What is the real issue of lockdowns?

AS of July 13, our daily cases reached 11,079.

But not all are in agreement on the necessity of lockdowns. Some are even calling for an outright abandonment of lockdowns in toto (ie completely) and in situ (ie immediately) to contain the COVID-19 pandemic – arguing that the costs outweigh the benefits.

Although well-intentioned, it’s a call for a premature end to lockdowns before herd immunity by vaccination is achieved. A very risky proposition indeed – one that your average policy-maker is hard-pressed to assume.

While the economic, social and psychological impact can’t be underestimated and downplayed, right now the balance between lives and livelihoods is tilted towards the former.

Thus, there’s an air of unreality or surrealism surrounding the call of those who tenaciously cling on to the tenets of the “Barrington Declaration” as embodying the anti-lockdown movement.

This leads us to the rehearsal of some basic facts.

Lockdowns are a form, albeit extreme, of physical or social distancing. They’re based on the scientific evidence of breaking the chain of transmission that thereby reduces the infectivity rate so that infections don’t peak or kept manageable with the view of gradually flattening the curve.

In turn, this situation ensures that the numbers don’t overwhelm and overstretch the healthcare services. Lockdowns apply at the borders too.

Whilst lockdowns are indiscriminate and therefore affects all – regardless of health and economic status – so is the COVID-19 virus. To state what’s obvious, there’s no ratio of infectibility as such between the healthy and non-healthy (co-morbidities). Both groups are equally susceptible to COVID-19.

What’s ignored is that those who die from COVID-19 may have been asymptomatic and hence not classified as such (see eg, article titled “Malaysia’s 0.4% COVID-19 Death Rate ‘Doesn’t Mean Anything Anymore’: Expert”, published by Code Blue @Galen Centre on April 13).

The irony is that if the healthcare services are overstrained, then the case fatality rate (CFR) will increase. This is so as there’s a correlation between level of healthcare provision and the CFR.

The Swedish experiment clearly demonstrates that a country cannot rely on natural herd immunity as the main tool (albeit alongside mass vaccination in tandem).

And let’s not forget the US experience under the Donald Trump’s presidency too.

The opposite is New Zealand – often touted as the exemplar par excellence in terms of the lockdown strategy.

It’d be counter-argued that, of course, the standard operating procedures (SOPs) need to be put in place, including physical distancing measures. However, SOPs alone may be insufficient to halt the spread of the virus.

Other non-pharmaceutical interventions (NPIs) such as lockdowns would still have to be implemented – depending on the context.

SOP compliance vs infectivity rate

Even in South Korea – where the lockdown strategy was never implemented but focused on quarantine measures only, certain establishments were shut down such as schools and entertainment centres. And to date, it has experienced three waves.

The reason why Malaysia keeps experiencing wave after wave is precisely because or either laxity/complacency in compliance or non-compliance secundum quid (in certain, qualified contexts).

Although not simpliciter (ie simply – non-compliance), Malaysians can be quite lax when it comes to social gatherings – as demonstrated by the Sabah state election and the Raya Aidilfitri visits.

Even Ministers and politicians themselves who are supposed to set a good example are guilty as charged!

Furthermore, it could be argued that there’s a correlation between the level of SOP compliance and the risk level of infectivity rate – the basic reproduction number/value or R naught (R0) – due to the two of the three underlying variables/derivatives, ie, the likelihood of transmission of infection per contact between a susceptible person and an infectious individual as well as the contact rate.

In turn, the R0 can be estimated based on epidemiological models reliant on contract-tracing data which in the case of Malaysia is primarily based on our MySejahtera app.

Heavy reliance on compliance doesn’t take into account that, eg temperature sensors may miss out on the presence of asymptomatic carriers.

Therefore, a lower level of SOP compliance increases the risk level of the infectivity rate.

The ratio between symptomatic to asymptomatic carriers (as after testing) could be as high as 0.6, ie 60% of cases tested positive involving asymptomatic carriers (“Estimation of undetected symptomatic and asymptomatic cases of COVID-19 infection and prediction of its spread in the USA”, Ashutosh Mahajan et al, Journal of Medical Virology, Feb 23).

Or even reaching 80%/0.8 (“COVID-19: What proportion are asymptomatic?”, Carl Heneghan et al, The Centre for Evidence-Based Medicine (CEBM), April 6, 2020; see also “SARS-CoV-2 Transmission from People Without COVID-19 Symptoms”, Jama Network, Jan 7).

In the case of Malaysia, it could be as high as 70% (as reported by Health Ministry (MOH) director-general Tan Sri Dr Noor Hisham Abdullah on July 8, 2020).

In the final analysis, the real issue is our current levels of SOP compliance.

Secondly, it’s over what kind of lockdown strategy.

Between lockdown versus no-lockdown, in the context of Malaysia with its highly inconsistent degree of non-compliance, lockdown is definitively the lesser of the two evils.

A synthesis between a full movement control order (FMCO) and targeted enhanced MCO (EMCO) could still be had. But this requires closer cooperation and collaboration between all the stakeholders – federal, state and private sector.

To conclude – as Keynes once famously said, “When the facts change, I change my mind”.

By : Jason Loh Seong Wei (Head of Social, Law & Human Rights at EMIR Research) – FOCUS MALAYSIA

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