614G, it will be decimated by us!

[00:23:33] FD: So Dr Leong, if this COVID-19 virus is evolving, how effective is any vaccine that we’re working on now, which is probably working on an older strain?

[00:23:57] Dr Leong: Brilliant question, the answer is “we walk by faith”. The virus will keep adapting, keep mutating and mutating, to the extent if you imagine, everyone’s been vaccinated with a vaccine, which fits into this spike protein. There is a potential threat that none of the new infectious viruses may transmit. It will then create a hostile environment for the viruses. The virus will then try to adapt and mutate until it can shift something that can overcome it. This is very crucial.

Thus, we need to find a structural protein, where the virus doesn’t change, or the moment it changes it kills the virus.. Find a structural protein, which will remain exactly the same, the virus cannot afford to change it. Or number 2, make the vaccine very potent..the vaccine effectiveness still recognises it. It depends on how much the virus can mutate, and how good the virus is in noticing the slight differences. This depends on the special powers of each vaccine. The more elaborate there is in the design, the better the ability to recognise the slight changes. The good news is, all the vaccines that are up in the Phase 3 trial shows that it works. In this point in time, the virus is still on target towards being totally controlled.

[00:26:09] Glenn: What about the vaccine that is being released in Russia?

[00:26:14] Dr Leong: The vaccine in Russia is a little unknown. We have no scientific evidence that’s published. We just know that they have completed Phase 1 and Phase 2 trials that are deemed to be safe. They haven't gone into Phase 3. Phase 3 needs large scale, in a place where there is active transmissions and you look at the 2 groups. Whether they have the vaccine, do they reduce down the numbers, and compared to the placebo (which was just another regular vaccine like Hepatitis A) and see the numbers. So we won't have Phase 3 trials but Russia is going ahead.

[00:26:56] Glenn: In Singapore we are also conducting some vaccine trials as well?

[00:27:02] Dr Leong: Yes, Duke-NUS in collaboration with another laboratory, is doing Phase 1 trials on the vaccines. We are a little behind, but this ensures we have our own vaccine. That is very important - you have the UK together with AstraZeneca, Moderna, Pfizer, together with the European labs, these 3 are the game changers at the moment. The China one is almost ready for sale. These 4 when they come onto the market, everyone will want to buy their vaccines. This makes the vaccines rather expensive. We will have difficulty in getting them. Where is the priority of Singapore in all scheme of these things? Really low.

So when we have our own vaccine, and our own vaccine manufacturing capacity, then we can actually do it ourselves. So Singapore, don't expect the vaccine to pop up the end of the year and to start travelling, middle of the year, unlikely. From the inventors of the vaccine, it seems it’s going to be towards the end of the year, before Singapore has its own vaccines. Indeed, if everyone cooperates and get billions of doses, we might get ours earlier.

[00:28:22] Glenn: And from what I hear, we are also looking for volunteers. They need more people, as much as there have been people coming in, they have not selected everyone. So they invite more people to step forward, people who are willing to volunteer to do this.

[00:28:47] Dr Leong: So for Phase 1 trial, we like people who are healthy.. the idea is get healthy people make sure they are safe and fine. You don’t want to give it to the elderly, not yet.

[00:29:34] FD: So Dr Leong, a lot of stuff has been coming up of the last couple of weeks, regarding COVID-19. Another one was that New Zealand suspected that they have another cluster because of the virus that could have come into New Zealand on cargo. China had the same reports from Brazil and Ecuador. What sort of surfaces will be able to hold this kind of virus?

[00:30:27] Dr Leong: If you think about it, if you’re a scientist now, you need to store this virus. How do you store a virus? What you’d need to do is give it a plasma, something similar which you have in your blood, put inside a tube, put inside the virus, and put in the freezer at minus 20. And the virus will live a long time. And when you take it out, freeze and thaw it, about 50% will die. If you think about it, the frozen packs that you get, if the person coughs into it, aren't you creating the same scenario, aren’t the viruses being frozen? In that sense, yes, it will work. You can actually freeze it, you ship it over to china, you will find it.

If you look at China where they did testing, they sample lots of places. They found the viruses on the packs, the question is, is it alive, is it dead, we have no idea. We do know that the viruses don't live very well with freeze-thaw. The more freeze-thaws there are, the viability falls. What it means is this - it can transmit, it may not transmit very well. And we don't know if it is really alive or dead. But I don’t think that's the narrative that happened in New Zealand, I think something else went wrong.

At the end of the day, consistently in China, Hong Kong, New Zealand, Korea or any country which has another wave. It was eventually linked to people who entered the country, who went away, who didn’t have their Stay Home Notice and their quarantine, and went out and started infecting other people. These people were asymptomatic transmitting and they started spreading. Theoretically, you can transmit it through frozen stuff. But no it doesn't. Point 3, the Singapore hot environment, the humidity is actually the perfect way to kill the virus. It doesn't live very long in hot, humid Singapore. It prefers the cold climate of the winter, like in Melbourne. They really have a tough time because the weather doesn't help them. The warm weather and humidity will actually kill it. What I will be really concerned about will be the frozen stuff, I get a frozen pack of chicken wings, I won’t bring it back home, I will handle it, but after handling it I will wash my hands with at least a spray alcohol or spray with water, I will bring it back home, I will rinse it under the tap. Remember, water kills. Alcohol drowns the virus, but water alone will kill the virus. Rinse it on the outside, and you're good to go then put it into the freezer. If you're worried, take it out of the freezer, rinse it over you’re good to go and you’re fine.

