On MCO exit strategy and continued surveillance — APM

APRIL 27 — Malaysians are now in the third phase, week six of the movement control order (MCO). The MCO together with aggressive screening have shown that the prevention and control strategies were working.

The falling numbers of positive cases, as well as increasing recovery rate (65.5 per cent as of 25 April) suggest that an exit strategy is needed and should be made public as soon as possible.

Before any exit strategy is conveyed to the public we think it is important for the government to point out a few facts to the nation through clear concise communication:

1. The MCO is not in place to eradicate the disease, this can only happen when there is a vaccine and/or a cure. Public must be made to understand the initial aim of the MCO, that is for the health authorities to contain and managed the virus transmission effectively.

This had successfully turned the active cases curve towards downward trajectory. Nonetheless, without the vaccine to combat Covid-19 virus, we still face the risk of infection.

Hence, we suggest two point-approach to the Ministry of Health and public until the vaccine is in place. The Ministry of Health should continue the Stit approach (Search, Test, Isolate and Treat) to the vulnerable and high risk groups.

The public should always be vigilant and continue to practice hand-washing, social-distancing, lessen unnecessary travel and to seek early medical help if there is any symptoms or even self-suspicion of having the infection.

2. The Covid-19 has changed the way we work, live and even communicate with each other. From the medical perspective, we now know that there are groups of people that are more at risk of contracting the infection.

Hence, the Ministry of Health through its primary care services, should act as a gate-keeper in detecting and screening these group of people for possible infection.

There is also the need to aggressively manage the non-communicable diseases (NCD) which are a significant public health burden in our country; through targeted health education, primary prevention and intensive management.

3. From the security perspective, the borders of our country needs to be further protected. If Malaysia is able to come out of the MCO earlier than other countries, the development of new clusters is a threat from these outsiders (people returning from overseas, tourists, foreign workers etc).

We suggest the government continue with the current proactive measures such as isolating people returning from overseas (in early phase post MCO), having declaration form and rapid screening test to people coming to our country, and mandatory temperature and symptom checklists in hotels, conferences and working places.

4. The zoning of areas must be updated weekly. Areas previously red if cases have decreased need to be reclassified. The MCO should be loosen in phases as recommended by APM in a statement on April 2, 2020 (refer to our website; www.akademiprofesor.org.my).

The government should engage the public (through state’s counsellors, community groups and NGOs) to work together in keeping residential areas, districts and states in green zones.

5 The higher learning institutions should also work in their R&D in developing ways to combat Covid-19, either through new innovations for preventive measures, smart-apps applications or creating the much needed vaccine or rapid mass screening kits.

6. Mass testing should be conducted to determine the number of infected, especially those who are asymptomatic, only then can we obtain the correct fatality rate. Rally the assistance of private laboratories to detect cases accurately and quickly.

Current targeted screening approach whilst successfully traced positive cases from identified clusters, is lacking in identifying sporadic clusters in the community. Thus, we suggest that mass screening to be done post-MCO, as to accurately detect the positive cases in the community.

7. Efforts are made to increase hospital facilities. Besides Sungai Buloh as the centre for infectious disease control and treatment, there should be at least another 2,000 bedded facility ever ready to be activated in an epidemic, when not it can be another centre to treat chronic infectious diseases.

Following recommendations from WHO and the exit strategies from countries such as United States and Germany, we may want to consider the following items to be part of our exit strategy.

• There should be guidelines for individuals and employers.
• People with chronic diseases, immune compromised diseases and elderly will need to be compliant with the treatment of their chronic diseases and avoid situations where they can catch the infection and encouraged to stay home as much as possible. People who are sick will have to seek medical help as soon as possible and isolate themselves immediately.
• Social distancing, using masks, and hand hygiene must be continuously practiced by everyone. Premises have to be disinfected minimum once daily. All premises must have hand sanitisers and temperature testing at entrance and exit. Premises should practice different areas for entry and exit as much as possible. There should be controlled numbers entering premises at any one time to avoid crowding, time spent inside the premise can be limited to 30 minutes for each person as is being practised now at some supermarkets.
• There will not be any mass gathering in concerts, conferences, open houses, buffets, or religious gatherings.
• Encourage businesses to allow half staffing to work in office on alternate days, while the other half work from home. If possible have temperature checks at entrance to workplace. Make it a rule that staff with fever and flu symptoms should see a doctor and not go to work.
• Dentists, chiropractors, physiotherapists, gym trainers, hairdressers, apas, massage and acupuncture centres must undertake precautions to guarantee hygiene for customers and staff.
• Social distancing measures in cinemas, restaurants, laundrettes, coffee shops, cafes and all other forms of eateries, should be practiced for example alternate seat allocations.
• Public parks may be reopened (with strict distancing rules and masks).
• Day-care centres would need to be reopened if parents are to return to work, otherwise all employers will need to come up with new ideas of creche services at the workplace.
• Empower community to be responsible for their health to keep or work towards their areas becoming green zones, to get them to initiate and maintain preventive measures in their areas. They can assist those with symptoms to get them to the screening centres or to clinics as some may need help with travel arrangements.

We understand that coming out of this MCO is going to be difficult, but people cannot be locked up for such a long time as personal savings are dwindling and the stimulus package does not reach everyone.

Many have loans to pay and the six months exemption by banks does not apply to those who borrowed from loan sharks. At the same time, part time income earners will most likely not have a job coming out of this MCO, many of whom are not included in the stimulus package.

* From Academy of Professors Malaysia's (APM) Prof. Dr Adlina Suleiman, head of Health and Medical Cluster; Prof. Dr Noor Azah Abd Aziz, secretary of Health and Medical Cluster; and Prof. Dr Jamal Othman, Head of Economics and Social Wellbeing Cluster.

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