Covid-19: Working together to make social distancing successful


  • Vital Signs
  • Wednesday, 18 Mar 2020

My dear friends,

Since the Prime Minister announced severely restricted movements to fight Covid-19, there has been uncertainty, fear and/or panic.

We may even feel powerless, because we have no control over a virus that we can’t see or Government decisions that we can’t predict.

Movement restrictions are inevitable during an outbreak, and indeed, Malaysia decided on them later than many other countries.

The restrictions will save lives and are proportional to the size of the problem.

This sudden announcement caught many by surprise, but at the very least, our complacency is broken and we’ll now take the outbreak more seriously.

I understand that we are looking for reassurance. Please allow me to share some reflections during these troubled times.

They come from my experience fighting A(H1N1) influenza in Hospital Taiping, Perak, in disaster relief in Cambodia and Nepal, and in corporate crisis management in China and Russia.

Social distancing works

Health professionals agree that social-distancing measures will save lives.

Therefore, the measures announced for Malaysia are generally welcomed by health professionals who are worried about the total number of cases overwhelming our hospitals.

However, movement restrictions are not magic solutions.

They have three important caveats: we won’t see immediate results, the outbreak will worsen before it gets better, and we must still be vigilant with our movements after March 31 (2020).

Malaysia may see a need to enforce movement restrictions for several months beyond the current announced period ending on March 31 (2020).

Every country with Covid-19 has implemented social-distancing movement restrictions.

They range from simple advice to stay home to cancelling sporting events (like Germany), restricting travel (like Australia), closing schools (like France), closing universities (like Norway), or a state of emergency (like Spain).

In China, cities were literally blockaded, and Italian police have sanctioned those who violated the nationwide lockdown.

With these dramatic examples, Malaysia’s restricted movement order looks more reasonable.

Of course, it’s true that the Government should have implemented it earlier, or one measure at a time, or in phases.

They could have also consulted health professionals earlier or sensitised us before dropping this bombshell.

However, as a crisis leader, I understand that every decision during outbreaks is imperfect and can never be fully comprehensive. It’s too easy to criticise.

Right now, we have no time to endlessly debate whether it’s a lockdown or not (it’s not a lockdown), whether the measures are too much or too little, or too early or too late.

Those debates distract from the national effort to fight Covid-19.

Once this outbreak is over, we can learn lessons and assign blame. Right now, we must focus everything on the national effort, and we must fight Covid-19 with no regrets.

Let's all make the effort

Malaysia last experienced such severe restrictions of movements perhaps only in May 1969 during the racial riots.

We’re at war now – not against each other, but against an unseen virus. To win this national crisis, we need everyone to join the national effort.

In this national effort, the health professions are uniting under the banner of the Malaysian Health Coalition, which has issued a series of joint statements of solidarity and recommendations.

But even a united health profession is not enough to guarantee victory over this virus.

The Health Ministry (MOH) is increasingly strained. The additional capacity from universities, the private sector and the military will be helpful, but fighting an outbreak goes beyond hospitals.

Relying only on hospitals to save us will be too late.

Join the national effort, my dear Malaysian brothers and sisters. Social distancing and restriction of movements will protect us and our loved ones.

My fellow health professionals and I hope that we will all observe these restrictions in good faith and good spirits, because staying at home will save lives.

There will be inconvenience and hardship. We hope that these are temporary.

A third economic stimulus package will be needed in several weeks.

Workers must be protected, and vulnerable communities must be supported. Unintended consequences of a good decision must be mitigated.

For example, join a community organisation to organise food delivery to older adults in your neighbourhood or lend a listening ear (on video call) to someone feeling lonely or scared.

Malaysians should not panic-buy supplies, hoard or be unreasonably selfish.

For example, fighting infections relies on other people washing their hands too, and that’s why we should not buy the entire shelf of hand sanitisers.

Similarly, let’s conserve medical supplies and medical care; we don’t want any rationing.

This is a national effort, which requires a reasonable amount of civic consciousness and selflessness.

Who knows? Maybe this virus will succeed where politicians have failed and unite Malaysia.

Considerations for the Government

While social distancing is effective and we must all join the national effort, there are three specific lessons that the Government can already implement beginning today.

One, give scientists a big seat at the decision-making table.

The health professions have been advocating for social distancing since early February (2020).

Their counsel needs to reach the National Security Council (NSC) table, and the Health Minister should be appointed as a semi-permanent member.

The Health Minister could also consider convening a short-term advisory panel to advise him, especially in his semi-permanent role in the NSC.

Where appropriate, this panel can advise the NSC or the Cabinet.

There are several advantages: a united health profession providing multi-disciplinary expert advice, crisis management skills, and perhaps even legitimacy.

Two, the government must watch for unintended consequences of social distancing.

This measure remains the right decision, but in crisis situations, every decision carries a cost.

For example, closing schools means that nurses (a predominantly female profession) must choose between caring for children at home or patients in hospitals.

The Government must step in to protect them from such agonising decisions.

Other consequences are in the economy, affecting those in the gig economy or Johoreans working in Singapore.

It will impact trade or food imports, and the job or wage security of the B40 or small business owners. We may see profiteering, which the health professions have cautioned against.

The Government must manage these unintended consequences, as this will impact their legitimacy and the wisdom of their decisions.

Three, the Government must consider predictability in their decision-making, and not just speed and proportionality.

During rapidly evolving and unstable periods, the population is looking for stability and confidence. Being predictable helps the population and the Government.

As a small example, press briefings can be held every day at 5pm sharp, delivered by the same person using the same format, length, structure and tone.

This is just one small aspect of crisis communications, which forces government into a crisis routine.

Familiarity with a predictable rhythm breeds confidence and trust.

As a large example, the Government should provide “forward guidance”, similar to the Global Financial Crisis in 2009.

The population should be sensitised, rather than ambushed, with decisions to escalate or de-escalate social-distancing measures.

The Government must prepare Malaysians psychologically, as much as logistically.

The first test of predictability will be the decision to continue, stop, scale up or scale down the restrictions of movements due on March 31 (2020).

A temporary hardship

Outbreaks are dangerous, testing a country’s health system, political leadership and social fabric.

Every choice carries a terrible human cost, but social distancing through restriction of movements is the best option for Malaysia now.

This is a temporary hardship to prevent a worsening of the outbreak.

We will succeed, but only if all Malaysians join the national effort, protect each other and trust the science.

Dr Khor Swee Kheng has postgraduate degrees in internal medicine and public health, and has worked in five health sectors across three continents. He is currently reading Public Policy at the University of Oxford. The views expressed here are entirely his own.

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