LETTER: On Nov 7, 2020, Senior Defence Minister Datuk Seri Ismail Sabri Yaakob announced that all but three states (Perlis, Pahang, Kelantan) in Malaysia would be placed under the Conditional Movement Control Order (CMCO) for four weeks from Nov 9 to Dec 6.
Following this announcement, several professional bodies and individuals voiced their opinions and suggestions on media. Many were of the opinion that since incidence rates are high in some areas and not in others, a more targeted approach to the MCO should be implemented instead. They also highlighted the need to continue health promotion via strong messages to comply with standard operating procedures as poor compliance now sets in among Malaysians who are into the ninth month of the MCO at various levels.
As of Nov 11, the Case Fatality Rate is 0.7 per cent, which is better than on April 9 when it was recorded at 1.58 per cent. Most of the deaths are among those aged above 60, mostly with underlying co-morbidities. As at Nov 7, the infection rate had reduced to 1.0 from 1.5 recorded at the start of the third wave in September.
At the same time, a statement by the Academy of Medicine Malaysia on Nov 10 highlighted the fact that the incidence rate is not the same for all states. The rates are higher in Sabah, Labuan, Negri Sembilan and Penang, whereas Selangor, Putrajaya, Penang and Kuala Lumpur are exhibiting a decreasing trend.
The Academy of Professors Malaysia (APM) is concerned with reference to the current CMCO; whereby we are of the view that the restrictions in place, which are too strict and prolonged, can lead to economic, social and health hardships for members of the public.
Of particular concern is the care of patients with chronic diseases such as cardiovascular, cancer, endocrine and cerebrovascular diseases who do not go for follow-ups or who are brought in too late to be saved.
In 2018, a staggering 18,267 people died in Malaysia from ischemic heart disease averaging 50 deaths a day, which happened without any restriction to movement or healthcare.
The World Health Organisation does not advocate lockdowns as the primary means of controlling Covid-19. The exception is when there is a need to buy time to reorganise, regroup, rebalance resources and to protect health workers who are exhausted. The WHO also reiterated that lockdowns only make the poor become poorer and there are concerns of possible doubling of world poverty and child malnutrition in 2021.
Studies have shown close exposure to working-age household member and neighbours is associated with increased Covid-19 mortality among older adults. This points to the fact that focused protection to protect such groups should be the strategy, not a national lockdown as practiced in many countries.
Added to these concerns is the impact on mental health from anxieties, fears, worries and stresses due to uncertainty imposed by the MCOs, especially on employment, schooling and lack of social contact. People are not meant to be isolated, their lives are based on face-to-face interaction and community integration, therefore depriving them of this may lead to other problems.
The Great Barrington Declaration on Oct 4, 2020 signed by nearly 6,000 scientists and medical experts across the globe as well as 50,000 members of the public argues that lockdown policies in place until a vaccine is available would cause “irreparable damage, with the underprivileged disproportionately harmed. They pointed out the risk from coronavirus is 1,000 times greater for the old and infirm, with children more at risk from flu than Covid-19.
With reference to these concerns, the APM would like to propose the following measures:
1. Red Zones with more than 40 new daily cases should continue to be under EMCO, but the rest of the country should return to RMCO. Perhaps these acronyms could best be replaced with number codes in order to avoid the misconceptions.
2. The continued detection of localised outbreaks (clusters) should continue. However, since the Covid-19 infection survival rate is 99.9 per cent for healthy people under 70, to achieve an optimal balance between health, social wellbeing, and the economy, the emphasis should be on “focused protection” and “targeted approach” for those at risk while allowing the less vulnerable to work and go to school.
a. Young and healthy adults and children above the age of 12 should be allowed to go back to school and work.
b. People with co-morbidities regardless of age and the elderly should stay at home.
c. People who go to work and school should be taught how to clean themselves and how to approach vulnerable family members when they return home. These measures should be taught on media, at the workplace and at school.
3. As advocated earlier, people should be taught and continually reminded about carrying out the responsibility of protecting themselves against Covid-19 by practicing the 3W and 3C as the daily norms.
The public should also be educated on the level of risk of getting an infection from activities so as to avoid the activities that are high risk, for example avoiding bars, indoor close contact, meetings and parties, eating in crowded indoor restaurants, etc. Activities outside, with physical distancing, is generally low risk and since we need the sun to produce Vitamin D, exercising outside should be encouraged.
4. That the SOPs need to be well defined, complete and accurate to avoid confusion. For instance, the misunderstanding on the usage of masks during fuelling at petrol stations, and the restriction of travelling together and eating at a table in restaurants, while the group may be from the same household, hence sharing the same living environment and air. Such restrictions may further increase the risk of depression, lethargy, and family discord of being cooped up for too long.
5. That nutritional education on the right food would assist the development of a stronger immune system. Get nutritionists and dieticians on board in the media to tell people what to eat, how to prepare and cook and when to eat is as important as showing people how to exercise in the mornings.
6. The creation of platforms for people with mental health issues to reach out to either at the university, healthcare, organisational or even individual level and if possible make it free so that anyone can get help when needed.
7. That the message of keeping the vulnerable and high risk groups safe should be constantly reaffirmed and resonated to the public via media and to communities. It is important to make sure that people above 70 and anyone who has chronic diseases do not get infected.
We believe everyone should learn to live with Covid-19, fear it, be cautious of it, but “live with it” because life has to go on calmly, but surely it can.
To all the frontliners, especially those in the health sector, we would like you to know that members of APM and the rakyat fully appreciate your contributions and sacrifice, that you have gone beyond the call of duty to serve the nation despite all the difficult challenges.
PROFESSOR DATUK SRI DR DAENG NASIR DAENG IBRAHIM
President, Academy of Professors Malaysia
PROFESSOR DR ADLINA SULEIMAN
Head of Medical and Health Cluster, Academy of Professors Malaysia
PROFESSOR DR JAMAL OTHMAN
Head of Economics and Social Wellbeing Cluster, Academy of Professors Malaysia