Covid-19 Immunisation Within The Context Of FTTIS — Dr Musa Mohd Nordin

By CodeBlue | 26 February 2021

The present FTTIS as implemented by the MOH is neither rapid, efficient, effective nor impactful.

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Three Chinese nationals who previously had close contact with an infected person in Singapore, comprised the first cases of Covid-19 reported by Malaysia on January 25, 2020.

The first local case was confirmed 10 days later on February 4, 2020. The patient was also infected while attending a conference in Singapore.

He passed it to his younger sister, who became the first case of Covid-19 acquired by local transmission.

This started the first wave of Covid-19, which had a total of 22 cases.

It is pertinent to note another milestone in the pandemic, which happened on February 24, 2020, which triggered the collapse of the Pakatan Harapan government

Three days after the Sheraton Move, Malaysia experienced the second wave on 27 February 27, 2020. There were no cases during the preceding 11 days.

tablīgh ijtimā gathering was held in Kuala Lumpur from February 28 to March 1, 2020.  The tablīgh cluster became the single largest cohort of Covid-19 cases in the second wave (40 per cent) and contributed to 23 per cent of Covid-19 deaths then.

And due to the grassroots appeal of the tablīgh persuasion, the disease quickly spread to every state, spawning a five-generational spread and multiple sub-clusters.

Malaysia then became the a hotspot for Covid-19 in Southeast Asia and spread the coronavirus to other countries in the region.

The Sri Petaling tabligh gathering cluster, which precipitated the second wave, officially ended on July 8, 2020.

The rakyat and leaders basked in their triumph over the coronavirus, and failed to capitalise on the opportunity to put in place serious long -erm plans to keep the virus at bay, pending the availability of safe and effective therapeutics and vaccines.

A senior minister in the government even declared: “It was a good omen (nasib baik) that the Pakatan Harapan government was not ruling, otherwise there would be more deaths due to Covid-19”.

The celebrations came to an abrupt end with an explosion of new cases registered in the Benteng Lahad Datu cluster in Sabah and the Tembok cluster in Alor Setar, Kedah.

The other super-spreader event was the state election in Sabah. The nation has yet to recover from this third wave, despite the imposition of the second Movement Control Order (MCO), reinforced with the Emergency Ordinance (EO) on January 12, 2021, the country’s fifth emergency since its independence in 1957.

Both the MCO and EO could be viewed as an indication of the failure of the government to curb the spread of the coronavirus.

Profoundly disturbed by the failure to adhere to good science to manage the pandemic, 46 top physicians in the country submitted a 10-prong strategy to the Prime Minister to save the nation. Except for a token reply, nothing else has happened since their submission on January 7, 2021, which is nearly 50 days ago.

The euphoria surrounding the arrival of the Pfizer-BioNTech mRNA vaccine in Malaysia on February 24, 2021, must not distract us from the number of new cases registered every day, which hardly bent the pandemic curve.

The trajectory of the pandemic continues to track upwards. I wish that the downward trend witnessed the past few days was real, but I cannot dismiss the fact that the decline in the number of new cases is actually related to the decreased number of tests carried out by the Ministry of Health (MOH), i.e. the self fulfilling philosophy of less tests equals less cases.

This thought is similar to that voiced by Prof Awang Bulgiba in an article from February 24, 2020.

Ever since the onset of the third wave in October 2020, the positive test rate has hovered between six to ten per cent, which well exceeds the World Health Organisation (WHO) benchmark of more than five per cent, which signifies that the pandemic is not under control.

Most of the better performing nations like Singapore, New Zealand, Australia and Thailand have posted a positive rate of less than 3 per cent. In fact, Malaysia at the height of its successful control of the second wave clocked a positive rate of less than one per cent.

Until and unless the basics of pandemic management is put in place, we will not be able to contain the outbreak and enjoy the optimal effects of the vaccine rollout.

There is an urgent need to transform the Find-Test-Trace-Isolate-Support (FTTIS) towards surveillance and prevention so that the MOH can always remain ahead of the pandemic curve.

This can only be achieved if the following pillars of the FTTIS are functioning optimally and quickly.

Three out of five Covid-19 cases do not show symptoms. They are either asymptomatic or pre-symptomatic. The MOH previously only tested those with symptoms, which would miss 60 per cent of the cases which would silently spread the disease. So the MOH must seek out both those with and without symptoms.

The public must be informed of the salient features of Covid-19, why they need to be tested and where they can get themselves tested. The SELangkah app has been able to detect hotspots and conduct targeted and mass testing campaigns.

Secondly, the MOH needs to shift away from PCR for surveillance tests and instead utilise RTK-Ag on a much larger scale than presently done. The RTK-Ag test results can be obtained within an hour at the point of care or a day at the latest, instead of the current three days.

And we need to ramp the test umbers to drive the positive to below the 5 per cent WHO benchmark. All the positive cases must be appropriately advised and informed as to what needs to do done next.

80 per cent of the contacts of the index cases must be traced within two days, instead of the present four to seven days, if they are even traced at all. The MOH has admitted to the failure of its manual contact tracing methods. Again, SELangkah utilises data science and machine learning to perform digital contact tracing, which has reduced the need for manual labour, increased the speed and accuracy and reduced the backlog of cases. This digital system also detects the sporadic cases before they spread to become clusters. Therefore, unfettered access to national data is critical.

To suppress Covid-19, we must isolate cases and quarantine contacts within two days instead of the present seven to ten days. Category One and Two cases can be isolated at home with close digital monitoring by health care professionals. Immediate transfers can be arranged for worsening cases.

Those who cannot quarantine at home can be referred to the Low Risk Centres. They must be provided with financial support for their lost incomes. They and their families should be provided with food and basic essentials such as masks and sanitisers.

Health care workers must follow up to check on their wellbeing. We should also empower the local community to provide support to their affected neighbours.

All of these basics of FTTIS are critically dependent on the availability of data sets, namely:

  1. To find hotspots to undertake targeted mass testing.
  2. To automatically upload test results into SIMKA (Sistem Informasi Makmal Kesihatan Awam).
  3. To do digital tracing of contacts.
  4. To do online admissions or bookings for isolated cases.
  5. To do digital monitoring of cases in home quarantines.
  6. To provide support to the needy.

It is obvious that the present FTTIS as implemented by the MOH is neither rapid, efficient, effective nor impactful. This has been pointed out repeatedly by various concerned doctors but has fallen on deaf ears.

The MOH is expecting the vaccine delivery to contribute to the falling numbers of daily cases and hence pacify the very anxious rakyat.

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