Jeyakumar Devaraj looks at whether we can return to business as usual once the order is lifted.
The prime minister’s announcement yesterday that the movement control order would be extended by another two weeks was a little premature, I thought.
It might be necessary to do so if we have not got the number of new cases down to below 50 by 31 March 2020.
But we might still be on course for that target.
The number of new cases was expected to continue increasing for at least a week after the implementation of the order. This is because, although transmission of Covid-19 would have declined markedly after 18 March 2020, when the ontrol order was implemented, many of the cases infected in the seven days prior to 18 March would have only become symptomatic and confirmed as new cases in the week following 18 March.
This is because the incubation period for Covid-19 is between three and 12 days. If you look at the figures of new cases, they seem to suggest we could be reaching a plateau.
Series 1: New Covid-19 cases in Malaysia
Do we have to maintain movement control order until we have zero transmissions?
Of course not! It is a luxury we can’t afford as each extra day under the order puts more pressure on our population as they are unable to earn and support their families under such tight restrictions. And we do not need to, either.
We know from available epidemiological data, that on average, a positive case will infect 2.6 others before the person is diagnosed and isolated from the public. If on average we could diagnose all newly infected persons early and isolate them such that they collectively only transmit to 0.6 persons each, then the number of new cases will reduce by 40% every six days (six days being the average incubation period for this bug).
To achieve or exceed this 0.6 transmission target, we need three main measures:
1) Proper screening/testing facilities so that we can diagnose cases early
We need people to come to designated clinics for testing if they have symptoms of fever, cough and or breathlessness.
We also need sufficient reagents to run the PCR-RNA blood test for all these people. There are already too many cases being sent away without the test being performed on them as they do not meet all the criteria such as travelling from a designated country or not having contact with a known case and later being diagnosed as positive after their clinical condition turns worse. The criteria for ordering the test has to be loosened.
2) Effective quarantine for the family and workplace contacts of each diagnosed case
Our Department of Health is actually quite good at this, and they should be commended. Our rates remained quite low until we slipped up with the Tabligh mass gathering.
3) Transparency and effective communication to the public
The daily announcements by the director-general of health are excellent as the occasions provide accurate figures and limits the room for fake news. It also reassures the public that things are under control. We need the full cooperation from the public for the first two measures to be properly implemented.
I believe the Ministry of Health has the capacity to trace the contacts of 50 new cases per day. If we can achieve the 0.6% transmission per patient target, the number of new cases would fall to about 11 new cases/day in three weeks, and it will keep sliding after that – that is, barring the importation of fresh cases from other international hot spots.
The fact that the PM has announced a two-week extension of the movement control order does not mean that it cannot be shortened, if the circumstances warrant it. I am sure the public health professionals and epidemiologists in the Ministry of Health will be reviewing the situation and advising the PM and the National Security Council about the timing of the lifting of the order.
I believe we will not have to wait till 14 April 2020 for the order to be lifted.
But for now, we should all fully comply with the order for that is crucial to bring the epidemic under control before it causes more suffering.
Will it be ‘business as usual’ once the order is lifted?
No way! Not until the Covid-19 epidemic is brought under control internationally.
We witnessed how just one mass event led to the epidemic spiraling out of control in Malaysia. So we need to be careful.
We probably will need to put a cap on mass gatherings, for large gatherings expose us to the risk of another explosive growth of the infection rate – and another economically costly movement control order might have to be imposed if our health workers cannot cope with the huge number of new cases generated.
So the National Security Council will need to come out with a set of guidelines on:
- sport events that attract large numbers of people
- school assemblies – Should these be broken up for different levels? Should temperature checking be done for all students daily?
- social distancing in markets and supermarkets. Perhaps temperature checking of all entering the market?
- wedding celebrations – Should there be a limit set as to the maximum number of guests permissible at these events?
- religious observation – Again, should there be a limit to the size of each religious event? Should there be mandatory checking of temperature?
- crowds at hospital outpatient clinics
We are in uncharted territory. We need to practise some social distancing even after the movement control order is lifted – at least until an effective and safe vaccine is found.
Unfortunately, some of the measures proposed will restrict our freedom of movement and of association and will be viewed as intolerable by some.
But if we do not want loved ones to die from this epidemic and if we want to avoid repeated movement control orders over the next year, we need effective social distancing that will prevent massive amplification of new cases.
Consultation with the Malaysian public
I hope that the National Security Council is giving sufficient thought to life after the movement control order. It would be best if the council could call in representatives of various groups and associations to discuss the measures being considered.
Representatives of sport associations, supermarkets, the Department of Education and religious groups should all be called in for separate meetings, so they also understand the need for social distancing measures and play a role in defining the measures being considered.
We need the cooperation of everyone to succeed in this difficult period. A list of the measures being considered should be made known to the Malaysian public so they too can give their input. It is so crucial to build consensus at this stage.
If the list of measures work well and the Covid-19 situation in the country remains well under control, then after some time, depending on the international situation, we could start relaxing some of the most onerous restrictions. There should be a mechanism that mandates the National Security Council to review these measures at regular (three-monthly?) intervals.
In the meantime, comply with the movement control order. Stay at home and keep safe!