Covid-19 Testing, Quarantine, Preventing Deaths — Dr Musa Mohd Nordin

By CodeBlue |

We need to very quickly immunise our population to achieve herd immunity and prevent super spreader strains from incubating.

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  1. The government has sought to clarify SOPs around ministers’ quarantine periods, saying they would only need to quarantine for three days, provided they strictly follow a “travel bubble itinerary”. Do you agree with this provision?

The ministers’ three-day quarantine period is not based on evidence-based science.

And we know only too well that when politics overrides science, we are headed for disaster, as what has happened in the US, when former president Donald Trump’s pseudoscience has led to the US leading the world with 28 million cases and half-a-million deaths.

The incubation period for Covid-19, which is the time between exposure to the virus and the appearance of symptoms is between five to six days, but can be as long as 14 days. The risk of transmission is extremely low (~1 per cent) after 10 days with monitoring and testing in place.

The Centers for Disease Control and Prevention (CDC) notes that the shortest period for quarantine is seven days if one receives a negative test result. This is practised in France. Therefore, three days is not only insufficient, it is actually potentially dangerous.

With the presence of super-transmissibe mutants of Covid-19, notably the UK B117 and South Africa’s B1351 and Brazil’s P1 mutants, it is extremely important that we maintain strict border controls to prevent importation of these strains.

If the minister returns from a foreign trip and is infected with one of these variants, and is allowed to roam free after three days, he will be spreading the mutant strain to the public and become a super-spreader.

The SOP of a ten-day quarantine period must be practiced to ensure that the mutant strain is not allowed to escape into the community. The Exemption Order must be revoked. It threatens the national effort to curb Covid-19 and especially in preventing the entry of dangerous mutant strains into our country.

We need to very quickly immunise our population to achieve herd immunity and prevent the super spreader strains from incubating here as it has created havoc in more than 82 countries.

  1. On Tuesday, the government announced that restaurants may now allow dine-ins again. This has sparked some mixed reactions online. While some welcomed the move, others expressed that our cases are still too high. Where do you stand on the latest relaxations of restrictions?

The guiding principles in this issue is related to the following; the more an individual interacts with others, the longer that interaction, the closer the distance and without masks, then the higher the risk of transmission. Dining in indoor spaces with inadequate ventilation carries 18 times the risk of transmission than outdoors with good ventilation.

The lowest risk in the food and beverage is limited to drive-throughs, deliveries and take-outs. The highest risks lie with on-site dining with indoor seating.

This risk can be further stratified according to the Infectivity Rate (IR) in any specific district or state. This utilises metrics called Infectivity Rate by Acute Cases or Incidence Rate.

For example, Malacca, Sabah, Negri Sembilan, Penang, Sarawak, Terengganu, Perak, Kelantan, Kedah, Pahang and Perlis have an IR that is lower than the Malaysian average of 1.6 per 1,000. The risk of someone getting infected by Covid-19 in theses states is less than 0.16 per cent or one in 600 persons.

However, the risk of someone getting infected by Covid-19 is three times in Kuala Lumpur, two times in Selangor, Putrajaya and 1.5 times in Labuan and Johor. Therefore it seems sensible to allow dining, preferably outdoors, with SOPs in all states, except these five.

  1. In any case, surely decisions around what SOPs to implement must be based on data. And we haven’t really seen many clusters of Covid-19 cases among diners, but rather, most have been centred around workplaces. Do you have a clear sense of the yardstick the government is using to set SOPs?

Digital apps that utilise data science, AI and machine learning should be able to do the risk stratification and advise us whether it is wise or not to dine outdoors. In fact, not just for dining but most other activities such as:

  • Meeting friends and family
  • Going to work
  • Activities in schools and nurseries
  • Activities during our leisure time
  • Shopping
  • Attending places of worship, funerals and weddings
  • Travelling

We are already one year into the pandemic. I think there is really no need for these daily press conferences by the Senior Minister for Security or the Ministry of Health. It is not helpful when the SOP changes from day to day.

