Covid-19: A doctor’s concerns

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Sketch by Wong Soak Koon

Not to seek public views about the best way forward is not only short-sighted but unworthy of a mature democracy, T Devaraj writes.

It would appear that many Malaysians like me were surprised by the prime minister’s Labour Day announcement of the 4 May easing of the many restrictions under the movement control order, which is now called the conditional movement control order.

This change of course was unexpected, as up to recently, local experts – both health and economic – had called for the movement control order to be extended to the end of May. They felt that, though the number of people infected with Covid-19 had dropped to below a hundred a day, it was still not sufficient to ease restrictions. Some were looking at single-digit infections for a period of two weeks as a more suitable criterion for easing restrictions.

Rushed?

Concerns have emerged that this change was rushed, perhaps driven by the desire to kickstart the economy. How do we balance lives and livelihood is a question being faced all by almost all countries of the world.

That we as a country have to bite this bullet at some time is a given. How do we chart a way to maximise the benefits? An option would be to start slow involving a few sectors with time slots and a review built for any negative consequences (here it will be an increase of infections) and take appropriate action.

In view of the fluid situation with Covid-19, we must be prepared even to change policies. The conditional movement control order is allowing the door to be opened too widely at one go thus risking what we have successfully done thus far in the fight against Covid-19.

When the time given for all of us to prepare for this change in course was just three days, there is the real risk that we are not ready and, in turn, compliance will fall short. Again we are shooting ourselves in the foot!

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Calibrated change

Calibrated change is a better option, which is being done in some other countries. New Zealand for example, which declared a state of emergency on 25 March has begun easing restrictions, one being that restaurants are now allowed to provide takeaways.

Granted that social distancing especially in public is key to reducing transmissions in practice, how practical will it be (for the owners and their patrons) in the thousands of food outlets that may have reopened on 4 May?

Has thought been given in the plan for easing of restrictions to take advantage of areas where Covid-19 infections have gone down to nil and thus called green areas such as Perlis, Kedah and Penang.

Calibration towards easing of restrictions can leverage on this fact. Those old enough may recollect that during the Emergency different parts of the country were declared white as the security situation was achieved, and the easing of the then severe restrictions was initiated in the “white areas”.

Much is made of standard operating procedures and rightly so. Take for instance temperature testing. Will the smaller food outlets have the needed tool? While recording client information will be useful, its practicality is questionable not only in small food outlets.

Some countries are moving to tech solutions such as mobile phone apps or coded bracelets to track the movement of people. Apart from availability and accessibility, local issues of privacy have risen all over the world. In Australia – which fiercely champions personal freedom and security – it apparently is being widely accepted in the belief that it serves the common good, with the rider that it will cease when the outbreak is over. Will it? This of course is anyone’s guess.

Similarly while home schooling is the rage, accessibility to the tools is questionable for many homes, along with parents’ ability to monitor their children in cramped living conditions and the questionable abilities to be able to teach some subjects.

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Lack of public consultation

The challenge for the public will be adhering to guidelines like social distancing, hand washing, cleansing and face masks in public. We have to learn to internalise such behaviour (an example will be the brushing of teeth) so that the need for monitoring and surveillance is minimised.

Regarding the wearing of masks by the public, a lot of toing and froing has emerged all over the glothe be including our country. My take is that while the basis for the use of face masks must be based on science, in uncertain territory the addition of common sense will be sensible.

Another concern is the lack of public consultation. Like what happens with our annual haze (who knows, we may, thanks to Covid-19 and the movement control order escape the haze this year!), the voices of the public are not being solicited by the authorities. We see this happening at federal, state and local council levels. Why this “us” vs “them” mindset which pervades our country?

While our medical and other frontline staff have earned our gratitude and respect, let us not forget that the public too have played their role by staying at home.

During this troubled times, we all want what is best for ourselves and our country. Not to seek public views is not only short-sighted but unworthy of a mature democracy.

Uncharted territory

We all must appreciate that, with Covid-19, we are in uncharted territory. Today we know more about the virus and how it works but there are still many gaps. As new facts come on board, old ones may have to be adjusted, and even U-turns in policy may arise.

A vaccine will come. Apart from remdesivir, which is credited with significant benefits, other medications are on trial and hopefully some may be found useful.

The measures adopted by the government, with continuing public support, will bring the curve sufficiently down, perhaps in a few weeks.

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It is fortunate that, though the Covid-19 is highly infectious, about 80% of those infected will recover, and of the remainder, only about 5% will become very ill, and sadly some may die.

Another peculiarity of this virus is that a large proportion of those infected (as much as 50% in a large community study in Iceland) will not have symptoms but can still infect others who come close to them. Some may have only mild symptoms, which the victim may ignore or live with without being diagnosed, but these people can still be infectious.

While this is of serious concern, we can take heart from this occurrence that there will be a slow rise in the community of a natural herd immunity. So till a vaccine comes along we must anticipate, hopefully, only small outbreaks from time to time which will be capably dealt with by our health services.

Covid-19 is already endemic in our country, and hence we need to know what is going on in the community. Testing for the virus and also for viral anti-body in different parts of Malaysia and seeing the trend over time will provide valuable information to health officials that will help in preventive measures.

Covid-19 is a new ball game for humanity. Much is known to date that can mitigate its impact on health. It is likely to be around for some time, for we live in a very interconnected world. It has still not gone through its full cycle in many countries, and thus the risk will persist till a vaccine is found.

Let us not lose hope for we know that this grave threat to our lives and livelihoods can be overcome. So let us continue to work together.

Dato’ Seri Dr T Devaraj is a retired physician who has been involved in hospice work for many years

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