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KUALA LUMPUR, Jan 25 — With new cases in excess of 3,000 per day, of which a significant proportion have emerged outside of known clusters, especially in Selangor and Kuala Lumpur, Malaysia appears to be struggling to contain the spread of Covid-19.
As the country waits to be immunised, the only way forward is to continue contact tracing efforts, find and isolate those who are asymptomatic — to prevent their condition from deteriorating to Tiers 4 and 5 — and increase SOP enforcement efforts as pandemic fatigue sets in, say several health experts pooled by Malay Mail.
Malaysia first recorded more than 3,000 cases on January 7 and hit its record high for daily cases on January 23 with 4,275 cases.
Hospitals have been inundated, forcing the Ministry of Health (MoH) to moot allowing patients with mild symptoms to quarantine at home.
The government has even declared a state of Emergency that is slated to last until August 1 to fight the pandemic.
Dr Rohan S. Shanmuganathan said with the current situation in mind, it is likely that many are asymptomatic yet unaware of their condition, which means they are unwittingly infecting others too.
“Out of 100 individuals, around 60 to 70 have probably been in contact with someone with Covid-19. That could be the situation now, but we will never know for sure.
“We must realise that we are living with this virus now, and to curb its spread, we need to continue with mass testing to find others with the virus,” said Dr Rohan.
“Now is the time to get the vaccines out and immunise the community and find a way to keep the virus at bay,” said the physician with the Taman Medan Health Clinic.
Kuala Lumpur and Selangor have registered the highest daily cases for several months on account of population density and factory clusters largely centred on workers’ domitories.
On January 21, Selangor recorded 545 cases, of which only 43 came from existing clusters. The remainder came from close contacts as well as other forms of tracing.
In Kuala Lumpur, out of 576 cases, 123 were from existing clusters, and the rest from contact tracing efforts.
The following day, just 153 of Selangor’s 782 new cases and 49 of Kuala Lumpur’s 435 were from clusters.
Time to get tough
Malaysian Medical Association (MMA) president Datuk Dr M. Subramaniam said poor compliance is to blame for the spike in cases, adding that expecting everyone to practise self-discipline is no longer enough.
He said the authorities will need to identify areas of weakness in their enforcement and educational efforts, and then strategise accordingly.
“There were 606 people arrested for breaching SOPs on Thursday, January 21. This is an incredibly small number to report for nationwide enforcement. The reports on the number of people flouting the SOPs have consistently been within this range. I think most would agree that the numbers are way higher.
“The lack of compliance with the SOPs can be seen by ordinary citizens on a daily basis around town. People are still crowding supermarkets, restaurants when ordering takeaway, and SOPs are being ignored at some workplaces.
“The authorities should study the reasons for the lack of compliance to target specific types of enforcement or if increased Covid-19 educational efforts are needed. We believe education is a factor. Not all have a sufficient understanding of Covid-19,” Dr Subramaniam told Malay Mail, adding that the ministry should review the fines for SOP offences which he deemed too low.
He also said there was a significant lack of police presence to enforce the rules during the current MCO in all states (except Sarawak).
He noted that people are still free to roam around and cross districts in many areas, even in the Klang Valley where Covid-19 cases are at an all-time high.
“Enforcement needs to be stepped up and there should be regular presence of enforcement personnel in public places. Random checks should also be made to offices and business premises, and employers should allow more workers to work from home.
"Aside from this, the government should screen all close contacts of Covid-19 positive cases. The Health Ministry recently stated that it will now only screen symptomatic close contacts of Covid-19 positive cases.
“MMA urges the Health Ministry to revert to its earlier policy of tracing and testing all close contacts to reduce the possible spread of infections in the community.
“If the government's resources are stretched, the Health Ministry should rope in the 7,000 MoH-trained private GPs to assist with the tracing and screening of close contacts,” he added.
Trust no one
Meanwhile, Malaysian Pharmacists Society president Amrahi Buang said the spike in Covid-19 cases shouldn’t come as a surprise as this had been predicted in September last year.
He said a spike had always been anticipated, but the Sabah state elections accelerated it.
“We shouldn’t be alarmed. There are many viruses in the community and we are living with them. Dengue is also a big contributor to human fatalities,” Amrahi told Malay Mail.
“In reality, we may see more cases than what we are seeing now because the current results — numbers-wise — are from testing done maybe a week to 10 days ago. So the real results of the effects of the MCO (movement control order) will only be known in two to three weeks’ time.”
“In the meantime, trust no one who comes to your home. Be extra hygienic, carry your sanitiser everywhere, and look at yourself in the mirror and ask yourself if you are doing everything to keep you, your family and the people around you safe.”
Due to the spike in cases, Malaysia is currently under a second MCO implemented on January 13, which is set to end on February 4. It currently encompasses all states except Sarawak, which is under a conditional movement control order (CMCO).
Social and Economic Research Initiative (SERI) chief executive officer Dr Helmy Haja Mydin agreed with Amrahi’s assessment, adding that we must allow the MCO to run its course.
“We must continue with close contact tracing as much as possible, but also be mindful that not all cases will be identified and the majority of people will not have symptoms.
“This means that there will be cases in the community that may not appear to be linked to a particular cluster. With that in mind, it is more essential than ever to minimise unnecessary physical contact to break the chain of spread,” said Dr Helmy when contacted.
Dr Arvinder-Singh HS, on the other hand, said the many cases seen now can be traced back to one or two existing clusters, resulting from a spillover effect.
“Besides that, it is taking a bit longer to get your Covid-19 results with the RT-PCR kit as there are lots of tests waiting to be processed due to mass swabbing and contact tracing efforts.
“Meanwhile, individuals who have taken these tests sometimes think since they have not heard from the medical fraternity in four days, they are Covid negative. They leave their homes only to get their results a few days later, notifying them that they are positive.
“This is probably happening because Malaysians are becoming desensitised to the situation. It does not help when they see high-profile figures breaking the SOPs without any repercussions,” he added.
So where do we go from here?
The public needs to be educated and constantly reminded of how easily they can be infected if they do not follow simple steps like wearing a mask and keeping it on at all times, until they reach home.
Leaders and public figures have to set a good example and be accountable for their actions, and there should be better communication between the various ministries and state authorities.
“Forming state task forces to be the boots on the ground in each state would be a good start to mitigate the problem,” said Dr Arvinder.
“They know their states better than the federal authorities and should be given autonomy and assistance in this endeavour.”