[ad_1]
MCOs inflict devastating damage on individual, family, community and national economic activity, severely affecting daily livelihoods and driving families and communities below the poverty line.
With the Ministry of Health (MOH) embargo on Covid-19 data, it is virtually impossible to decipher the rationale for extending the CMCO from November 9 to December 6.
What is the matrix used by the National Security Council (MKN) or the Ministry of Health to justify the extension? We searched extensively for the science behind the move, to no avail.
With the help of our colleagues in Public Health (PH) and Infectious Diseases (ID), we would like to offer data and trends captured from Ministry of Health statistics in the public domain that make CMCO unsustainable.
Understanding the data
The absolute number of Covid-19 cases in any state is not a useful parameter. It should be expressed as a proportion of the state’s population.
The infectivity rate (IR) by state is the number of active Covid-19 cases per 1,000 population. The IR in the Klang Valley, Selangor (0.295), Putrajaya (0.294) and KL (0.101) are well below the national average of 0.414 under the current CMCO.
If anything, the IR trend for KL, Selangor and Putrajaya is slowing down and flattening out. A CMCO continuation does not make any scientific or economic sense.
Therefore, it is difficult to understand the DGs of health affirmation that “the decision to order a partial closure in six peninsular states came about because the conditional movement control orders (CMCO) take time to take effect”.
Another commonly cited metric is the Replay Number (RO), or its brother RT. RT (or an RO compartmentalization model) is inherently complex, from which an independent review cannot be made unless the author reveals the many assumptions made. RT’s complexity, combined with its tendency to be biased by context on the ground (for example, a new large group in a detention center in District A that is isolated from the District A community), contributes to the lack of of a systematic and daily report by the Ministry of Health of the number of RT for each state.
In a previous article, we have discussed the limitations of R0 in the context of the new science of the superdifferentiating phenomenon of coronavirus and the most accurate value and utility of the new variable, the dispersion factor “k”.
However, in the same media report (FMT November 7), the Ministry of Health stated: “If we look at the start of the third wave, the infection rate (R0) was 2.2, but in two weeks We have lowered it from 1.5 to 1.0. “
Lift, do not extend, the CMCO
The ultimate goal of any degree of physical distancing, in our case the OLS, is to quickly suppress positive cases, reduce CFRs, and allow infected or quarantined HCWs to recover and return to work. Buy precious time so the healthcare system isn’t overwhelmed.
All the data that we currently have at our disposal suggests that the Ministry of Health is in control of the Covid-19 situation in West Malaysia. The sanitary facilities are not threatened or overwhelmed as in Sabah. This scientific foundation, among others, discredits the need for any form or continuation of OLS.
But the fundamental condition is that the rapid Test-Follow-Isolation-Support (TTIS) response must be functional and robust.
For surveillance purposes, we strongly recommend the mass use of RTK-Ag instead of RT-PCR due to its fast response time (TAT), low cost, and ease of use at the point of care (POC).
WHO and its global partners are making rapid antigen test kits available at US $ 5 per kit for all low- and middle-income countries (LMICs), including Malaysia. This is at least 15 times cheaper than PCR.
The price of RTK-Ag is astronomical, like masks and PCR at the beginning of the epidemic. With the WHO price, we call on the MKN to make this test widely available so that everyone can get tested.
The Ministry of Health should be compared to the best in managing Covid-19 pandemic crises. The following key indicators would determine if our TTIS Rapid Response is robust enough:
- What percentage of tests are performed and results returned within 24 hours?
- What percentage of cases with a positive test are successfully contacted within 24 hours to trace their contacts?
- What percentage of positive cases do your close contacts share with contact trackers?
- What percentage of named contacts are tracked in the next 24 hours?
- What percentage of contacts meets the insulation?
- And, if someone with symptoms has a test that is negative and symptoms persist, how quickly do they get another test?
Malaysia’s Covid-19 strategy must be informed and adapted to the local context, using evidence-based measures, not hard-hitting tools. CMCO is like a blunt scalpel and any surgeon would know that a blunt scalpel cannot remove cancer, but will inflict unnecessary damage to surrounding tissues.
CMCO alone, without a rapid response from TTIS based on large-scale data, it would not be enough to contain Covid-19. It can lead to longer open / close cycles that will devastate the economy, hamper our children’s education, impede access to healthcare for non-Covid-19 patients, and ruin our mental health.
Given the negative repercussions of lockdowns, we must always stay ahead of the curve and use evidence-based and data-driven tools. The rakyat and the economy are bleeding.
With the experience gained from the second wave, we should now map out an exit strategy to protect the lives of our rakyat, prevent disruptions to our livelihoods, restart our national economy, and ensure the long-term health and well-being of our rakyat and socioeconomic stability. .
The Ministry of Health must ensure that our TTIS response meets the Rapid Response key indicators so that we can dispense with OLS and move on with our daily lives within the context of the new normal.
Dr. Musa Mohd Nordin is a pediatrician.
The opinions expressed are those of the author and do not necessarily reflect those of FMT.
CLICK HERE FOR OUR LIVE UPDATE ON THE COVID-19 SITUATION IN MALAYSIA