Instead, by using my handphone SELangkah or MySejahtera app, I should be able access the following information daily:

  • The risk of getting infected by Covid-19 in any given district or state
  • The trends of Covid-19 cases in any given area
  • What SOPs to follow
  • The risk of getting infected by Covid-19 in other districts or states

4. One measure to assess whether we’re testing enough for Covid-19 is by looking at the share of tests that are positive. And Malaysia’s share of positive tests have been above the World Health Organisation (WHO) recommended level of 5 per cent (as of early February, we are about 8 to 9 per cent). So why do you think there has been insufficient testing, as this measure suggests? Is the system just overwhelmed?

The WHO benchmark of positive rates is less than 5 per cent, which means that the outbreak is well under control.

Malaysia’s positive rate since the onset of the third wave has hovered between 6 to 9 per cent. This is much higher than Thailand, South Korea, Taiwan, Singapore and New Zealand, countries which are doing very well in containing the pandemic.

The Ministry of Health (MOH) says that the number of cases will go down to double digits soon. This is not much different from Trump’s pseudoscience. If you do less tests, you will get less cases.

We are only doing about 50 to 60 thousand tests per day. The MOH plans to ramp to 200,000 tests per day.

To meet the WHO benchmark of 5 per cent, we expect to see 5 per cent of 200,000, that is 10,000 cases per day But we are only registering three to four thousand cases per day. This means we are either under-testing, under-detecting or under-reporting.

The public health test of choice for surveillance is the Rapid Antigen Test RTK-Ag. The Turn Around Time (TAT) is one hour, so you can immediately isolate and do contact tracing, which will lead to a rapid response in our Find-Test-Trace-Isolate-Support (FTTIS) strategy.

The MOH has a flawed obsession with Polymerase Chain Reaction (PCR) testing. The PCR is not a one-size-fits-all test, but admittedly, it is the test of choice for confirmation and clinical diagnostic purposes in a hospital setting.

  1. You have also highlighted that it’s perhaps not as useful to know the cumulative number of Covid-19 cases or deaths because it doesn’t give us an accurate illustration of how widespread it is. What metrics do you think the government should focus on instead to ensure clearer communication?

The daily cases count by the respective states does not paint a true picture of the pandemic.

Of course Selangor will register the most number of cases because of the folliwng reasons:

  • There is a large population in Selangor, 6.57 million exactly. About one in five Malaysians live in Selangor.
  • It is the most industrialized state, contributing 24 per cent to Malaysia’s GDP.
  • Most industries and construction sites are here.
  • There are one million registered migrant workers in Selangor, and another one million unregistered workers.
  • There are 100,000 refugees who live in the Klang Valley. Both migrant workers and refugees contribute heavily to Covid-19 outbreaks.

The best way to illustrate the transmission of Covid-19 is through the use of incidence and prevalence rates. Active cases per 1,000 population can tell us the incidence rate of Covid-19, which is the likelihood of you getting infected by Covid-19.

Cumulative cases per 1,000 population tells us the prevalence rate of Covid-19, which is the number of persons in any state getting infected by Covid-19 at any given time.

  1. In recent months, the MOH has also allowed for some patients to be quarantined at home. This has led to some concerns over deaths of patients at home. How can this be avoided?

Category One and Two cases, i.e. asymptomatic and mild cases can be isolated at home with clear SOPs. All Category One and Two cases must register with SELangkah or MySejahtera, so that they can be assessed and provided with home kits, which must include the following:

  • Face masks
  • Hand sanitisers
  • Info pamphlets
  • Food vouchers for B40, the unemployed, and those involved in day jobs

Saturation monitors, including training and monitoring, is reserved for high-risk patients. All high-risk positive cases must be assessed to decide whether they need to be admitted to quarantine centres or Covid hospitals.

In Selangor, every contact related to positive cases will be notified by the SELangkah App and they can be tested at community mass screenings or SELcare panel clinics (B40 are provided with free testing vouchers). Others can get it at an affordable price of RM50-70 per test, compared to RM150-280 at private centres.

The Covid Symptom Monitoring System (CosMoS) is a home monitoring service for patients diagnosed with Covid-19. It allows health care providers to monitor symptoms closely. An over-the-phone consultation service is provided if symptoms get worse.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
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