Coronavirus Doesn’t Differentiate Between Family And Strangers: Experts

By Sharon Lee | 25 May 2020

Medical experts also urge the elderly not to congregate at places of worship.

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KUALA LUMPUR, May 25 — Public health experts stressed that Covid-19 transmits within the community without bias, as they expressed uneasiness about Raya visits and reopening places of worship.

Former Institute for Medical Research director Dr Fadzilah Kamaludin pointed out that the novel coronavirus doesn’t differentiate between family and non-relatives, even as the government has allowed people to receive 20 visitors at their homes — albeit family members only — on the first day of Raya.

“As an epidemiologist, I do not see any difference between family members of 20 and general people of 20. The virus does not recognise you as a family member, (and) thus you are safe,” Dr Fadzilah told CodeBlue in an interview.

Yesterday marked the first day of Hari Raya amid the Covid-19 pandemic. People have been sharing on social media pictures of gatherings of their extended family at home during the celebration.

Dr Fadzilah, however, separated the idea of visits and people, highlighting that it is the discipline of the people that is key in Raya visitations, and that visitation itself is not the main concern.

“Visits are not dangerous. It’s the people visiting or the host entertaining who must be disciplined enough to make sure the four pillars of control measures to break the transmission of the virus is maintained at all times, i.e. social distancing, hygiene, wearing mask and sanitising, and no hugging, et cetera,” she explained.

She further added that in all Aidilfitri gatherings, food is the main factor, and the way that the food is served should be an important consideration during the Raya celebration.

“Food should not be served buffet style, no self-service and must use disposable utensils. The gathering, with its laughter, talking and eating, (must) be done with social distancing. No handshake and (masks should be worn) at all times!

“What if the moment you open your mask, and the next person close to you starts coughing or sneezing or (is) talking (and) laughing? As we now know, Covid-19 cases can be asymptomatic. You are putting yourself at risk unnecessarily.

“Just cook the rendang and ketupat at your own home. Best is to ‘Stay Home, Stay Safe’,” Dr Fadzilah advised the public.

Dr. Christopher Lee, Deputy Director General of Health, Malaysia

Former Health deputy director-general Dr Christopher Lee said a “Raya cluster” was a real concern, especially with reports of more than 2,000 vehicles with passengers having tried to travel across state lines to visit their hometowns prior to the Hari Raya celebration, against advice from the government.

“I feel that (a) 20-pax gathering is of concern. It almost sound(s) like a provision for people to visit each other, (as if) less than 20 (people) is (an) okay sort of thing.

“Furthermore, this is happening in private homes, making it impossible to monitor. Instead, I feel we should have pivoted the distancing principle to fit the festivities by encouraging and promoting ‘virtual Raya visits’, especially those involving our elders,” Dr Lee told CodeBlue.

Echoing Dr Lee’s point of view, public health medicine specialist and associate professor of epidemiology at Universiti Malaya, Dr Nirmala Bhoo Pathy, said limiting visitors to 20 family members on the first day of Hari Raya would not prevent Covid-19 transmission during home visitations.

“In my opinion, the magic number of 20 does not mean anything. Twenty people gathering in a big mansion is very different compared to 20 people gathering in a 1,000-square feet apartment. We Malaysians gather during festivals for ‘makan-makan’,” Dr Nirmala told CodeBlue in an interview.

“Firstly, it is impossible to keep our face masks on while eating, and secondly, we will end up walking around the food table touching all the utensils used to serve food.

“In short, celebrating Hari Raya outside the immediate family circle is potentially catastrophic to the elderlies in the family and also other vulnerable family members,” she added.

Public health medicine specialist and associate professor of epidemiology at Universiti Malaya, Dr Nirmala Bhoo Pathy. Picture from Dr Nirmala Bhoo Pathy.

Malaysian authorities announced last week that as many as 88 mosques and selected surau in Federal Territories would be allowed to resume Friday prayers with a limit of 30 persons in the mosques at any one time.

Churches and temples in green zones will also follow suit to reopen on June 10 after the current Conditional Movement Control Order (CMCO) ends, with similar standard operating procedures (SOP) in place as the ones implemented at mosques.

Defence Minister Ismail Sabri Yaakob reportedly announced that places of worship would have an age limit of 12 to 70 years old for attendance at worship services, as cited by Free Malaysia Today.

The Council of Churches of Malaysia (CCM) has also decided to keep churches closed until movement restrictions are lifted on June 10, as reported by Malaysiakini.

Reduce Age Limit For Visitors To Places Of Worship

In response to the authorities’ decisions, Dr Nirmala said that most health care professionals would not agree with the government’s judgment to reopen places of worship; however, she also pointed out that people cannot be held in their homes forever.

