80% Community Immunity Is Not Enough, Minister (Part 2) — Dr Musa Mohd Nordin & Asst Prof Mohammad Farhan Rusli

Excess Covid-19 mortalities and brought-in-dead cases can be mitigated with earlier and better medical intervention and a social security net.

There are essentially four tools to tame the pandemic. These are:

  • Vaccines.
  • A national testing policy that pivots on rapid test kits.
  • Improving indoor air.
  • The pandemic trio of masks, physical distancing and hygiene.

In Part One, we deliberated on ramping up the vaccination rates to at least 90 per cent of the population, whereby a large enough critical mass in the country is immune, thereby conferring indirect protection to the unimmunised cohort of the population.

Only then we can protect the nation from recurring surges of the coronavirus, which would only cease or dwindle when virtually everyone has achieved immunity either through vaccination or infection with the virus, preferably the former.

An equally critical prerequisite before we transition from the pandemic phase to the endemic phase, apart from the vaccination rate, is to ideally stop the transmission of the virus, as what was done in the zero Covid-19 strategies undertaken by China, New Zealand, and at one juncture, Australia.

Malaysia has lost the plot since October 2020, and should now endeavour to mitigate the viral transmission to an acceptable baseline rate. This would mean the authorities would need to agree upon the maximum numbers of hospitalisations, ICU admissions, fatalities and the chronic numbers of long Covid cases which are acceptable and tolerable.

In the Australian model, with 90 per cent of adults vaccinated (to help explain the health minister’s concept of adult herd immunity, they anticipate:

  • 77,000 hospitalisations.
  • 21,000 deaths.

However, with 90 per cent coverage of the population (adults, adolescents and children), these so-called ‘tolerable’ numbers are reduced to:

  • 31,000 hospitalisations.
  • 10,000 deaths.

A third booster with an mRNA vaccine would improve the outcomes further with:

  • 18,000 hospitalisations.
  • 5,000 deaths.
  • 40,000 long Covid cases.

We need excellent data collection and analytics for this kind of modelling, but alas, it was like déjà vu yesterday when the health minister admitted that “the high number of Covid-19 deaths reported daily does not reflect the actual number of fresh deaths that occur within 24 hours”.

On January 30, 2021, we wrote; “Yesterday Malaysia was in panic mode, triggered by the humongous Covid-19 numbers. Chill out Malaysia! It is not real-time case numbers. These are just backlog cases only just being reported.”

These are all symptomatic of the failures of the Ministry of Health’s (MOH) tracking and reporting systems, which is highly regrettable, since we are now at least 20 months into the pandemic.

The repercussions can be clearly seen in its failure to efficiently and effectively implement the second strategy to tame the pandemic, which is Find-Test-Trace-Isolate-Support (FTTIS).

This is a critical public health intervention programme with a national testing policy that pivots on rapid test kits in order to safely transition to the endemic phase with tolerable case numbers, hospitalisations, brought-in-dead (BID) cases, deaths and long Covid cases.

With the lacklustre reporting system and sub-optimal FTTIS programme, it would not be wise to rush into the endemic phase, with the minister’s below-par “80 per dent adult herd immunity” assertion.

Reporting tells what has occurred in the past and gives no added value to pandemic response. Predictive analysis is what matters as it looks into the future, enabling us to be ahead of the virus and the pandemic curve.

Key [erformance indicators must be set for the rapid and accurate reporting of data, hence the introduction of digitalisation with the elimination of ineffective and archaic manual methods. There needs to be a summary reporting mechanism first so that the data is as “fresh and contemporary” as possible, with a timeline of seven days for a full report that can be furnished later for recording purposes.

The health minister, like his predecessor, cannot be continually blaming the backlog of cases every time the MOH is unable to explain the spike in cases, deaths or BIDs.

Regardless of case backlogs, the deaths are not declining, BIDs are persisting, and the final fatalities are among the worst per capita mortalities in the world.

The only sure way of reducing morbidities and mortalities is to stop or massively reduce the community spread of the coronavirus, which we have alluded to as the raison d’etre of the FTTIS programme.

There is an urgent need for BID granular data to be assessed thoroughly by experts so that we can develop a model that may help create patient profiles that will ensure the reduction of BIDs immediately.

Working on behalf of the National Health Service (NHS) in the United Kingdom, researchers examined approximately 17.5 million records of individuals, with 17,063 dead from Covid-19 and 134,316 from other causes.

They concluded that Covid-19 multiplies existing risks faced by patients. “Identifying the unique factors contributing to the excess Covid-19 mortality risks among non-white groups is a priority to inform others to reduce deaths from Covid-19”.

Our best guesstimate is that the marginalised population among the B40s, refugees, migrant workers and undocumented migrants are the major contributors to the excess Covid-19 mortalities and the BIDs. These can be immediately mitigated with earlier and better medical intervention and a social security net.

Dr Musa Mohd Nordin is a paediatrician and Asst Prof Mohammad Farhan Rusli is a public health physician.

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

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