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Sunday, Jan 17, 2021 - 03:26 SGT
Posted By: Gilbert

Enter 2021

New year, new responsibilities, short update.


Vaccines All The Rage


Wir sind die Besten!
(Source: r/singapore)


It's been about a month since the first vaccine shipments have been flown in (for which we apparently paid a pretty penny, as grouched by a Malaysian minister - and actually, I can believe that), and the immunization process has been trundling along, with the Prime Minister himself receiving a Pfizer dose about a week ago. The Ministry of Health has also moved to allay some fears by announcing a vaccine injury financial assistance program, which brought some gripes on the lack of details so far, and that there was no indication that it would apply to delayed effects - but hey, it's a good start.

Before continuing, a recent survey by YouGov has been done on how inhabitants of some countries would feel about vaccines developed by various other countries, and the headline was that Germany, Canada and the United Kingdom were top of the charts, while some local Redditors couldn't get past the ang mohs supposedly sticking together, with Europeans generally trusting each other more than others. On this, perhaps some adjacent observations might be illuminating:
  • Basically, everybody likes and trusts themselves the most (when they are an available option), which is entirely unsurprising. For example, Singaporeans gave a hypothetical Singapore-produced vaccine a +61 opinion score, and while I'm sure our R&D folk in the business are entirely competent, it's not clear why our (as yet nonexistent) product should objectively be rated that much higher than established producers (next highest being Germany, at +36)

  • On the apparent German superiority, it might be noted that this seems partly due to the Germans kinda being negative Nancies, and dumping on everyone else; they gave themselves a +44 opinion score, with the next closest being Canada at a mere +16; compare say the U.K., who gave themselves +40, and Germany +29. Had the Germans merely returned the favour, the U.K.'s average would have jumped a couple of points.

  • This predilection is only starker when considered alongside, say, India. Although the Indians gave themselves a +68, they also gave all but two countries at least a +20 (exceptions being Iran and China, probably due to the developing New Cold War), as opposed to the Germans who gave nobody but themselves better than +20. What do you say, nice guys don't win...

  • The greatest self-other gap belongs to China, who awarded themselves a massive +83, with their next-highest score going to frenemies Russia at +24, a near sixty-point chasm. Germany and Singapore were next, and the relative positions of Iran (-6), Australia (-12), the USA (-25) and India (-32) must reflect geopolitical realities far more than any honest assessment of vaccine efficacy (they've signed up for 100 million doses from BioNTech despite these offerings being co-developed with the American-based Pfizer, with the latter officially uninvolved in the deal)

  • Interestingly, while China's relatively trusting of Germany (+20), these sentiments aren't being reciprocated (-38)

  • Singapore (and South Korea) seems to exist in an intermediate band between East and West - the Western opinion of these countries appears clearly somewhat more favourable than Russia/India/China/Iran, and the Aussies and Brits actually have a net positive opinion - which might be something, recalling that the German opinion of the U.K. was just barely positive.

  • Hong Kong had the U.K., USA and the West in general at well over +30, and China at -20, which seems the only exception to all the self-promotion that's been going around. That said, it's kind of eye-opening that China received just two net positive ratings, other than from themselves - Mexico (+16, though they more or less like everyone, like India) and Indonesia (+5)

My own stand remains constant - medical and public health treatments should know no borders or politics, and if a cure works and is accessible, it should be adopted. The problem is that trust remains in short supply in reality, and when The BMJ is pressing for more raw data and pointing out issues on the treatment of suspected cases (found only after 41 pages of the original briefing document) that could significantly impact the claimed 95% efficacy, one thinks it hardly unreasonable to remain skeptical, as many locals are indeed remaining, what more with reports on side-effects rolling in; that said, such possible vaccine-induced deaths should be considered alongside baseline mortality, and with all indications being that the coronavirus has become endemic, possibly in mutated forms, it's understandable if policymakers regard vaccination as a bullet to be bitten sooner or later.