[00:35:06] FD: The other thing that has come about - these migrant workers who were cleared of the virus, and then now in their bi-weekly testing, they’re suddenly positive again. What's going on?

[00:35:19] Dr Leong: That’s a good question. I can't speak for Ministry of Health, what I'm going to say does not represent what the MOH or what the government has been doing. No doubt, there was a lot of transmission in the first half of the year. Many of the foreign workers were infected, and they went on transmitting to many people, where more than 55,000 cases coming from the foreign workers alone. A lot of them were cleared.

The government went through every single case making sure every single one was cleared. But if you think about it, the test of the swab, is only about 93-94% sensitive under NCID hands. These are professionals, who do it day in and day out. Which means there is still 6-7% which they may miss out. So these people who miss out, would theoretically spread or potentially spread to other people around.

Number 2, let's look at the dormitory environment. They don’t have the luxury like each of us, living in a single isolated room. They will still have the dormitory. Third thing, no offence to the foreign workers - if I were a foreign worker, I would stay in my room, but when the opportunity comes out to interact to someone on the other side, I would. If you look at the dormitory environments in Singapore, it’s not just the foreign workers, but army boys, we were living in dormitories. The prisoners live in a very close environment. Yet these other dormitories, about soldiers, about prisoners, they don't get widespread cases, what then is about the foreign workers that actually makes them suitable. I think is the social interaction. They might be wearing a mask, but they are social creatures like you and me. They will be wearing a mask, when the opportunity arises they will interact with other people compared to the army discipline to the prisoner discipline, the discipline on the foreign workers not under these control will be poorer. What happened then, is that probably one or two cases were missed out, or picked out by community when they went out to work, and in turn, they caused a little mini spread.

This is where I give kudos to the government, they were aware that these foreign workers could get infected again. And in turn, they kept them, segregated them and do routine checks. What does it mean to us, to the numbers? The foreign worker numbers will be a persistent angst in Singapore's fight. They will always be a problem, and it's not just Singapore’s foreign workers, but foreign workers in every other country. From the Middle East to any other countries where there are foreign workers, where the living environment is a little different, where there is a need to social interact in other dormitories, they will be the perfect breeding ground for viruses, in this case COVID-19.

[00:39:18] Andre: I wanted to ask about people who are anti-vaccine. What do you tell people who are anti-vaccine, why it is not bad for you?

[00:39:41] Dr Leong: That is a very strong tough movement - the Anti Vaxxers. If they were to put themselves back in the shoes in the 1950’s or 60’s, before the vaccines were available, when you see the harm the viruses have done, you will really freak out.

The problem is many of these Anti Vaxxers do not appreciate the problems - Smallpox, it literally kills. Smallpox was eradicated by vaccines. Something even worse, is polio. Polio doesn’t kill, but it leaves a scar on you for life. Vaccines have done an incredible amount of job but these people are not exposed to polio, not exposed to smallpox because it is very much eradicated, they do not appreciate the dangers. No doubt vaccine may cause harm, hence it is extremely important to go through all the trials, and even after all the trials are done, you need to monitor for side effects consistently.

A little background - In 1976, Fort Dix, a place in the USA had an influenza outbreak. What the American government did was, they took the vaccine, they accelerated the whole vaccine development, they didn’t go into Phase 3 trials. They immediately started vaccinating after the second trial. What happened was, there was a lot of unnecessary side effects that destroyed many people’s lives and bodies. They call it the Guillain-Barre syndrome. After that, it was really a wakeup call for everyone. Don’t rush it. Make it go through the whole process so that everyone knows that this vaccine works. Even after if it has been approved for Phase 3, we need to be very sure and monitor the vaccine for other effects thereafter. This will ensure good safety vaccines against the COVID-19.

[00:42:58] Glenn: Thank you Dr Leong, before we let you go, any last words for ONE FM fans?

[00:43:00] Dr Leong: If you think about it Singapore, what did you do exceptionally that made the control of COVID-19 that was different from what it was April before circuit breaker? It was our compliance social distancing, and wearing a mask. And by doing that, we succeeded. The chinese did it, the chinese is so good now, they don't wear the mask they go out and play! We have the Koreans who did it, the Taiwanese, the Hong Kongers, the Italians, they won it over. The recipe to overcome COVID-19 is already there, you know it- it’s distancing and wearing a mask. Life can reopen and restart again with good methods like these and once the numbers in the community come down to consistently zero, I expect the government to open up more, more and more normal things. Singapore is blessed by the fact that we are surrounded by water with water tight immigrations all around. Anyone who comes into Singapore, they get screened, they get sorted out with their Stay Home Notices. Then Singapore will be the idyllic island where the COVID-19 doesn’t exist. So we have the winning formula, you are doing a fabulous job. Hang on in there, push on a little bit more, when the vaccines come on, we are going to show the whole world what a small little red dot can do.

 

Stay Safe. Stay Healthy.