THE Health and Sciences Covid-19 Advisory Group of Experts is disturbed by the sharp surge in cases that has led to major hospitals in the Klang Valley surpassing 70% capacity for Covid-19 patients. This calls for a re-evaluation of our Covid-19 response strategy.
It bears repeating that a blanket movement control order is not the answer. The national Covid-19 response must instead be a targeted basket of solutions informed by granular, risk-stratified epidemiological data.
We commend the work done by the Hotspot Identification for Dynamic Engagement (HIDE) team at Bank Negara Malaysia in this area. As HIDE launched in March 2021, there is not yet definitive data on its effectiveness, but it has immense potential in supporting rapid Covid-19 response. So we strongly urge the integration of HIDE tools across all health authorities in the country, as in the following:
> Integrate HIDE with digital, automated find, test, trace, isolate and support (FTTIS) protocols.
Insufficient testing and surveillance measures prevent authorities from effectively containing potential outbreaks and stemming the escalation of clusters. There must be more rapid antigen tests deployed in areas identified by HIDE analysis, which will allow for early interventions such as swift isolation of persons-under-investigation and a targeted MCO.
Highly targeted MCO phases at the district level will reduce the burden on hospitals by containing outbreaks. Also, automated contact tracing must be quickly deployed across the board to phase out manual contact tracing so resources can be better utilised in other areas.
There must also be greater emphasis on support for persons-under-surveillance (PUS). PUS and their casual contacts need clear instructions on testing and isolation to maximise compliance. Those who are isolating must also be given mental, emotional, and financial support during isolation.
> Train and empower state and district health authorities to utilise HIDE data.
HIDE technology and data must be shared with health authorities at all levels. Along with that, decentralise decision-making and empower health authorities at the state and district levels to manage and make decisions that impact their populations.
Should some states or districts not have the public health or epidemiological expertise, the Health Ministry (MOH) should provide training. Alternatively, invite experts from outside the MOH and leverage on existing networks from various fields, ministries and universities to provide analytical support.
It is imperative that local health authorities are equipped to monitor and evaluate Covid-19 data on the ground. There must be sufficient resources allocated to ensure that decentralised, data-driven decision-making can happen on the ground.
> Improve granularity of data by integrating with MySejahtera.
Once HIDE analysis effectiveness is proven, its functionality should be better integrated with the MySejahtera app.
Currently, HIDE provides a seven-day advance notice of large outbreaks based on MySejahtera data. However, there is still a lag between analysis and response on the ground. Premises and casual contacts should be notified as soon as there is any hint of an outbreak, and they must be given clear instruction on how to proceed with the FTTIS process.
MySejahtera data can provide greater granularity on hotspots and clusters, and better inform experts about behaviours surrounding public health measures.
With Hari Raya celebrations around the corner and the vaccine rollout underway, we cannot risk being complacent. The vaccine is not a panacea, and the current rollout rate requires that we deploy all public health tools at our disposal.
We must not be fixated on the unrealistic goal of zero cases; rather, we should channel all our resources towards inhibiting severe illness and deaths as well as preventing our healthcare system from being overwhelmed.
We must act swiftly to deploy the new predictive tools in our arsenal for an improved and rapid pandemic response.
TAN SRI DATUK DR ABU BAKAR SULEIMAN
PROF DR ROSMAWATI MOHAMED
Academy of Medicine of Malaysia
DR MARY CARDOSA
Malaysian Medical Association
DATUK DR FADZILAH KAMALUDIN
Malaysian Public Health Physicians’ Association
DATUK DR KULJIT SINGH
Association of Private Hospitals of Malaysia
DATUK DR CHRISTOPHER LEE
Infectious Disease Physician