‘Rethink healthcare for migrant workers’

Chan Chee Khoon

KUALA LUMPUR: The government needs to rethink its healthcare policies towards undocumented migrant workers as the current policy drives them underground and made contact tracing and quarantine difficult for management of outbreaks, said epidemiologist Dr Chan Chee Khoon.

He said Malaysia could not ignore its large pool of undocumented migrant workers as long as contact tracing (those who have come in close contact with those who have been tested positive with Covid-19) and quarantine remained as tools for managing the outbreak.

“The Health Ministry and Home Ministry need to rethink their policies towards undocumented migrant workers, which currently drive them underground rather than encourage them to come forth to seek treatment when afflicted with infectious and other ailments.

“It would be extremely difficult to carry out contact tracing when undocumented migrant workers have strong incentives to avoid contact with government agencies, ” he said.

Dr Chan was asked whether Malaysia should change its strategy of handling Covid-19 following reports saying that the Covid-19 was different from the SARS and has more similarities with H1N1 and spread as quickly as influenza but not as deadly as SARS.

On Saturday, Universiti Malaya academician Emeritus Prof Datuk Dr Lam Sai Kit said the government could refer to the National Influenza Pandemic Preparedness Plan it developed in 2006 should the Covid-19 outbreak turn pandemic.

But Dr Chan said that when countries moved towards Red Alert (out-of-control epidemic spread), contact tracing and quarantine may be less useful.

“At that point, the emphasis may shift to include tracing recovered cases, and even infected individuals who shrugged it off with mild symptoms or even without symptoms, and who never came to attention.

“An antibody test to identify those who have been infected and subsequently recovered would be very useful to allow for collection of plasma from them.

“China has been attempting to use the plasma to treat the severely ill cases, ” he said.

Based on China’s statistics, there would be four times more cases of recovered persons than of severely ill persons, which is a potential huge pool of plasma to harvest, he said.

“So, the challenge is keeping track of these cases and having the capacity to produce safe and efficacious plasma in the required volumes, ” said Dr Chan.

He said that this would be useful while awaiting vaccines and more effective treatment modalities to be introduced, on top of stepped-up measures at social distancing.

Asked if the same would be done if the outbreak reached pandemic level (out-of-control community spread in many countries), Dr Chan said countries would have to deploy multiple measures or reallocate resources to include social distancing and mandatory self-quarantines when targeted contact tracing and institutional quarantines no longer suffice.

Individual measures to reduce infection risk such as frequent, proper handwashing, informed risk avoidance behaviours and institutional responses which are not unduly alarmist should be undertaken.