Optimise The Circuit Breaker With Science Based Interventions — Dr Musa Mohd Nordin

We must fully utilise this two-week “circuit-breaker” to reset our public health strategies to ensure that the lockdown is optimised with science-based, anti-Covid-19 interventions.

1. Can you help explain why lockdowns are set based on two weeks, and not less or more?   

The objectives of a lockdown, the most extreme form of physical distancing is to:

  • Break the chain of transmission of the coronavirus by keeping the Ro (Reproduction Number) below 1
  • Help to mitigate, slow down, but not necessarily stop the spread.
  • Reduce the demands on the health care services and not overwhelm the capacity of the hospitals and ICUs.
  • Allow our health care workers and other frontliners a breather.
  • Allow the vulnerable among us, the senior citizens, those with co-morbidities, the OKU, those in nursing homes a fighting chance to survive the pandemic.

A total lockdown with a combination of quarantine of the entire population, closure of virtually all social, academic, economic, and religious activities is predicted to result in a reduction in hospital and critical care requirements within three weeks of its introduction.

In my opinion, the two-week period is an arbitrary and random number picked by the National Security Council (NSC) to give some semblance of authority and control over the pandemic management.

2. We need to work effectively in order for the next 14 days to yield some encouraging results. What should the government be doing concurrently to help bring the surging number of Covid-19 cases down?

We need to work not just effectively, but also efficiently, smartly, quickly and scientifically.

We must fully utilise this two-week “circuit-breaker” to reset our public health strategies to ensure that the lockdown is optimised with science-based, anti-Covid-19 interventions, sanitised from all forms of political interference.

There is a critical need for two major interventions:

  • Firstly, a Rapid Response Find-Test-Trace-Isolate-Support (FTTIS) pandemic management.
  • Secondly, a warp speed vaccine rollout programme to achieve population immunity.

3. How best can authorities carry out mass testing during the lockdown?

The big boys in the Ministry of Health (MOH) must first descend from their Putrajaya offices to ground zero and witness first hand how triaged mass testing is done.

With the SELangkah app, the hot spots have been identified. These are the areas which artificial intelligence and machine learning have predicted a high concentration of positive Covid-19 cases.

A team of 30 in PPEs are dispatched to the hot spot, which can cater up to 2,000 persons. From registration to the last stage of informing results, the work process is completely digitised.

Testing is undertaken with RTK-Ag. Results are obtained within 30 minutes and is uploaded within two hours onto the person’s handphone. It is then fed into the SIMKA (Sistem Keputusan Ujian Makmal Kesihatan Awam Kebangsaan), also known as the Public Health Lab Information Systems

If a person is Covid-19 positive, he is advised to report to the nearest Pusat Kesihatan Daerah (PKD) or the nearest Covid-19 Assessment Centre (CAC)

With the digitised and automated app, all his close contacts will be advised to act accordingly either to quarantine for ten days or access the nearest Covid-19 testing centre.

This digital workflow, unlike the MOH’s manual work processes, will unburden the health care workers, relieve them of laborious paperwork, and save them from calling up 400 to 600 close contacts per day.

The lockdown respite must be effectively used to clear up the backlog of contact tracing, enhance backward and forward tracing with digitised and automated FTTIS, and to ensure that the epidemiological link is detected so that we may return to mitigation and containment.

4. The government announced that it is planning to set up free Covid-19 Rapid Test Kit Antigen community screening test centres, including drive-throughs. In trying to achieve mass testing, do you think it should be done country-wide, and perhaps have RTKs made more accessible to the public?

Finally, the MOH has agreed to utilise the RTK-Ag, instead of its chronic obsession with the slow, expensive and laboratory-based PCR test kits. Better late than never!

My hospital was probably the first private hospital to offer drive-through Covid-19 testing, which we emulated from the South Korean experience.

And if you remember when the super-spreader Covid-19 Case No. 26 infected over 140 persons, it was our Covid-19 mobile team that drove to the GLCs, and tested all their panicky employees due to their close contact with Case No. 26

Since March last year I have pleaded to the MOH and the National Security Council (NSC) to cap the prices of surgical masks, PPEs, PCRs and RTK-Ag.

It fell on deaf ears. I suspected politically connected cronies selling all these basic Covid-19 necessities were laughing all the way to the banks.

RTK-Ag is simply unaffordable, costing between RM150-400, when the cost price is only RM20-30.

The Selangor state government made it free to all in the B40 group. And others could readily access them at SELCARE clinics and clinics designated by Members of Parliament at RM50-75 per test.

