#kerajaangagal143 – Time to craft a new Covid-19 strategy based co-existence with the new coronavirus as the current Covid-19 strategy has failed

With the extension of the 28-day “total lockdown” from today, the first phase of the National Recovery Plan continues until the threshold of less than 4,000 cases a day is reached.

When will this be?

More and more Malaysians are asking as to how scientific and data-driven are the thresholds that have been set for the National Recovery Plan to move from one phase to the other.

It has been 28 days since total lockdown started. Covid-19 should have subsided significantly if one considers its 10-14-day incubation period.

On Day One (D1) of total lockdown, there were 7,105 new cases and 71 deaths. On D27 yesterday, there were 5,586 new cases and 60 deaths. On D1, the active cases were 80,747 and as of yesterday on D27, the active cases were 61,395. The numbers refer to the total number of people who tested positive and being held “captive” at home, isolation centres or hospitals.

On D1, 100,885 tests were done and as of yesterday, D27, the number of tests dropped by 33.3% (66,969 tests done).

These numbers provide little value as it is dependent on the number of tests being done, the three-day lag for the result to come out and the target locations where the tests are being done.

The Health Ministry also use another index called R0 (R nought). This index is dependent on several factors. They are, the infectious period (10-14 day average,) contact rate (which lockdown reduces contact rate) and mode of transmission (mask, face shield and social distancing reduce the airborne transmission) and ability to be infected (vaccinations) and the success is computed based on outcome monitoring (hospitalization etc).

Though the Health Ministry indicates the R0 has reduced, but public trust is lacking because of the lower testing being done.

Community activist, Dr. Mohamad Rafick Khan commented on his blog that the recent announcement by the government using the “Phases of The National Recovery Plan” (NRP) as an indicator is aimed at addressing the population psychological impact as the people are affected with depressive news daily.

He said: “The progressive phases are meant to give people a sense of hope rather than being dumped with a sense of despair and loss of hope. It doesn’t mean the way KKM (Health Ministry) approach managing the epidemic has changed. It just means that the government is changing the way it communicates with people i.e. either a glass being half-filled or half empty.”

Dr. Rafick is of the view that from a cost-benefit analysis (CBA), the current strategy is too costly and yield insignificant results to abate the spread of the virus.

He advocated a change of the Covid-19 strategy towards one co-existing with the virus and instead of reporting from the perspectives of “Daily new case” or “Total Active Case”, he suggested reporting the situation based on the outcome by using a 3-class concept (Class A: stage 1 & 2; Class B: stage 3 & 4 and Class C – stage 5 and Death related to Covid-19).

The outcome-based classification will tell Malaysians the severity of the infection and allow the planning on the usage of hospitalization resources.

He suggested: “While these are monitoring indicators, we need to ramp up the vaccination and use the EMCO strategy in high-risk zones. Vaccines need to be distributed based on medical risk assessment and not based on political policies. The state and the Federal governments must learn to work together as partners and not as ‘masters and slaves’”.

Dr. Rafick is of the view that the current principle of over-relying on lockdown doesn’t work and a new Covid-19 strategy is needed.

He said: “Four weeks of lockdown has not yielded the desired effects. Lockdown is punishing the population mental state. Temperature is rising that may affect people’s behaviour. Suicides though formally not reported are rising. Risk-based identification and containment measure must be enhanced. It must be done based on activities and location using medical knowledge and science. Failing to do this, the situation will never change. We must now accept that having zero infection is not possible and feasible.”

Another medical specialist has suggested an alternative approach.

He said that the criteria under the National Recovery Plan are “too soft” and can be easily manipulated, using punishment to drive objectives.

He suggested the opening up of the “political space” to use states to achieve the objectives.

He suggested: “Those states that do well, open earlier and progress. Those states who do nothing then get held back longer. This is the carrot approach.

“States must work with the Federal Government and there must be an independent adjudication committee.

“ We must begin to consider livelihood issues.”

He proposes a Healthcare Index for Phase One where the three conditions to be complied to transition to Phase Two are: 125 cases per million population, moderate ICU use and 10% of the population vaccinated; and an Economic Index where there are less than 10 workplace clusters and 10% workers vaccinated.

The Federal Government should also give a commitment of fair vaccine distribution to all sates, the involvement of all GPs in the national vaccination rollout and allow doctors to use whatever is safe to treat patients like all the therapeutics.

It is time that both the Executive and the Legislature should set up a mechanism to craft a successful Covid-19 strategy to win the war against the Covid-19 pandemic.