KUALA LUMPUR, August 26 — Malaysia urgently needs a national Covid-19 testing strategy to reduce the risk of future small outbreaks as states begin to reopen, said Dr Jemilah Mahmood.
Dr Jemilah, former special advisor to former Prime Minister Muhyiddin Yassin on public health, said the lack of a robust testing, tracing, isolation and support system remains the weakest link in Malaysia’s pandemic management strategy.
She stressed that testing is necessary to stop Covid-19 transmission and navigate the nation’s transition from mitigation back to containment in specific localities when necessary. Contact tracing and isolation reduce the risk of the virus spreading into communities.
“I want to, first of all, say that Covid-19 is not over. What is happening very clearly is that we will have waves of outbreaks, but hopefully, the waves are small and very manageable, and patients don’t feel very ill as more people are vaccinated and our health system can cope.
“But it doesn’t mean that we should forget about testing. In fact, once the numbers come down and things are calmer, this is when our find, test, trace, isolate, support (FTTIS) becomes very important. This will allow us to go into containment again, which means we want a minimal number of cases of outbreaks,” Dr Jemilah told CodeBlue in an interview recently.
While test sampling has increased nationwide with over 21.8 million tests administered to date, the country’s positive rate remained in double-digits at 13.2 per cent yesterday, pointing to a severe case of under-testing.
National positive rates have exceeded 10 per cent daily since July 21, hitting a record high 15.17 per cent on August 16. The World Health Organization (WHO) recommends a maximum benchmark 5 per cent rate as an indicator of sufficient testing.
Citing Singapore’s TraceTogether system, the equivalent of MySejahtera, as an example, Dr Jemilah said Malaysia’s tracing methodology needs to be more automated so that persons who come into close contact with those who tested positive for Covid-19 can be quickly identified.
“In Singapore, they have something called TraceTogether, but you also have a token that you put together with your phone in your pocket, so that when you cross each other, if you’re a close contact, the token will ping to your phone. That way, you don’t miss any of the contacts, and you have an automated tracing approach.
“We need to use much more artificial intelligence and machine learning to be able to build models and predict, and it’s all available. There are experts in the country already doing it.
“But most importantly is that the Ministry of Health (MOH) must not try to do everything on its own. You must bring in external expertise to help look at the data more broadly, look at new ways of tracing, new ways of isolation, and then be very transparent with the public on the information as well,” Dr Jemilah said.
In addition to automated tracing, Dr Jemilah said a national Covid-19 testing strategy must also include comprehensive yet practical isolation and surveillance plans.
“FTTIS means to test, trace, isolate, and support. So, how do you make sure they’re isolated? What is our surveillance method for them to be isolated? Do we have a monitoring system where we can have community surveillance?
“We cannot just depend on MOH. The neighbourhood, state representatives (ADUN), village committees, enforcement officers, civil society organisations all have a role in ensuring that if you’re positive or close contact, you have to stay put at home.
“The other very important thing is support. How do you make sure you support the person who is being isolated? Do they have enough psychosocial support? If that person is a breadwinner, how will the family receive their provisions and food? This is where the community comes in.
“So, effective pandemic management, I would say the medical part is one aspect. But the biggest, and very important part of it, is community participation,” said Dr Jemilah, who is the founder of MERCY Malaysia.
“When I talk about governance, it is not just about the governance of leaders. It’s also about how communities are part and parcel of your overall structure because good governance means bottom-up and top-down,” Dr Jemilah said. “You need to have a complete governance system where every layer of society is held accountable and is responsible.”