Covid-19 numbers in Malaysia continue to soar a year to the day since the country’s first case was detected – but after more than 180,000 infections, 678 related deaths and two nationwide lockdowns, public health experts are now concerned that the nation’s contact-tracing efforts are falling dangerously short.
People who have tested positive for the disease have taken to social media to complain that they had not yet been contacted by health officials, while contact-tracing applications such as MySejahtera and SELangkah are overwhelmed, with reports indicating that thousands of close contacts are potentially being missed on a daily basis.
“MySejahtera is supposed to help facilitate contact tracing, but as we continue to hit four-digit [increases in] cases on a daily basis, it’s not clear that contact tracers are able to make full use of the data collected by the app for contact tracing. They likely have to resort to doing manual contact tracing, which can be a tedious task,” said Nazihah Noor, a public health researcher at the Khazanah Research Institute.
In a media briefing on Monday (Jan 25), the health ministry told reporters that issues with the system had been addressed, and that there would be closer monitoring of close contacts via the MySejahtera app and therefore fewer delays.
But experts are adamant that a drastic overhaul of digital contact tracing is needed, although an already burdened health care system – which the nation’s top health official recently described as being at “breaking point” – may be unable to deputise staff to tracking down potential Covid-19 cases.
According to Nazihah’s estimates, Malaysia would require about 10,000 physical contact tracers as it works to upgrade its MySejahtera system – or about 30 tracers per 100,000 people.
She said the numbers could be made up by civil service personnel seconded to the health ministry, or through community volunteers, as “this would free up existing health professionals to do more specialised activities”.
Dr Zulkifli Ismail, secretary general of the Asia Pacific Paediatric Association and member of the Malaysia Health Coalition (MHC), said more responsibility needed to be given to the people. “There must be public buy-in to make people more responsible and disciplined by self-quarantining and admitting to meeting positive contacts. More public health education and engagement is needed.”
Contact tracing the “traditional, arduous” way was no longer feasible, said Dr Tan Maw Pin, secretary of the Malaysian Society of Geriatric Medicine and an MHC member.
“We were supposed to be aided by MySejahtera,” she said. “Our public needs to be educated and empowered to contact trace, and self-isolate when necessary. Individuals or community leaders should be able to help with contact tracing, and many have been doing it since the response from our District Health Office is taking longer and longer.”
Earlier this month, former deputy health minister Lee Boon Chye urged the government to hire an additional 10,000 contact tracers to deal with the surge in Covid-19 cases, with opposition politicians noting the health ministry had not disclosed the number of contact-tracing personnel it was using.
“Without a proper contact-tracing infrastructure, our ability to contain this pandemic even after the end of [the second lockdown] will remain in question,” member of parliament and former deputy minister Ong Kian Ming said in a statement.
Low trust in the government
As of November last year, the MySejahtera app – which requires people to ‘check in’ at restaurants, shops and even taxis – had recorded an average of 15 million daily check-ins.
“But until now, we are not aware of whether this massive database has been analysed for transmission trends,” Ong said. “For example, are the transmission rates higher in certain places such as gyms and restaurants compared to optometrists and hair salons? Once a factory cluster has been identified, what transmission mechanisms are most likely to cause community spread in the affected area?”
MySejahtera currently takes down personal details including contact numbers, email addresses, age, gender, ethnicity, and home address, and data extraction only takes place when a positive Covid-19 case is detected.
This was sufficient for now, said senior Khazanah Research Institute research associate and digital policy expert Rachel Gong, with more invasive means such as tracking credit card transactions or surveillance cameras currently not necessary.
“However, we certainly need to use the data we have better and we need to continue building public trust and educating people on why they need to be honest about where they’ve been and whom they might have come into contact with,” she said, adding that the issue was less about privacy concerns and more about people’s low trust levels when it came to the government.
“I think MySejahtera users are already giving up some privacy rights, specifically location data, in the interests of public health. The issue is whether the shared data is being used effectively. States like Sarawak and Selangor are communicating specific location information to the public, which seems like a good first step. This offers some degree of individual privacy protection while alerting the community.”
Another gap, Gong said, was how vulnerable populations such as the homeless, migrants, refugees, and other persecuted groups could be harmed by more invasive contact-tracing methods.
“In Singapore, for example, mission creep set in when the government took contact-tracing data and used it for criminal investigations.”
Health policies specialist Dr Khor Swee Kheng said as it stood, Malaysia’s contact tracing was not fast or comprehensive enough for even an influenza pandemic, let alone Covid-19.
“The government now has two broad strategic choices. One, to continue with contact tracing as a strategy but rapidly add digital capabilities to a currently analogue model. Or two, to accept that we are in the mitigation phase of a pandemic, and then deprioritise contact tracing and shift resources to other areas like health care delivery,” he said.
Khor added that while Malaysia’s manual contact-tracing system could handle daily cases when they were in the tens or hundreds, it was not practical now that thousands of new cases were being reported every day. The country on Monday recorded 3,346 new infections.
He also called on the government to introduce a set of key performance indicators – including the seven-day average of new cases, total active cases and fatality rate, among other factors – to measure the pandemic broadly but also allow for agile decision-making, for instance to determine when the lockdown could be lifted.
With vaccines due to arrive in late February and hospitals packed, experts say the ‘trace, test and isolate’ strategy is key for countries to not just emerge from lockdown but beat the pandemic altogether.
More money and manpower must be pushed towards test and trace systems, said Nazihah of the Khazanah Research Institute, or “otherwise we’d be flying blind. It’s no news that our health care workers are exhausted – to reduce their burden, it’s not enough for us to treat cases, we must stop them from happening in the first place. Contact tracing is key to doing that.”
For the past several weeks, Malaysia’s daily reports of new cases have been in the thousands – a worrying outcome for a country that at one point appeared to have brought Covid-19 under control with a nationwide lockdown in March last year, following the emergence of a large cluster resulting from a mass religious gathering.
Malaysia recorded its first case in January last year after three members of a family from China holidaying in the country tested positive.
Earlier this month, a second movement control order, as it has been dubbed by the authorities, was put in place, though much of the economy remained open.
The nation’s king also assented to the declaration of a state of emergency, under which political activity has been suspended until August, although Prime Minister Muhyiddin Yassin has said general elections will be held after.
Various factors have contributed to Malaysia’s loss of control. Though infection levels had dropped following the first lockdown, elections in the state of Sabah last September saw voters and politicians travel frequently, which helped to spread the virus and led to its resurgence.
On top of this, safety measures became more lax after the economy reopened, with people engaging in social gatherings even though mask-wearing and physical distancing remained mandatory. Gyms reopened, birthday parties and weddings went on, and so new clusters emerged.
Now a flagging contact-tracing system is the latest burden on a system already stretched far too thin.
“Every part of this [control] strategy is crucial, making up the so-called ‘Swiss cheese model’ [a series of barriers] for responding to the pandemic, even if vaccination is on the horizon,” Nazihah said.
“This means that we can’t afford to neglect contact tracing. We may be overwhelmed now, but if we don’t fix our contact tracing system immediately, we may see a further surge which will overwhelm us even more. Because if we’re not tracing close contacts enough, we’re not testing enough – especially absent a mass screening campaign – which will likely lead to further spread of the virus.”
By : TASHNY SUKUMARAN – SOUTH CHINA MORNING POST