Explainer: Why MOH Is Relaxing Close-Contact Quarantine During Omicron

MOH is using a mitigation rather than containment strategy, as severe Covid cases and deaths are increasing at a much slower pace than surging infections amid high vaccine coverage.

KUALA LUMPUR, Feb 28 – At first glance, the Health Ministry’s new quarantine exemption for asymptomatic boosted close contacts appears paradoxical – looser protocols for Omicron, a more contagious coronavirus variant than Delta.

Starting from March 1, adults who do not show symptoms and who received a Covid-19 vaccine booster do not need to quarantine at home; they only need to self-test with an antigen rapid test kit (RTK) on the day of their exposure to a positive Covid-19 case, which is counted as Day One, and again on Day Three.

Health Minister Khairy Jamaluddin tweeted that three vaccine doses are more than 90 per cent effective compared to two against Covid-19 infection.

Several European countries have also relaxed Covid-19 rules, with England lifting all legal restrictions, including dropping quarantine requirements for those infected with the coronavirus. In its “Living with Covid” plan, England has also ended routine contact tracing; close contacts will also no longer be advised to self-isolate or to take daily tests.

Similar to Malaysia, the United States does not recommend quarantine for close contacts if they are up-to-date on Covid-19 vaccinations, including getting a booster shot, unless they develop symptoms. Testing is recommended for people exposed to Covid-19 at least five days after their last close contact with a positive case, even if they don’t develop symptoms.

In the past two years of the pandemic, Malaysia’s Ministry of Health (MOH) previously mandated quarantine for close contacts, including those who didn’t show symptoms, because its public health strategy then was “containment”.

The objective of testing, contact tracing, and quarantine then was to contain outbreaks as much as possible, with an eye on eliminating the virus, by preventing asymptomatic people who were unknowingly infected from going out and infecting others.

However, like most other countries around the world, Malaysia has abandoned its “zero Covid” strategy in the face of an extremely transmissible virus and prepares to live with Covid-19 as an endemic disease.

Only China and Hong Kong are maintaining their “zero Covid” strategy, but the Omicron wave is testing the limits of Hong Kong’s stringent quarantine measures, sudden lockdowns, and mandatory tests. The Chinese territory reported nearly 50,000 Covid-19 cases over the past 14 days, Al Jazeera reported last Thursday.

What “living with Covid” means is that it’s acceptable for people to catch Covid-19, as long as hospitals are able to handle the number of seriously sick patients coming in every day.

There is no need to curb outbreaks by quarantining close contacts because people who have received a third vaccine dose and those without symptoms are considered the least likely to have caught Covid-19 and to spread the virus.

But even if this happens, it’s still okay because most of these infections will probably be “mild” – at least milder than the Delta variant that sent thousands to hospital requiring oxygen support – and people will be able to recover at home, since nearly all adults have been fully vaccinated. More than six of 10 adults nationwide have received boosters.

MOH’s focus on symptomatic cases now during Omicron, compared to previous waves of the epidemic, is to enable early diagnosis (via testing) and treatment to prevent deterioration and death from Covid-19, with lower priority on reining in the spread of infection. In other words, this is the “mitigation” strategy – to prevent serious impact of disease, rather than infection itself.

So far, it looks like the Malaysian public health care system has been able to cope with Omicron despite record-high daily case tallies – over 32,000 on February 24 – superseding the Delta peak last year. Unlike the Covid-19 crisis that overwhelmed the Klang Valley health care system in July 2021, hospitals now seem to be able to handle the number of daily new admissions.

Hospitals now can even continue non-Covid care despite soaring coronavirus infections, which was impossible during the Delta wave that forced the suspension of surgeries and non-Covid procedures to manage the deluge of sick Covid-19 patients.

Khairy also noted that many patients coming to hospital now are people who were admitted “with” Covid, rather than “for” Covid, as they sought treatment not for Covid-19, but for other health problems. They just happened to be found with Covid when they tested positive for the virus, as part of hospital testing protocols for incoming patients.

This means that even Covid-19 hospital admission trends may be an overestimation of the severity of the epidemic as many of these cases – still manageable at current levels – are actually receiving care for something else, unlike during Delta when admissions were of patients who needed treatment for Covid-19.

Ventilated Covid-19 patients, those in the intensive care unit (ICU), and daily fatalities – although on an upward trend – are a fraction of numbers seen during the height of the Delta wave. Covid-19 patients also have shorter hospital stays now, with soaring discharge rates.

The government had also considered the economic cost of continuing a mandatory quarantine policy for close contacts of people with Covid-19 during Omicron, as more than 20,000 people are catching the virus every day, mostly mild infections.

Many Malaysians work in the informal sector, so five days’ of self-isolation means five days of lost wages. Employed individuals also may be forced to use their medical or annual leave to comply with mandatory quarantine.

Unlike the UK government that provided £500 (RM2,816) self-isolation support payments to employees, the self-employed, and those who cannot work from home and will lose income as a result of quarantine, among others, the Malaysian government provides no financial assistance to people required to quarantine either because they tested positive for Covid-19 or because they’re a close contact.

Lastly, compared to Europe where many governments are completely scrapping all, or nearly all Covid-19 restrictions, such as Sweden that is even dropping Covid-19 testing, Malaysia still maintains mask mandates in public areas.

Masks are critical in helping to prevent Covid-19 infection, especially in indoor spaces with poor ventilation. Khairy recommends wearing high-quality face masks like the N95 or KF94.

Vaccinations have kept most out of hospital or the intensive care unit with severe Covid-19 disease, despite surging infections, with this “decoupling” effect one of the key factors behind MOH’s decision to relax its quarantine policy.

What we’re seeing now with Omicron is not the same as what we experienced with Delta, paving the way for Malaysia to transition into resuming pre-Covid life as normally as possible.

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