Choose a transparent middle path over CMCO

In the peninsula, only Negeri Sembilan has a higher Covid-19 case incidence rate per 100,000 population than the national rate.

This statement is in response to the government’s decision to expand the conditional movement control order (CMCO) to include most of Peninsula Malaysia from 9 November until 6 December 2020. This is in addition to the nationwide recovery MCO already in place until year end.

We have learned from the last nine months that an MCO is effective in controlling the spread of Covid-19 and allowing time to conduct contact tracing while ensuring that the health system is not overwhelmed. The Ministry of Health (MOH) has managed the latter with great success, and the Rakyat have learned to take on the collective responsibility of breaking the chain of transmission.

Therefore, the Academy of Medicine of Malaysia (AMM) is puzzled by the government’s decision to impose a blanket CMCO. In examining the available evidence, we urge the government to lift the CMCO and adopt a transparent ‘middle path’.

Data Sharing and Transparency

MOH cites the basic reproductive number, R (sometimes also referred to as R0 or Rt), as a metric for decision-making on MCOs. It was reported on 9 November 2020 that the R in the country is now around 0.95 compared to 2.2 at the start of September.

This improvement indicates that despite relatively high infection rates still seen in Sabah, Selangor and Penang, the infections are well-contained and there is no indication of a surge in cases.

Covid-19 case incidence rate per 100,000 population from 21 October to 3 November 2020. Graphic by Academy of Medicine of Malaysia.

Based on the 14-day incidence rate from 21 October to 3 November 2020 (see table), many states should not need a stricter MCO. Only Negeri Sembilan has a higher incidence rate than the national rate while Kedah, Perak, Terengganu, Johor, and Melaka are at relatively low levels.

However, we acknowledge that these numbers do not give the full picture and is not the same as estimating R, which is a more complex calculation involving data points that only the government is privy to.

We call on the government to explain the science behind its decision to impose a blanket CMCO in the Klang Valley, Kedah, Perak, Melaka, Negeri Sembilan, Johor and Terengganu, despite the improving R figure.

We also urge the government to increase data sharing with researchers, health professional organisations and other official bodies which may support them in the battle against Covid-19.

CMCO in all but 3 Peninsular states
All but three states in the Peninsular will be placed under the CMCO for 4 weeks. – Bernama pic

Transparency will not only allow scientists to better understand Covid-19 in Malaysia, it will also reinforce public trust and boost compliance of standard operating procedures (SOP).

Impact of Prolonged Lockdown

Furthermore, prolonged MCOs can have damaging effects on the economy and the rakyat. We have expressed this concern in previous statements (refer here: 13 October 2020 & 3 June 2020).

While economic life can continue, the limits on movement and public life can be detrimental to small-and-medium businesses, which employ 48% of working Malaysians, as well as impact low-income households. But perhaps there is no group more deeply affected by this lockdown than children.

Schools across the country closed on 9 November 2020 in accordance with the CMCO in most states, forcing students to resume home-based learning for the rest of the academic year. It has been widely reported that not all students experience home-based learning the same way.

A study found that 37% of students do not have the appropriate device. Another study by the United Nations reported an increased drop-out rateamong urban poor students, with one in five students citing demotivation and disinterest in education.

Moreover, school is where many children of low-income households get nutritious meals they otherwise would not have. Alarmingly, reports point to higher rates of domestic violence during prolonged lockdowns as families are under increasing financial and emotional stress.

We cannot yet know the long-term impact that this will have on school children. It is imperative that they have the structure, socialisation, and outdoor activity normally experienced at school to mitigate the negative effects this pandemic may have on their cognitive and mental health.

As such, AMM strongly urges the government to minimise uncertainty and ambiguity regarding schooling during the pandemic. Guidelines set must be consistent, thoroughly considered for the medium- and long-term, and prioritise the mental, emotional and physical wellbeing of the child.

Alternatives to CMCO

There are other ways to contain and mitigate the spread of COVID-19 without enforcing a blanket CMCO. AMM urges the government to pursue these other strategies and revert to the recovery MCO.

We must adopt the World Health Organization’s (WHO) recommended ‘middle path’ and learn to coexist with the virus, minimise suffering and deaths without stopping and restarting the economy and public life.

If Malaysia is to beat Covid-19, we must first learn to live with it.

In an earlier statement on 13 October 2020, AMM suggested that the government adopt a targeted enhanced MCO (TEMCO) for zones with high infection rates as it is less disruptive to the economy and public life. This can and should still be employed in lieu of a blanket CMCO.

TEMCO must of course come hand-in-hand with aggressive contact tracing, testing and isolation to ensure that there is no spread of the virus in surrounding areas. MOH’s excellent track record of this should continue.

Finally, there must be high rates of SOP compliance across the board. Compliance has fluctuated as pandemic fatigue sets in, despite increased awareness of the 3Cs and 3Ws. The WHO recommends that in combatting this fatigue, SOPs must be transparent and consistent.

The rakyat must understand the scientific reasoning behind the SOPs or restrictions, and those SOPs cannot constantly change over time. Moreover, the message must be consistent with action. Should there be any confusion, such as the recent uncertainty over ‘checking in’ at petrol stations, MOH must lead in providing clear, evidence-based recommendations before any penalties for non-compliance are enforced.

Also, government officials and politicians have a responsibility to lead by example and always abide by the recommended guidelines. This reinforces trust in the government’s advice and ensures a cooperative rakyat.

It will be some time before a vaccine can fully rid us of this virus, but progress is possible if we work together as a country to break the chain of transmission. We hope the government opts for the middle path into our future.

We, the under-signed:

  • Academy of Medicine of Malaysia (Professor Dr Rosmawati Mohamed, Master)
  • College of Anaesthesiologists (Dato Dr Jahizah Hassan, President)
  • College of Dental Specialists (Professor Dato’ Dr Lian Chin Boon, President)
  • College of Emergency Physicians (Dr Ridzuan Dato’ Mohd Isa, President)
  • College of Obstetricians and Gynaecologists (Professor Datuk Dr Siti Zawiah Omar, President)
  • College of Ophthalmologists (Dr Nur Fariza Ngah, President)
  • College of Paediatrics (Professor Dr Thong Meow Keong, President)
  • College of Pathologists (Professor Dr Cheong Soon Keng, President)
  • College of Physicians (Dr Letchuman Ramanathan, President)
  • College of Public Health Medicine (Dato’ Indera Dr Sha’ari Ngadiman, President)
  • College of Radiology (Professor Dr Norlisah Ramli, President)
  • College of Surgeons (Professor Dr April Camilla Roslani, President)

Academy Of Medicine Of Malaysia

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

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