The recent implementation of the Conditional Movement Control Order (CMCO) across all Peninsular states except Kelantan, Pahang and Perlis has led to some negative sentiments being expressed by the public. This is understandable as our “new normal”, with its strict Standard Operating Procedures (SOPs), requires significant sacrifice. So-called Pandemic Fatigue has set in: many are struggling to adapt, livelihoods are affected and people are simply tired of what seems to be an endless set of restrictions.
This is all well understood – but we need to be clear; managing the Covid-19 pandemic is a marathon, not a sprint. It is a race that we can win, but only if we continue to persevere.
Unfortunately, this pandemic has generated an “infodemic” that the country has been fighting to control. Rumours and misinformation are spreading across social media platforms about the implementation of the CMCO, including claims that the decision to implement it was a political one. Such unfounded and incorrect claims are dangerous. They can discourage the public from taking the measures that are needed to curb the spread of the virus. In this fight, and it is a fight, we should not spread misinformation, cast doubts and thusr add unnecessary pressure to our frontliners, health workers and rakyat. Now is the time to listen, connect and reinforce the strong support systems that have gotten us this far.
Many medical professionals, civil society organisations and the rakyat have shared feedback, provided constructive criticism and practical recommendations on social media or personally with me. Most of it comes from expressions of mutual concern and a desire to better understand the current management of the pandemic here. I truly appreciate, encourage and am humbled to listen to those who have reached out to me.
Among the most frequently asked questions is about the risk matrix used by the government in deciding to implement a CMCO, and if it is possible to target restrictions only to vulnerable groups such as the elderly or those with pre-existing medical conditions. Many argue that the young and healthy should be able to resume their daily activities, including going to work and socialising with other healthy individuals. This is seen as a strategy that could protect the health of vulnerable groups, whilst reviving the economy.
Sweden is sometimes held as an example for “shielding” only the vulnerable and high-risk populations. In Sweden the government never officially issued a full lockdown. Instead, its public health agency instructed those above the age of 70 to avoid socialising with others and banned visits to old age care homes.
But there is no evidence showing that this strategy has been effective. The death rate in Sweden is 11 times higher than its neighbour Norway and is the twelfth highest in the world. While full data is not yet available, the Swedish economy is predicted to be at similar levels to its Nordic counterparts, despite seeing much higher deaths. Other countries such as the UK, which previously adopted the same strategy, revised their approach and, even with these revisions has had to implement new lockdowns, even harsher than those in Malaysia. Thus, in an argument of lives versus livelihoods, it is not clear that lifting movement restrictions to boost the economy will succeed at protecting livelihoods, much less lives.
Would a “shield the vulnerable” approach work for Malaysia? Short of a potentially very cruel social experiment, we would not be able to know for sure. What we do know is that the prevailing culture in Malaysia makes it difficult to separate our elderly from the rest of the population; they do not stay in aged care facilities, but instead in multigenerational households. Furthermore, many individuals in Malaysia have existing medical conditions that make them vulnerable to dying from Covid-19. For example, approximately one in five of Malaysian adults have diabetes, and one in three have high blood pressure. We cannot adequately shield them from the completely healthy when they live in the same households.
The Malaysian government has chosen to implement the CMCO based on the Ministry of Health’s clear risk assessment matrix that not only includes numbers of cases but more importantly reproduction rate, doubling time, case positivity and mortality rates, and other public health indicators. These are coupled with mapping of transmission patterns, factored in with population density and mobility. The risk matrix has room for improvement and must take into consideration special situations like re-opening schools and learning institutions as quickly and safely as possible – work which needs to be constantly evaluated and updated.
In March, Malaysia went into a strict MCO which successfully brought the number of cases down to single and low double-digit numbers. A second smaller wave in July saw targeted movement controls particularly as the outbreak was confined to a defined area. This third wave from end September has seen large numbers from Sabah and West Malaysia. Despite targeted controls, the reproduction number spiked to 2.2 and warranted serious action.
There are different schools of thought in deciding on the best management of a pandemic. These include “block and control”, open (and hope for herd immunity) and an in-between “stepladder approach” to restricting red zones only. In the early part of this third wave, the latter was employed. A targeted approach was undertaken but unfortunately the numbers continued to rise. More worryingly, risk assessments projected significant spread to neighbouring states and the dispersion of cases was wider, with less well-defined and confined areas. Using data in tracing apps like MySejahtera helped identify patterns of movement, including active movement of people that led to the virus moving across districts and states.
Following data analysis and advice from the Ministry of Health, the Government agreed to work at federal and state levels to implement CMCO in states with growing red and yellow districts, with stricter restrictions on social activities. With these measures, there will be disruption to our social lives but it I want to assure you that it is done for the greater good of the rakyat. When we see a rapid decline in the number of cases, restrictions will be eased quickly from state to state and then across the nation. This requires all of us to be frontliners ourselves by practicing public health safety measures and limiting social interactions. In a crisis situation, a judgement call needs to be made for the wider benefit of all, whether popular or not. I know that this is not popular, but it is necessary.
In a crisis, we must make robust and timely decisions based on the best data and science available. We must be humble and willing to learn, acknowledging that no decision will be perfect but also learning from global examples. New Zealand deliberately opted to close its borders for a long time until it judged reopening would not pose any risks to its people. The entire state of Victoria in Australia was made to strictly lockdown for three months, limiting bar and café goers from their regular habits and was one major factor in helping the state and country reduce infections so that their citizens were able to eventually resume economic activities safely.
On the other hand, countries in Europe that prematurely relaxed lockdown measures are now experiencing resurgences that are worse than previous waves. More stringent lockdowns and curfews are now in place in many parts of Europe, including France, a country with just over double the population of Malaysia experiencing over 23,000 cases a day.
We must balance lives and livelihoods, allowing some economic activities to continue while limiting social activities through which the majority of infections spread. It is undeniable and deeply unfortunate that some economic sectors will be affected too but this is where government social protection mechanisms must come in. The CMCO was ordered to curb further spread of the virus. It may not be the sharpest tool, but it gets the job done in the interim.
In the meantime, we need to continually improve predictive data analytics as a basis for effective communications with the public. I ask health professionals and scientists to work with the government to find new solutions, as a way to decrease public anxiety. We need to embrace more open data approaches, and continually sharpen our tools to manage this epidemic in the absence of a safe and effective vaccine.
To my medical colleagues, you carry the people’s trust; it is a privilege that comes with big responsibility. We have a duty to curb the Covid-19 pandemic and the infodemic. We cannot address the former without crushing the latter. The Hippocratic oath to “first do no harm”, is applicable to not only clinical settings but also in how we communicate information to the public. Unfounded speculation and misinformation only serve to instigate unnecessary panic.
Managing the pandemic effectively requires humility to learn constantly from other countries’ successes and mistakes, as well as our own, and to continually improve. We all have a role to play in managing and adapting to life in the age of COVID19. Our compliance to the standard operating procedures is essential, irrespective of status, race, nationality or religion. We have flattened the curve before - and we can, and we must do it again.
No comments
Post a Comment