FEBRUARY 12 — The medical and health cluster of the Academy of Professors Malaysia are concerned about the latest federal government gazette under the Prevention and Control of Infectious Diseases (Exemption) Order 2021 which stated that cabinet ministers are no longer subjected to mandatory home quarantine for 10 days like other overseas returnees, whereby they are only required to undergo three days of observation or surveillance before they are discharged with a clean bill of health.

With reference to this we concur with the Academy of Medicine Malaysia, Malaysian Medical Association and the Malaysian Public Health Physicians Association that reducing the quarantine period to three days for cabinet ministers who return from abroad is not an evidence based decision, the explanation of which has been well covered in NST report entitled “Experts Rap 3-Day Quarantine Rule” on 10th February 2021. We also agree that the quarantine period should be at least 10 days.

Another concern is the implementation of SOPs during the MCO period that keeps on changing. We understand that we are now back to the MCO that we were first encountered on 18th March 2020 but the application of SOPs seems to have changed without the MCO level changing.

We were told that the MCO has been extended to 18th February for the whole country except Sarawak yet today dining in has been reinstituted and there are few checkpoints across boundaries, the question being are we now into recovery MCO?

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Police conduct roadblock checks during movement control order 2.0 (MCO) in Subang Jaya, February 2, 2021. — Picture by Miera Zulyana
Police conduct roadblock checks during movement control order 2.0 (MCO) in Subang Jaya, February 2, 2021. — Picture by Miera Zulyana

Another matter of confusion is the two person in a car rule that keeps on bouncing back and forth to four, then back to two and then to four again, such that everyday we need to find the SOPs for the day before we make our move to work or to do our daily shopping.

We suggest that instead of using alphabets for the type of MCO just use either numbers or colour code MCOs and assign the SOPs for that numbered or coloured MCO. For example level 1 is the strictest MCO meaning that it is total lockdown of a red zone district (this was EMCO). Level 2 would be partial lockdown with restricted movement for daily needs, two in a car within 10km radius, no gatherings at all, street hawkers can continue business, takeaway only no dine in (this was known as CMCO). Level 3 would be unlimited family members in a car but four if non family members, allow movement across borders, gatherings of up to 20, dine in allowed with strict SOPs, most businesses can operate (RMCO) and so forth. Please spell out the SOPs precisely and please follow it strictly, do not change when pressured.

We understand that daily wage earners, “pasar malam” vendors and street hawkers need to continue working otherwise they will have problems sustaining their families, so they should be allowed to do so except in level 1 MCO.

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Our case fatality rate remains low at around 0.37 per cent though the number infected per day remains high (around 3000). The high number of positive cases is a burden to the Ministry of Health as they cannot accommodate these cases. The suggestion by Associate Professor Dr Marlina Osman to empower volunteers or trained government and private healthcare staff who are working from home to monitor patients undergoing home quarantine within their vicinity is a viable solution that needs to be explored.

We suggest that these “community quarantine domes” will be a community based close monitoring enclave where the enforcers are chosen from the community itself, whereby there will be a leader who coordinates the monitoring process, a doctor or nurse in charge of the medical aspect (if none in the community chose a qualified person living nearby or a volunteer) and security to ensure everything is kept in check while reporting to the state health office who compiles the reports and sent a summary to the Crisis Preparedness and Response Centre (CPRC) daily.

There is a need to resolve some “missing links” in the efforts to flatten the curve.This includes an urgent need for a national Covid-19 database that combines Covid-19 related data either in terms of case reporting, hotspot areas, swab test reporting involving government and private health services to coordinate data reporting, evaluation for more effective actions.

There is the need for “opportunistic testing” to detect asymptomatic cases in the community. Some issues have arisen from individuals who visit the health clinic with no fever, travel history or close contact but with ‘anosmia’ (loss of sense of smell), ‘ageusia’ (loss of sense of taste), sore throat, lethargy and body pain. The issues were:

a. Eligibility for such cases to be screened to detect Covid-19 cases. For now, MOH facilities have not yet received blurred cases with no fever to be screened, while screening at the private level requires payment that individuals may not be able to afford. Cheaper alternatives have to be found and research should be encouraged while fostering flexibility in the choice of screening method.

b. There is no SOP regarding the process of handling patients who come voluntarily, especially in terms of the referral process for screening, documentation, staff responsible in such cases. Health workers, especially outside the MOH facilities, have difficulty in handling such cases where there is confusion in terms of responsibility and governance on this issue, especially now when case collection is mandatory by private hospitals.

c. The absence of a mass mechanism or voluntary screening accessible to the people that may be ‘the missing link’ in our efforts to fight Covid-19 at the community level. As the MOH focuses more on intensive screening, sporadic cases like these may escape the community in turn cause new cases or clusters to arise in the community.

It would be good if the Question and Answer session with the Director General of Health is conducted daily to create awareness as well as prevent misconceptions and false rumours. Adherence to SOPs can only be enhanced if the public are well informed and trust the authorities with strict emphasis on “stable unchanging” SOPs.

There must be transparency in reporting case distribution according to workplace, factories, prisons and the community, with emphasis on hotspots listed daily for the public to avoid. It is important that evidence based science in making decisions should be carefully considered when issuing any new order under the Prevention and Control of Infectious Diseases Act (Act 342).

We urge citizens to follow the SOP and stay at home for the safety of everyone. We thank the health workers for their hard work in treating patients and to all security personnel and enforcement officers who guard the border and ensure the SOP is followed. We pray that our beloved country will be free from this disease soon.

Obey 3W (Wash, Wear {Mask}, Warn), Avoid 3C (Confined Spaces, Close Conversation, Crowded Places), Stay Home-Stay Safe

* Opinion of:

Profesor Dr Adlina Suleiman, Head of Medical and Health Cluster Academy of Professors Malaysia

Profesor Dr Noor Azah Abd Aziz, Deputy Head of Medical and Health Cluster Academy of Professors Malaysia

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