The Health Minister, Dr Adham Baba reported a positivity rate of 6.89% or 1 in 14.5 for the whole nation. It ranges from a low of 3.79% in Perlis to 11.84% in Kelantan. It is 7.99% or 1 in 12.5 in Selangor, which is the most populous state. The WHO positivity rate threshold is 5%.
Based on the positivity rates, the estimated actual incidence in the country is 2.25 million or almost 4 times the official figure of 595,374 as at June 3, 2021. The latter figure refers to reported cases and the former estimate reflects the incidence including undetected asymptomatic and unreported cases.
With the high positivity rate, which has exceeded the WHO threshold, it is surprising that the Government has not imposed a full and complete lockdown. The current lockdown, which is more laxed than MCO 1, may only bring the numbers down slightly. This is because of the large number of asymptomatic cases, not present then in MCO 1, who are now allowed to move around freely and continue to infect others unknowingly. Datuk Dr Rais Husain, the CEO of Emir Research, also doubts the effectiveness of this diluted lockdown. Our situation can quickly deteriorate to that like India if the current lockdown does not work based on our past experiences with MCO 2 and MCO 3. It is indeed worrying that WHO has projected that Malaysia may realise total deaths of 26,000 by September – representing almost a 9-fold increase from the present total of 2,993 deaths.
We should learn from China and countries like New Zealand, Australia and Singapore on how to bring the pandemic under control. China executed draconian lockdowns in Wuhan and its neighbouring provinces when the virus started to spread and managed to bring it under control. We can recall how strict China was when the WHO team visited China to trace the possible origin of the virus early this year. They were strictly quarantined for the full mandated period before they were allowed to proceed with their work. A few members were not allowed into China with the team because of their contacts with infected cases enroute to China. New Zealand and Australia quickly closed their borders and had no hesitation implementing lockdowns in cities when just a few cases of infection were detected. Singapore quickly addressed the key areas e.g. the cramp living conditions of their foreign labour and travellers from overseas as the island state is an international hub. It developed DIY testing kits to help identify and isolate Covid-19 cases quickly and ramped up the vaccination program rapidly.
Despite the ease of Covid-19 transmission, we note that the mortality rate is low at 1 in every 200. It used to be even lower last year at 1 in every 300. This has gone up when we ran short of ICU beds to provide better care for severe cases in recent weeks. The health facility constraints are likely to worsen significantly.
It is important to note that the majority of deaths are from those above 60 just like the rest of the world. This has important implications on policies in handling the pandemic. Because the mortality in the younger working group is low, our Government has opted to allow some essential economic sectors to continue scaled down operations during the lockdown. In view of the low mortality rate, people also tend to adopt a laidback attitude and do not follow the SOPs strictly.
Notwithstanding the low mortality rate, the incidence can rise very rapidly as reflected by the recent positivity trends. Once the next threshold level is breached, our front-liners and current hospital facilities may not be able to cope and we may end up like India or worse.
Until recently, the Government had not focused sufficiently on the importance of rapid vaccination when the programme was launched in February. We must give them credit for heeding the advice of the medical fraternity and take corrective action by involving private hospitals, health clinics and other groups to ramp up vaccination significantly with effect from June. This objective must be accorded top priority in order to contain the pandemic expeditiously and at the same time minimise opportunities for new variants to arise through mutation. The Government can do better if the following additional measures can be implemented.
The NSC has given some priority to the elderly, albeit in Phase 2. Correctly, all those above 65 should have been lumped with the front-liners in Phase 1 in view of their high vulnerability. The number of deaths could probably have been much lower then. Learning from this experience, vaccination priority in Phase 3 should preferably be based on descending age groups as the death rate of younger people is still relatively low. It should also consider spreading out the interval (depending on the type of vaccine) between the first and second doses from 3 to 12 weeks so that more people can have partial protection after the first dose. This was successfully carried out in UK.
Provided that we have adequate supply of vaccines, the NSC should also seriously consider 24-hour vaccination wherever feasible. This is especially so for states that have a high population and are currently behind in the vaccination programme. As the elderly will be completing their vaccinations shortly under Phase 2, those below 60, who do not mind the inconvenience, should also be accorded opportunity to register for the night vaccinations. Drive-in vaccination kiosks should be widely implemented soonest possible. These combined measures will speed up the vaccination programme to enable the nation to reach herd immunity soonest possible. We have seen the benefits of this in US. UK, Israel and other countries that were able to expedite their vaccination programmes and the people are beginning to resume their normal life.
It will also be important for the NSC to monitor closely and make fuller use of the big data from HIDE and focus on the clusters. This is especially important once the lockdown is lifted in order to contain potential spread of the virus more effectively. It will also be important to facilitate easy access to DIY testing kits and scale up testing intensity in view of the high incidence of asymptomatic cases to identify and isolate infected cases quickly to check the spread of the virus.
Dr Ho Chai Yee
Citizens Network for a Better Malaysia