Covid-19: Experts Urge New Strategies

KUALA LUMPUR: New strategies that include stricter measures implemented under the Movement Control Order (MCO) should be enforced swiftly to curb the spread of Covid-19 nationwide.

Malaysian Public Health Physicians Association president Datuk Dr. Zainal Ariffin Omar said Targeted Enhanced MCO (TEMCO) should be considered in Selangor and the Klang Valley, which recorded a high number of daily cases.

“The authorities should review and strengthen the current approach, especially in regard to public health intervention at primary care and community settings,” he told the New Straits Times yesterday.

Dr Zainal Ariffin said by implementing TEMCO in identified areas, the country’s economic activities and essential business sectors would still be able to resume.

Datuk Dr Zainal Ariffin Omar.
Datuk Dr. Zainal Ariffin Omar.

However, he said, the government should also look into increasing medical and health resources, as well as related recovery requirements during the pandemic and beyond.

“The authorities should also increase manpower in carrying out enforcement in health and safety areas, and in vaccine procurement to ensure access to effective Covid-19 vaccine,” he said.

Dr. Zainal Ariffin said it would be a difficult decision whether to implement either a full-scale MCO similar to what was done in March last year or to continue with life as usual.

He said the obvious result of the full-scale MCO would be a drop in Covid-19 infections and transmissibility, but it would also mean upending lives and forcing the country to lose an estimated RM2.4 billion daily.

“There are also issues such as the declining mental health among the public during the pandemic, as well as the concern about a ‘lost generation’ in regard to children’s education.

“These puts the future of an entire generation at risk when learning is hugely disrupted.”

On the other hand, Dr. Zainal Ariffin said by not imposing any form of lockdown, the impact could be devastating for the health sector.

Epidemiologist Datuk Dr. Awang Bulgiba Awang Mahmud said any plans to enforce the MCO must be done with due diligence as it would affect the livelihoods of many.

“The Conditional MCO (CMCO) appears flawed and it does not seem to have much effect in curbing people’s movement, which in turn, has resulted in high contact and infection rates,” he told the New Straits Times.

Datuk Dr Awang Bulgiba Awang Mahmud.
Datuk Dr Awang Bulgiba Awang Mahmud.

Dr. Awang Bulgiba regarded the classification of colour zones (red, yellow, green) as simplistic, and proposed the use of an indicator index that covered cogent scientific data instead.

“The indicators, which he had previously suggested, should include data such as cases per capita, deaths per capita, test positivity rate, doubling time, the ratio of new cases to discharges, proportions in each clinical-stage, percentage of beds occupied, locality-specific R-naught or Rt (which means R at time t), cluster-specific Rt, Spatio-temporal correlation values, virus genotype and so on.

“Absolute numbers (of cases) do not provide a very holistic picture as localities vary in population size, density, and the capacity to handle infections.

“Even a single rate like cases per capita gives a much better picture than just absolute numbers,” he told the NST.

From the data, Dr. Awang Bulgiba said the authorities could help to predict where and when infections would overwhelm the healthcare system if left unchecked, and subsequently, alert the relevant agencies to act accordingly.

“As the number of cases rises, it is clear that some states like Selangor, Kuala Lumpur, Johor, and Negri Sembilan have 14-day rates (cases per capita) that are higher than 100 per 100,000, higher than states like Sarawak and Perlis, for example.

“The doubling time for some states is also short, which means that their rate of increase is high. In addition, the proportion of unlinked cases is also rather high, which speaks of widespread community transmission. So there is a very high possibility of healthcare facilities being overwhelmed.

“It is vital that we take into account these factors, and if we factor in the Rt for some of the clusters in those states, which appear to be much higher than the national average, I would say that some states are inexorably heading for a full-fledged MCO.

“This is where a change in strategy is needed, from containment to mitigation,” he said.

Associate Professor Dr. Malina Osman, an epidemiology and biostatistics expert at Universiti Putra Malaysia, agreed that a new strategy in implementing MCO was needed, now that the total active cases in the country had surpassed 25,000 compared with 2,596 in April last year.

“Drastic steps are needed, including an immediate ban on social gatherings and travel restrictions in all areas identified as Covid-19 red zones.

“The Standard Operating Procedures (SOP) that rely on self-regulation should also be revised and replaced with specific mechanisms to enhance compliance,” she said.

Meanwhile, the Federation of Malaysian Manufacturers (FMM) raised concern that a second round of the MCO could lead to the collapse of businesses and industries in the country.

FMM president Tan Sri Soh Thian Lai said business and economic activities must be allowed to continue, albeit under stricter SOP.

“We support a targeted MCO, which is more localised coupled with stricter SOP and travel restrictions, but not a total lockdown similar to that implemented in March last year.

“Breaking the chain of infection is of utmost importance and must involve a concerted effort of both the public and private sectors. But it must not involve a second round of total lockdown.”

Tan Sri Soh Thian Lai.
Tan Sri Soh Thian Lai.

Soh said the business fraternity was still reeling from the impact of the Covid-19 pandemic and the first lockdown, and most have yet to rebuild their businesses back to the pre-Covid-19 level.

He said feedback from FMM members revealed that an MCO lasting for four weeks and more would reduce business sustainability by one to three months.

“There is also grave concern on whether the government can continue to provide financial aid to businesses, especially wage subsidies and loan moratoriums, to safeguard the people impacted by a second total lockdown.

“This is because most of the aid given by the government, which has been instrumental in supporting the recovery of businesses and ensuring job security, will be ending soon,” he said.


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