“If you ask us, the health care professionals, majority will say ‘no’ to keeping places of worship open during a pandemic.”

Dr Nirmala Bhoo Pathy, public health medicine specialist and associate professor of epidemiology at Universiti Malaya

“I personally would have preferred all places of worship to stay closed (until) about two weeks after Hari Raya, when they can open up in stages. After all, praying at home is always an option in almost all religions, especially during times of disaster.

“Even in Saudi Arabia, the highest religious body had urged Muslims worldwide to pray at home during Ramadan in view of the pandemic,” Dr Nirmala said.

Dr Lee thinks that the government authorities’ decision to reopen 88 mosques with a 30-person limit is “clearly” their way of “gradually opening the tap”.

“There will be some risks as we open up our country (and) folks may disagree on which areas (or) sector(s) have a higher priority, whether it should be focused on the economy or other socially driven activities including religious ones,” said Dr Lee.

He noted that the authorities could monitor the places of worship and use the feedback to tweak the guidelines accordingly as plans to open up more religious activities gather momentum, explaining that “this phased approach would also allow the religious communities to get accustomed to the ‘new normal’”.

Dr Fadzilah expressed her view that the government authorities’ decision to open up places of worships is merely their quest to “balance the sentiment of the people,” adding that as a public health medicine epidemiologist, she looks at the order from two perspectives—the perspective of the people, and the perspective of health care management.

“We see more of elderly people going to the mosque or any religious centres. This is a normal human behaviour even at non-Covid times. The older you are, the tendency to be nearer to God and House of God is greater as compared to the younger ones, no matter what religion you hold.

“Thus, I fully understood why the authorities extended the age limit to 70 years. But, I do not personally support it. This is the vulnerable age group and from the statistics of non-communicable diseases (NCD) in Malaysia, (the) majority of Malaysians in this age limit have the three most common health problems, i.e. hypertension, diabetes and cardiovascular diseases,” said Dr Fadzilah.

National Health and Morbidity Survey 2015 – Ministry of Health, Malaysia

Similarly, Dr Lee also noted the elderly is one of the vulnerable high-risk groups for Covid-19 and added that people of all ages with comorbid conditions, such as NCDs, are also a vulnerable group. He further stated that he would encourage these vulnerable populations not to congregate for prayers at places of worship to minimise their risks.

Dr Fadzilah further added that the authorities could lower the age limit for visiting places of worship, and that the resumption of places of worship is a planned strategy before the reopening of the education sector.

“I see the opening up of the religious centres before the universities or schools as a planned strategy. The result and impact of reopening the mosque will allow us to respond on how to move forward, especially opening the education institutions. It will give us feedback on how to manage Covid-19 within the limits of health care capacity,” she said.

“If we do not plan well, we may be faced with the second and third wave that may be beyond the current stretched capacity. So, opening up the religious centres first as compared to schools and universities, to me, is a better option if we compare the numbers we may be dealing with,” Dr Fadzilah said.

“The second and third wave(s) are expected, but it will be manageable provided (that) everyone plays their role appropriately and effectively,” she added.

When asked about whether the government should rethink its decision on resuming operations at places of worship, Dr Nirmala pointed out that the constant change in government decisions can create confusion for the public.

“It is not a good idea to go back and forth with decisions, as this will reflect poorly on the government, and also create confusion. In fact, other governments from across the globe also face the same predicament, to open or not to open places of worship?” said Dr Nirmala.

Statistics on the Sri Petaling mosque Covid-19 cluster as of May 24, 2020. Graphic from the Ministry of Health.

She further emphasised that the government can no longer make mistakes in the nation’s public health effort against the Covid-19 outbreak, noting that the country’s previous misstep related to the Sri Petaling tabligh Covid-19 cluster caused nearly half of the nation’s coronavirus cases.

“Since our government had made the decision to allow congregational prayers to restart (on) May 15, they must remain vigilant.

“They can’t afford to make any more mistakes, bearing in mind that close to 50 per cent of our detected cases came from our previous blunder, i.e. the Sri Petaling cluster. The relevant ministries must therefore work closely and there is absolutely no room for slip-ups,” she said.

The Ministry of Health said as of yesterday, 3,369 (or 46.5 per cent) of 7,245 confirmed Covid-19 cases in Malaysia came from the tabligh gathering at Sri Petaling mosque in early March. Over 1,000 of those cases had personally attended the tabligh event, while some 1,100 cases were the direct contacts of those participants (also known as the first generation of spread), and another 900 people had been infected by the contacts of the participants (second generation).

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