2019-nCoV Outbreak — This Too Shall Pass — Azrul Mohd Khalib

Travel bans delay the spread of the virus, but are unable to actually prevent infections.

Recently, a petition with over 350,000 signatures has been going around calling for a ban on people from China travelling into Malaysia. The intent is to supposedly protect the Malaysian people.

Reading its content and call for action, based on the “unhygienic lifestyle” point, one could be mistaken for thinking that it was more xenophobic and bigoted in nature rather than being based on any real scientific basis or good public health strategy.

However, it didn’t stop more than a quarter of a million Malaysians from all walks of life from adding their names to the petition.

The fact is despite the Chinese government imposing an unprecedented travel restriction on over 20 million people in three cities, this drastic move to contain the spread of the current coronavirus outbreak is not likely to succeed.

This is the Chinese New Year period during which the world’s largest annual human migration occurs. This involves an estimated 2.8 billion trips within China alone.

The time for containment of this disease within the geographical borders of a country (which are not recognised by any virus, bacteria or pathogen) has long passed. It may have been possible months ago, but the barnyard doors are wide open now. The virus is already moving rapidly across the globe, thanks to air travel and the holiday season.

Based on that fact, a century’s worth of public health experience and epidemiological evidence from previous outbreaks of coronavirus, we can definitively say that travel bans simply will not work for this type of viral infection.

Yes, they delay the spread of the virus due to the reduced movement of people, but travel restrictions and bans were found to be unable to actually prevent infections. They also diverted much needed political attention and resources.

Travel bans enforce a harmful Maginot mentality which conveys a false sense of security for the population, implying that they would be protected.

Malaysia’s Ministry of Health is already being guided by the World Health Organisation’s (WHO) prevention and control strategies regarding this outbreak.

WHO’s recent Emergency Committee meeting, which reviewed current reports and recognised the urgency of the situation, decided to hold off declaring the ongoing situation as a Public Health Emergency of International Concern (PHEIC), which imposes a legal duty on member states to act.

The 2009 H1N1 pandemic, 2014 polio declaration, 2014 Western Africa outbreak of Ebola, Zika virus epidemic in 2015-16, and 2019 Kivu Ebola epidemic were previously declared as such. They may still do that for this outbreak.

What we can do now is to use what we learnt from the previous and ongoing pandemics and epidemics (e.g. annual flu, influenza, SARS, MERS) to figure out the best way to manage and control the spread of this virus.

The reality is that in this globalised environment, it is not possible to completely isolate this country from having cases of this novel coronavirus. We know that and we should (and we are) prepared for that eventuality. We have learnt a lot from previous coronavirus pandemics, SARS and most recently, MERS.

In 2002, severe acute respiratory syndrome (SARS) caused global panic, infected more than 8000 people, in 29 countries including Malaysia. There were 774 deaths. The fatality rate is around 10 per cent. There is no treatment available, but a possible vaccine is on the horizon.

The Middle East Respiratory Syndrome (MERS) emerged from Saudi Arabia in 2012 and is still spreading today. It has been found in 27 countries, including Malaysia. More than 2,500 people have been infected. There have been around 860 deaths, which leads to a fatality rate of around 35 per cent. There is no treatment available, and there is no vaccine.

Despite the far higher mortality rate for MERS and the nightmare scenario of any infectious disease epidemiologist of hundreds of thousands of people congregating to the epicentre of a disease, the annual hajj or umrah pilgrimages were not stopped.

Neither were thousands of Malaysian pilgrims quarantined or not be allowed into the country, despite there being fatalities from MERS infection among Malaysians.

Knowledge and good understanding of public health, virology and epidemiology inform and guide us on what, how and the best course of action to manage and contain these epidemics, using science and our combined knowledge and expertise. It isn’t blind faith but informed decision making.

In times like these, everyone turns into epidemiologists or infectious disease specialists, fuelled by information derived from social media and the internet. Suddenly, R0 values are the thing to know.

Make no mistake. This is a serious epidemic. We should not downplay it or trivialise concerns. Like all its brother coronaviruses, this novel one will move around the globe. People will be infected, treated and there will be deaths. Absolutely.

However, communication and dissemination of accurate and evidence driven information and practices will serve us better rather than calling for bans, depending on messages spread through conspiracy sites and paranoia of our neighbours and friends.

There is much information out there, but there are those which are misleading, sensationalised and even deliberately wrong “facts”.

Constant vigilance, accurate information, good communication, practice of the recommended precautions and most importantly cooperation, will be what brings this outbreak under control.

These days, using social media, it is easy for many of us to second guess the efforts of the Ministry of Health or question whether they are being transparent with the public. We justify it out of concern and fear for ourselves and our families. It is only human to do so.

However, take a minute and think about the courage and fear faced by our women and men who are health care professionals, have family and colleagues, at the frontlines of this epidemic. They are doing the necessary and critical work to protect the rest of us.

The least we could do is to have their backs and support them as they go about doing the work that they are trained to do.

A recent report by the Economist Intelligence Unit, using its Global Health Security Index, found that Malaysia ranked higher than Singapore in preparedness of major infectious disease outbreaks. This country’s response framework ranked 18th out of a total of 195 countries.

So, this is not blind faith but trust that the women and men of the Ministry of Health not only know what they are doing but are also highly skilled in what they do.

Unfortunately, due to climate change and the consequences of the global population explosion, there will be more such outbreaks. We must prepare for them.

We have lived through several pandemics, and from the looks of it, we can and will get through this one too.

Azrul Mohd Khalib is chief executive of the Galen Centre for Health and Social Policy.

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