COMMENT | Covid-19: It’s all doom and gloom unless…
COMMENT | There is much misunderstanding about the Covid-19 situation in the country.
In particular, the high rates in the Klang Valley and the role of the only state task force, the Selangor Task Force on Covid-19 (STFC).
Allow me to share a few points and insights.
Don't look at absolute numbers which the daily press releases only harp on. This is unthinking sharing of numbers which is a lousy description of the disease epidemiology.
The numbers are misleading unless expressed as per population. Klang Valley is densely populated, of course, the absolute numbers will be high. More importantly, look at where the positive cases are...
COMMENT | There is much misunderstanding about the Covid-19 situation in the country.
In particular, the high rates in the Klang Valley and the role of the only state task force, the Selangor Task Force on Covid-19 (STFC).
Allow me to share a few points and insights.
Don't look at absolute numbers which the daily press releases only harp on. This is unthinking sharing of numbers which is a lousy description of the disease epidemiology.
The numbers are misleading unless expressed as per population. Klang Valley is densely populated, of course, the absolute numbers will be high. More importantly, look at where the positive cases are.
Socso is aiming to complete testing of about 850,000 workers in Kuala Lumpur and Selangor in January and February, so don’t be alarmed with the anticipated hikes in the numbers.
Look at incidence and infectivity rates expressed as per 100,000 or per 1,000, respectively.
One must understand the influence of demography and the socio-economic circumstances on the data.
Selangor contributed 24 percent to the national GDP. It is rich in industrial plants and factories. It, therefore, houses about one million registered migrant workers and probably similar numbers of unregistered migrant workers. These communities are epicentres of Covid-19 due to their poor working and living conditions.
There are also 100,000 refugees in the Klang Valley, another high-risk community. To its credit, the STFC convinced the Selangor government to purchase vaccines for both high-risk communities. The state government has put aside X million for Y million migrant workers and refugees who would otherwise be the last in the hierarchy for Covid-19 vaccines, if ever at all.
Health is a federal matter. There is very little that any state can do without federal blessings or intervention (except Sabah and Sarawak). Even when Pakatan Harapan-controlled state planned to roll out the Pneumococcal Conjugate Vaccine (PCV) well before the Budget 2019, BN blocked it.
In many ways, if the STFC had not stepped in, did mass testing, rolled out POIS (Prevention of Outbreaks at Ignition Sites), allocated Z millions for FTTIS (find, test, trace, isolate, and support), the situation in Selangor would be far worse, critical even.
The federal government has stopped sharing cases line-listing to STFC since Oct 2, 2020, at the onset of the third wave. This severely hampered the state’s response and coordination of Covid-19 cases. Former health minister and STFC chief Dzulkefly Ahmad exclaimed: “You ask us to box in the ring, but you blindfolded us.” Cases began climbing from Oct 10, 2020, onwards. Now you go figure out why.
It is dishonest and misleading to point out that Selangor‘s use of its own contact tracing system, SELangkah, is the reason why cases are spiralling out of control. Allow me to emphasise two points:
1. No contact tracing can be initiated if no patient data is shared. You can have the best contact tracing ecosystem in the world, but with no “case data”, contact tracing cannot be initiated.
2. Quite to the contrary, when Selangor was actively using SELangkah, daily incidence were well controlled. Yes, there were still cases appearing, but we managed to trace it fast and clamp it down faster.
On Aug 18, 2020, an announcement was made in the daily press conference, obligating all stores to use MySejahtera. Words on the streets went wild – stores were fined/harassed for displaying SELangkah QR code.
Effectively, SELangkah contact tracing ecosystem died off when many shops no longer displayed it. During this period, and until today, MySejahtera was the exclusive contact tracing ecosystem operating in Malaysia.
Post-Aug 18, too, is the exact time when we saw case numbers climbing up. It doesn’t take much to figure that MySejahtera has failed not only Selangor but entire Malaysia when we consider the number of cases today.
If the Health Ministry is doing such an excellent job at crushing Covid-19 and flattening the curve, and STFC was terribly hopeless, the sequelae would be obvious - everywhere would be green and Selangor would be the only red state. Is that what is happening? I’m afraid not.
And other states, industries, agencies, etc, are buying in STFC’s POIS programme and implementing it. This tripartite initiative between government-industry-NGOs pivots on three preventative strategies namely, enhanced public health measures, early detection testing regime and health education.
So STFC doesn’t just talk but rolls out programmes, mass testing, POIS, procuring vaccines, etc, to end the pandemic.
In no uncertain terms, the Health Ministry has failed in its back-to-basics of pandemic management. Their FTTIS is a colossal failure, and you can have cycles upon cycles of MCOs but if you do not get the basics of FTTIS right, you will fail to check the spread of Covid-19. Imagine the one to two days turn around time (TAT) of STFCs strategy versus the five to seven days TAT of the ministry.
STFC since October 2020 has been trying to share information and new ideas with the Health Ministry, but it is falling on deaf ears.
For example, Imaret (IMAM Response & Relief Team) went into Sabah with our RTK-Ag kits. This was when the ministry was still adamant with PCR testing (they still are). We covered most of the islands off Tawau. We did not require a boat ride for our tests to Tawau and then fly them to Kuala Lumpur and wait for at least a few more days for the results.
We diagnosed within one hour of testing, isolated the positive case, and completed contact tracing and quarantine within one to two days. This is how you bust a cluster and prevent sporadic spread, definitely not with the modus operandi of the ministry.
Indeed, this is how we handled a disaster. We were well trained by our public health maestros and our generals in the military (Angkatan Tentera Malaysia). I remembered in Cox Bazar, Bangladesh, the ATM’s top commanders, including their one and two-star generals were with us virtually all the time, dirty their hands, sweating out the only referral tertiary hospital serving one million Rohingya refugees.
With due respect, I would still be wary of the Sabah and Sarawak numbers, and for that matter most states. I suspect they are under testing, like former US president Donald Trump’s self-fulfilling prophecy. Our positive rate is still above the WHO threshold at 5.8 percent as of Jan 26, 2021.
Whenever STFC through SELangkah finds (the 'F' in FTTIS) hotspots, Imaret, SelCare and JKNS (Selangor State Health Department) and our team of volunteers will undertake mass testing of a few thousand at any one time. So, in Selangor, STFC captures the asymptomatic/pre-symptomatic and not just the symptomatic which the Health Ministry only does, thus missing the forest for the trees.
At the end of the day, we are in it together. If we refuse to learn from each other and operationalise the best public health practices, we are in for a rough ride.
I hope the national task force, as petitioned by the 46 top physicians, is rapidly recognised, accepted, and formalised to empower it to immediately re-strategise and transform the mindset, and policy at the top end of the Health Ministry, so that the operations at ground zero will be a truly rapid-response FTTIS which has zero-tolerance for cases, clusters or outbreaks.
MCOs are the blunt tools of those who have failed to operationalise the back-to-basics of pandemic management and in my opinion, they should either seek a second opinion from the task force and/or gracefully exit to minimise further harm to the nation and allow the task force to steer the nation out of this Covid-19 conundrum and to protect the lives and livelihood of its rakyat.
Otherwise, we are doomed!
DR MUSA MOHD NORDIN is a paediatrician and chairperson of the Federation of Islamic Medical Associations advisory council.
The views expressed here are those of the author/contributor and do not necessarily represent the views of Malaysiakini.