Empowering the rakyat to do self-testing at home would truly be a game changer which I am afraid neither the NSC, MOH nor the rakyat is ready for.

One of my colleagues as part of the Safe@Work initiative developed originally by the Selangor Task Force POIS Initiative (Prevention of Outbreaks at Ignition Sites) is already spearheading the saliva self-testing with RTK-Ag with a few manufacturing factories in Klang.

The factory workers are supervised on how to administer the test and are required to do the test twice per week. This is the way forward, to empower our rakyat, to empower self-risk assessment and to act responsibly, instead of the name and shame, compound and fine and the punitive methods of the present political governance.

The HIDE (Hotspot Identification Dynamic Engagement) big data analytics should be able to pin-point the Hotspots (like the SELangkah app) and direct the MOH to do targeted mass testing.

5. The aim is to have 1,000 GP clinics to administer Covid-19 vaccines by June 30. How much will this help the existing NCIP?

GPs and family physicians have been vaccinating adults before the top guns in the MOH and the Special Committee for Ensuring Access to Covid-19 Vaccine Supply (JKJAV( were even born. They immunised our parents and grandparents with the pneumococcal, meningococcal, influenza, chicken pox, and shingles vaccines which the MOH hardly ever did.

Not only they have the know-how, the skills and experience, there is also a wide network of clinics right across Malaysia, and most importantly they enjoy the trust and confidence of their clients which is like family to them.

One lady in responding to my tweet on GPs administering the Covid-19 vaccine wrote, and I quote:

“My grandma who is 81 years old did not want the vaccine despite everyone in the family telling her to get it. Her GP convinced her and did the registration for her on the spot.”

This is beauty and the legacy of the GP and the family physician since time immemorial.

And I trust them to take the National Covid-19 Immunisation Programme (PICK) to the next level.

6. In trying to ramp up vaccination, what do you make of the argument that mega vaccination facilities will only defeat the purpose because it encourages crowds which poses the risk of Covid-19 transmission?

I remember my paediatrician colleague in CHOP, Children’s Hospital of Philadelphia, Dr Paul Offit, who also sits on the ACIP (Advisory Committee on immunization Practices) of the FDA, who was very concerned that the pick-up rate of vaccination in the early days was terribly slow. He actually recommended that they open up the huge community halls, the football stadiums, the churches, the synagogues and mosques to ramp up the vaccine rollout.

Now in Arizona, they have the US army to assist at an efficient and effective vaccination centre doing right to nine thousand vaccinations per day with a capacity for 12,000 vaccines per day.

This is war! We need precision, disciplined, even regimented logistics. And who best to provide the state of the art logistics than the boys in uniform.

To the MOH and JKJAV I would say — do not be too proud to admit that you’ve lost the plot and require the assistance of other experts to get you out of the rut. Besides, plagiarism is the highest form of flattery. There are so many working vaccination models for you to choose from and imitate to suit our local circumstances.

The over-crowding at the vaccination centres is simply a logistical issue which can be solved outright, if they would only think through their workflow processes. Let me give an example:

I’ve been twice to the largest and busiest CAC at the Stadium Melawati in Shah Alam. 1,200 to 1,600 people were lined up and packed into the stadium. I advised the senior doctors to get out of the stadium, move along the crowds and/or create marquees outside the stadium and do the assessment in the cleaner air in the open space outside the stadium. And the following day the crowd was cleared by 2pm and they did not need to stretch their assessment until 6-7 pm.

7. Do you think, like in the first MCO, this lockdown will extend beyond the two-week mark?

George Santayana, the Spanish philosopher once said: “Those who do not remember the past are condemned to repeat it.”

The political and health leadership created this mess in September last year when they forced the Sabah state elections and condemned Sabah to its worst epidemic ever.

The MOH and NSC which everyday pleaded to the rakyat to follow SOPs did not follow its own SOPs and did not retest nor quarantine the Sabah returnees, resulting in spillovers into Peninsular Malaysia and unleashed the third Covid-19 tsunami.

For the past eight months, despites all the variables of MCOs and the EO (Emergency Ordinance), the MOH and the NSC have failed to tame the coronavirus.

And yet, despite the painful lessons from Sabah and the deadly third wave, the minister has the audacity to say that two million vaccines are being channelled to Sarawak to enable it to hold its state elections. This is not Covid-19 science. This is Covid-19 politics, and with this brand of political governance, the nation is doomed to a vicious cycle of lockdowns and Covid-19 waves.

So my short. politically incorrect answer is the lockdown will extend beyond the two-week period.

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

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