Some treatments are likely to be better than others, though, which might have become a bit of a hot potato here and elsewhere, what with Sinovac's vaccine reporting four efficacy rates from between about 50% to 91%. Now, it being produced by a more traditional non-mRNA-based technique could be a plus for some, and I'm hardly one to discount anything that might help, but the optics of providing some of the populace a purportedly 95% effective vaccine, and others a merely 50% effective version, must be problematic. Well, the Health Minister has placed it under further review with some blasting it as a failed gamble, so let's see how this gets resolved.


Cycle Thresholds

And on the all-important cycle threshold (CT) from PCR tests, further poking around suggests that the threshold itself may not be as objective as was assumed. A Public Health Ontario publication, for example, states that in a proficiency testing panel distribution to 26 different labs, variability of up to 8 cycles was observed for the same specimen, and thus "...it is inappropriate to compare CT values from different assays, and to extrapolate CT cut-offs for virus viability from one laboratory to any other laboratory and that CT cut-offs cannot be reliably used for the determination of virus viability"; this seems largely assented to by a summary in the NYT, which advocates that "...reporting CT values alone can be misleading, especially since CT values can vary significantly between various tests and labs. However, a result comment for low positive results may be helpful".

Interestingly, the Public Health Ontario overview further informs that "Several studies have been conducted in an attempt to correlate CT values with infectivity of SARS-CoV-2 virus. For example, viability of virus can be determined by inoculating cell lines in culture and assessing for evidence of viral replication... it is not currently standardized and cannot be used to guide clinical decisions. Critically, it has not been established that persons with PCR-positive specimens that cannot be cultured are not infectious".

On the wide variability of cycles between labs at least, there has been a rebuttal that different labs do indeed use different versions of PCR tests, with different probe-and-primer combinations and targeting different genes, and as such concerns based on raw CT threshold values (e.g. apparently CT=30 in a local trial) are unfounded. Fair enough, one supposes, but the correlation of particular threshold values to viability - which seems much of the whole point - appears to remain unresolved, and moreover this explanation does not seem to preclude the recording of CT thresholds together with protocol used, for future analysis; it's one thing if comparisons between labs is inappropriate, but it would surely be of interest as to how the number of positive tests is impacted by a changing threshold value, when following the same method.


Railroaded

The High Speed Rail (HSR) project's officially done - for now at least, with local authorities putting on a brave face about the implications for Jurong East's development. Anyhow, it does appear to be mostly about the money, as with so many other things, and most importantly what faction gets it. Remarkably, Singapore has supposedly already been invited to invest in their new HSR vision, but at this point I'd settle for collecting the promised compensation without our water supply getting threatened yet again.


TrustBroken

When the TraceTogether contract-tracing token was launched earlier this year, it was feted as a key contributor to Singapore's relative success in containing the coronavirus, and opposition to it due to worries that the government would only be used for contact tracing were forcefully shushed with reference to the government's reputation - word as good as gold and all that. Before the year was out, however, it transpired that the police had been freely accessing it in their investigations, to which observers from the rest of the world mostly went well duh, what did you expect?

To this easily-avoided betrayal, various ministers would claim to not have thought about the relevant Criminal Procedure Code when making assurances, and that use of such data would be restricted to very serious offences only so why not just trust them, and not I say one hor. Netizens would further note that it looked like the government wasn't aware of its own laws, which brought a very rare slap on the wrist by The State's Times; however, one might recognize that rectifying the situation is actually straightforward - the government could just declare that such use of data was a mistake, and pledge to stop all non-contact-tracing applications, as originally promised. That no such correction has been offered, could be taken as a hint about the true intent behind such compulsory surveillance.

This happens to be just one example of the increasing authoritarianism and censorship that the pandemic has provided an excuse for, with valid perspectives oft getting shut down under the cloak of "misinformation", to which one can only remember the many times that the officially-sanctioned "scientific!" line turned out to be misplaced. Ironically, CNA's commentary on misinformation itself listed "Asians [being] more susceptible to [COVID-19] than Caucasians" as an example of a falsehood, which as it turns out, appears to be entirely plausible from published research involving over 18 million patients from fifty studies, without getting into vaccine efficacies. Then again, one doesn't really expect the mainstream media to get even the basics right these days, on which more next time.



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