Suffering from a lack of awareness

PETALING JAYA: The lack of health literacy and infrastructure, as well as poor socio-economic and socio-environmental status of some communities in Sabah have contributed to the active spread of Covid-19 in the state, health experts say. Public health expert Prof Datuk Dr Lokman Hakim Sulaiman said many of the affected areas in Sabah were poor neighbourhoods of mixed migrants and undocumented migrants.

Some of the public health specialists who went to the slum areas to distribute face masks said most of them were unable to buy enough face masks to protect themselves, he said in an interview.

“Some can’t even afford soap or hand sanitiser, ” said Dr Lokman Hakim, a former deputy Health director-general.

Lack of health literacy further compounded the problem, he said.

“The houses are small with many people squeezed together, and the population density per area is very high, facilitating the spread even if they are asymptomatic.

“It’s the same explanation for why an outbreak easily occurs in prison and detention centres, ” he said, adding that a similar situation happened in Labuan.

Since the pandemic began in January, over half of the deaths were recorded in Sabah, with 146 out of the total 282 deaths (51.77%). Between Oct 1 – the start of the third wave – and Nov 7, Sabah had recorded a total of 18,021 Covid-19 cases and 134 deaths.

Malaysian Public Health Physicians Association president Datuk Dr Zainal Ariffin Omar concurred, saying that the lack of health literacy among policymakers, the government and people is the main reason.

He said the government should invest more in health promotion and listen to the public health fraternity, which has the knowledge and capacity to guide.

Dr Lokman Hakim and Dr Zainal Ariffin both agreed that logistic constraint was another concern in Sabah that hampered the timely delivery of medical aid and attention to the people.

“Sabah is huge but sparsely populated. Health infrastructure and resources (are available) only in major towns that may take hours to reach, ” said Dr Lokman Hakim, adding that this compromised the speed, efficiency and effectiveness of healthcare delivery.

Based on data, he also noted that cases in Sabah were already climbing even before the state election.

“It was already showing an upward trend before the incubation period, and certainly the state election aggravated the spread.

“It further propagated the transmission through massive movement of people and their failure to observe the standard operating procedure (SOP), ” he added.

Dr Zainal Ariffin agreed, saying the spread of infection was “underestimated”, as testing currently only skims the surface and suspects that there is an even more forceful undercurrent of higher infectivity.

Universiti Malaya professor of epidemiology and public health Prof Dr Sanjay Rampal opined that the increase in Covid-19 cases in Sabah is being driven by three factors – unmitigated community transmission, localised socio-environmental factors that hamper interventions, and difficulty in preventing transmission in closed system populations such as prisons and detention centres.

“More intensive testing in the community can also cause a rise in the number of cases, but this is beneficial as it reduces the source of infection in those communities, ” he said, adding that to prevent infection in prison and detention centres, new detainees should be isolated in separate locations.

To prevent the spread of Covid-19 from worsening, Dr Lokman Hakim said the current approach should be reviewed with a shift from containment to mitigation strategies.

He also believed the testing turnaround time should be improved.

Dr Zainal Ariffin stressed that Malaysians and non-Malaysians should abide by the government SOP as everyone waits for the vaccine to be available.