Malaysia must ramp up testing

THE current policy of the Health Ministry is to only run tests on the persons under investigation (PUI). Even the persons under surveillance (PUS) were not tested but were instead counselled, given a Health Assessment Tool (HAT) brochure and told to self-isolate for the next 14 days.

This modus operandi is probably due to the shortage of test kits and finite funding when the first Covid-19 case was announced to the world by China on Dec 31, 2019.

The Health Ministry was doing extremely well in its early Covid-19 containment strategy. If anything, our best virology brains at the Institute of Medical Research (IMR) was at the cutting edge of the genetics of SARS-CoV-2.

When the scientists from China first released information on the Covid-19 viral genome on Jan 11, 2020, the team from IMR’s virology unit had produced the “primers and probes” specific to SARS-CoV-2 on the very same day. The World Health Organisation (WHO) only released the protocol for real time rt-PCR (reverse transcriptase-Polymerase Chain Reaction) several days later. The WHO reagent sequence (primers and probes) was very similar to that produced in our IMR laboratory, so Malaysia actually had a head start in Covid-19 testing.

Malaysia’s IMR even overtook the Centres for Disease Control and Prevention (CDC), which only approved the first US test on Feb 4, 2020, but announced problems with the Covid-19 test a week later.

IMR’s reagent was supplied to the National Public Health Laboratory (MKAK) Sungai Buloh, which diagnosed Malaysia’s first Covid-19 case on Jan 24. Unfortunately, the Health Ministry did not capitalise on this advantage and did not make the test more widely available to our rakyat. It did not follow closely the WHO’s three golden rules for epidemic control, namely test, test and test again. This is not rocket science. This is simply back-to-basics epidemiological detective work by public health teams to objectively define the burden of Covid-19 disease in the community, identify the clusters of infection and capture the persons who are infected but remain well and asymptomatic.

The asymptomatic carriers of SARS-CoV-2 are especially worrying. On average, the Covid-19 patient takes about seven days from exposure to the virus to manifest symptoms (ranges from two to 14 days).

But a considerable percentage of Covid-19 carriers (one study quoted a figure of 12%) can spread the disease for two to four days before they exhibit the signs of fever, cough and respiratory distress.

By casting our testing nets as wide as possible, we would be able to pick up most, if not all, of these and undertake contact tracing and place them on 14-day quarantine to contain the spread of the disease.

Malaysia’s Covid-19 test per million capita of 482 is higher compared to other Asean countries and several EU countries, but it lags behind the benchmarks set by South Korea at 3,692 and Guangdong at 2,820.

Hospital Sungai Buloh and a specialist hospital in Petaling Jaya were the first to imitate the South Korea model of Drive-Thru Covid-19 testing. There are about 60 Drive-Thru stations throughout South Korea that were able to test up to 0.7% of their 52 million population. They now know that 2.8 per 100 persons have been infected by SARS-CoV-2. This is the best evidence thus far of the infectiousness of the virus, which correlates well with the estimated Ro (reproductive naught) ranging from 2.0 to a high of 3.6 during the height of the Wuhan outbreak.

All the public health measures, from epidemiological surveillance of testing, tracking, isolating and more recently social distancing in the form of the movement control order (MCO), are designed to flatten the Covid-19 epidemic curve to allow our healthcare infrastructure and services to recoup to avoid being overwhelmed by an accelerated and wide peak, as has happened in Italy and Iran.

If we get the pivotal quartet of interventions in tandem, we will be able to drive the Ro to below 1, and this will almost surely reduce the transmissibility of SARS-CoV-2 and extinguish the outbreak.

Trust us, it is not too late to ramp up our Covid-19 testing. Wuhan had allowed the epidemic to spread without tests and containment measures for four to six weeks before the authorities got their act together. With their most draconian lockdown strategy (total isolation and social distancing) coupled with the dyad of testing and tracking, they have been able to drive the Ro from a high of 3.6 to 0.4 and have, after six weeks of lockdown, begun to ease their drastic outbreak management policies.

Trust us, Malaysia Boleh, provided the government undertakes a comprehensive response which, among others, prioritises and makes Covid-19 testing widely available and affordable.

Trust us, Malaysia Boleh, provided each of us play our part as a whole-of-society response to this unprecedented Covid-19 pandemic.




Petaling Jaya

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