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Id Subject Object Predicate Lexical cue
T1 0-55 Sentence denotes A Critical Appraisal of COVID-19 in Malaysia and Beyond
T2 57-65 Sentence denotes Abstract
T3 66-210 Sentence denotes When the first report of COVID-19 appeared in December 2019 from Wuhan, China, the world unknowingly perceived this as another flu-like illness.
T4 211-327 Sentence denotes Many were surprised at the extreme steps that China had subsequently taken to seal Wuhan from the rest of the world.
T5 328-514 Sentence denotes However, by February 2020, the SARS-CoV-2 virus, which causes COVID-19, had spread so quickly across the globe that the World Health Organization officially declared COVID-19 a pandemic.
T6 515-652 Sentence denotes COVID-19 is not the first pandemic the world has seen, so what makes it so unique in Malaysia, is discussed to avoid a future coronacoma.
T7 654-684 Sentence denotes The New Year with New Pandemic
T8 685-890 Sentence denotes As of 26 March 2020, 171 countries have been affected by the coronavirus disease 2019 or known as COVID-19 pandemic with 467,866 infected patients and 20,845 deaths, representing a 4.5% mortality rate (1).
T9 891-1150 Sentence denotes While, at the time of writing, China is the most affected country, the rate of infection in China has slowed down significantly; however, this is not the case in Italy or the United States, which are the second and third most affected countries, respectively.
T10 1151-1416 Sentence denotes Association of Southeast Asian Nations (ASEAN) countries, including Malaysia, have not been spared from COVID-19, although there have been fluctuations in the rate of infection demonstrated in the number of new cases and deaths reported in March 2020 (Table 1) (2).
T11 1417-1526 Sentence denotes Barely three months after the first reported case, many countries have ordered lockdowns, including Malaysia.
T12 1527-1647 Sentence denotes The Malaysian government announced an initial movement restriction order on 16 March 2020 and an extension to mid-April.
T13 1648-1696 Sentence denotes These measure have been enacted for good reason.
T14 1697-1964 Sentence denotes The trend in new cases does not appear to have peaked yet for Malaysia or other ASEAN countries (Figure 1) (3), although there have been fluctuations in the death rates (Figure 2) (1) perhaps due to different critical care capacities and resources in these countries.
T15 1965-2085 Sentence denotes COVID-19 is likely a zoonotic infection, which was transmitted from an unknown animal or environmental source to humans.
T16 2086-2190 Sentence denotes It is now spreading via human-to-human transmission with an average basic reproductive rate (R0) of 2.2.
T17 2191-2267 Sentence denotes In other words, for each patient, 2.2 other individuals become infected (4).
T18 2268-2419 Sentence denotes For comparison, the R0 for severe acute respiratory syndrome (SARS) was estimated at 3.0 and Middle East respiratory syndrome (MERS) was less than 1.0.
T19 2420-2653 Sentence denotes Based on the epidemiological data from Wuhan, there are several notable differences between COVID-19 and SARS and MERS: i) case fatality rates are lower; ii) asymptomatic spread can occur and iii) fever is more frequently absent (5).
T20 2654-2815 Sentence denotes Gastrointestinal complaints are uncommon among COVID-19 patients but loss of smell and loss of taste have been increasingly reported as early signs of infection.
T21 2816-2998 Sentence denotes Severe acute respiratory illness (SARI) is a severe complication, and typical computed tomography (CT) features include ground-glass and consolidative opacities in the periphery (6).
T22 2999-3223 Sentence denotes However, it must be borne in mind that SARI can also be a manifestation of respiratory illnesses with other infectious or non-infectious causes, which need to be ruled out before attributing the presence of SARI to COVID-19.
T23 3225-3264 Sentence denotes Halting the Spread with Rapid Diagnosis
T24 3265-3348 Sentence denotes A critical factor in slowing down the pandemic is the rapid diagnosis of new cases.
T25 3349-3552 Sentence denotes Nucleic acid amplification tests, such as real-time reverse transcription polymerase chain reaction (RT-PCR), provide the earliest and most accurate diagnosis, but they are costly and time consuming (7).
T26 3553-3766 Sentence denotes Point-of-care tests, e.g. lateral flow assays for the detection of antibodies are more ideal in the field; however, these tests are of limited value due accuracy issues and the time required to obtain a diagnosis.
T27 3767-3869 Sentence denotes Rapid antigen detection tests are still undergoing evaluation, and their efficacy is yet to be proven.
T28 3870-4011 Sentence denotes Figure 3 illustrates various tests being evaluated for COVID-19 and their diagnostic coverage from the acute phase to the convalescent phase.
T29 4012-4087 Sentence denotes The sources and accessibility of specimens are also critical for diagnosis.
