30th April 2021 – (Hong Kong) In Hong Kong yesterday, 1,600 residents in 400 units of Tower 11 of Caribbean Coast in Tung Chung were evacuated after the first local mutant case involving a possible South African strain was discovered. This has become the first local case of unknown sources with a variant virus in Hong Kong involves a Filipino domestic helper with no travel history. Her employer’s baby was also infected. More than a week ago, 8 Kennedy Terrace, No. 8 Kennedy Road in Central was placed under lockdown for testing . The main reason for this operation was that a confirmed case was discovered in the building, involving a Philippine foreign domestic helper who is infected with the mutant virus.  She stayed at Ramada Hong Kong Harbour View in Sai Ying Pun during her quarantine for 21 days after arriving from the Philippines. After completing her quarantine, she entered the community for 6 days. On 19th April, the Filipino domestic helper visited Melbourne Plaza in Central to undergo body checkup, Level 8 of Immigration Tower in Wan Chai and she also visited an employment agency 176, Queens Road Central. Earlier, an Indian engineer became the first imported case infected with South African strain to enter the community. He visited multiple places including Cheung Chau. Bearing in mind that the incubation period for the variant can take longer than 21 days, the new fifth wave involving a more potent South African variant seems to be inevitable in Hong Kong.

Under the original mechanism, the Air Travel Bubble (ATB) would be suspended for two weeks if the seven-day moving average of the daily number of unlinked local COVID-19 cases (the 7DMA figure) is more than five for either Singapore or Hong Kong, and can resume if the 7DMA figure reported on the last day of the two-week suspension period for both places do not exceed five. To address potential fluctuations of the epidemic situation, a new requirement is introduced so that the ATB can resume only after fulfilling the original threshold and subsequently having three consecutive days with the daily number of unlinked local cases for both places not exceeding three, and the 7DMA figure on the third day for both places do not exceed five.

This mechanism would easily be triggered based on the development of the current outbreak in Singapore and the incoming fifth waive in Hong Kong. Taking into account the low numbers of vaccinated Hong Kong population and the recently relaxed anti-epidemic regulations in Hong Kong to reopen bars, party rooms and extend the opening hours of restaurants based on vaccine bubble, the air travel bubble may face another huge hurdle towards the end of May. As of 9am yesterday, Cathay Pacific tickets would not be available until 3rd June at the earliest, but there were only 2 selected economy class seats left. The round-trip ticket price costs HK$14,500 which is more than twice as expensive as the normal ticket price. It seems like naive and eager Hong Kong travellers are too optimistic with the epidemic situation but only to face with highly possible disappointment by next month. As cases in India continue to hit record daily highs, cross-continent travel is basically impossible but many countries stubbornly continue to explore reopening their borders. The mutant cases will continue to inch one step ahead of mankind and more lockdowns will eventually take place in the near future once these countries decide to welcome travellers back to their backyards by importing some mutant strains along the way.

Despite surpassing a total of 18 million cases, Air India is planning to reintroduce near pre-pandemic frequency of direct flights to the US in the first half of May. The airline is planning to operate 32 direct flights to the US per week from 11th May. Before the pandemic, Air India operated 33 flights per week. It is yet to be seen if U.S. will allow Air India to land its flights there. Scientists are studying what led to an unexpected surge in cases in India, and particularly whether a variant of the novel coronavirus first detected in India is to blame. The variant, named B.1.617, has been reported in some 17 countries, raising global concern. The B.1.617 variant contains two key mutations to the outer “spike” portion of the virus that attaches to human cells. The WHO has described it as a “variant of interest”, suggesting it may have mutations that would make the virus more transmissible, cause more severe disease or evade vaccine immunity. Other strains with known risks, such as those first detected in the United Kingdom, Brazil and South Africa, have been categorised as “variants of concern,” a higher threat level. One bright spot is that vaccines may be protective. White House chief medical adviser Anthony Fauci said earlier this week that preliminary evidence from lab studies suggest Covaxin, a vaccine developed in India, appears capable of neutralising the variant.

