 Yes, good morning, good afternoon, good evening everyone, welcome po saan man pang pag naman do na naroon kayo to our 88th episode of the Stop COVID Dets webinar series brought to you by the University of the Philippines. Thank you for being part of our credible online community and to all those who have just discovered us for today, welcome po at saan na po masihahan po kayat, marami po kayong matutunan sa webinar po for today and for future webinars. We would like to also greet those po ang ating mga local viewers po na talaga naman po masigasig at talagang sumusubay-bay po sa ating webinar series. I'm talking about those from the provincial DOH office in Ifugaw, Lagawi, Ifugaw, from the Philippine Dental Association, Makati City, the Bureau of Quarantine in Sambuanga Station in Sambuanga City, Ilegan City Health Office in Lano, Del Norte, those from Nasipit District Hospital in Agusan, Del Norte, lahat po na ating mga sumusubay-bay na dito paan po sa Zoom, sa Facebook o sa YouTube po, maraming-maraming salamat. In the past few weeks, news of a sub-lineage of the Omicron sub-variant BA.2 has been referred to as stealth Omicron. It has genetic mutations that could make it harder po to distinguish from the Delta variant using PCR tests compared to the original version of the Omicron. The Omicron variant, as we all know, has been classified as a variant of concern by the World Health Organization and also being trapped by the US Centers for Disease Control and Prevention. The WHO has also indicated that since BA.2 is Omicron, so ito po ay partin rin po na matin atrak po nilang variants of concern. For today's virtual international conference, ito na po ang ating ikalima, part five of our international conferences, we will be tackling stealth Omicron BA.2, what every front-liner needs to know. So if you are looking for the latest science-based and evidence-based information from the most distinguished experts, keep it right here. I'm Dr. Raymond Francis Sarmiento, director of the National Telehealth Center, National Institutes of Health University of the Philippines Manila. Always a pleasure to be with all of you during our regular Friday lunch date. Looking forward also to sharing hosting duties with my mentor, also our adjunct research faculty at the National Telehealth Center, also the President Special Envoy for Global Health Initiatives, Dr. Susie Pineda Mercado. Dr. Susie. Hi. Hello Raymond, good afternoon and good afternoon everyone. We would like to welcome all of you. Ito meron tayong international conference, will speak a little bit in English, but we are going to translate as much as we can. And we'd like to welcome you to the webinar. This is Raymond, I can't believe it, it's 88. That's correct. We have organized and we wouldn't be here without you. So we thank all of you for faithfully coming back every Friday and giving us a reason to try to bring you the best speakers. And I have to tell you, we have some of the best speakers you can get on this topic. And I know all of you want to hear more about this stealth omicron sub variant. But before I go into that, I'd like to welcome our guests from the National University Hospital of Singapore, the Nagasaki University in Japan, Kyoto University in Japan, Chonin Hospital in Taipei, Bukit Mertajang in Malaysia, Canthos City Hospital in Vietnam, the Ministry of Health in Oman, Riyad Elm University in Saudi Arabia, Lonichi Ali University of Bilda II in Algeria, Stockton, California, Pasadena, California, the UP International Nursing and Healthcare Forum in Lexington, Virginia, Massachusetts General Hospital Cancer Center in Boston, and the New York Presbyterian Veil Cornell Medical Center in New York. So we have a lot of guests from around the country and from around the world. And we'd like to just welcome you to this webinar. In the news, you know Raymond, I was researching what stealth means, right? Because there was a movie called stealth, right? And so I was looking at it. And the synonyms for stealth are very interesting. Secret, crafty, enigmatic, sneaky, silent, shifty. So I wonder why we call this sub-variant stealth. And maybe we're going to hear that from our resource persons. But we do know that we heard about this first from Denmark and then India, and then the United Kingdom. And I was looking at the news the other day and Hong Kong had shut down about 16 blocks of apartment buildings, but people could not leave the area because of stealth omicron. So there is a lot we want to learn about this. It turns out that this is the most dominant form of omicron in the Philippines today. We're going to hear about that from our Philippine expert. We will hear from our expert from the United Kingdom and from Singapore. So stay with us. This is going to be a fantastic webinar. So Raymond, over to you. Thank you, Dr. Susie. It usually conjures something along the lines of military affairs, just because a lot of our aircrafts have those capabilities, but hopefully it's not as too sneaky as it is when we refer to stealth omicron, at least for this variant. Okay, so we also have a very, very quick announcement po in preparation for our second year anniversary of the SOP COVID-19 webinar series. TV UP may we have it on the screen. Our COVID-19 Heroes Memorial. We are calling for photos if you are also keen to share maybe stories of your family members, friends, colleagues with regards to how we can honor our global Filipino medical frontliners, those who have succumbed to COVID-19. Please, we do hope you're able to share with us. We are going to put them in digital album and in a special audiovisual presentation. If you have a Filipino medical frontliner, family member, close friend, colleague, whether in the Philippines or across the world whom you want to honor as part of the COVID-19 Heroes Memorial, we would like to request that you send a high resolution portrait photo. The criteria is shown on the screen at least 300 DPI with the following demographic information that we would be requiring and send them hopefully via email before the deadline as shown on the screen. We would like to remember their sacrifice and honor their memory as part of our fight against COVID-19. Ramond, when we did this last year, it was a very touching moment I think for all of us to see so many Filipino health workers from around the world who, as you said, sacrificed their lives in the service of patients with COVID. So please send your photographs, names, and I don't know, it's like a small thing we can do but we must never forget. We must never forget what our frontliners are doing, have done, and have sacrificed during this pandemic. So anyway, sorry that was a little too serious, I think. Ramond, go ahead. Thank you, Dr. Suzie. Just to let everyone know, especially those who are joining us for the very first time, our webinar in Zoom can accommodate up to a maximum of 3,000 participants. Please join us so you can fully experience the interactive program. Those who are joining us in YouTube and Facebook, we would really appreciate it if you could also engage with us through the comment section, especially if you have any questions, we will try to pick up any interesting questions either in Zoom, YouTube, or Facebook. So please start typing in your questions. If you have any, in parallel, we are also tracking any questions or any comments or feedback that may be written up and shown on the chat box and also in the Q&A box that we have here in Zoom. But hopefully, we're able to see a whole lot of you in Zoom. We are still a little less than 800 here in Zoom, so hopefully po marami po ang sumale. For those who are asking, we are working towards our CPD units, our continued professional development units for this webinar and for those certificates of attendance po, for the previous 87 webinars, we are still trying to push out and disseminate all of those certificates at least for webinar number 87. But for webinars 1-86, we have already sent them out. Please let us know if you have not received any certificates and only those who have watched at least 50% of the webinar duration will be given certificates. For our today's webinar, we will have a panel discussion format with our three main speakers representing three different perspectives from each of their countries. And we have then a Q&A session wherein we will be entertaining questions as mentioned, and we really are looking for a very, very excited to pull a jam-packed webinar for today, Dr. Suzie. Thank you very much, Raymond. So for those of you who want to do Mentimeter, we're not having any today. So typically when we have an international conference, we go straight to our speakers because we want to give them more time to explain the subject matter and to speak to you. We encourage you to use the Q&A box and our speakers have agreed to answer your questions directly. And you can use the chat box, you can use the Q&A box. But later we'll have an open forum. So without further ado, we are going to introduce our opening remark speaker, one of our favorites, your favorite as well. I know her very well. She's so hardworking. I would say oftentimes behind the scene, but really changing so many things in the field of research. So we have Dr. Eva Putionco de La Paz, who is the Executive Director of the National Institutes of Health, University of the Philippines Manila. Dr. Eva, welcome to the webinar. And please take the floor. Good afternoon to our dynamic duo hosts, Dr. Susie and Dr. Raymond. And I'd like to welcome everyone to the University of the Philippines Stop COVID Deaths webinar series and today's virtual international conference. Now, let me thank the people who have made this program successfully running for almost two years now, right, Dr. Susie? You mentioned your second year anniversary. So we have the UP Vice President for Public Affairs, Professor Elena Perna, AVP Maria Angelica Abad, AVP Jose Wendell Capili, DVUP Executive Director, Professor Emeritus Grace Javier Alonso and her team, and UV Manila Chancellor Carmen Sita Padilla. Now, on my slide, this is the cover of the latest issue of the Time Magazine. It is what everyone is interested in and hoping for how COVID ends. So the story goes in this article that when the virus expert from the University of Massachusetts saw the mutations of the Omicron, he said it was like looking at the first page of a comic book and all of the Marvel villains got together and posed a big threat to the human race. But as it turns out, Omicron, like all villains, it has an Achilles heel. It does not cause severe disease for those who have been vaccinated or have previously been exposed, so people became more optimistic. Please click. The Time Magazine article goes on to paint two scenarios. Please click. Scenario number one is that the SARS-CoV-2 virus has achieved equilibrium with humans. It may have found the right mutations that allow it to become more efficient at spreading from one host to another while not causing so much disease that the host dies. It chooses transmissibility over virulence. Please click. Scenario number two is the virus could keep changing in unpredictable and possibly deadly ways. And the warning was that the next Omicron could already be out there. And yet we wouldn't know. Important strategies remain, improve global surveillance efforts and increase genetic sequencing of the virus because knowing the genome of the circulating viruses can help provide the earliest hints of any changes and clues as to which of these changes could be dangerous for humans. And I'm happy to, I'm pleased to report to everyone the Philippine, the regional, the whole genome sequencing is about to commence in the different regions spearheaded by the Philippine Genome Center Visayas and Philippine Genome Center Mindanao. And we hope to hear more about that from our executive director of the Philippine Genome Center, Dr. Cynthia Saloma perhaps during the open forum. Now this afternoon, the University of the Philippines in partnership with UP Manila PGH National Telehealth Center together with the PGH has invited an outstanding panel of speakers from the London School of Hygiene and Tropical Medicine from the National University of Singapore, Saw Sweet Hawk School of Public Health and from the University of the Philippines, Philippine Genome Center. Thank you, Dr. Hibbert, Dr. Suleyang, Dr. Saloma for accepting our invitation and we look forward to learning more about telehealth omicron from all of you. So back to you, Dr. Susie and Dr. Raymond and welcome everyone again to this conference. Okay, thank you. Thank you very much. As Dr. Eva Putiongo de la Paz and thank you for that great introduction and I think what we want to do right