What’s The Science Behind Covid Colour Zone Indicators? Dzulkefly

By Kanmani Batumalai | 08 October 2020

Faster Covid-19 spread in densely populated Selangor has huge administrative and human resource implications, directly impacting livelihoods should any form of MCO be imposed.

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KUALA LUMPUR, Oct 8 — Former Health Minister Dzulkefly Ahmad called for the scientific rationale behind the number of cases used to determine Covid-19 colour zones, and subsequently, lockdown decisions.

According to the Ministry of Health (MOH), an area is classified red with 41 or more new local Covid-19 cases reported in the past 14 days, yellow denotes one to 40 cases, while green has zero new cases. Imported cases, including inter-district and inter-state cases, are excluded from the coloured zoning. Strict movement restrictions have been instituted in 10 red and yellow districts in Sabah, amid multiple coronavirus outbreaks and nearly 1,700 active cases in the country’s poorest state.

Federal authorities yesterday also announced a Conditional Movement Control Order (CMCO), effective from tomorrow, on the entire district of Klang, including Port Klang, in Selangor. The CMCO will see the closure of non-essential services, schools and places of worship, as well as prohibition of travel in and out of the area.

According to the Selangor Task Force Covid-19 (STFC), the district of Klang — which is 626.78 sq km large — has 79 active coronavirus cases (73 in the Klang mukim and six in Kapar mukim), excluding 24 interstate infections in the Klang mukim. As of yesterday, Selangor has recorded 249 active Covid-19 cases who are in treatment.

“The good thing with the current colour coding indicator is clarity. It is easy to differentiate between the zones based on round numbers,” Dzulkefly, who is also head of STFC, told CodeBlue in an interview last Saturday.

“What needs to be improved is the precision and usability. Why is 40 chosen as the threshold? Is it arbitrarily chosen? Is it based on any scientific inferences or consensus?”

However, Dzulkefly also suggested a few parameters to be made public when differentiating case burden, according to zone and states, to derive and surmise a comprehensive comparison of Covid-19 scenarios.

According to the STFC chair, the incidence or prevalence rate and population density in states or zones, as well as the amount of coronavirus testing done per 1,000 population, should be announced.

“To illustrate, the number of cases may be the same. It may have different case burdens, for example the infectivity rate (spread) and speed (fast) even of super-spreader,” he added.

The United Kingdom’s coronavirus alert level has five stages — Level One or green alert shows that the country is free from Covid-19, whereas level 5 or red level indicates the overwhelming risk of health care services in the country.

The Covid-19 reproduction (R) number, which indicates how fast the virus is spreading, and the number of reported cases at any one time determine the alert level in the UK. The R number refers to the average number of infections of a virus at the beginning of an outbreak within a society.

Singapore’s DORSCON, which shows the current disease situation in the country, has four colours — green, yellow, orange and red — and is used to declare the severity and spread of a disease, and the according general guidelines for each phase.

Dzulkefly stated that the infectivity of Covid-19 is also a function of population density, congestion, and urbanisation-interaction of workers. Therefore, any escalation of cases, including cluster-related or unlinked sporadic cases, happening in the community will lead to serious implications for a state like Selangor, the most developed state in Malaysia.

“Perhaps it is better and easier to be appreciated that one positive case in a congested residence area would surely have serious implications, as opposed to having one new case in a rural fishing village,” Dzulkefly explained.

“The epidemic implications in Selangor are clear. The spread is faster; it’s more difficult to track; people share the same facilities, amenities, public transport, shops, malls, banks, markets etc.”

Dzulkefly Ahmad, chair of the Selangor Task Force Covid-19

“It will cost a huge administrative and human resource implication, not to mention the direct impact on economics and livelihood of Selangoreans, should any forms of the Movement Control Order be instituted.”

In July, the Selangor state government allocated RM413.9 million through the Prihatin Economic Stimulus Package to address the Covid-19 impact in the state.

“There can be some policy options to respond to this possible escalation of outbreak and all with the goals to slow down the spread, to test more, and isolate and treat faster. These are the same things that we have done before. We also need to return temporarily to restricted operation hours for business,” said Dzulkefly.

It is to be noted that Selangor has banned all types of nightclubs and bars from operating beyond 11pm since October 3. According to Selangor Mentri Besar Amirudin Shari, the restricted operational hours were implemented under the CMCO by the National Security Council (NSC).

Dzulkefly also called for a more efficient, informative, and responsive contact tracing system that works for all levels, including health care workers, business owners, and ordinary citizens.

“We need to boost testing capacity; the state will have to re-ignite its community testing policy to support the current good works of MOH.”

Dzulkefly Ahmad, chair of the Selangor Task Force Covid-19

“We need to decongest our detention institutions, not only for the sake of the inmates, but for the staff and frontliners too,” said Dzulkefly.

According to Amirudin’s October 2 statement, Selangor will establish temporary detention centres for undocumented immigrants in suitable locations to reduce risk to health and safety fronliners.

MOH reported on September 29 a Covid-19 cluster — the Benteng PK cluster — that was discovered in a screening of undocumented immigrants in Klang, Selangor, with 15 positive cases, eight of which were foreigners, as of October 7.

The state also offered free Covid-19 screening to all Selangor residents who had a history of travel to Sabah between September 20 till September 26.

Dzulkefly mentioned that the state is not intended to do community testing for others, besides Sabah returnees, as of now.

“I think for now it is only for those returnees from Sabah. Additional coverage will be extended based on situation and after discussion with Selangor Task Force Covid-19 (STFC) and Selangor State Health Department (JKNS). I’m sure that will be always reassessed from time to time,” Dzulkefly said.

MOH announced that all Sabah returnees from September 27 until October 10 will have to undergo Covid-19 testing upon arrival at their destination airport. This decision was made after Sabah reported a surge in the number of positive Covid-19 cases over the past few weeks.

However, MOH already started reporting cases all over the peninsula involving returnees from Sabah a week prior since September 20.

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