The Covid-19 Chronicles: The end has no end?

IF YOU had asked me six weeks ago what was I looking forward to the most once the MCO ended, I would have said, “Going for sushi.”

A friend said the first thing he was going to do was have a maggi goreng at his local mamak. Regardless of preferred cuisine, I'm sure many Malaysians, like my friend and I, are probably dreaming of dining-out days post-MCO.

A day before the conditional movement control order (MCO) was announced (before the possibility

of eating out emerged), Khazanah Research Institute (KRI) published a discussion paper on a model projecting Malaysia's Covid-19 epidemic post-MCO and its public health implications.

This collaboration between colleagues at KRI, Universiti Sains Malaysia and I was intensely pursued over the past month, as we raced to meet the deadline of the MCO3 ending on April 28.

Modelling is a method used to study the effects of different components and to describe patterns and/or trends based on changes in factors that influence a "system" using mathematical equations.

In this case, the "system" is the spread of Covid-19 in Malaysia, and the type of model used is an epidemiological model, which inputs currently known measures of the pattern of disease in the

population (such as how contagious it is and how long it takes to recover), then projects disease trends of active cases and deaths over time and into the future.

We know that public health interventions influence the natural course of the spread of disease, and so the model also incorporates effectiveness of behavioural interventions (e.g. social distancing, handwashing and mask-wearing) to reduce the risk of getting infected; and isolation interventions (e.g. early detection, contact tracing and quarantine) to prevent infected people

from spreading the disease to others.

Arguably, the highest behavioural intervention effectiveness was achieved during the law-enforced MCO.

When we gradually reduce the level of behaviour intervention effectiveness starting from the end date of MCO4, while keeping isolation intervention effectiveness constant, we are able to observe the change in projected number of active cases and deaths over time.

So what does the model tell us? First, the projections show that there is some leeway where the epidemic can still be manageable even when reducing effective behavioural interventions such as social distancing, post-MCO.

However, there is a tipping point or threshold where the trend of controlled transmission achieved

during the MCO can quickly reverse. We may suffer another rapid surge in the number of Covid-19 cases, overwhelming the health system, causing the death toll to quickly rise.

So while there is room for some respite from restrictions, we must be mindful that it is housed in a modest margin.

Second, because the risk of resurgence awaits us if we let our guard down, everyone needs to play their role to maintain public health precautions as much as possible. The ease in restrictions is important to give a breather to life and economy, but it is not a time to relax.

Like those 20-second breaks between exercise routines, it is a time for active rest. The workout is not complete.

Many are questioning the timing of the ease in restrictions, but the model suggests that what happens after the MCO is lifted is a more influential factor on the future trend of the disease.

The model tells us that exceeding a threshold of reduced behaviour intervention effectiveness can catapult us into another Covid-19 wave. What it cannot tell us is how this reduction translates into practice. Thus, we must err on the side of caution.

We must self-regulate and self-enforce preventive measures such as only going out when necessary and avoiding crowded places (this includes avoiding peak times), keeping up hygiene, and wearing a mask properly in public (that means covering the mouth and nose, and not touching the mask once its on until we go home and are ready to take it off).

We must empower everyone with education and the tools they need to maintain precautions, especially those who have the least access to both. Sadly, it may still not be a time for reuniting with friends and family beyond our immediate household.

It would not be for a while, until we have a vaccine or the threat of the virus diminishes.

Third, the model highlights that one of the most influential factors on disease trends is how long it takes before an infected person is isolated. This emphasises the importance of early detection and isolation.

To achieve this, the barriers for efficient testing and contact tracing need to be addressed. Funding and resources for tools and capacity for the health system to conduct the testing and contact tracing must be ensured; but equally important is communication, engagement and access so that people will want to and can afford to get tested.

It will be more challenging for the health system to achieve their targets if people resist getting tested, if the tests remain expensive, and if being sick with Covid-19 is stigmatising.

We should feel like heroes taking one for the team whenever we quickly alert authorities if we think we may have been infected (whether we feel ill or not), so that we can be tested and isolated faster, and we prevent others from getting infected.

All of these projections tell us one thing, the end of the MCO is not the end. It is merely the beginning of a long "dance" with Covid-19 that one we must approach with caution.

So, if you had asked me six weeks ago, I would have told you going out for sushi was a necessity. But working on this project, I found failed social distancing and super spreader events slowly became the subject of my nightmares.

I realize now that old definitions of necessity need to be recalibrated, and modes of standard

operation need to be rewired to keep up with this "dance" with Covid-19.

Knowing that frontliners constantly risk their health and lives, while people succumbed or lost their loved ones, especially where the peak is not yet reached in countries hit hardest by Covid-19, I realise that many of our modern norms are a luxury.

In times like these, the price of comforts like dining out (not to mention the acrobatics of wearing a mask while eating) might be too high a price to pay. Besides, there is still takeaway.

Good luck to us all, 33 million players in Team Malaysia, playing our part as best as we can.

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Covid-19 , MCO , Column , Khayriyyah Mohd Hanafiah

Dr Khayriyyah Mohd Hanafiah

Dr Khayriyyah Mohd Hanafiah

Dr Khayriyyah Mohd Hanafiah is senior lecturer in Medical Microbiology at Universiti Sains Malaysia, and an affiliate of Young Scientists Network-Academy of Sciences Malaysia. She is active in science communication and infectious disease biomedical research. She was the first female Asian champion of FameLab, the world’s longest running science communication competition, in 2018. The writer’s views are her own.


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