now is to introduce our first speaker. So our first speaker, Raymond, is there anything else we wanted to do to say first before we go into our panel? No. So I think we should go ahead, Dr. Susie. We just wanted to mention that those who would be typing in your questions, especially those who have been our avid viewers for several webinars now, please start typing in your questions in the Zoom Q&A and as well as the comment section of the Facebook pages, stop COVID deaths or TVUP or in the TVUP YouTube channel. Dr. Susie. Okay, great. Thank you for that reminder, Raymond, we don't have a mentimeter but we do want you to ask questions and we will ask our resource persons to try to answer the questions to the extent that they can. Okay, our first speaker, Professor of Emerging Infectious Diseases in the Department of Pathogen Molecular Biology at the London School of Hygiene and Tropical Medicine. It is my privilege to introduce and to welcome Dr. Martin Hebron. Dr. Martin, welcome to the webinar and please take the floor. Great. Thank you very much for the kind introduction and I'm very happy to be here today. So let me just share my screen and let me get started. Hopefully... Okay, you need to go into presentation mode, I think. Is that okay now? There you go. Yeah, you're good. You're good. Great. So looking forward to get started. I think we have lots to discuss and I'll move on. So we all know what COVID-19 is. It's a disease caused by the virus, SARS-CoV-2. And I think when we started, we thought about the droplets transmission, something which is similar to influenza and also through direct contact. But as the virus has evolved and really what we're talking about here is this spike protein, the outer surface of the virus particle binding to the ACE2 receptor, which is on the human epithelial cells. So that's binding process is really the source of all of our troubles and problems. Because as this binding has improved, the virus has become more transmissible and now we can see that the virus is found in smaller particles and that means they can be suspended in the air for longer and so you can have this more airborne transmission. And maybe there's also a little bit of indirect contact which might also be able to spread the virus. So this spike protein found on the surface of the virus binding to the epithelial cells in your nasal or your lungs. This binding is what's critical to that. I mean, we use this spike protein for the vaccines but also for the detection and the virus use it for entering into cells. So this, we know that the SARS-CoV-2 virus originated originally in bats and we can see that the new virus is somewhat similar to the old SARS virus that turned up in 2003 and a little bit more distant related to those common cold viruses that we commonly experience. These are the coronaviruses that we see every year. We have on those sniffles from that. What's interesting is that all of these viruses are able to infect a very wide range of animals. So we've heard about SARS-CoV-2 infecting zoo animals ferrets in Europe and guinea pigs in Hong Kong and that's because this virus is able to infect a wide variety. That spike protein binds to a whole range of mammals in particular which have that same ACE-2 receptor. And this is just a little bit of background for everybody so we're all thinking along the same lines. This is a close-up of the virus particle with that spike protein on the outer surface. And with those other components. And this because we're going to be talking about the genome quite a lot. This is the whole genome of the virus with its different proteins represented across there. And here is the S which is the spike protein. This is the DNA the RNA that makes the protein on the surface of the virus. So those virus genomes have been sequenced from around the world and this has been a worldwide public effort to try and understand those genomes and the differences. And this has been cataloged by this juice aid which was originally set up for influenza but it was then put forward to the SARS-CoV-2. And this actually from colleagues that we've worked together with for a long time so I'm very pleased to see this initiative. If we look now at where we are in 2022 you can see that the the virus is most numerous this is an omicron but we can see a lot of these other variants which have occurred over time and in the UK for example we had a big problem with alpha and then we had delta and you can see that during 2020-21 delta was by far the biggest strain and you can see there's quite a lot of diversity of that but now we have omicron but I want to draw your attention to the fact that this is an evolutionary tree telling us when the omicron first appeared and you can see that it goes right back to the very early stage of the virus evolution before March 2020 the omicron occurred and it's been in the background all of this long period of time and now it's suddenly started to expand and what we think happened is that this virus was not particularly good at transmissing at the early stages but when it's just recently it's suddenly acquired on this whole set of new mutations which has generated this new variant which is more transmissable and these variations occurred in a rush in a very short time and possibly through one person who was infected and that we think this omicron occurred in South Africa maybe in a person who had immunocompromised so it didn't have a very good immune system infected for a long time and then generated all these mutations and we saw that previously in the alpha variant here and that was first recognized in the UK and this also was around for a long time and then suddenly became a highly transmissable variant so if you ask me to predict the future I would say maybe one of these early strains here which we are currently ignoring might be the next one to turn up and it could be that it requires a lot of these mutations that allows us to transmit more so let me just spend one slide talking about my own work this is work that we've done in London school thinking about what those mutations might mean and here we've developed an analysis tool so you can put your sequence data in and see whether your new variants are able to alter the immune response how does it interact with your human immune system and whether it possibly might be able to escape that and here we're concentrating on that spike protein yet again and looking again at this the receptor binding motif or that central part which seems to be so critical for the changes that we're observing in the virus so here it is again so this is a 3D structure of the spike protein binding to that ACE2 receptor and you can see in red here these different mutations and those are the things that we're talking about and that allows this spike protein to bind better or worse to this ACE2 receptor and here these different variants from the World Health Organization giving us their names but we also had these lineage names and these different mutations across this spike protein which lead to these different characteristics and one of those in a little bit more detail we can see this is the Wuhan the original strain out of China and these are all the variants which came from that original virus that have been changed over time with all these different new variants you can see that all of the new variants have this 501 a different mutation here so this is important for allowing these to become more transmissible but you can see there are differences between the alpha variant the delta variant and the omicron and actually omicron as you can see here has got by far the most variations from that original Wuhan Chinese strain so why is that important well it's because of the PCR detection system we know how we can detect with PCR we look at the sequences of these different viruses we take a nose swab we do a PCR test and typically the PCR test looks for three genes within the within the virus it looks for the N2 nuclear protein the envelope protein and then this critical spike protein and we've already heard that a lot of the mutations that causing these variants are in this spike protein and so this is the one that that suffers from these mutations that might affect the PCR and right now we're detecting omicron without having to do the sequencing by comparing it to the delta virus and we can do that by looking at whether this spike protein is detected or not in the genome so is the S gene detected yes it's currently unlikely to be omicron and no you know well it could be omicron but you need to confirm this with the full genome analysis but let's have a little look at what's happening in the previous variants so we've had the original Wuhan where the PCR was designed and it detected these three genes when alpha turned up in the UK and then traveled all the way around the world it had this dropout the mutation in the spike protein stopped the PCR from detecting that and so we could detect alpha by comparing it to Wuhan as delta came along first described in India actually the spike detection came back and we could detect all three gene components again omicron as we just heard you know it again dropped out the S because it gained sorry gained this mutation and now we have the omicron the A2 the so-called stealth one and it's actually the detection has come back again and so we've now unable to distinguish the delta variant from the omicron variant although we can now distinguish between the original omicron and the BA2 variant using the standard three test PCR so we'll hear more about this later but the original omicron is the BA1 and you can see this is a lot of diversity building up now around the world as it spreads there BA2 is a distinct lineage and goes right back perhaps to August 2021 and it's been isolating isolated and developing in its own path since then and we can see that that's developed a number of different mutations as a result of that and that variation is building up however at the moment we don't see any clinical differences between the different variants of omicron so while the PCR is distinguishing those and the BA2 can be called a stealth it's still not any different clinically fortunately I want to spend a little bit few minutes now thinking about what's happening in the UK at the moment and where we've come from so I've shown here a plot of time so when we started first cases in the UK back in March April 2020 and this is the UK's new coronavirus cases per day and it's the rolling average of the week so you can see that there was a small number detected in April 2020 we had a peak with the alpha variant back in the winter of 2021 then we had delta came out in July and now we're just past the peak of the omicron variant in the UK if you look at that it looks as though omicron is much more spreading than the original Wuhan or even the alpha strain but there's a reason for that that's because the testing has been rather different but in the UK we've been lucky to be able to do a normal survey of people with the virus and this is the recent results across the UK where we've tested a random proportion of households throughout the UK and tested them to see how many of them actually have COVID and you can see from that rather than just counting the incidents or the number of cases reported you can get an estimate of the total numbers and you can see here the percentage of all of those people randomly selected how many were positive for COVID-19 and you can see at this current time we've got omicron and we're testing about 5% of the people being positive and if you look in a little bit more detail you can see that that's slowly coming down by the 12th, 14th of February which is our latest survey but that still means nearly two and a half million people across the UK are currently infected with omicron so that's looking at the number of cases this is looking at the number of people in hospital and here we've had much better more consistent testing and you can see that we have a clearer idea of how many people and when we do hospital testing the number with Wuhan and omicron look much more similar than when we look at the general population and you can see we've suffered the most with the alpha variant as that came through back in at the end of 2020 beginning of 2021 our winter season and if you look at the severity or the sadly the deaths that have occurred you can see in the early stages when they first arrived there was up to nearly 1,000 deaths a day in the UK with alpha that moved up to nearly a maximum of 1,800 we had delta at this stage and then we've got omicron and omicron has at this particular day which is Valentine's Day there was 35 deaths at that time let's put that all together