Malaysia must ramp-up SARS-Cov-2 testing — Musa Mohd Nordin and Zulkifli Ismail

MARCH 25 — I received an SOS message from an old friend yesterday prior to my chit-chat with Melissa Idris and Sharaad Kuttan on Astro Awani’s Consider This, on late night, March 24, 2020.

She wrote, “My son in law, a doctor, was exposed to a Covid-19 positive colleague but the head of department said, no need to test. He self-isolated from his family but still had to go to work, taking the necessary precautions. Now he is having URTI (Upper Respiratory Tract Infection), namely a sore throat and running nose.”

I replied, “I cannot help with Ministry of Health (MOH) issues, but I can sort your son’s issue. Get him tested ASAP at DSH (Damansara Specialist Hospital). I will advise you the results the very same day. Dr Nazri, our laboratory partner is our top notch microbiologist.”

The current policy of the MOH is to only run tests on the Persons Under Investigation (PUI). Even the Persons Under Surveillance (PUS) were not tested but were instead counselled, given a Health Assessment Tool (HAT) brochure and told to self-isolate for the next 14 days.

This MOH modus operandi is probably due to the shortage of test kits and finite funding when the first Covid-19 case was announced to the world by China on December 31, 2019.

The MOH was doing extremely well in its early Covid-19 containment strategy under the stewardship of the then Minister of Health, Datuk Seri Dzulkefly Ahmad.

If anything our best virology brains in the Institute of Medical Research (IMR) was at the cutting edge of the genetics of SARS-CoV-2.

When the scientists from China first released information on the Covid-19 viral genome, on January 11, 2020, the team from IMR’s virology unit, had already produced the “primers and probes” specific to SARS-CoV-2 on the very same day.

The World Health Organisation (WHO) only released the protocol for real time rt-PCR (reverse transcriptase-Polymerase Chain Reaction) several days later. The WHO reagent sequence (primers and probes) was very similar to that produced in our IMR laboratory.

So Malaysia actually had a head start in Covid-19 testing. Malaysia’s IMR even overtook the Centers for Disease Control and Prevention (CDC) who only approved the first US test on February 4, 2020, but announced problems with the Covid-19 test a week later.

IMR’s reagent was supplied to Makmal Kesihatan Awam Kebangsaan (MKAK) Sungai Buloh, who diagnosed Malaysia’s first Covid-19 case on January 24, 2020. 

Unfortunately, the MOH did not capitalize on this advantage and did not make the test more widely available to our rakyat.

The MOH did not follow closely the WHO’s three golden rules for epidemic control namely: TEST, TEST and TEST again. This is not rocket science. This is simply back to basics epidemiological detective work by public health teams to objectively define the burden of Covid-19 disease in the community, identify the clusters of infection and capture the persons who are infected but remain well and asymptomatic.

The asymptomatic carriers of SARS-CoV-2 are especially worrying. On average, the Covid-19 patient takes about 7 days from exposure to the virus to manifest symptoms (range from 2-14 days). But a considerable percentage of Covid-19 carriers (one study quoted a figure of 12 per cent), can spread the disease for 2-4 days before they exhibit the signs of fever, cough and respiratory distress.

By casting our testing nets as wide as possible we would be able to pick up most if not all of these and undertake contact tracing and place them on 14 day quarantine to contain the spread of the disease.

Malaysia’s Covid-19 test per million capita of 482, is higher compared to other Asean countries and several EU countries but it lags behind the benchmarks set by South Korea at 3692 and Guangdong at 2820.

Hospital Sungai Buloh and KPJ Damansara Specialist Hospital were first to imitate the South Korea model of Drive-Thru Covid-19 testing. They have about 60 Drive-Thru stations throughout South Korea and were able to test up to 0.7 per cent of their 52 million population. They now know that 2.8 per 100 persons has been infected by SARS-CoV-2.

This is the best evidence thus far of the infectiousness of the virus which correlates well with the estimated Ro (reproductive naught) ranging from 2.0 to a high of 3.6 during the height of the Wuhan outbreak. The estimates of the Ro during the H1N1 influenza virus in the 2009 pandemic ranged from 1.4 – 3.5. Malaysia recorded 12,307 H1N1 influenza cases with a total of 77 deaths during this 2009 pandemic.

All the public health measures from epidemiological surveillance of testing, tracking, isolating and more recently social distancing in the form of Movement Control Order (MCO) are designed to flatten the Covid-19 epidemic curve to buy time for our healthcare infrastructure and services to recoup and so as not be overwhelmed by an accelerated and wide peak, such as have happened in Italy, Iran and I am afraid the US if Trump and his administration does not get their act together.

If we get the pivotal quartet of interventions in tandem, we will be able to drive the Ro to below 1 and this will almost surely decrease the transmissibility of SARS-CoV-2 and extinguish the outbreak.

Trust us, Malaysia is not too late to ramp-up our Covid-19 testing. Wuhan had allowed the epidemic to spread without tests and containment measures for 4-6 weeks before they got their act together. With their most draconian lockdown strategy (total isolation + social distancing) coupled with the dyad of testing and tracking, they have been able to drive the Ro from a high of 3.6 to 0.4 and have after 6 weeks of lockdown begun to ease their drastic outbreak management policies.

Trust us, #Malaysia Boleh, provided Perikatan Nasional (PN)  undertakes a whole-of government response which among others prioritizes and makes Covid-19 testing widely available and affordable to embrace AirAsia’s Tan Sri Tony Fernandes philosophy of #EverybodyCanTEST.

Trust us, #Malaysia Boleh provided each of us play our part as a whole-of society response to this unprecedented Covid-19 pandemic by #StayHome #DudukRumah

#GodBlessMalaysia

* Datuk Dr Musa Mohd Nordin and Datuk Dr Zulkifli Ismail are paediatricians

** This is the personal opinion of the writer or publication and does not necessarily represent the views of Malay Mail.

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