Widen Covid-19 Testing When Lockdown Eases, Expert Says

By Boo Su-Lyn | 02 May 2020

Dr Amar-Singh HSS recommends testing all flu-like and pneumonia cases; all adult deaths; frontline health care workers, including private ones; as well as immigrants and frontline service staff like cashiers, delivery workers, and police.

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KUALA LUMPUR, May 2 — A paediatrician has called for increased coronavirus testing in the community to identify Covid-19 hotspots when most of Malaysia reopens on May 4.

Dr Amar-Singh HSS projected a Covid-19 peak four to six weeks after the Conditional Movement Control Order (CMCO) is imposed on May 4, if there was still significant community spread, where people may later turn up with severe conditions requiring hospitalisation.

The first area in which to increase Covid-19 testing, Dr Amar suggested, is to screen all influenza-like illness (ILI) and severe acute respiratory infection (SARI) cases, where he predicted positive Covid-19 infections at around 0.6 per cent to 1 per cent.

He noted that the Ministry of Health (MOH) has tested all pneumonia cases for coronavirus at hundreds a week, but health authorities have yet to test all ILI cases numbering in the thousands that would likely turn up in private general practitioner (GP) clinics and hospital outpatient departments.

Instead of simply relying on the official Covid-19 death toll from those who succumbed to the disease in hospital, Dr Amar said every adult death — whether at home, old folks’ home, or hospital — should also be tested to identify deaths related to coronavirus.

He pointed out that only half of deaths in Malaysia are medically certified, while other fatalities certified by the police.

Dr Amar highlighted “excess deaths” in countries like the UK and Jakarta in Indonesia, where deaths during the Covid-19 pandemic exceeded usual mortality rates in a typical year.

ABC reported Thursday that England and Wales have recorded the most deaths in a single week for at least 27 years, reporting 22,351 deaths in the week ending April 17. A normal year would see only about 10,000 deaths in that week. Professor Alan Lopez from the University of Melbourne was quoted saying that the “all-cause death rate” was the best way of measuring the overall impact of Covid-19 on mortality.

The New York Times reported that at least 46,000 more people have died during the Covid-19 pandemic than official coronavirus death counts, according to its review of mortality data in 14 countries. The UK, for example, had 55 per cent deaths above normal from March 14 to April 17, while Jakarta recorded 57 per cent deaths above normal in March.

Malaysia has yet to release details on total mortality during the Covid-19 epidemic that hit the country late last January.

Dr Amar also recommended frequent Covid-19 testing on frontline health care workers, preferably once every fortnight, including those in the private sector as they usually see patients with coronavirus-like symptoms like flu, cough, and fever.

Finally, he suggested using any excess tests to do sample screenings on immigrants from different parts of the country, particularly asymptomatic Covid-19 carriers; as well as frontline service individuals like supermarket cashiers, delivery workers, and the police.

“If there are no resources, just ask those mildly unwell,” Dr Amar said.

“If we test these four areas, our numbers will definitely go up straight away, but that’s to be expected because we’re only doing targeted testing right now.”

From the start of the outbreak until today, MOH has used a targeted testing approach by only screening high-risk groups and locations, such as those linked to a tabligh gathering at Sri Petaling mosque here in March that accounted for the biggest Covid-19 cluster.

Health director-general Dr Noor Hisham Abdullah said yesterday that MOH’s testing capacity has increased to 16,635 tests daily.

Dr Amar stressed that the main issue now is to prevent another wave of Covid-19 infections and to continue retaining daily case numbers at a low level like South Korea.

South Korea reported zero local Covid-19 infections on Wednesday for the first time since the outbreak was recorded 72 days previously, TIME reported, despite not imposing a major lockdown unlike other countries. South Korea has kept its national Covid-19 case tally to 10,765, attributed to its early preparations, extensive testing, and technological contact tracing.

When asked if Malaysia should have abruptly relaxed its nationwide lockdown on May 4, eight days ahead of the initially scheduled May 12 end-date of the MCO, Dr Amar acknowledged that Malaysians have yet to be adequately prepared on the “nitty-gritty” of safe distancing measures.

Prime Minister Muhyiddin Yassin announced yesterday that most movement restrictions would be eased next Monday, allowing social activities and the reopening of the majority of economic sectors. But border controls and school closures will remain, while interstate travel and mass gatherings like religious congregations are still prohibited.

“I think the concerns I have are one of the major risk factors, which is for transport. I think it’s okay if you’re traveling in your own car, but a lot of us use public transport, like immigrants. We’re spending 30 to 45 minutes on the bus or LRT. I worry we haven’t thought through this,” Dr Amar said.

He also highlighted office tower blocks, where lift etiquette should be put in place, such as a maximum of four people at one time in an elevator, with each person facing away from each other and standing at four marked circles on the ground.

“It’s not just the government — people can get their act together, we need to take responsibility. Anyone can reach out to medical professionals for advice — both employers and individual employees,” Dr Amar said.

“Not just looking to the government to fix everything.”

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