and try and think about that in context a little bit so if we look at the cases how many cases were reported at the early stages we were only testing in hospitals and the numbers were pretty low across if you weren't in hospital you weren't tested by the end of beginning of 2021 we were doing PCR testing with everybody the symptoms and you can see there's a lot more cases reported and then from July last year we had widely available self testing and then the number of cases reported went up dramatically if we look at those in hospital you can see that we had a big problem when the virus first arrived the UK locked down and those numbers dropped we opened up and the cases went back up again and this is when talking about the alpha wave with those high numbers of people in hospital and the deaths we locked down again and then in July opened up again and those we've had a fairly steady state with minimal interventions at this point and this is when Delta arrived into the UK and then with the arrival of Omicron which is more transmissible we've seen a rise in the number of cases and the rise in the number of patients in hospital and the other big difference of course is those first two waves with the number of deaths that occurred match the numbers in hospital but since this alpha wave we've had the vaccines and that's deemed to a much smaller proportion of deaths compared to those two previous waves so during Delta and Omicron we've had vaccines and a smaller number of deaths in fact if you look at those waves the alpha wave the delta wave and the Omicron if you look at the number of cases we can see clearly that Omicron had more cases but the number of hospitalizations was lower with a maximum from alpha Omicron and Delta wasn't that high and if you look at deaths it was by far the biggest problem in the UK was with alpha with Delta and Omicron so while in the world we're more severe than Omicron actually this is we've had deaths in the UK from Delta because when Delta arrived we had the lockdown and we had effective vaccines in the UK it's been very good at rolling out vaccines we've been dosing recently up to a million people a day with the booster doses and you can see that we've concentrated with the age effect we've been looking at the older age populations which are more at risk of disease and we get more than 90% of the older population have been vaccinated and that's why we can show that the death rate has reduced dramatically with the Omicron infections and just to say that the UK has been going ahead with its third booster dose is because of the the escape that Omicron can do compared to previous infections so we've now got a large amount of data coming through looking at reinfections and this is a kind of estimate at how many reinfections are occurring and because you have to account for time as well as people at reinfections per 100,000 participant days at risk and we get a value for about 11.7 for Delta but you can see that Omicron is more than 10 times able to do reinfections compared to Delta so Omicron is much more likely to reinfect you for a second time so this with our large amount of data we're able to do a comparison about the different age groups and what we've been trying to do in the UK is keep this group the 60 plus in this higher risk group low and you can see that during last year and up until our winter season we've been quite good at keeping those numbers low and Omicron arrived with there's been a peak but look, it's interesting to look at the children's group here under 19's in this graph which is in red and you can see that we've had peaks and this is corresponding to the schools opening and closing during their holiday periods and we can see that we've kept schools open in the UK and that has led to cases amongst children in fact that's where most of the Omicron has been occurring recently has been in the children's group but we've managed to keep the schools open by these widespread testing and children test regularly twice a week or if they have symptoms they also test and if they're positive we keep them home so they have to isolate at home they're not so it's just a matter of isolating at home so this is the UK's effort and we can see that in the early stages UK had relatively poor response so UK is here in this color but we can do a comparison about what we did and how well that responded and every country had a slightly different approach and with a slightly different result and we can learn some lessons from that what gives you a good outcome for your country so well top one is obviously vaccination rate if you can get your vaccination rate particularly in your vulnerable groups that's a huge advantage but we also know that the age profile of the country such as in the UK that's more of a risk and if you have the older population with cobra omidities that's also a risk so the Philippines is a younger and less cobra omidities in the UK so that's all good but look at these other factors so essentially it's how likely you are to meet a positive person so that social mixing your contact rates do you have to do public facing work from home is there your family mixing is there a large number of people living together at home whether your healthcare access is good and your self-isolation support so all of those things talk about an economic factor and if you are you know that's why COVID is becoming more of a disease with those with less economic means so just as a summary I think pandemic to endemic this is what everyone is thinking about now so COVID is a nasty new disease that is here to stay I don't think we're going to get rid of that and that's because it's so widespread in humans around the world and also found extensively in animals and it's always going to be able to come back my prediction is that there's going to be new variants each year and we need to monitor for those in the same way we do for influenza for influenza we take a sample of those and we make a new vaccine every year which protects those vulnerable people from a new influenza strain and my feeling is we're going to have to do that with COVID as well and that means your vaccination needs to be updated every year I'm hopeful I think new, longer lasting and broader response vaccines are on the way but they haven't been trialled yet and the other good news I think is that we have therapies that have come through so these are direct antiviral therapies and those will offer help to those people that haven't been vaccinated or have got disease despite vaccination but to make the most of those we need to test find out early and treat patients early so that's the end I'd just like to say that I've been doing my best to do a little bit of public speaking and I've been engaging as much as possible and I hope this talk has been useful and I'm happy to take questions later so thank you everybody thank you very much that's Dr. Martin Hebert at the London School of London School of Hygiene and Tropical Medicine excellent presentation I think you see in the chat how much our audience appreciates the clarity and I think looking at how the pandemic unfolded over time in a place like the UK is really something that pushes us to think a little bit more about how this pans out in the future so thank you so much for that and I'm going to turn and we'll have you Martin for the Q&A later and if you have some time and there are questions in the Q&A box or the chat box please feel free to answer them I'm going to turn over to Raymond now Thank you Dr. Suzie and thank you Professor Martin just giving us a quick back rounder in the BA.2 sublinage of Omicron and for sharing with us the situation in the United Kingdom there are few questions with regards to your presentation we hope to be able to get your answers to these questions during the Q&A our next speaker is the Vice Dean for Global Health and the Program Leader for Infectious Diseases at the Sausie Hawk School of Public Health at the National University of Singapore was also the former clinical director for the National Centre for Infectious Diseases and also the former director of the Singapore Infectious Diseases Initiative please welcome to our webinar Dr. Su Liang Dr. Liang Hello everyone and thanks very much once again for the opportunity to be here I think it's it's wonderful to see how many people are here listening in and you really have organized something fantastic I was asked to talk about the COVID-19 pandemic in Singapore which is a good thing because I'm not sure I can share very much about the BA2 lineage of the Omicron variants after Martin's excellent talk earlier so this is the main things I'll talk about I'll give you some statistics about Singapore and how Singapore has approached major epidemics some of the key moments in the pandemic I do receive funding from several pharmaceuticals many of whom have produced products or vaccines that's related to the pandemic Now let's get started So this is where Singapore is now with cases and you can see for instance that for a long period of time when the pandemic first appeared to sometime this year Singapore had this approach where we tried to limit the cases spreading in the community we even had a circuit breaker which I guess is a different way of saying lockdown and between January 2020 where we had the first case and 2021 we kind of kept things under control except for the outbreak in the dormitories and then we had the first delta case in April of 2021 last year it took a few months before there was and then we had the first omicron case in December 2021 and you can see that this omicron came as the delta wave was receding and not too long after less than a month after on about the 22nd or 23rd of January we realized that we have to BA2 sublineage or subvariance of the omicron with us as well and the case count has been rising so far although we don't sequence every single virus that we isolate nonetheless between January 2022 and now the proportion of cases that's due to the BA2 variants has jumped to 50% or more which took place in less than one month so you can see the replacements of the different variants that's what Martin has described don't be a no doubt you're seeing in the Philippines as well how about deaths so you can see that the deaths kind of tally and follow after the cases we had a number of deaths at the beginning of the pandemic but it really started to increase when the delta wave happened and now we are seeing the deaths rise again in Singapore as the omicron variant spreads and in fact more and more people I think we have more than 10,000 cases or 16,000 cases reported yesterday which is quite a lot for a small country like Singapore and then this is our vaccination rate the proportion of cases who die by age and vaccination rates although I think close to 90% or more of our population of our whole population have now been vaccinated but nonetheless there are still people who don't want to be vaccinated or cannot be vaccinated and it's about almost eight times the death risk for them especially for the older age group if they are not fully vaccinated or boosted I spoke a little bit about our vaccination rates and this is one of I think Singapore's success stories we managed to obtain the vaccine early and we roll out mass vaccination fairly quickly as well not as fast as we can but we kind of caught up somewhere near the end and you can see that for different age groups we have reached more than 85% and exceeded 90% for both completion of vaccination with close to 64% of the total population having received the boosted dose as well we started rolling out the vaccines for children age 5 to 11 at the start of this year and that's gone over 35% of all children age 5 to 11 being vaccinated at this point in time how do we approach pandemics I think unlike several other countries Singapore was one of those unfortunate countries that experienced SARS in 2003 that first SARS epidemic was like a major wake up call to us and we tried to think about what we would do in future epidemics at us our response to SARS was not the best but fortunately SARS the COVID-19 virus spread less easily between people so I think we decided that major epidemics would require a whole of government approach not just the ministry of health because it was quite clear that it affected whole segments huge numbers of segments of the government machinery and the population as well so there's always been a whole of government approach multi ministry task force to deal with epidemics and that served us through the 2009 pandemic when Zika hit Singapore in 2016 and in other things as well so the multi ministry task force in Singapore was set up prior to the first case coming in