T30 4088-4242 Sentence denotes For upper respiratory specimens, the viral Ribonucleic acid yield from nasopharyngeal swabs seems to offer more accurate results than oropharyngeal swabs.
T31 4243-4413 Sentence denotes The SARS-CoV-2 virus is also detectable in blood, urine and stool; such specimens are not as reliable for diagnosis but are important from the transmission point of view.
T32 4414-4559 Sentence denotes Proper transport and handling of specimens is necessary to ensure the integrity of the viral RNA and, hence, the accuracy of the diagnostic test.
T33 4560-4785 Sentence denotes Adherence to biosafety practices is essential, and any testing should be performed in appropriately equipped laboratories by staff trained in the relevant technical and safety procedures (World Health Organization, 2020) (8).
T34 4786-5043 Sentence denotes Non-propagative diagnostic laboratory work should be conducted at a biosafety level 2 (BSL-2) facility, whereas propagative work, including virus culture and isolation, should be conducted at a containment laboratory with inward directional airflow (BSL-3).
T35 5044-5182 Sentence denotes Virus isolation is not routine but necessary for characterisation and to support the development of vaccines and other therapeutic agents.
T36 5184-5216 Sentence denotes Challenges to Healthcare Workers
T37 5217-5386 Sentence denotes Until a vaccine is developed, healthcare workers who are in close contact with a suspect or a person under investigation (PUI) are at high risk of exposure to the virus.
T38 5387-5618 Sentence denotes Other than doctors at the frontlines, i.e. screening and critical care units, certain specialties may have increased risks of aerosolised exposure, including respiratory medicine; otolaryngology; ophthalmology; and dental services.
T39 5619-5714 Sentence denotes Many non-urgent procedures have been cancelled or postponed, including non-emergency surgeries.
T40 5715-5811 Sentence denotes Other than the aerosolised risk, the virus may contaminate the operating theatre during surgery.
T41 5812-5960 Sentence denotes Many learned societies, including the Academy of Medicine of Malaysia, have started releasing statements and guidelines to assist their members (9).
T42 5961-6127 Sentence denotes Meanwhile, grey areas and dilemmas exist without clear consensus, including guidelines for cancer patients on chemotherapy or those needing early surgical treatments.
T43 6128-6266 Sentence denotes Furthermore, other issues should be addressed by hospitals through a management protocol or algorithm in place for frontline workers (10).
T44 6267-6418 Sentence denotes For example, although many resources are being diverted to the frontlines and critical care, they will be inadequate during the height of the pandemic.
T45 6419-6570 Sentence denotes Thus, there is an ethical but pragmatic challenge in the allocation of critical resources, such as intensive care unit (ICU) beds and ventilators (11).
T46 6571-6704 Sentence denotes Age is often the sole criterion used for decision-making regarding ventilation, which can be morally difficult for people in general.
T47 6705-6834 Sentence denotes Therefore, it is imperative that such decisions be made by a different team, and that the triage algorithm be reviewed regularly.
T48 6836-6856 Sentence denotes Flattening the Curve
T49 6857-7255 Sentence denotes Although various antiviral agents such as avipiravir, ritonavir/lopinavir and hydroxychloroquine and other therapeutics, e.g. steroids and vaccines, are currently being considered to reduce the complications associated with COVID-19, including SARI and cytokine storms (12–14), the most cost-effective methods remain the public health approaches of contact tracing, isolation and social distancing.
T50 7256-7455 Sentence denotes The COVID-19 pandemic is predicted to run a protracted course, and available healthcare resources are likely unsustainable; hence, we need to flatten the curve with lockdown measures (Figure 4) (15).
T51 7456-7567 Sentence denotes However, the imposition of a lockdown needs to consider the sociocultural and economic factors of each country.
T52 7568-7665 Sentence denotes Extreme measures, such as the Wuhan closure, will not work in many countries, including Malaysia.
T53 7666-7756 Sentence denotes Instead, many countries may look to the South Korean model as a more suitable alternative.
T54 7757-7917 Sentence denotes In South Korea, rapid testing to rule out COVID-19 has been the key to its success, along with using personal information to track the spread of the virus (16).
T55 7918-8121 Sentence denotes In Malaysia, where social gathering is a norm, the initial days of the movement restriction order have been extremely difficult but necessary so that containment measures could be put into place quickly.
T56 8122-8275 Sentence denotes The current mitigation phase is critical in order to create a small window of opportunity to break the transmission of the virus to the larger community.
T57 8276-8388 Sentence denotes To do this, everyone should be transparent about their history of travels, mass gatherings and any new symptoms.
T58 8389-8480 Sentence denotes It is also important not to spread fake news to prevent panic and anxiety among the public.
T59 8481-8629 Sentence denotes The most common psychological reactions to a pandemic are fear and anxiety-related symptoms, such as panic, worry and emotionally distress (17, 18).
