Jemilah: With Delta, Impossible To Achieve Zero Covid

Dr Jemilah Mahmood proposes highly localised measures to curb Covid-19 outbreaks, as the highly transmissible Delta variant is unlikely to be fully contained.

KUALA LUMPUR, August 24 — Malaysia’s public policy approach to Covid-19 must shift away from the zero transmission model at the national level, although containment measures can be implemented in very localised settings, said Dr Jemilah Mahmood.

The former special advisor to former Prime Minister Muhyiddin Yassin on public health,said the current focus should be to get to a number that’s manageable and does not risk overwhelming the health system, while continually putting in place mitigation measures to curb potential outbreaks of the coronavirus.

“If we take an attitude that we can only move forward if we have zero cases or very few cases, then you’ll never be able to move forward. And we’ve seen the devastating impact that has had on society, on the economy, on social wellbeing, on education, everything. 

“I think we have to look at data at a very granular level and also look at very localised action. Why is it that Perlis didn’t have a case for the longest time, and yet schools were not allowed to open? Why do we penalise, for example, you know, a state which has low numbers by not allowing them to do a certain thing?” Dr Jemilah told CodeBlue in a recent interview.

“So, I think with an effective find, test, trace, isolate, support (FTTIS) system, you can then say okay, only in this area, we predict that it will be a bit out of control because the capacity of the hospitals is not high enough, or there could be a real risk because this area has a very high-risk population, for example, so then you can target and localise your action.”

Dr Jemilah said the nature of the Delta variant, which is highly transmissible and like many other viruses, can spread through aerosols, meaning that it is unlikely that the virus can be fully contained. Scientists say that people infected with Delta have about 1,000 times the number of viral particles, called “viral load”, in their nasal swab compared to those infected with another variant. Several studies also show that vaccinated people infected with Delta have similar viral loads as the unvaccinated. 

The World Health Organization’s (WHO) guideline on public health and social measures for Covid-19 classifies response capacity into four levels based on community transmission (CT) rates, which is divided from low incidence of locally acquired cases to very high incidence.

“When the CT level is too high, there’s no way you can contain the virus until everybody in that area is vaccinated, and then the case numbers come down. Only then can you start to do some containment measures.

“It’s like a tug of war (between mitigation and containment). But the approach now has got to be no longer about getting to zero. It’s about getting to a number that’s manageable for that locality and putting in mitigation measures so that it doesn’t spread,” Dr Jemilah said. 

“Importantly, we need to appeal to the public and regain their trust – we cannot win this battle with Covid-19 without behavioural change and compliance to public health measures.”

Malaysia’s daily infections continue to hit new highs, with a record 23,564 cases reported on August 20. Malaysia also has among the highest rates of confirmed daily Covid-19 deaths per capita on average — seventh highest globally at 7.54 deaths per million population on August 21 — despite having one of the world’s fastest vaccination rates per capita, according to data tracker Our World in Data.

While higher vaccination rates in some states like Sarawak led to a decline in hospital admission and mortality rates, the surge in new Covid-19 infections has prevented Sarawak from being overly optimistic. To date, about 90 per cent of Sarawak’s adult population has received at least a single Covid-19 vaccine dose, while about 85 per cent are fully vaccinated.

Meanwhile, in poorly vaccinated states where less than a third of their total populations are fully vaccinated, such as Kedah, Sabah, Johor, Kelantan, and Perak, Covid-19 intensive care unit (ICU) bed occupancy rates exceed 100 per cent. Kedah and Sabah are at 127 per cent ICU capacity for critical Covid-19 cases.

Breakthrough infections among fully vaccinated people more than two weeks after their second jab are also a cause for concern in Malaysia. The breakthrough rate hit a peak of 21.6 per cent of 22,948 daily Covid-19 cases on August 19, before declining to about 17.4 per cent of 19,807 daily Covid-19 cases on August 22.

Medical experts have long called for the government to focus on mitigation measures to prevent a fourth Covid-19 wave in Malaysia, amid a surge of infections.

Mitigation means no longer using containment measures like the Movement Control Order (MCO), but to ensure that the health care system is not under pressure and to protect people from developing severe disease or dying from Covid-19.

The former Perikatan Nasional (PN) government earlier this month announced that it will use Covid-19 hospitalisation rates, instead of daily Covid-19 cases, as one of the three indicators to allow states to move to the third and final phase of the National Recovery Plan (NRP). The two other thresholds – vaccination rates and ICU occupancies – remain the same.

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