and it's set to direct all parts of the government response to the pandemic and this is broadly the strategy in 2020 at a time when there was no vaccine and no effective treatments the key to us was to try to reduce the number of cases as far as possible doing a few things that Martin has already mentioned which is to try to improve the surveillance to try to find as many cases as we can and then to isolate those persons as well as that close context and of course what every country did was to try to reduce the population and we also strengthened the healthcare capacity to deal with the pandemic but I think nobody expected the pandemic to last as long as we did and the pandemic also highlighted weaknesses in Singapore things that we had kind of overlooked, blind spots in how we had looked at Singapore as a whole and one shock to us very early in the pandemic workers living in the dormitories were affected Singapore is largely dependent on migrant workers and actually we have a lot to thank the people of Philippines because if you know very well that many of the nurses in Singapore a large proportion of the nurses in Singapore are from Philippines and we have many domestic workers who are from Philippines as well but this outbreak occurred amongst migrant workers who are living in dormitories and there are close to 250,000 of them in Singapore living in some 40 over dormitories so each dormitory can have between 5 to 10,000% and we tend to live in fairly crowded conditions that you can see in these pictures so in April 2020 when dormitories started to be affected then we realized we had a huge problem and because there was no way that we could isolate 250,000 people who get infected and a separate task force was set up to deal with this outbreak that lasted from April to August 2020 and you can see from here that what we actually did was to close down the dormitories and then to put in place medical outposts then and of course to be sure that the workers will see food, they receive the medical treatments and finally they receive their pay because this is a terrible period for the workers who are shocked in the dormitories for many, many weeks and I think this is still the one single blight on the whole of Singapore's response to pandemics and our response to these migrant workers we also set up facilities like what you can see this is the Singapore Expo that used to have huge concerts of more than a thousand people well since nobody could travel converted into facilities for taking care of COVID-19 patients who did not require hospitalization so there's one key moments and then the second key moments occurred when we had a Delta wave at this time which is after August through December and in 2021 we were kind of happy about what we were doing like the case count was less than 10 every day and things were okay and we were preparing to open up again it occurred in airport workers who were wearing PPE it occurred in our main hospital that was taking care of the patients during the pandemic and everyone was wearing PPE with N95 mask as well and then this cluster started to grow and I think at that moment we realized that when you had a virus like the S-transmissable as the Delta variants which is between three to six times more transmissable than the original Wuhan virus then we decided that there was no way we could keep the numbers down anymore and then the strategy changed to trying to vaccinate as many of the population as possible while trying to keep the numbers low enough so that our healthcare system wouldn't be overwhelmed and that brings us to vaccines and again an area which I think Singapore has done reasonably well to the vaccines reaching a phase three in clinical trials we had already formed therapeutics and vaccines expert panel that just didn't comprise of medical doctors and scientists but also the economic development boards private sector individuals from the pharmaceuticals and all that and the whole point at that time was to try to give advice on which vaccines to bet on so that we could kind of purchase them in advance because we could already see that around the world there would be a mad scramble for vaccines once they were available and Singapore being a small country the strategy was to try to purchase them early so that we wouldn't be left out at the end when I guess the high income countries from the west started to corner the markets in these vaccines so it was I think one signal moment of success that's been managed to get the first mRNA vaccines to Singapore by December 2020 and then to roll it out in the population so the vaccination rollout again was a huge exercise and I think Philippines and UK there were the same kind of processes undertaken in Singapore we had a progressive rollout healthcare workers first frontline workers those who were more vulnerable to the pandemic such as elderly and then we went down the line as the evidence showed that the vaccine was both safe and effective in them one of the reasons for this kind of a slow rollout was that we also had vaccine supply issues there was just no way that we could get enough of the mRNA or other types of vaccines into Singapore in large enough quantities to vaccinate everyone so we kind of had to adjust to the vaccine supply as well but all over Singapore now there are vaccination sites that are open for people to walk in and to get their second hand or their booster doses with facilities on site so that if touch with something happen at anaphylactic reaction or whatever they could be taken care of then I think this is something that Martin wouldn't touch on but maybe you have experience in UK, in Philippines and other countries through and that's misinformation and this is something that still boggles me like with COVID-19 and then with the rollout of the vaccines suddenly there was a huge spread of misinformation about both the pandemic as well as the vaccine and even members of the healthcare community including doctors stepped up to say that the vaccines are not safe the vaccines cause a lot of different diseases the vaccines are more dangerous than the virus and Singapore had to have a response to this kind of misinformation as well Previously we did not have much of an anti-vax problem compared to Europe or US but for the first time we had websites, WhatsApp groups and telegram groups dedicated just to the spread of misinformation about vaccines and there was really co-reality that stared us in the face but I think in Singapore again we aren't as vocal as many parts of Asia or Europe so this also didn't affect our vaccination rollout which as you can see has reached 90% of the people and then I guess near the end we talk about the testing strategies initially we had problems with testing supplies as well especially in the early part of 2020 when there just wasn't enough PCR machines or even reagents to do the testing and we had debates about which was the better form of testing either for angel or saliva or you sort them out in the nose together and we had to fit in things like serology and antigen rapid tests or natural flow tests which I think are the main means by which we in Singapore and many other countries detect COVID-19 now we have always had viral whole genome sequencing Martin knows this well GZ was also set up by colleagues from Singapore collaborator with scientists around the world and so we have always been sequencing the viruses as they came in which is how we knew when we had the delta when we had Omicron and when we had this BA2 variants as far as the BA2 variants is concerned currently we are not treating it any difference from the Omicron although I think there is some worrying information that has been preliminary release about how some of the monoclonal antibody treatments like social remap don't work so well against the BA2 variants I think we are waiting for GSK to confirm this before we think about what we should whether we should do something different for the BA2 sub variants of COVID-19 so at this point there is Evo Shield in Singapore, the combination monoclonal which we give to relatively sick patients at a higher risk of disease we don't go down to determine whether they are BA2 or Omicron at this point in time but I think as the treatment differs for cases who are higher risk or more ill then we have to think about testing strategies that allow us to detect the BA2 or future variants so that the management can be a little bit more directed and precise so we have moved the whole gamut from isolating everyone at COVID-19 in a dedicated facility to now telling people just stay home you can come out again when your antigen test is positive even though we understand that the sensitivity of the antigen rapid test far lower than the PCR test sensitivity is only about 80% and only useful for the first few days and that kind of brings me to the last part which is that now that we have gone through more than 2 years of the pandemic what is the way forward during all the three moments I've shown you with all the different experience that come to Singapore we have realised that we cannot keep the virus out the Singapore economy like China would not survive and by the same time we have done our best to protect the population with some would say rather coercive measures to push people to get vaccinated without making it mandatory so at this point I think we are still one of the most cautious countries with regards to stepping down restrictions everyone still wears a mask when they go out or they'll be fine about $150 and we don't know when that's going to change but I think everyone of us is now looking forward to what's all these restrictions being stepped down and integrating with the rest of the world again and touch with our new, more dangerous experience coming up in the future so I'll stop here and thanks very much for giving me the opportunity to speak to all of you Thank you Vice Dean Lee Young it was really an eye-opener with regards to just in contrast with how the UK has been doing with all of their restrictions measures and in comparison how strict Singapore continues to be with regards to all of those measures there are a couple of questions that's very much targeted for Singapore but we'll put them aside and we'll tackle them during the Q&A Thank you Vice Dean Lee Young Dr. Susie Thank you very much Dr. Lee Young I thought that was really a great presentation We all watch what's happening in Singapore because it seems that Singapore is ahead of the curve in the ASEAN when it comes to to the response and so hearing from you about the details of how you're managing and the challenges that you see currently this is very good for all of us and I think our audience really appreciates this Okay so we'll go to the next speaker and of course we will not have an international conference without a Filipino who's going to speak and itasang bandera ng Pilipinas we are very proud to have with us representing the Philippines in this international webinar somebody you've met before pero kilala natin siya dahil kung sa anong unan natin genome sequencing siya was the one who came and explained this to us so it is my honor to present the Executive Director of the Philippine Genome Center she's trained here in the Philippines and in Japan and has been with us a couple of times but she's here to talk about the Philippine situation so Dr. Cynthia Saloma welcome to the webinar and please take the floor Thank you very much Dr. Susan for that invitation and also to Martin and Dr. Lee now I'm going to give to you a on the ground analysis of the B.A. Queen II that we have found here in the Philippines I have not incorporated so much about some of the public health measures that our government has done but I'll try to see if I can remember and incorporate this in my discussion so today I'm going to talk about some of the updates on the Omicron variant B.A. Queen II in the Philippines Dr. Martin has already told you about the reason why this was called stealth Omicron and we'll go down to the data that we have so as of February 2022 there have been 418 million cases reported worldwide with 5.4 million confirmed deaths in the Philippines 0.6 million confirmed cases and about 55,000 deaths so the impact of this pandemic is expected to be felt for a very long time but at least which is because we don't really know the trajectory that this virus went to so this is the summary of the SARS-CoV-2 variants that we have detected at the Philippine Genome Center when we went around Southeast Asia as well as in the US when we were trying to conceptualize a genomic center here in the Philippines we went to Singapore, we went to Taiwan we also went to Hong Kong and of course in the US