Academy of Professors Malaysia: ‘Focused protection’ and ‘targeted approach’ the way to go


A prolonged conditional MCO will have negative effects on the public. — LIM BENG TATT/The Star

On Nov 7, 2020, Senior Defence Minister Datuk Seri Ismail Sabri Yaakob announced that all but three states (Perlis, Pahang, Kelantan) in Malaysia would be placed under a conditional movement control order for four weeks from Nov 9 to Dec 6, 2020.

Following this announcement several professional bodies and individuals voiced their opinions, pointing out that since incidence rates are high in some areas and not in others, a more targeted approach to the conditional MCO should be implemented instead. They also highlighted the need to continue emphasising the need to comply with SOPs as “pandemic fatigue” sets in among Malaysians, now into our ninth month of various levels of MCOs.

As at Nov 11, 2020, the Covid-19 case fatality rate was 0.7%, which is better than on April 9, 2020, when it was recorded at 1.58%. Most of the deaths are among those aged above 60 years old and with underlying co-morbidities. As at Nov 7, 2020, the infection rate had reduced to 1.0 from 1.5 recorded at the start of the third wave in September.

On Nov 10, 2020, a statement by the Academy of Medicine Malaysia highlighted the fact that the incidence rate is not the same for all states. The rates are higher in Sabah, Labuan, Negri Sembilan and Penang whereas Selangor, Putrajaya and Kuala Lumpur are exhibiting a decreasing trend.

The Academy of Professors Malaysia (APM) is concerned by the imposition of the current conditional MCO: We believe that the restrictions in place are too strict and prolonged and could lead to economic, social and health hardship for members of the public. Of particular concern is the care of patients with chronic diseases such as cardiovascular issues, cancer, and endocrine and cerebrovascular diseases who do not go for follow-ups or who are brought in to hospitals too late to be saved. In 2018 a staggering 18,267 people died in Malaysia from ischemic heart disease, averaging 50 deaths a day – and this happened when there were no restrictions on movements or healthcare constraints.

The World Health Organisation does not advocate lockdowns as the primary means of controlling the spread of Covid-19. The exception is when there is a need to buy time to reorganise and regroup, to rebalance resources and to protect exhausted health workers. The WHO has also reiterated that lockdowns only make the poor become poorer and has expressed concerns that there could be a possible doubling of world poverty and child malnutrition in 2021.

Studies have also shown that close exposure to working-age household members and neighbours is associated with increased Covid-19 mortality among older adults. This points to the fact that focused protection to protect such groups should be the strategy, not national lockdowns as practiced in many countries.

Added to these concerns is the impact on mental health, with people grappling with anxiety and fear as the MCOs affect employment and schooling. The lack of social contact can also cause mental health issues, as human beings are not meant to be isolated.

The Great Barrington Declaration – released on Oct 4, 2020, and signed by nearly 6,000 scientists and medical experts across the globe as well as 50,000 members of the public – argues that keeping lockdown policies in place until a vaccine is available would cause "irreparable damage, with the underprivileged disproportionately harmed”.

In view of these concerns, the APM would like to propose the following measures:

1. Localities with more than 40 new daily cases should continue to be catergorised as red zones and placed under an enhanced MCO but the rest of the country should return to the recovery MCO phase. (Perhaps these acronyms could be replaced with number codes to avoid misconceptions.)

2. The detection of localised outbreaks (clusters) should continue. However, since the Covid-19 infection survival rate is 99.9% for healthy people under 70, to achieve an optimal balance among factors such as health, social wellbeing and the economy, the emphasis should be on “focused protection” using a “targeted approach” for those at risk while allowing the less vulnerable to go back to work and school. Specifically:

> Young and healthy adults and children above the age of 12 should be allowed to go back to work and school.

> People with co-morbidities, regardless of age, and the elderly should stay at home.

> Those who leave the home for work and school should be taught how to keep clean and how to approach vulnerable family members when they return home. These measures should be taught through the media, at the workplace and at schools.

3. As mentioned earlier, people must be continually reminded to carry the responsibility of protecting themselves against Covid-19 by practicing the 3Ws and 3Cs as daily norms. (Wear a mask, Wash hands and Watch your distance; and avoid Confined spaces, Crowded spaces, Close contact.)

4. The SOPs under the various MCO phases need to be well-defined, complete and accurate to avoid confusion. For instance, there have been misunderstandings over the need to wear masks at petrol stations, and over restrictions of people travelling together and eating at one table in restaurants when everyone in the group is from the same household and hence sharing the same living environment and air. Such restrictions may further increase the risk of depression and family discord arising from family members being cooped up together for too long.

5. The public should be educated about the right types of food that can help build and support a stronger immune system. Get nutritionists and dieticians on board and use the media to tell people what to eat – it is as important as showing people how to exercise in the mornings.

6. Create platforms for people with mental health issues to reach out to either at the university, organisational or even individual level, and if possible make it free so that anyone can get help when needed.

7. The message of keeping vulnerable and high risk groups safe should be constantly reaffirmed among the public via the media. It is important to make sure that people above 70 and anyone with chronic diseases do not get infected.

We believe everyone should learn to live with Covid-19 – fear it, yes, but live with it because life has to go on.

To all frontliners, the members of APM and the rakyat fully appreciate your contributions and sacrifice in serving the nation.

PROF DATUK SERI DR DAENG NASIR DAENG IBRAHIM

President, Academy of Professors Malaysia (APM)

PROF DR ADLINA SULEIMAN

Head of Medical and Health Cluster, APM

PROF DR JAMAL OTHMAN

Head of Economics and Social Wellbeing Cluster, APM

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Covid-19 , MCO , lockdowns

   

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