T60 8630-8870 Sentence denotes While these reactions are expected, they can be overwhelming to those with pre-existing mental health issues (19) and can lead the public to panic buy excessive amounts of food or health-related items, such as masks and hand sanitizer (18).
T61 8871-9203 Sentence denotes According the most recent data on COVID-19 study among 1,210 respondents from 194 cities in China (20), more than half of the respondents suffered moderate to severe psychological impacts; of those, 28.8% had moderate to severe anxiety, 16.5% had moderate to severe depressive symptoms and 8.1% had moderate to severe stress levels.
T62 9204-9307 Sentence denotes The majority were worried about their family members and they spent at least 20 h per day at home (20).
T63 9308-9606 Sentence denotes The psychological sequelae of the pandemic is the emergence of fear and anxiety not only due to the disease itself but also due to the disruption of daily activities, social isolation caused by the restricted movement order and financial burdens, especially among those with low-income levels (21).
T64 9607-9906 Sentence denotes For healthcare workers, the pandemic is exposing them to long-term stressors, which could impact their wellbeing (22) and lead to burnout due to increased job demands (such as increased workload and role conflicts) and reduced job resources which lead to loss of workplace control and autonomy (23).
T65 9907-9996 Sentence denotes Early mitigation and psychological crisis interventions are already in place in Malaysia.
T66 9997-10143 Sentence denotes Several government and non-governmental agencies are offering psychological first aid to the public through tele-counselling and hotline services.
T67 10144-10388 Sentence denotes These interventions should be continued even after the pandemic is over, as data has shown that those who are affected by a pandemic still have varying degrees of stress disorders even after the event ends or they recover from the disease (24).
T68 10389-10549 Sentence denotes In addition, clear information about the disease and progress updates on the situation could reduce the psychological impacts of COVID-19 among the public (20).
T69 10551-10589 Sentence denotes Addressing the Socio-economic Impacts:
T70 10590-10608 Sentence denotes Local Perspectives
T71 10609-10838 Sentence denotes There is no doubt that the imposed movement control order in Malaysia will have adverse economic impacts; however, the government has been quick to respond by announcing an economic stimulus plan to weather this difficult period.
T72 10839-11102 Sentence denotes Numerous important bodies, including the Academy of Sciences Malaysia, the Ministry of Health and the Ministry of Higher Education, are exploring the technology drivers of the present and the future to prevent and manage future epidemics and pandemics (Figure 5).
T73 11103-11216 Sentence denotes Weaknesses have been identified and improvements are being explored before government action plans are made (25).
T74 11217-11254 Sentence denotes Another impact is on day-to-day work.
T75 11255-11401 Sentence denotes Since many people are working from home, there is an urgent need to make better internet and software applications available for virtual meetings.
T76 11402-11473 Sentence denotes From the healthcare perspective, telemedicine will play a greater role.
T77 11474-11598 Sentence denotes Stable patients needing regular follow-ups, as well as patients in clinical trials, can be directed to tele-health services.
T78 11599-11734 Sentence denotes These services could even be used for COVID-19 patients as a form of ‘forward triage’ before they arrive at emergency departments (26).
T79 11735-11833 Sentence denotes In addition, this unique crisis has provided an opportunity to improve online education from home.
T80 11834-12000 Sentence denotes Almost 5 million school students and 1.2 million university students (including about 130,000 international students) in Malaysia have been affected by closures (27).
T81 12001-12171 Sentence denotes Distance learning is not new for Malaysians and can be traced back to the 1990s but times have changed with rapid advancements in technology and new teaching innovations.
T82 12172-12355 Sentence denotes Due to COVID-19, online learning is no longer merely an option; however, adopting virtual technologies and ensuring the readiness of students and institutions can be challenging (27).
T83 12356-12490 Sentence denotes In this regard, Universiti Sains Malaysia (USM) is taking a leadership role as a model for other learning institutions in the country.
T84 12491-12600 Sentence denotes Finally, there has been a rise in research and collaborative opportunities during the COVID-19 pandemic (28).
T85 12601-12737 Sentence denotes This is the time when scientists and clinicians should come out from their shining silos to work together and share their research data.
T86 12738-12848 Sentence denotes Doing so will lead to more effective curbing of the disease and more rapid advancements in viral therapeutics.
T87 12849-13041 Sentence denotes Therefore, we, the editorial members, urge the scientific community and the public to rise to the challenge, change their mindsets and stay safe and healthy whether you are at home or at work.
T88 13043-13059 Sentence denotes Acknowledgements
T89 13060-13197 Sentence denotes We dedicate this editorial to our Malaysian frontliners and thank you for your dedication and sacrifices in this battle against COVID-19.
T90 13198-13259 Sentence denotes You are part of Malaysian history as our heroes and heroines.