and realize that one of the imperatives of having a genome center here in the Philippines was the possibility that of a pandemic and that if there is a pandemic and that borders will be closed then the mechanism over way by which our samples can be sequenced so those were some of the reasons why in 2009-2011 we had a Philippine Genome Center DNA sequencing core facility that was helped by the Department of Science and Technology so now we have here the summary of our Omicron cases in the country and in the beginning of 2021 before the end of 2020 we were actually called by the president of the Philippines and we're asked if we have a way by which we can detect the B.1.1.7 or the variant of concern called eventually the alpha variant and it was an opportune time because the Secretary of Health brought us there together with Dr. Eva to show to the president that oh we already have a facility that is ready to do whole genome sequencing and at that time we also had some sequencing kits of the COVID-19 kits which we were able to procure through a PCHR graph so our first cases of COVID-19 the first variant of concern we have detected was on just January 3 and that was in Cordillera at the next period so that was the first time we were able to detect and of course utilize the Philippine Genome Center in the National Genomic Bioservice Effort so this is current 25 2022 and this is a summary of the SARS-CoV-2 variants we have detected in the Philippines so to summarize so far I think for whole genome sequencing we have done about 23,000 whole genome sequences about half of these have been uploaded to DC the others are awaiting approval from the Department of Health before we can upload to DC okay so if you look at the alpha cases we have about 3,000 and about 3,000 beta cases in many countries there have always been more alpha cases than beta cases but in the Philippines we actually have more beta variants than alpha variants then the delta variant in terms of cumulative number we have about 8,651 sequence already but in the beginning towards the end of 2021 and in the beginning of 2022 it's all practically on the con variant so you can see here that all of a sudden we have so many on the con variants and we can hardly get any delta or the p.3 data variant of interest so this was one which we detected originally in Central Visayas in January 31 to February 2 when they had a spike of cases and when we did whole genome sequencing and mutation analysis we are looking at a potential local variant that was very similar to the gamma variant of Brazil so eventually it was declared as a variant of interest but eventually of course it was relegated into a variant under monitoring by our government because it apparently did not spend so much around the world but this has also some telltale mutations that were concerned so we will see here that we have all on con variants if you look at the emergence and evolution of our SARS-CoV-2 variants here in the Philippines and this is from outbreak.com based on the sequence that we have shared to this day so far this is only based on certain thousand sequences you can see for example look in the months of March to May in the Philippines we have a lot of alpha as well as beta variants in our sequence cases so the green one is the alpha and the red one is the local variant and if you really look very closely the cases went down by May and then by July of 2021 we are looking at spike in cases and very fast spike in cases that were of the Delta variant if you look at the epidemiologic curve of the Philippines here so you can see there seems to be a small wave here and this is really because towards June of 2020 the Philippines opened our airports to returning overseas Filipinos so between March 7 or March 17 to March to May 31 2020 our borders were closed so we had a lockdown no one was allowed to enter the country no visitors or even returning overseas Filipinos but eventually they were we allowed our returning overseas Filipinos to return in June of 2020 and that also marked the detection of the B614G variants you can see here for example there is a small wave a lot of our frontliners demand requested that should be a circuit breaker so that we will be able to rest and of course to strengthen our health capacity our health system so we had a rest sometime August or September when eventually the UK and the WHO announced the discovery of a variant of concern called alpha and that was the time when we were called to Malacanyang to discuss on the country's measures and from the Philippine Genome Center if we can help in the genomic by surveillance effort that is being done about the genomic by surveillance effort that is being held so that was the beginning of our involvement in this process in a whole of government approach so we first detected the alpha variant from people Filipinos returning coming from the United Arab Emirates and then of course we have also but the earliest alpha variant when you look back at Biobank samples it's really from a Filipino Filipino worker who came from the UK so that was December 12, 2020 and apparently they did not have any on-road transmission in the early part of December so eventually we had a rise in cases and this was a time when we also detected the beta variant amazingly the alpha variant we mostly detected first in the airports and our ports at entry so the government had quarantine measures in place but the beta variant we detected in an area surrounding the airport around area of Pasay and when we were requested by Central Visayas to sequence some of the cases where they had a rapid rise in cases that was the time when we discovered that we have local variant the theta variant so now it's just called p.3 so you can see that this curve is actually a combination of alpha and beta and some theta most likely limited in certain regions of the country such as region 7 and some on the national capital region and it's still over in region 6 so up to July there were reduction in cases by May but by the beginning of June-July we saw we observed our rights in cases of the delta variant so by August about 90% and above all sequence cases coming from the national capital region were really already of the delta variant so you can see here that the waves are of course associated with an introduction or the rights in cases associated with our variants of concern so we have the delta wave, alpha or beta wave and of course now we have the omicron wave which we first detected in December at a time on the tail end of the delta variant so we thought we could rest for a while indeed we rested for a while in December but actually be unbeknownst to us by the third week of December the dominant variant in the Philippines with a radio wave omicron variant and we also noticed that in contrast to some of our Asian neighbors particularly in Southeast Asia the peak of cases for the delta variant in the Philippines is about a month or two months later and probably that is a reflection of the controls that our government has initiated and also take note that in the Philippines you do not allow or you did not allow face-to-face classes or elementary students high school students and college students are still studying at home so this is the omicron that has become the dominant variant in the Philippines by the last week of December 2021 so you can see just a very very rapid rise in cases our earliest omicron was detected on December 22 and that was a BA.1 our earliest BA.2 was a local case and that was detected in the now on December 2, 2021 so the actual number of confirmed cases dwindled toward the end of the third week of December so you can see here for example and we also had difficulty asking people for examples from different parts of the Philippines but eventually there was a rapid increase in cases particularly after the holidays so that was in January of 2022 so when we were looking at our sequences there was something interesting about the sequences that we have been analysing and that's what I will be sharing with you today so this one is again, luckily and now a case load of about 2,000 level every day probably lower before the end of the month so it seems as though we have already reached the peak in omicron we are earlier than some of our Asian neighbours in terms of omicron cases we had a very very rapid rise of cases with peak in about the second week of January with about 39,000 cases reclined and now we are at the level of about 2,000 so what is the story behind this so if we look at the cases as shown by Martin for the UK the rise in cases at the concomitant equivalent rise in the number of deaths that was true for the detection of the B614G in the Philippines in the middle of 2020 and also for the detection of the alpha and beta cases between March to May of 2021 where we had a lot of deaths also but this was also a time when there was a move to vaccinate the Philippine government was able to secure vaccines to vaccinate our frontliners so I think the earliest was in the first week of March which we tried to vaccinate our frontliners our doctors, nurses on all those working in our hospitals was in March and as the examples or as the vaccines the number of vaccines became more and more then we increasingly vaccinated also the priority groups particularly those with comorbidities and those who are senior citizens I would like to point out also that when there were cases for delta increase in the national capital region there was also a drive to vaccinate people as possible in the NCR plus region because this is the region where we have the highest number of cases so as we speak I think the vaccination rate for the national capital region is very high sometimes it's the values they give is beyond 100% it's 100% only because the target population has been exceeded since NCR also vaccinate people from outside of the national capital region so the vaccination rate within the national capital region is probably quite high and that was also probably the reason why our presentation of cases with Omicron is not as severe or even also for Delta so when you look at the Delta cases the Delta actually is a long period probably from July to November and this is also a time when we have lots of deaths but compared to the Omicron where we have a very sudden rise in cases we have a decoupling in terms of deaths and that could be because of vaccination and of course of the inequality or characteristic of the Omicron virus itself so what is the regional distribution of Omicron cases in the Philippines so far we have detected 3,230 Omicron cases 2,795 of which are local cases and they are found all over the country so you can see here how many 3 you can address so the original B.1.1.529 Omicron is actually now subsumed into B.1.1 and B.1.1 and then of course you have yourself Omicron B.8.2 so the red one here are returning Obesers Filipinos and some international travelers so you can see for example that all over the country in the 17 regions of the country we have already detected the B.8.2 variant not so much with B.8.1 because the B.8.1 we normally detect among our international travelers and returning Obesers Filipina workers so there has been recently an update of B.8.2 cases from returning Obesers Filipinos and this reflects also the global trend where they have been same cases of increased detection of B.8.2 in the UK also in India and also in Europe then more for example so let's continue but what is amazing about the Philippine cases is that 98% of our local cases are under B.8.1 so 98% of sequence local cases of Omicron are under B.8.2 so you can see that in contrast to the fact that B.8.1 coming from international travelers arrived much earlier our earliest detection was November 22 it did not really gain some foothold or it may be also a manifestation of the fact that our quarantine measures are working because it could hardly see onward transmission from our overseas Filipino workers returning into the country but even that it does not preclude the possibility of certain founder events which have led to the rapid local spread of B.8.2 so what is the story about B.8.2 the Philippines for example in other countries India and UK as well as now Hong Kong they have detected as much as 50% in the Philippines as early as January the number of B.8.2 was really really high because we also found mutations in the B.8.2 that are circulating locally in the Philippines so far we have not found any clinical significance about these additional mutations but it would be worth sharing this to you so this is the sublinage this is the global sublinage so you will notice that the B.8.2 increasingly at the latest count in the global database is