Although vaccine developed by Pfizer Inc and BioNTech is around 91% effective at preventing COVID-19 for up to six months, the South African variant may evade the protection provided by Pfizer/BioNTech’s COVID-19 vaccine to some extent, a real-world data study in Israel found, though its prevalence in the country is very low and the research has not been peer reviewed. The study, released earlier this month, compared almost 400 people who had tested positive for COVID-19, 14 days or more after they received one or two doses of the vaccine, against the same number of unvaccinated patients with the disease. But among patients who had received two doses of the vaccine, the variant’s prevalence rate was eight times higher than those unvaccinated – 5.4% versus 0.7%. This suggests the vaccine is less effective against the South African variant, compared with the original coronavirus and a variant first identified in Britain that has come to comprise nearly all COVID-19 cases in Israel, the researchers said.

In Singapore, more than 1.1 million vaccine doses have been administered as of end March but the amount is still insufficient to prevent the spread of the virus as the recent outbreak was first caused by a nursed who has received 2 doses of COVID-19 vaccination. She was fully vaccinated and she was still infected.

According to CNA Singapore, two more staff members of Tan Tock Seng Hospital (TTSH) and six patients who were in Ward 9D have tested positive for the coronavirus, bringing the total number of cases in this COVID-19 cluster to nine.  The two staff members who tested positive are a 30-year-old doctor and an 18-year-old healthcare assistant trainee.  All the patients who tested positive are Singaporeans. Most of them are elderly, with the oldest being 94 years old. This is Singapore’s first COVID-19 hospital cluster and the largest active cluster currently. In addition to Ward 9D, TTSH has now locked down Ward 7D as one of the COVID-19 cases had transferred from there.

The 30-year-old doctor, who is a Singapore permanent resident, attended to patients in Ward 9D but had not gone to work after he developed a fever on Tuesday. The doctor has been fully vaccinated against COVID-19, having received his first dose on 18th Jan and the second on 8th Feb, said MOH. His serological test result has come back negative, which indicates a current infection. The 18-year-old healthcare assistant trainee is asymptomatic and her infection was detected on Wednesday as part of TTSH’s testing of patients and staff members in Ward 9D. Her test result came back positive the next day and she was taken to the NCID. 

Among the patients who tested positive is a 57-year-old man who was initially warded in Ward 7D, before being transferred to Ward 9D.   Giving a timeline of his case, MOH said he developed a fever on 16th April but did not seek medical treatment.  Two days later, as his fever persisted and he had developed a runny nose and cough, he went to TTSH’s emergency department. He tested negative for COVID-19 and was subsequently placed in Ward 7D. On 20th Aprirl, he was transferred to Ward 9D. With his fever persisting, he was reviewed by an infectious diseases physician and transferred to an isolation ward on 27th April.  The next day, he tested positive for COVID-19 and was transferred to NCID.  The other five patients who tested positive (Cases 62567, 62568, 62573, 62574 and 62582) were detected as part of TTSH’s swab of patients in Ward 9D. 

Case No. 62541, the nurse who first tested positive on 27th April, was deployed at Ward 9D, a general ward. The Philippine national was fully vaccinated against COVID-19, having received her second dose on 18th February. After her infection was confirmed, TTSH locked down the affected ward and tested patients and staff members who had been there.

A total of 16 community cases were reported in Singapore on Thursday, including seven family members of the 38-year-old Immigration & Checkpoints Authority (ICA) officer deployed at Changi Airport Terminal 1 who tested positive earlier. Nineteen other cases are imported and were placed on stay-home notice upon arrival in Singapore. 

The 38-year-old Immigration & Checkpoints Authority (ICA) officer deployed at Changi Airport Terminal developed a cough on 23rd April and sought medical treatment the next day at a general practitioner clinic, where he was given two days’ of medical leave. He developed a fever, anosmia (the loss of the sense of smell) and body aches on 26th April.  The man sought medical treatment at Tan Tock Seng Hospital the next day. He was tested for COVID-19 and his test came back positive on the same day.  “His previous tests from rostered routine testing – the last being on 22nd April – were all negative for COVID-19 infection,” said MOH, adding that his serology test is pending. 

Travellers should hold their horses and adopt a wait and see attitude before making hasty decision to book flights and hotels in the new air travel bubble arrangement. They will later find themselves struggling with disappointments when dealing with the tedious refund process. The world is not ready for reopening in the near future even though governments worldwide is racing to vaccinate their population and selling hopes to reopen their borders. As long as the mutant variant continues to linger in the air, it will always be one step ahead until the second generation of vaccines can finally protect the world population. Till then, drop the travel plans unless necessary, stay put and keep social distancing.