In an effort to control the Covid-19 outbreak in Malaysia, the movement control order (MCO) was implemented on March 18 (2020).
However, mandatory social distancing, which is the objective of the MCO, is not the panacea to control this outbreak caused by the SARS-CoV-2 virus.
It is vital that everyone comprehends the seriousness of the outbreak and the extraordinary threat to life posed by Covid-19.
According to the World Health Organization (WHO) report on the China outbreak, which is the largest published series, about 80% of laboratory-confirmed patients had mild to moderate disease, which includes non-pneumonia and pneumonia cases, about 13.8% had severe disease and 6.1% were critically ill.
The crude fatality rate (CFR) for China was 3.8% (5.8% in Wuhan and 0.7% in the rest of China).
The numbers in the Malaysian population who will die from the illness depends on the percentage infected and the CFR.
The table titled below provides some estimates to ponder over for Malaysia.
The current data is that well-prepared health systems like Hong Kong, Taiwan, Singapore and South Korea, which all had the benefit of experience managing SARS (severe acute respiratory syndrome) in 2002-2003, have lower fatality rates than that of health systems that are less well-prepared or have less experience with this type of disease.
The objective of the MCO is social distancing, which is the deliberate absence of contact with other people unless there is an absolute need.
It involves an increase in the physical space between people.
This is because the virus spreads when an infected person coughs or sneezes out droplets containing large amounts of the virus into the air, which is then breathed in by another person.
An infection can also result if one comes into contact with droplets that have landed on a surface, then touches one’s eyes, nose or mouth, where the virus can enter the body.
The less time people spend together and/or maintain a distance of one to two metres from another person, the less likely the virus can spread.
The reasons for the criticism of the MCO by a former Health deputy director-general are obvious.
The exodus from major urban areas after the announcement of the MCO did not promote social distancing at all.
Instead, it increased the chances of viral spread through crowding at transportation centres and police stations.
It also led to the dispersal of those with undiagnosed infection across the country, with its attendant consequences.
The data is that social distancing slows the spread of the disease, thereby reducing the burden on the healthcare system.
This is termed as “flattening of the curve” by public health specialists.
It only buys time for the healthcare system to restrategise, and improve capacity and capabilities.
The WHO recommends frequent handwashing with soap and water, or the use of an alcohol-based (more than 60% alcohol content) hand sanitiser if the hands are not visibly dirty, as one of the basic protective measures against Covid-19 infection as these measures kill any viruses that may be on the hands.
The virus gets onto your hands when you touch contaminated surfaces and objects, and gets into your body when your contaminated hands touch your eyes, nose and/or mouth.
If you want to touch your eyes, nose and/or mouth, you should only do so after your hands have been washed with soap and water, or sanitised.
Droplets from coughing and/or sneezing spread the virus.
Covering your mouth and/or nose during coughing or sneezing with a tissue or your bent elbow, reduces the chances of spreading infection to others in the vicinity.
The tissue should be disposed of, and your hands washed with soap and water or cleansed with alcohol-based (more than 60% alcohol content) hand sanitiser, immediately.
Commonly-used items are potential sites of contamination by the virus.
These include door knobs; lift buttons; trolley bars; bank notes; coins; ATM machines; petrol pump handles, keypads and nozzles; credit card machine keypads; items in the supermarket; and eating utensils, among others.
There are common-sense ways of avoiding them, e.g. using one hand to handle potentially-contaminated items and the other hand to handle personal items; using glove(s); opening doors with your foot or elbow; not holding onto railings; cleaning your hands before going home; and washing your hands immediately before or upon entering the home, among others.
Commonly-used items should be disinfected regularly depending on their usage.
When you are unwell, you should stay at home.
If you have a fever, cough or breathing difficulties, medical attention should be sought immediately.
A telephone call in advance to a healthcare facility, which will be able to provide you directions to the appropriate healthcare facility treating suspected and confirmed Covid-19 patients, avoids unnecessary wastage of time in getting treatment.
It is important to remember that private clinics and hospitals do not have the capacity to manage Covid-19.
Persons who have recently visited or have been in contact with a person with Covid-19 should stay at home for 14 days and follow the measures above, even if they feel well.
If you are unsure whether you have been in contact with someone with Covid-19, e.g. involvement in the exodus out of urban areas when the MCO was announced, you should also do the same, even if you are staying at home.
This will allow healthcare facilities to operate more effectively and prevent possible spread to your family members.
When you take the approach that everyone, including family members and workmates, is Covid-19 positive, you will adopt the measures above all the time, and not just sometimes.
This will prevent possible spread.
Covid-19 is caused by the SARS-CoV-2 virus. If every infected person is identified, monitored and treated if necessary, then the pandemic can be controlled.
This requires testing, contact tracing and testing repeatedly until tests on all contacts are negative.
If not, spread will continue at a lower level and resurge once social distancing measures are lifted.
Individuals have a responsibility to themselves, their family and society.
Reports of irresponsible behaviour have exposed frontline staff to possible infection and reduced the country’s capacity to manage other medical and surgical conditions.
Imagine what would happen if the country’s healthcare facilities are overburdened by unbridled Covid-19 cases.
For example, if a family member has a heart attack, but the ambulance takes a longer time to arrive, then upon arrival at the hospital, there is no doctor, nurse or intensive care unit (ICU) bed available, because of the overwhelming number of Covid-19 cases.
Death would be inevitable.
In summary, comprehensive measures are needed to contain and suppress the virus for a period of time, the duration of which is as yet unknown.
The measures above may be disruptive and may require changes in habits.
However, it is vital to remember that the battle against Covid-19 has just begun, and the signs of the end of the war will be when a vaccine is available.
Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email firstname.lastname@example.org. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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