now 21% B.8.2 and that we hardly get already will be .1.1.529 and divided this into B.8.1.1 and B.8.2 so but this is a very very interesting data from the Philippines and this is from the first 500 cases we have so we now have 3,000 what did we observe so among our international sublinage is based on lineage so we have local case so this is based on B.8.2 B.8.1 B.8.1.1.529 so there is actually much later data but this is just to show to you with the first 500 cases we have we observed that among international travelers when turning overseas for workers and some international travelers the lineage that they bring to the country of course they are quarantined is B.8.1 so in our local cases in our community transmission is B.8.2 and this was very very significant and it is also part of the reason where our government opened up borders because the transmission of the virus is not so much because of fresh introduction events coming from the airport but it's really driven by local community transmission of B.8.2 now many of the local clusters exhibit a treatapology consistent with exponential growth and community transmission and there seems to be no clustering based on location but we observe for example these yellow ones are national capital region samples there seems to be a temporal change of course where the early cases have been detected in the national capital region and then there is a past decline of cases in the MCR and now we see cases in nearby regions around the MCR first and then of course it goes on as well as in the rest of the Philippines so if you look at the data you can see that it's really really challenging even if some cases have localized lockdowns it's really challenging to control the spread of Omicron and in the Philippines if Omicron B.8.2 so when we did nutrition analysis as we have done in almost all cases that's why we were able to detect the P.3 variant the X access to be the number of samples analyzed what did we observe we observed all the B.8.2 local cases we found two rare mutations in the global cases so these are in the ORF-1AB 1.2909V and another in ORF-3A consistent probably 98% of our local cases if not all are carrying this B.8.2 to additional mutations even if we have B.8.2 coming from all these working workers or also from international travelers most of the time they do not carry these two additional mutations so the presence of globally rare mutations suggests that a majority of our local Omicron cases are being sustained at the degree of transmission of the circulating sub-image of B.8.2 with these two additional mutations so what is the significance of these mutations so we have here the two non-significant mutations we looked at the database in jissade and searched which countries have this prevalence of A29OV in the ORF-1AB gene as well as the L14K in the ORF-1AB so the highest count is of course the Philippines with 822 followed by the United Kingdom and Japan and we know for a fact that some of the Japanese cases are really travelers from the Philippines also those reported in Singapore some of them are travelers from the Philippines so the two non-significant mutations globally appear to be distinct to be a .2 and seems to be recently they are not key B.8.2 mutations and they are only appearing in about 4% of the jissade B.8.2 samples about 1,281 of the 30,000 B.8.2 in jissade carry these two mutations as of the beginning of February so although they are found in at least 28 countries mostly in the UK and in the Philippines but the number one the most number of cases are found in the Philippines so we wanted this to ask was this introduced in the Philippines was this a new local mutation so we looked at the map so the earliest globally collected B.8.2 with these two mutations was found in the Philippines December 2, 2021 now regarding the UK we cannot plot them in the graph because in the database they do not indicate the time of swabbing or the time of sample collection so we cannot see whether this was important in the UK or somewhere else so we cannot discount the possibility that these mutations were introduced from a country that is not frequently submitting sequence data to the global databases or there is also the possibility that the mutations were locally evolved the Department of Health has tried to track all these B.8.2 with these two additional mutations to see if there is a difference in symptomatology and this is presentation and so far it is not any different than the other Omicron variants B.8.2 as well as of course B.8.1 so will the Omicron variant be the last of the variants probably not is the Omicron variant the end game for this pandemic because it continues to post-risk and the virus could continue to mutate and that other variants will continue to emerge will these be even more transmissible where they have a more severe phenotype or perhaps could they mutate into a more benign form or could it mutate perhaps with outbreak symptoms these are things we don't also know at this point in time some experts are of the opinion that this pandemic appears to be an un-evolutionary decline a slide towards endemism and new normal where the virus and humans coexist as we do now with the influenza virus actually we don't really know because this coronavirus has repeatedly surprised us I'm not really sure how this pandemic will play out but it is important that we continue to monitor and be vigilant and do not put our guards down to summarize genomic surveillance revealed at a steep increase in the proportion of detected local omicron cases from the last week of November 2021 where we first detected B8.1 and has rapidly become the dominance our scope to variant by the beginning of 2022 in the Philippines the variant has now been detected in all regions of the country with B8.2 being the dominant sublimage observed locally not the globally predominant B8.1 sublimage although the majority of detected local omicron cases have no travel histories belonging to the B8.1 sublimage most of the returning overseas Filipinos that were classified with B8.1 most of our returning overseas Filipinos were classified as B8.1 suggesting that many of these important cases did not have onward translation of the virus there was of course a recent uptick in cases of going B8.2 so actually this data has been used by our government to relax our border control and allow people to come back to the country and also tourists the earliest detected case of B8.1 and B8.2 are both local transmission B8.1 and 22 22 November from CAR, B8.2 from Soxygen the source and origins of these infections are also currently unknown we have done phylogenetic analysis suggesting that of course the patterns of transmission reflect exponential growth consistent with the community transmission of this virus in our country there is apparent clustering of omicron cases from different regions of the country suggest porous borders and hidden lines of transmission the globally rare 2 globally rare mutations in the local sample suggest that transmission is largely driven by this community transmission we don't know whether these two positive advantage or survival advantage and so far based on our modeling at least in terms of viral genome we could not really pinpoint what would be the positive attributes of these two additional mutations in the variant B8.2 the infections occur in a wide range of samples the data of which I have not shown the majority of which were from individuals between 20 to 40 years old and that the cases are mostly again asymptomatic and mild so to end I would like to thank our funding that's the funding support from the DBM department of budget management the department of health at DOHC the PCH at the end of the system and this has been an effort done with the department of health epidemic knowledge bureau and the many laboratories around the country have been sending samples to us so thank you very much thank you very much that's Dr. Cynthia Professor Cynthia Saloma of the Philippine Genome Center na pahusay po na kanyang paliwanag so pa lang dahilan kung bakit big lang pwede na maggyay sa Pilipinas hindi hindi siguradong ng galing sa labas itong omicron it could have been mutation from inside and this is why genetic sequencing is so important so na pahusay po na anong paliwanag nyo thank you so much for that excellent presentation and I think it's very enlightening for us here in the Philippines to hear that explanation and maybe it could have been explained more because people were like why all of a sudden relaxing so I think this is very important to be able to communicate properly Professor Saloma okay so we're going to call everyone in now for our panel discussion so Dr. Eva, Dr. Martin Dr. Liyang and Dr. Saloma kindly open your videos and we'll have a panel discussion but before that Raymond has an announcement thank you Executive Director Saloma from the Philippine Genome Center just trying to understand our current situation in the Philippines regarding all of the variants that we have right now we'd like to take a quick break for our special public service announcement for today Bayad po Dlamat po Mama Bayad po na po anak tabi mo na yan para masuklian ko ang mga sacrificio na sanatang bayan Bayad po kayo na ikita ko ang mahal na mahal ninyo ang inyong pamilya kama ka kaya nag-alala na ako paano ba matapos ang pandemiyong to? para matapos umpisahan na ninyo magpabakuna na kayo magpapabakuna ko thank you tv up the covid communication public service announcement is one of the many outputs communicating covid-19 in post quarantine Philippines headed by the UP vice president for public affairs Dr. Elena Perna and funded by the DO STP CHRD and the Department of Health through its ahead HSPR project we also have very very quickly just because we understand everyone is so busy selected presentations from our past webinars these are what we lovingly call our SCD shorts these are short clips that can be found if you go to the youtube channel of tv up you'll be able to essentially consume bite size information and hopefully that's something that you could really view if you wanted to not really consume all of the playback webinar but really those important points from our speakers now let's go to the panel okay thank you very much Raymond and thank you so much to all our panelists for the excellent expectations and for actually answering the questions in the Q&A box and I could see a conversation going on there but I'm going to pick up on a question that came out in the Q&A and I think is something that the Philippines is currently struggling with so we're going to ask Martin and Liang to speak to this issue so you have moved into antigen testing and self testing what is the role of antigen testing and self testing in returning to school and returning to work in your countries so maybe Martin first okay so the school system has been an important help actually you know the testing has been very useful notice that the infection rates has been very high in children and that's been worrying and it was perhaps a worry that we might have to close the schools but by introducing the self testing and getting everyone to test at least twice a week and possibly more of their symptoms we've able to keep children who are positive at home and this has allowed the rest of the class to carry on and actually that testing means that currently if you are negative by your test you can go back into the school so there isn't a two week window it can be five days or six days and if you're negative you can go back so actually testing has been very useful in keeping the schools open right and how long have you been doing antigen testing in the UK so we started really during the mass testing is from maybe May or June last year okay thank you very interesting how about for the work place new workers have to do self testing also or what's the what is the norm so for education facilities like where I work we have to test twice a week at home self testing before we can come in but we also expected if you're coming into the office or into your workplace you should do a test before you do that and that's to try and minimize the contact rate so lots of places are able to do that and tests are available widely so anyone can pick up and use those I mean are they free Martin the tests are free or people have to pay for them so at the moment they're free they're supplied by the government nice okay so that would be very important point for us how about liyang in Singapore that was the first time I heard that antigen test were being used so please tell us how you're using the antigen test and what's the what's its use or value in education and in work places sure it's much like what