With MCO showing mixed results, health experts press Putrajaya for transparency, community empowerment

A healthcare worker collects swab samples to test for Covid-19 at Dewan Desa Temuan in Kota Damansara January 29, 2021. — Picture by Ahmad Zamzahuri
A healthcare worker collects swab samples to test for Covid-19 at Dewan Desa Temuan in Kota Damansara January 29, 2021. — Picture by Ahmad Zamzahuri

KUALA LUMPUR, Feb 3 — Malaysia’s worsening Covid-19 situation requires the government to be fully transparent with information on the pandemic in order to fully utilise all available expertise in the country to effectively tackle the matter, said health experts.

Malaysian Medical Association president Prof Datuk Dr M. Subramaniam said the movement control order (MCO) implemented to help prevent the country’s health system has not had the intended result.

Instead, he said rising cases in Selangor, Kuala Lumpur, and Johor indicate that Covid-19 is now entrenched in the local community.

Apart from suggesting the government widely deploy Antigen rapid test kits (RTK) — which he said were cheaper and faster than laboratory tests — Dr Subramaniam also said general practitioners should be given more authority to ferret out Covid-19 cases in their vicinity.

“As the government plans to empower private GPs to issue quarantine orders on suspected cases of Covid-19, the GPs should be engaged to carry out  RTK Antigen testing of the community. There are 7,000 MoH trained private GPs that are well distributed in both urban and rural populations in the country.

“Apart from testing, the GPs should also be engaged to monitor mild cases of Covid-19 detected in the community. The move to keep mild cases at home or in less well supported environments is understandable in view of the surge in infections.

“The onus is now on the Covid patients and their home carers to monitor their symptoms to detect progression of illness.  In the experience of other countries, many have been brought in dead (BID). This is because the disease progression may be quite swift and that the lay persons in monitoring may not have the expertise or experience to diagnose advancing illness,” Dr Subramaniam told Malay Mail.

Additionally, he said the government should also urgently provide the unambiguous standard operating procedures for home quarantine patients.

Cases in Malaysia have steadily risen in 2021 to reach a peak of 5,726 cases on January 31. The seven-day average of cases on that same day was 4,451 cases. This high number was due to cases ranging between 3,000 and 4,000 in the two weeks since the MCO was implemented.

Initially set to end on January 26, the MCO was then extended till February 4 in all states and Federal Territories, except Sarawak. And now in the latest, the MCO is extended till February 18, spanning the Chinese New Year holidays which fall on February 12 and 13 this year.

Health director-general Tan Sri Dr Noor Hisham Abdullah said last week that public hospitals are close to being overrun and asked non-critical patients not to visit hospitals unless necessary.

He also mooted the idea of home quarantining as long as several criteria are met.

To that effect, Dr Arvinder Singh, a medical officer for the Institute of Clinical Research Malaysia agreed with Dr Subramaniam and said the government must admit its shortcoming and start utilising technology to better fight the pandemic.

“The government must embrace the fact that they cannot do contact tracing manually, they need AI (artificial intelligence); that’s the way forward and it must be done in a bipartisan manner.

“We’ve been fighting Covid for a year now and we should know our shortcomings by now; in fact every country has shortcomings. It’s not something we need to be worried about. We must instead come together and discuss these pressing issues.

“There needs to be more data sharing form the government to the states and thus we can create state task forces to be boots on the ground, go into the hard to reach places, do outreach programmes and raise awareness at places the government cannot reach,” Dr Arvinder said when contacted.

“Besides that, there is a lot of information from technocrats and academicians that are not affiliated with the government or its agencies. They should also take into account these individuals’ findings and in return give more autonomy to the states to handle this crisis.”

Dr Subramaniam concurred and said the Health Ministry must engage more closely and regularly with the medical experts including from the private sector.

“It is also very important that medical devices used be of high standard and approved by regulatory bodies and not sold by the dozens online which is tantamount to having care  provided by unqualified staff.

“We cannot jeopardize our people’s health. The private GPs can help if provided the right tools and information. The situation will get worse over the next few weeks and we have to start now to incorporate technology and call centres in this national effort,” Dr Subramaniam warned.

According to Malaysian Pharmacists Society president Amrahi Buang, there is a severe lack of community engagement resulting in lax adherence to SOPs from the public, which is causing cases to be spread out.

Amrahi said that without community engagement when things go wrong, the government would be blamed for any problems since it wanted to handle it all itself.

He cited how areas that have cases or are near to a cluster have little or to no informational or awareness programmes about Covid-19, let alone proper adherence to SOPs.

“Everything is done paternally,” said Amrahi.

“The authorities are the ‘father’ and everyone must follow when in fact we need to really engage the community and empower them. The Health Ministry has all the info, and if possible it should publish these data and then we can react to it.

“Right now if we implement a lockdown we may get the same results as we’re seeing now because the virus is already in the community. This is the keyword here.

“So when we say the virus is in the community but the community is not involved, there is something wrong here.”

Malaysia is expected to receive its first batch of the Pfizer Covid-19 vaccine on February 26 and it will be distributed in stages starting with the frontliners, high-risk groups and so forth.

Amrahi said Malaysians who were lackadaisical about Covid-19 prevention based on the belief that vaccines would save them must review their position.

“The vaccine is not a silver bullet. There is a lot of distrust towards getting vaccinated so if we do not educate the people the outcome will be bad,” said Amrahi.

“Whether they agree or not, the government must realise there is a trust deficit between them and the public.

“It’s not good when the authorities say MCO is done to discipline Malaysians who are breaking SOPs. When we do such things the people will lose trust in the authorities and claim them to be corrupt and so on. Hence the need for community empowerment and engagement.”

As of February 2, the total national cumulative cases are 219,173 while active cases have hit 48,074 with 770 deaths.

Some of the main contributing factors to the rise in cases are the factory and construction site clusters involving foreign workers living in cramped quarters.

Their living and working conditions have been described as inhumane. Despite the uproar, these clusters continue to be major contributors to new cases.

Not much is being done to mitigate the problem as the living conditions of these migrant workers are still the same.

In December last year, glove maker Laglove was ordered to close its Kajang plant for Covid violations after the human resources minister visited its workers’ quarters.

Before that in July last year, the US government blocked imports from Top Glove, allegedly due to labour abuses.

Putrajaya has been cracking down on factories here after a rise in Covid-19 cases originating from its crowded workers dormitories.

A number of Malaysia’s largest glove manufacturers have faced Covid-19 infections among its workers, including Top Glove, Hartalega, Careplus and Kossan.

Malaysia’s largest Covid-19 cluster dubbed Teratai began at Top Glove’s Klang facilities. Over 2,000 workers tested positive for the virus.

Dr Subramaniam told Malay Mail that this matter needs urgent attention to avoid sending the country into another devastating lockdown.

“As long as they continue to live in cramped housing, the country will be at risk of new clusters, more community transmissions and the threat of the nation going under lockdown every now and again.

“Most important of all, is the public’s commitment to adhering to the SOPs. A more strategic approach in educating the public on prevention and stricter enforcement is needed. However with sufficient educating there will be less need for enforcement.

“The entire population must fully understand the health and economic consequences as well as the overall impact on quality of life when cases spike as a result of poor SOP compliance.

“Ministers must also walk the talk and lead by example,” he added.