KUALA LUMPUR, April 6 — Just a week before the targeted end date of the Movement Control Order (MCO), an epidemiologist expressed difficulty about predicting the Covid-19 epidemic without solid data.
Only with good numbers, Universiti Malaya epidemiologist Dr Awang Bulgiba Awang Mahmud said, can epidemiologists draw up mathematical models to project the progress of the highly infectious coronavirus in Malaysia to help inform the country’s public health response. Until now, the government has yet to state what exactly will happen after April 14, saying only that authorities will decide this Friday on whether to extend the MCO.
“Only with good models, can you make an informed and well-thought out decision whether to continue or not to continue with MCO, or modify it with whatever form,” Dr Awang Bulgiba told CodeBlue in a phone interview.
“The first thing is to get our data cleaned up and make sure we’re very clear on actual numbers and clear this backlog of testing so there’s no backlog,” added the professor from Universiti Malaya’s Department of Social and Preventive Medicine at the Faculty of Medicine, referring to the Ministry of Health’s (MOH) backlog of nearly 8,400 pending Covid-19 test results.
Dr Awang Bulgiba also questioned the basis of economic think tank Malaysian Institute of Economic Research’s (MIER) rosy projections about the coronavirus curve supposedly “flattening” in Malaysia, saying: “We don’t really have good data; they can’t have any better data.”
The kind of public data Dr Awang Bulgiba would like from MOH are actual dates of when Covid-19 tests are run and dates of when these test results come back, so that health authorities can specify that a particular number of people were infected on a certain date.
So far, MOH only releases daily statistics of what it describes as “new” infections reported as of noon each day, “new” deaths reported every day, as well as cumulative figures of the number of individuals tested as of a particular date.
“On the number of infections, it is unclear whether this is coming from the backlog or whether we’re truly seeing people who were tested yesterday, for example,” said Dr Awang Bulgiba.
What this means is that it is uncertain if MOH’s daily Covid-19 statistics reflect “real-time” coronavirus infections in Malaysia, or if the figures reported each day actually include backlog cases that were infected and tested some time ago, and not yesterday per se.
According to MOH’s tweet, there was a backlog of 8,398 pending Covid-19 test results as of April 5. A total of 51,937 people were tested as of yesterday, out of which 3,662 tested positive and 39,877 tested negative. Besides a total of 3,662 confirmed coronavirus cases in Malaysia, the country also reported 61 deaths.
Health director-general Dr Noor Hisham Abdullah said Saturday that 30 per cent of the 47,723 Covid-19 tests done over the past couple of weeks were actually repeated tests for Covid-19 patients treated in hospitals, not tests to diagnose new cases.
“Those repeat tests should be taken out of whatever numbers or graphics they’re putting out. It just confuses people,” Dr Awang Bulgiba said.
“I can’t really make out head and tail on how many actual people were tested, rather than how many tests were carried out. It makes life for epidemiologists like me very difficult. We’re trying to help, we’re trying to model, but it’s very cloudy.”
When asked if Malaysia was testing enough for coronavirus, the epidemiologist said authorities were still not doing mass screening, as tests were only run on contacts of patients turning up in the health system, as well as on people falling sick with influenza-like illnesses or severe acute respiratory infections.
“So, because of that, it’s difficult to estimate the true infection rate in the community,” Dr Awang Bulgiba said.
“I can’t really say if we’re doing enough or not enough testing. Even if you take swabs but you’re unable to cope with the backlog of swabs, can you say you’re doing enough testing? Yes, we’re taking more swabs, but whether we’re able to test all the swabs is another matter.”
He said for RT-PCR tests to detect coronavirus, a batch of 100 Covid-19 samples usually takes about six hours per machine, so each lab should run 200 tests if two batches are done in one day, or perhaps 400 a day if a lab has two machines.
“If they are not capable of running huge numbers, you’ll see lower numbers, maybe 100 per day. It does take hours to come back.”
The Health DG said Saturday that MOH’s coronavirus testing capacity is now 11,500 tests daily, pointing out that 43 laboratories across the public and private sectors can run RT-PCR tests. MOH hopes to increase testing capacity to 16,500 tests daily. Dr Noor Hisham also said yesterday that MOH was considering importing a machine from China that could automate Covid-19 testing and perhaps run an additional 5,000 tests daily.
Dr Awang Bulgiba believes South Korea has the truest community infection rate in any country due to its aggressive Covid-19 testing. The Guardian reported last Thursday that South Korea has tested over 300,000 people for free out of its population of 51.5 million, with a testing rate of 8,222 per million population, higher than the UK’s 2,109 tests per million population and the US’ 447 tests per million population. South Korea has confirmed 10,237 coronavirus cases as of yesterday, as well as 183 deaths.
Malaysia, in comparison, tested nearly 52,000 people out of its 32.6-million population as of yesterday, according to official figures, though it is unclear how many were new tests to diagnose Covid-19, as opposed to repeated testing. Assuming that 70 per cent are new tests for diagnosis, this yields a rate of 1,115 tests per million population.
The epidemiologist told Malaysia to think beyond the MCO, saying that although the nationwide lockdown — where people are now generally restricted from travelling beyond 10km from their homes, except for medical purposes — must end at some point, social distancing must be practiced in one way or another. Working from home could be a new normal, and businesses may be allowed to open, but under more restrictive conditions.
“Life will not be normal for six to 12 months, until a more permanent solution is found for this outbreak,” he said, citing vaccines.
But a vaccine for Covid-19 will take at least a year to develop, Dr Awang Bulgiba said, pointing out that despite the existence of several candidate vaccines, clinical trials take months. Safety is also paramount to ensure that the vaccine doesn’t end up becoming more problematic than the disease itself.
“Whatever it is, we have to think beyond the MCO and how the country is going to work with a different mode for the next 12 months.”