Martin had mentioned our antigen test are widely available they're sold in the pharmacist and some provision shops and needs to encourage people to self-test and then not to go to work or go to school if they are positive very briefly in Singapore last year late last year we tried to have children test themselves or parents test the children before they went to school I think we thought this was a little bit of a disaster so after all a disaster okay why was it a disaster it's very difficult to implement and there were lots of complaints especially for parents of young children and since in Singapore all the children have to attend school wearing masks and there is all different sorts of distancing measures in the end we dropped it but for university students if they go on campus every week they still have to submit masks okay and is this again is this something that they have to pay for themselves or it's provided by the government and the government subsidizes or pays for a lot of the mandatory testing so for instance last year my kids are young I received this packet of like 20 test kits for the children for free for three years for university students for example there is this vending machine that dispenses test kits and if you have a university code then it's free as well but it just gives you two at a time oh wonderful so this play is a very big role I think moving forward as we open up and we try to stop the spread we have testing in in a very different way okay so Raymond you had a question you wanted to ask the question would be the Philippines is also exploring well right now how the government can do the same especially for 110 plus million Filipinos was educating the public with regards to how to correctly do the self-test a challenge in the UK or in Singapore because that's something that we're trying to elucidate from the FGDs that we're conducting right now Martin it's interesting when we started I was very worried that people wouldn't be able to do the tests very effectively and that was a big concern actually however it seems that even poorly taken tests seem to work quite well probably much better than I imagined we changed the swabs a little bit we now just used the nose and not the throat and actually I think that makes the test less sensitive but we still get a very large number of positives and my students and children still seem to manage to get a positive result despite apparently poor technique so I'm sure it's less sensitive than if a healthcare professional did it it's probably still good enough to be informative and just to go back to to Liang so we also we don't test the very young children so we have an age cut off of about 12 if you're under 12 we assume the test is going to be difficult so it's only for older children right okay thank you now let me ask a little about masking because Liang said that at school go there with masks on is this like mandatory that's a requirement and are masks provided by the school how does that work yes Singapore is very strict with masking so can you public space even outdoors people have to be masked and this being Singapore there are people walking around to check who's wearing masks and to issue warnings or issue fines and the masks for the kids are those free when you go to school there were masks given out at different points in time but no the masks are not free but masks are very cheap in Singapore now yeah okay that's great you probably produced your own masks right I guess some of it but a lot of it is still important yes still important and Martin let's talk about masking what's the thinking on masking now in the UK so the UK is very poor at wearing masks in contrast to Singapore we're terrible at it and but I have to say we try to restrict the mask using to particular places so on public transport we have to wear a mask where you might be squashed next to other people but and in schools and in fact schools it's a bit easier to imply those rules so there was masks when you met with other people in the schools but that's been dropped recently as a an opening up measure so I think masks are very useful we use the simplest is we homemade our masks that we use it's just a cloth mask three layer cloth mask that we use all the time and just after washing so I don't think they're overly expensive necessarily but the UK yes very poor mask wearing and I'm sure that's why our background rate of disease during that delta wave was much higher than many other countries right thank you very much I mean I bring both Eva and professors into this conversation because genomic testing we are very fortunate that well Chancellor Menchikpade is here and should probably say something about this later but I think you're doing much more genomic testing than we are so what's the level of genome testing that you're doing in the UK and in Singapore and then we're going to ask Professor Sintia and Dr. Eva to talk about this also because you know geographically we are an archipelago we have the genome center doing its best it's very new but tell us a little about the history of genome testing in the UK and in Singapore and the levels of genome testing in the triggering maybe Lee first or Martin go ahead Martin go ahead sorry don't want to go first it's the UK did do an awful lot of testing you need a PCR test in order to do the genomic sequencing and early on that was the only type of testing that we were doing and restricted mostly to hospital use and so at that time most of those samples were genome sequenced but as PCR has become less common the sequencing as a proportion has gone down quite dramatically most of our testing now is with the rapid antigen test but if you're in hospital you still get a PCR test and we're still sequencing a good proportion of those although I have to say the government now is talking about reducing that and I think that's a mistake because we should be monitoring that it's been very useful the alpha variant was detected through that sequencing first detected in the UK and I think it's important to keep an eye on those new variants coming through so that sounds like it's becoming a sentinel testing model or if it's mainly the hospitals where you're doing genomic sequencing when we started I think most of the genome sequences came out at the UK we had a very big effort to do the sequencing in the UK but now it's much less mostly because PCR is much less right, thank you Liang, tell us about genome sequencing in Singapore I think UK has been the gold standard Singapore we have National Public Health Laboratory that does the whole genome sequencing of the virus isolates but we also have academic centers that do some of the sequencing and the experience is similar with Martin's except that we have always just done sentinel sequencing so we took for example a proportion of all the cases in the hospitals with the positive PCR tests and then we attempted to do a whole genome sequencing for them as the case count rose again the capacity couldn't match the number of isolates and therefore the proportion of positive PCR tests being sequenced fell but we still do it routinely not just from the hospitals but also from clinics, GP clinics sending the results in so that we can get some sense if new variants appear in Singapore imported Okay, so in your case you're doing sentinel plus some communities Maybe we're going to ask Professor Cynthia to talk about how you're doing it in the Philippines and then ask Eva what's the vision Professor Cynthia, go ahead How are you doing it in the Philippines? It's every region has a regional epidemiology surveillance units and they are the ones coordinating the local effort of collection from laboratories and hospitals which has for example experience of spike in cases so in the beginning it was really directed because of spike in cases now the move is just every region has some sample something like 75 or 50 samples every week is sent to us now but we are also moving towards sentinel sites and doctors we see the RITN as well as the other sub-national laboratories will also be joining the effort so we have three sequencing centers from the PGC or PGSTB sites in the now on PGC main and then I think the big hospitals in the DOH will also be doing their own sequencing effort to a smaller scale Okay Eva, how are you going to train everybody to do this? Go ahead We're happy to inform everyone that we have expanded our genomic biosurveillance efforts to the different regions and fortunately we have the Philippine Genome Center Visayas and Philippine Genome Center in Mindanao that those two facilities should be able to take care of genome sequencing in the regions but of course you did mention our challenges in the Philippines because we have a lot of geographically isolated and disadvantaged areas and for now even if we have a facility in Visayas it may not be that easy to send samples to PGC Visayas as opposed to sending samples over to Manila because of the flights right so logistically we're trying our best to figure out the correct way to do our genomic surveillance in such a way that there will be good representation we will have data from the regions and not only from the national capital region the very near vision is really for us to open those facilities it will be probably in the next two to three weeks and we're very happy about that the people have been trained to do exactly what the Philippine Genome Center main campus in UP is doing so everything is set and as Dr. Rick Saloma said I think we're also moving into a Sentinel site with other sub-national labs coming into the picture this has to be a country effort and not just for just a few it will be a collaboration with many testing laboratories thank you okay thank you very much Emma that's great news Raymond did you have a last or final question for us because we're moving towards the top of the earth and we don't want to keep Martin up further than we have so so let's go Raymond one of the final questions and this was aggregated from the Zoom chat as well as the ones in YouTube has to do with since we're talking about variance of concern and what will be next one of the things that have come up towards the end of 2021 was a variant that combines Delta and Omicron that costs quite of concern especially in Cyprus is that something that we should be preparing for or is there anything that would be much worse than what we have right now in light of the fact that there are countries already that have high vaccination rates I'll post that first to Dr. Saloma before we go to Dr. Liang and Dr. Martin Okay so regarding the Cyprus Delta Crohn thing that has been checked it's apparently a contamination so many of the people in Jiseid as well as in Pangol and we do the submissions those were probably contaminated samples nevertheless the possibility of recombinant viruses that could happen we don't know however what will be the next one because for one we were already concerned with the Delta variant and then all of a sudden Omicron came with so many mutations in the spike region fortunately the clinical presentation is milder compared to Delta so if you ask me Dr. Rain are there to be more hands as long as there are areas in the world which have been deprived of vaccination and as long as transmissions keep on going there will always be variants that will happen what is good is of course our arsenal of drugs and armamentarium has improved but still the question of vaccine equity is a big question mark for Vice Dean Liang I think we expect that there will be new variants in the future and whether they are milder or more severe we won't know but I think on the positive side the global surveillance system is much better now than it was over the past two years and it keeps getting better and better I'm sure most of us remember that when the Delta variants arose for months we couldn't determine whether it was a variant or concern how the different treatments affected it and whether it would give late vaccines and for Omicron we know fairly quickly and similarly for this BA too so I think while the system is in place we can be reasonably confident that we will get information on new variants in a fast enough way that hopefully we can react even as it spreads around the world Thank you and finally Professor Martin I think the answer is already being covered I agree with both Cynthia and Liang I'm expecting new variants to come up and as I showed on my talk they come out of surprising places so we have to keep an eye on them Okay, thank you very much We are close to the top of the hour and I'd just like to extend our profound thanks to our speakers to Dr. Martin, Dr. Liang and of course Professor Cynthia and of course Executive