KUALA LUMPUR, July 3 ― The government’s extension of Phase One of the National Recovery Plan (NRP) earlier this week gained the support of some doctors, even as many Malaysians bemoan the continued lockdown.
At the same time, the doctors also expressed a desire for clearer, more quantifiable measures in the government’s benchmarks for Malaysia going forward.
Private practitioner Datuk Dr Kuljit Singh said the government should also take into account the infectivity rate of Covid-19 or the R0/RT (R-naught) as an additional independent indicator alongside existing ones under the NRP.
“Yes, the infectivity rate is rather important. R0 should be at an acceptable level before lifting [any lockdown].
“When you try to downstep a lockdown phase, we have to look at many aspects. R0 is equally important because that gives us a perspective of the infectivity rate,” the president of the Association of Private Hospitals Malaysia told Malay Mail when contacted. He stressed that he was speaking in his personal capacity and not on behalf of the association.
As of June 30, Malaysia’s r0 stood at 1.05 with daily cases hovering above the 5,000 mark for at least a week since June 23.
R0 is a mathematical term that indicates how contagious and infectious a disease is. It’s also referred to as the reproduction number.
If the R0 is more than 1, each existing infection causes more than one new infection. The disease will be transmitted between people, and there could be an outbreak or epidemic.
Prime Minister Tan Sri Muhyiddin Yassin had on June 15 presented a four-phase NRP with three specific threshold indicators that will decide if and when Covid-19 pandemic restrictions are lifted in stages.
Each of these phases, he said, will be based on thresholds that will look at the daily Covid-19 case average numbers, the capacity of the public health system, and the vaccination rate of the general population.
Dr Kuljit said these indicators were laudable so as to not overwhelm the healthcare system with soaring cases of admittance into Intensive Care Unit (ICU) for treatment and hospital bed usage amid the pandemic.
“The main worry at the end of the day is death and critical hospital beds. If you lift a lockdown and the number goes up, then more people would require ICU beds,” he said.
Subsequent to the June 28 two-weeks extension deadline of the “total lockdown” imposed since June 1, Muhyiddin maintained that existing Covid-19 containment measures under Phase One will continue as the country’s Covid-19 infection numbers have not met the threshold set.
Malaysia would not be able to exit Phase One until all three NRP indicators — new cases below 4,000 daily, “moderate” demand on intensive care capacity, and 10 per cent vaccination in the country — have been met.
Datuk Dr N. Ganabaskaran, the Malaysian Medical Association’s immediate past president, is another advocate for the inclusion of R0 values ― which measure the potential transmission rate or decline of a disease ― as the more accurate gauge of how Malaysia is managing the Covid-19 outbreak.
“I think the government is trying its best to bring back lockdown in a proper manner, but apart from all these they also must consider the infectivity.
“All these measures we're taking, I am not against it, in fact I am in support of it, but daily infectivity is another big indicator,” he told Malay Mail.
In stressing the importance of R0 values, Dr Ganabaskaran said the 4,000 daily case threshold may be arbitrary by nature. He pointed out that daily cases might not always remain below this figure if infectivity is still high.
He said Malaysians have been told how to prevent the spread of the infectious disease and should do all that is necessary on their own.
Dr Lim Kuan Joo of the Federation of Private Medical Practitioners' Association Malaysia (FPMPAM) expressed reservations over the NRP’s indicators.
He said while the use of ICU and hospital capacity were currently the best indicators, the Health Ministry has not been able to quantify their utilisation.
“What is critical, non-critical and manageable? What is no longer critical and ICU bed at moderate level? What is manageable and ICU bed usage reduced to adequate level?
“To support the roadmap, we must have the answers to the above questions,” he said.
He was referring to one of the indicators for Phase Two transition which reads: “The healthcare system is no longer at a critical stage, with ICU bed usage returning to moderate levels.”
Lim, who is also FPMPAM’s honorary council member, also stressed that there was no such thing as a time frame for lockdown caused by an infectious disease, adding that duration of phases should be based on incidence and its sequelae.