No magic bullets in dealing with Covid-19


A RECENT opinion piece by the director-general of the World Health Organisation’s special envoy on Covid-19 is sending shock waves among governments around the world.

In it, Dr David Nabarro emphasised the need to adopt a middle path approach that balances controlling the spread of the disease while allowing people to carry on working and living. A test-trace-isolate-protect approach combined with public health services working to disrupt transmission rather than dependence on lockdowns were key to successful Covid-19 responses, he says, and cautions that lockdowns by themselves do not lead to elimination of the disease.

As the conditional movement control order (MCO) is again imposed in Sabah, Selangor, Kuala Lumpur and Putrajaya from Oct 14 until 27, people living in these areas are understandably worried about its effects.

When introduced at the early stage of an epidemic, and sufficiently strict and stringent, lockdowns such as the MCO are useful, even necessary, to give breathing space for public health authorities to contain possible new infections, treat existing cases, and strengthen capacity of the health infrastructure while protecting workers within those borders.

They are intended to rapidly control and manage the spread of an infectious disease within the borders of a defined area, achieving what is now known as “flattening the curve”.

However, lockdowns come at great cost and sacrifice. When our MCO was first imposed, we did not know as much about the disease as we do now. Our level of outbreak preparedness was also not where it needed to be, and time was something that we needed to have to ensure that we got and were able to mobilise the resources necessary to mount an effective response.

We needed to know what worked and what did not. The previous lockdown bought us that time.

So, the earlier harsh restrictions were necessary and justified. But it would be a mistake to think that large-scale lockdowns should be the go-to control method whenever the number of infections significantly increase.

Malaysia, particularly the economy and livelihoods of many households, is still struggling to recover from the effects of the strict restrictions imposed from mid-March until June 9. Twenty percent of SMEs are estimated to close by year’s end and thousands of jobs have already been lost.

We are now in a third wave. The total number of new cases that are emerging over the past couple of days is likely to exceed the cumulative total from the past two waves. The unlinked cases, which indicate that the outbreak is now in the community, spreading beyond existing known clusters are increasing. It is tempting to press the panic button.

When it comes to something as infectious as Covid-19, lockdowns are pointless if people (especially politicians and civil servants) do not understand why it is necessary for everyone, with few exceptions, to comply with the SOP and safe practices such as wearing face masks and cleaning hands and work surfaces.

In fact, after achieving a lull and a perceived decrease in the incidence of new cases, the numbers could simply go back up and cause a rebound of the epidemic.

At best, wide-scale lockdowns and movement control orders are blunt instruments and stop-gap measures. They are not solutions.

What we need instead, besides increasing the level of compliance and adherence to SOP, is to improve measures targeted at specific areas and localities. This includes restrictions on dense indoor gatherings or measures to identify, isolate and protect people who are more vulnerable to the virus, such as individuals in detention facilities and aged care facilities. This is already being done.

Large-scale and frequent population-level testing strategies, which look at infectivity using antigen-based Rapid Test Kits (RTK-Ag) that are faster and more affordable, should become the norm.

Knowing a lot more about the outbreak today compared to back in March, we can take on a more nuanced approach towards disease control. A casual visit to a mall in spacious, well-ventilated surroundings presents very little risk unless you had direct contact with the individual who is positive.

Malaysia's response should be focused more about people and not just solely about the disease itself. We need to focus on protecting people, not just beat Covid-19. Unfortunately, this is one of the consequences when a public health emergency is described as a war.

Households and communities, especially those in the lower- and middle-income groups, are arguably more vulnerable today compared to where they were back in March. Whatever reserves they had are now either gone or depleted. The recovery that had started to occur over the past few months is likely to be wiped out by this new conditional MCO. Make no mistake. What we have today is incredibly fragile.

Even with the assurance that business will be allowed to continue, the conditional MCO threatens to increase unemployment, decrease revenue and reduce the ability of households to be resilient and self-sufficient. Many will need welfare assistance. Think about the state of their mental well-being.

Arguably, a conditional MCO now could even increase people's vulnerability to infection as they become more desperate, take more risks and are less able to afford to take precautions. It will cause many households who are already at the borderline of poverty due to the previous MCO to slip into absolute poverty.

The reality is that our welfare systems have struggled to aid and are still ill-suited to proactively go into the community to provide help and support. People are still able to go to shops that are open during this period, but where are they going to get the money to spend if they become unemployed due to the conditional MCO?

Compliance to SOP, therefore, is the key to an effective and sustainable Covid-19 response. We cannot afford to lurch from one large-scale conditional MCO to the next or another national lockdown.

We need everyone to cooperate and help prevent cases by taking care of themselves and others around them. There must be no double standards or inequality of treatment when it comes to managing this outbreak.

We are all in this together.



AZRUL MOHD KHALIB

Galen Centre for Health & Social Policy

Kuala Lumpur

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