T91 13260-13282 Sentence denotes Authors’ Contributions
T92 13283-13309 Sentence denotes Conception and design: JMA
T93 13310-13366 Sentence denotes Analysis and interpretation of the data: WFNWI, KIM, LYY
T94 13367-13395 Sentence denotes Drafting of the article: LYY
T95 13396-13484 Sentence denotes Critical revision of the article for important intellectual content: JMA, WFNWI, AAR, AH
T96 13485-13542 Sentence denotes Final approval of the article: JMA, IM, AAR, AH, KIM, LYY
T97 13543-13569 Sentence denotes Statistical expertise: KIM
T98 13570-13620 Sentence denotes Administrative, technical, or logistic support: IM
T99 13621-13672 Sentence denotes Collection and assembly of data: WFNWI, IM, AAR, AH
T100 13674-13780 Sentence denotes Figure 1 Trajectory of the cumulative number of COVID-19 cases in a (a) linear scale and a (b) log scale.
T101 13781-13874 Sentence denotes The increase in cumulative COVID-19 cases slowed between January 2020 and late February 2020.
T102 13875-13978 Sentence denotes However, in early March 2020, the case trajectory in these five countries increased significantly 1(a).
T103 13979-14041 Sentence denotes The increases were most stark from mid-March to 28 March 2020.
T104 14042-14269 Sentence denotes The trend on the log-scale 1(b) indicates an exponential growth in cumulative cases for three countries—Thailand, Malaysia and Singapore—which was steeper between mid-January and mid-February and then reduced until early March.
T105 14270-14426 Sentence denotes Overall, the log-scale 1(b) shows two trajectories: a lower trajectory (Brunei and Singapore) and a higher trajectory (Thailand, Malaysia and Indonesia) (3)
T106 14427-14548 Sentence denotes Figure 2 (a) Trajectory for cumulative COVID-19-related deaths and (b) daily reported number of COVID-19-related deaths.
T107 14549-14700 Sentence denotes Thailand reported its first fatality in February 2020 and other countries (except for Brunei) began to report their first fatalities in mid-March 2020.
T108 14701-14847 Sentence denotes Indonesia has had the largest number of fatalities (70 as of 27 March 2020), and the lowest were in Singapore (two deaths) and Brunei (no deaths).
T109 14848-14926 Sentence denotes All countries reported fluctuating fatality numbers (except for Singapore) (1)
T110 14927-15043 Sentence denotes Figure 3 Diagnostic coverage of various available tests for COVID-19 from the acute phase to the convalescent phase
T111 15044-15148 Sentence denotes Figure 4 Movement restriction is critical to battle the pandemic within healthcare system capacity (15)
T112 15149-15403 Sentence denotes Figure 5 The Academy of Sciences Malaysia with assistance from Ministry of Health and the Monash University Malaysia, are exploring 10 technologies that will drive many aspects of Malaysia’s socio-economy, including preparation for future pandemics (25)
T113 15404-15519 Sentence denotes Table 1 Number of new cases, new deaths, total cases and total deaths in South East Asia region (23–27 March 2020)
T114 15520-15583 Sentence denotes Date Country New cases New deaths Total cases Total deaths
T115 15584-15621 Sentence denotes 27/3/2020 Malaysia 235 4 2031 23
T116 15622-15657 Sentence denotes 27/3/2020 Thailand 91 1 1136 5
T117 15658-15696 Sentence denotes 27/3/2020 Indonesia 103 20 893 78
T118 15697-15732 Sentence denotes 27/3/2020 Singapore 26 0 594 2
T119 15733-15764 Sentence denotes 27/3/2020 Brunei 7 0 114 0
T120 15765-15802 Sentence denotes 26/3/2020 Malaysia 172 4 1796 19
T121 15803-15839 Sentence denotes 26/3/2020 Thailand 111 0 1045 4
T122 15840-15877 Sentence denotes 26/3/2020 Indonesia 104 3 790 58
T123 15878-15913 Sentence denotes 26/3/2020 Singapore 10 0 568 2
T124 15914-15945 Sentence denotes 26/3/2020 Brunei 3 0 107 0
T125 15946-15983 Sentence denotes 25/3/2020 Malaysia 106 1 1624 15
T126 15984-16019 Sentence denotes 25/3/2020 Thailand 107 0 934 4
T127 16020-16057 Sentence denotes 25/3/2020 Indonesia 107 6 686 55
T128 16058-16093 Sentence denotes 25/3/2020 Singapore 49 0 558 2
T129 16094-16126 Sentence denotes 25/3/2020 Brunei 13 0 104 0
T130 16127-16134 Sentence denotes Source:
T131 16135-16189 Sentence denotes European Centre for Disease Prevention and Control (2)