Endemicity: Hopes And Pitfalls — Dzulkefly Ahmad

The word “endemic” has also been unintentionally misused to invoke misplaced complacency with safety or an end to the pandemic.

It has been over a week now since the announcement on Malaysia’s transition to endemicity was made by the Prime Minister. With it, all restrictions on business operating hours and 50 per cent capacity limits on social events will be removed and prayer activities allowed without physical distancing.

Doubtless, we all welcomed and embraced this with great delight and a long sigh of relief. It is perfectly understandable.

Simply put, it is a reflection of how tired and sick we were with the many movement control orders (MCO) and, especially, of the long poorly executed MCOs that had taken huge tolls on our lives, livelihood, and the national economy.

Arguably, the very mention of the word “endemicity” conjures such a therapeutic effect on the public, equivalent it may be to that of the potent anti-viral drug for Covid-19, Paxlovid.

But to politely remind us all, let me quote Mike Ryan, the executive director of the World Health Organization’s (WHO) health emergencies programme, who recently said: “‘Endemic’ in itself doesn’t mean good or safe. It just means that the SARS-CoV-2 virus is here forever. It also means it can still spread, it can still hurt and it can still kill.”

To cite some examples, influenza and the four human coronaviruses that cause the common colds are also endemic. So are dengue, malaria, and polio.

Very unfortunately, though, the word “endemic” has also been unintentionally misused to invoke misplaced complacency with safety or an end to the pandemic.

The current context of Covid pandemic management in our country warrants a critical appraisal. Quite ironically, the transition to endemicity was announced during record numbers of Covid cases, which have yet to show any signs of real decline.

Acceptable baseline pandemic metrics, stability, and predictability are arguably key factors in determining endemicity. Perhaps only the Ministry of Health (MOH) is privy to make more accurate predictions of numbers based on their SEIR mathematical model, known only to themselves.

The good news, however, is that the Omicron surge in other countries peaked within six to eight weeks and, thereafter, dropped sharply. This means that Omicron peaks faster and similarly drops faster than the Delta variant.

But the bad news is that our ventilated and intensive care unit (lCU) patients are at a three-month high. Our Covid deaths and particularly our brought-in-dead (BID) are at a four-month high and numbers are unabating. Another 105 people died on March 17, which brings us to an average of 87 people dying daily, due to Covid this week alone.

Although the good news is that 99.5 per cent of all news cases in Malaysia are in Category 1 or 2, thanks to the high vaccination rate plus boosters, the surge in cases may eventually overwhelm our public hospitals, by sheer magnitude of numbers.

In view of that eventuality, l would want to join the chorus of critique that the government and, especially MOH, must take cognisance of and articulate clearer directions and measures as follows (beyond the appropriate SOPs of masking, physical distancing and TRllS):

Firstly, rather than emphasising on getting a booster dose for everyone (and stop talking about the fourth dose for now), focus our resources on a Vaccination Mopping Strategy and intensify work on the vulnerable as a mitigating strategy to lower death numbers and BIDs.

Secondly, despite the fact that Omicron is less virulent, sadly, we are not seeing BID numbers falling. We should have learnt from the Delta wave that we must be focused on aggressively managing symptomatic patients, especially senior citizens with comorbidities and effectively mitigating them from dying before arrival at health care facilities.

Thirdly, improve case management at the primary care level and even at home (Home Surveillance Order) and effectively engage the network of private clinics nationwide as part of our primary health care system.

Fourthly, enhance public health care capacity, including human resources at the primary care level, and upgrade our infrastructure and technology, so as to be capable of detecting and managing any future epidemics within an “endemic” state.

Fifthly, enhance genomic surveillance to detect introductions of new variants. The MOH must undertake to conduct full genomic sequencing, on at least 2 per cent of positive samples as advocated by the WHO, so as to be ahead of the curve in identifying new variants in the endemic phase.

Finally, we must tell ourselves that the next potent variant is coming, even more pathogenic than the BA.2 Omicron sub-variant. Only this way will we actually prepare our public health infrastructure, our pillars of response, and our clinical resources.

Countries need to learn lessons. Malaysia must not be too bold in what she knows not — that is the future.

We must place great emphasis on a plan, a health minister who is guided and committed to uphold science and leverages on public health experts rather than kowtowing to political pressure.

We have to ensure that our next steps forward are for real and put our national health, economy, and livelihoods at the forefront of a holistic reform policy.

Transitioning to endemicity will be the most favourite and welcomed phrase for now. Let us together undertake this journey responsibly and reboot our national economy sustainably and better.

Dzulkefly Ahmad is the Member of Parliament for Kuala Selangor, chairman of the Pakatan Harapan health committee, and a former health minister.

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

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