AS Malaysia battles with a pandemic spiralling out of control, we debate between two difficult choices — impose a full lockdown or risk collapsing an already overburdened healthcare system and its team of dedicated frontliners.
Public health experts have no doubt that a proper lockdown, with adequate social support provided, is necessary to halt the fast-spreading virus. The lockdown would be for a period that would allow the healthcare system enough time to recuperate.
The first 18 days of May 2021 recorded 500 Covid-19-related deaths — the same number of lives lost to it in the whole of 2020.
On the ground, some hospitals are running well over 100% capacity with most intensive care unit (ICU) beds occupied.
There are both direct and indirect economic costs when a healthcare system collapses.
Based on current demographics, the majority of those infected are in the working age group. Each infection takes out an individual for at least 14 days, with physical and psychological consequences to close contacts at work and at home.
Multiply this with a prolonged pandemic and you soon see how there is great disruption to not only the economy and health, but also to schools and personal lives.
Yet, the decision to impose a proper lockdown is being delayed to ostensibly spare the economy.
Even the most developed countries have implemented lockdowns, knowing how this pandemic can stretch resources, both physical and human. In Malaysia, haphazard movement control orders — thrice iterated — have only led to greater confusion, and will lead to an increasing trust deficit if restrictions are imposed without prioritising scientific and public health considerations.Socioeconomic impact
It is undeniable that a lockdown will have some negative socioeconomic effects. Low-income workers are less likely to be in jobs where “work from home” is an option, exposing them to potential loss of income and higher risks of Covid-19 infection. In a 2020 study focused on the impact of Covid-19, the United Nations Children's Emergency Fund and United Nations Population Fund found the following numbers for Malaysia:
> Nine in 10 urban poor are self-employed with no employment coverage;
> Four out of 10 female heads of households depend on government assistance;
> Six in 10 households are unable to provide enough food for families;
> One in two households are unable to pay utility bills, mortgage or rent on time;
> One in four households have reduced their food intake; and
> One in three households are unable to provide enough money for children to buy food at school.
Cash aid and food baskets
The people have already shouldered the burden by dipping into their own Employees’ Provident Fund (EPF) savings, resulting in a depletion of private retirement savings of RM78bil. Even so, the numbers show that the most vulnerable segments are unlikely to benefit from the withdrawal, considering the fact that almost 2.6 million EPF members have less than RM1,000 in their Account 1.
As such, the scheme will only act as emergency relief for a select few, leaving those who are most in need bereft of assistance. With businesses on hold, there is little choice for survival other than relying on government disbursement.
The duty of imposing a lockdown is tied to the duty of managing the socioeconomic impacts of such a move. The government must ensure sufficient disbursement of aid to society’s most vulnerable irrespective of constituencies. These include regular cash handouts and food baskets. The fulfilment of basic necessities will go a long way in staving
off short- to medium-term economic effects. Others will benefit from loan moratoriums or even simpler interventions such as fully subsidising utility bills, as is done in Hong Kong.
Education and infrastructure
Various studies have demonstrated that poverty is multidimensional. Cash handouts will help in the short term, but we must also address the other dimensions of poverty, including access to healthcare, education (especially as it becomes predominantly online), and/or access to public infrastructure. We can no longer behave as though there are only two options — give a man a fish or teach a man to fish — when the underlying factors contributing to poverty are systemic and fundamental in nature.
With schools closed and likely to remain so for the immediate future, it is even more critical that the appropriate digital infrastructure is in place to optimise learning. The government must equip students with the appropriate devices in a timely fashion and ensure that Internet connectivity is free and reliable.
Covid-19 has caused irreversible harm to children’s education, cognitive development, nutrition and overall well-being. Any chance to rectify the regression should be taken immediately.Healthcare
While it is reassuring to note that the Special Committee on Covid-19 Vaccine Supply is putting almost 100,000 shots of vaccines into arms daily (at the time of writing), the full impact of vaccinations will only become apparent in a few weeks. In the meantime, more urgent interventions are needed to help arrest the burgeoning number of cases.
> Supporting the Health Ministry’s and Defence Ministry’s efforts to create more "field ICU" beds;
> Further increasing capacity for Covid-19 detection (especially more efficient contact tracing and investment in emerging technology, e.g. self-diagnostic home testing kits that will allow for quicker case detection);
> Prioritising SOP that highlight the importance of ventilation, given the acknowledgement by bodies such as the World Health Organisation that SARS-CoV-2 is airborne;
> Supporting compulsory work-from-home policies for the foreseeable future for all companies that can do so; and
> Increasing support for mental health services, including providing online services.Increasing the fiscal deficit
More spending is required in order to achieve these support mechanisms. The Finance Ministry should not fear an increased fiscal deficit given the urgency of the current public health crisis. It would be unethical and irresponsible for this to continue, especially as Malaysia’s actual fiscal stimulus, at 4.7% of GDP, remains among the smallest in the
A conservative estimate sees the government raising another RM35bil in debt to fund expenditure as yields are still attractive.
Spending per se is not a panacea; indeed, it would lead to further erosion of Malaysia’s standing among international rating agencies if it is not coupled with transparent and detailed plans on spending priorities and a clear exit strategy. These are only possible with Parliament reconvening as soon as possible in order to provide the necessary check and
Historian and philosopher Yuval Noah Hariri recently opined: "But today humankind has the scientific tools to stop Covid-19. Several countries, from Vietnam to Australia, proved that even without a vaccine, the available tools can halt the epidemic. These tools, however, have a high economic and social price. We can beat the virus — but we aren’t sure we are willing to pay the cost of victory. That’s why scientific achievements have placed an enormous responsibility on the shoulders of politicians."
There is no doubt that we are facing a complicated situation with many difficult choices to be made. It is a situation that calls for all stakeholders — especially politicians from all sides — to focus on the difficulties facing the rakyat.
The mark of leadership lies in making tough calls on behalf of the people while responsibly mitigating the consequences of such interventions.
DR HELMY HAJA MYDIN, Kuala Lumpur
(The writer is a respiratory consultant and CEO of the Social & Economic Research Initiative)