Director of the NIH Eva Synthesis by the Chancellor of the University of the Philippines in Manila Dr. Manchit Padira Manchit, the floor is yours Okay, go ahead, thank you So good afternoon and probably good morning to Martin Today's webinar was opened by Dr. Eva Kutyong-Kodela-Past with the cover page of Time Magazine it is an animated story of the Marvel characters with predictions for 2022 Here are the two scenarios the two predictions Scenario number one, the SARS-CoV-2 virus has achieved equilibrium with humans The second scenario the virus could keep changing in unpredictable and possibly deadly ways So you've got the whole of 20 people to find out exactly which one will be the right scenario for us Our first speaker is Professor Martin Hebert He gave a brief overview of the virus in terms of action of spread and modes of transmission which we have extensively discussed in prior webinars There is a worldwide effort to hold genome sequence of SARS-CoV-2 and we now know that the different strains all evolve from mutations that occurred very early in the pandemic So I'd like to encourage all of you to watch the replay and review first what mutations found in Omicron B8.2 and third, the PCR diagnostics that can identify the three genes of the virus and we've heard it again and again as well as in the past conferences despite the N2 and the E Now Omicron has been around what we're knowing is that Omicron has been around but initially not transmissible So eventually it had mutations that became more transmissible So Dr. Martin warned us that the next variant could be one of the silent mutations which will eventually become more transmissible Dr. Martin gave a preview on the effect of Omicron of the Omicron B8.2 in the UK and he said that and I think just the same like here in the Philippines and Singapore the PCR is distinguishing the stealth, the B8.2 but there is no clinical difference Now the UK is fortunate to have a national survey and I think this really allowed them to see the real numbers and pictures in their population So the random testing of households has revealed that 5% are positive for the Omicron and the policies for testing have actually also increased the numbers. He said that with self-testing the numbers really went up but what they can see is that it is milder and there is less hospitalization so Dr. Martin said that the combination of vaccination and the lockdown are probably the two reasons why the numbers have brought down the numbers of deaths have brought down Now there was a question on schools and the audience is very keen to know what's happening but the schools in the UK have remained open because of massive testing Countries vary and one of his last slides actually showed that the risk of severe disease will really vary and it's for many reasons that we all know now the vaccination rates the age profile the comorbidities the element of mixing among the people in the population healthcare access and of course the facilities for self-isolation and the support from the government Now in closing, Professor Martin said this is what we have to accept it is a nasty new disease that is here to stay but once likely each year the vaccination will need to be updated every year and we need new therapies because there will be those that will escape the vaccination that's given to the patients Our next speaker is Vice Dean Shu Lee Yang from Singapore who shared insights from Singapore Omicron B8.2 entered their borders in January only of this year They're very lucky because 90% of the total population is fully vaccinated with 64% having received already a booster dose may be a number that we hope you can have in the Philippines The lessons from SARS in 2003 helped them plan better Singapore invokes the whole of government approach very similar to what we have in the Philippines but let me just mention what they consider as their definition of the whole government approach a national effort coordinated by the multi ministry task force set up to direct national response to the outbreak number two coordinated community response to protect all in Singapore and working with international community to respond to the outbreak Now the COVID-19 strategy in 2020 involves the enhanced surveillance containment active case finding and reduced importation Vice Dean Lee Yang mentioned key moments in the COVID-19 story in Singapore The first one is the migrant workers in the dormitory outbreak in April 2020 The second one is the delta wave and this is interesting because they said that the prior strategies of public health standards were no longer effective and that's why they push for vaccinations which is their key moment three, they needed a solid vaccine strategy The key moment number four in terms of the vaccines I wanted to mention that they made an early negotiation to buy vaccines they wanted to make sure they had to supply for their population and their Singapore Airlines flew wherever the vaccines were to fly them back to the country The key moment four was the vaccination rollout very similar to the Philippines which is a progressive facing of the vaccination to the population The key moment number five is misinformation we also have this in the Philippines and last but not least is the key moment six which is the use of the various testing strategies that could be needed by the population at a particular time So just like in in the UK as far as the B-8-2 is concerned there is no difference in treatment as of this time Our speaker is Professor Cynthia Saloma the Executive Director of the Philippine Genome Center and she started by sharing actually the beginnings of the Philippine Genome Center or PGC It was established in 2009 to primarily provide sequencing services especially at times when the borders closed and this is actually the time To date, she reported that there are 23,000 have had whole genome sequencing at the Alpha, Beta and Delta but just to highlight that since January cases have all been the Omicron variant So I would like you to watch the replay to review the evolution of the different variants in the Philippines because she talks about when we had Alpha, Beta, Delta and then exactly when the Omicron entered the borders of the country Now as far as the Philippines is concerned Dr. Saloma said that it peaked actually Omicron peaked usually two months later as compared to our neighbors because of our border controls As for Omicron, the peak was actually in the second week of January So to date, we have more than 3,000 cases mostly local across the regions with 98% from being Omicron B8.2 So just allow me to mention a few points that she mentioned in the summer slide. Well, number one Omicron Biosurveillance revealed a steep increase in the proportion of detected local Omicron cases from the last week of November 2021 and rapidly becoming dominant the SARS-CoV-2 variant by the beginning of 2022. The second is the variant has now been detected in all regions of the country and she pointed out that the finding of the B8.2 primarily local as compared to the B8.1 that is found among the overseas workers is one reason we opened up our doors to foreign travelers because what we're getting is the local variant not the one coming from overseas The overseas workers usually would pick up a variant from where they came from Now the third point is the apparent classing of Omicron cases from different regions suggests the porous borders at hidden timelines of transmission and definitely it covers a wide range primarily between 20 to 40 being the working mobile population So, just like in Singapore and the UK, our cases are mild. The cases we have picked up are primarily asymptomatic and with mild symptoms So in closing, here are some messages to remember from this webinar First, let us brace ourselves in anticipation that this pandemic will soon be endemic Second, as far for treatment of Omicron B8.2 there is no difference at this particular time Third, regardless of variants as Dr. Eva said in the opening important strategies remain improve global surveillance efforts and increase genetic sequencing of the virus because knowing the genome of the circulating viruses can help provide the earliest hints of any changes and clues as to which of these changes could be dangerous for humans. And lastly, as shown in the closing slide of Vice Dean Li Yan the future is living normally with COVID-19 Thank you and good afternoon to see and Dr. Rehman Thank you very much That's our very own Chancellor Manchit Padilya with an X Summary I don't know how she keeps all those notes while she's listening to the webinar But thank you so much for that summary Alright, next week We have a very what should I say a very urgent issue we want to take up So some of you may have been monitoring the possibility of war in Europe between at the border of Ukraine Russia and the NATO countries Western countries are building up military strength and it's been described by many as the most dangerous moments in World War II Now we don't mean to scare people but we believe that it is time for us to understand what's happening there and how that might affect us and how that might affect the pandemic So our topic next week is something like gara sa panawan ng pandemia Hopefully it doesn't happen but by all indications it seems that the tension is becoming more what should I say more severe and we should know ahead of time what we're going to expect for Europe not only in Ukraine but in Poland in Hungary in Romania and Belarus which all neighbor Ukraine So we want to talk about that and we have some very special guests who will talk about gara sa panawan ng pandemia kahit na malayo yan we might think oh malayo yan it won't affect us no if this pushes through there will be effects on the economies and I was just checking this that Russia has 200,000 new cases of COVID every day 200,000 a day and Ukraine with a population of 41 million has about 30,000 new cases a day if people start fleeing from Ukraine and moving into different places I don't know what's going to happen so we should be prepared thinking about what preparations are best for us and of course people are also a little bit concerned that if there is if there is armed conflict in Europe then other parts of the world where there are flash points or their intentions like the West Philippine Sea for example would be affected we don't know so we have some experts who are going to talk of course we'll have Ted Robosa opening this we will have attorney Tony Lavina is one of the best analysts I would say on global politics we'll have Dr. Johnny Nanyagas who you've had before and Dr. Daniel Leasing of the Global Health Law Center of the University of the Philippines College of Law and some others so don't miss it don't miss gara sa panahon ng pandemya okay over to you Raymond Thank you Dr. Susie and we would like to extend our deepest appreciation to our panel of experts for today we really learned a lot and that's something that hopefully all of our viewers will be able to take away from this webinar again another excellent recap and synthesis from our UP Mandila Chancellor Dr. Padilya for next week we hope you'll still be able to join us I don't want to say it's a little bit unorthodox or something that we really talked about but it will be something that will affect us and think about it especially during this time that we are still in the middle of the pandemic so sana po makita-kita po tayo ulit next week but before we conclude we'd like to thank the very hard working team behind the stop COVID-19 webinar series without each and every one of you we won't be able to churn out quality content each and every week and also for those who want to be able to watch either in whole part in the playback you'll be able to watch each of our 87 webinars and then right after this one webinar 88 in the YouTube channel of TVUP you'll have to go to www.youtube.com forward slash tvupph to be able to see all of our webinars today so maraming-maraming salamat po ulit makita-kita po tayo ulit next week this formally closes our webinar for this week and next week for Friday from 12 noon to 2pm it's a date together we will stop COVID-19 so keep safe, keep healthy and see you online put your thumbs up at the bottom of the video if you like this video please subscribe and hit the bell so that you don't miss our next video so until then bye hold on to the word keep my head until my head's dying my fears the others laugh before my tears but right behind your eyes I look into myself and ask do I have strength to carry on if you're here to keep me strong I'll keep my word before my tears pushing on the spine of tears please take me through another day another day