KUALA LUMPUR: Malaysia needs to re-strategise its Covid-19 containment measures by adopting a more targeted approach instead of broad sweeping restrictions nationwide. 

Experts said a targeted approach aimed at the worst-hit areas would not only be more effective at saving lives but also minimise the impact on the physical, mental and financial health of the vast majority of the population.

Former Health deputy director-general Professor Datuk Dr Lokman Hakim Sulaiman believes a targeted approach would work better at this stage of the Covid-19 pandemic as the number of daily fresh infections had failed to see a significant drop despite a month-long total lockdown. 

Dr Lokman, who is also a public health expert and epidemiologist, said the overall situation in the epidemiological week 25 (June 20 to June 26) showed a "very worrying trend", indicating that Malaysia has reached a critical level.  

He said the positive rate for Covid-19 tests last week (week 25) was 8.5 per cent, exceeding the World Health Organisation's recommended positive rate of less than five per cent, which meant that Malaysia had been under-testing. 

"It has been more than six months (since Jan 13) when interstate travel in the Klang Valley has been banned and over a month since the total lockdown has been implemented nationwide, but the Covid-19 situation has not shown any positive change, which means we are still failing. 

"I do not think it is because the people failed to comply with the standard operating procedures (SOP). For over a month, supermarkets, recreational parks, mosques, surau, schools and universities are closed, but Covid-19 has not subsided. Why?

"I urge the government to seriously consider taking a targeted lockdown instead of a blanket lockdown nationwide.

"There are districts and sub-districts that have not reported any Covid-19 cases since the beginning. Why is the District Outbreak Committee not empowered to conduct a risk assessment and determine the SOP of each sub-district? They know their regions better."

Dr Lokman noted that the number of cases jumped by 10,000 in week 25 from the previous week, possibly indicating a fifth wave. 

Mortality rates, he said, continued to show an increasing trend and the number of patients in the ICU remained high. 

"More worrying is the high number of brought-in-dead (BiD) cases, which means there are many cases undetected, or due to poor home quarantine management or transportation problems.

"A high BiD rate exceeding 10 per cent reflects an uncontrollable situation."

Dr Lokman, however, said the authorities had to visit other strategies apart from lockdowns and SOP compliance by the public.

He cautioned that the risk of a possibly worse fifth wave was high — especially with the more transmissible Delta variant present — should the government fail to implement strategic pandemic management measures. 

"The failure to curb the ongoing spread, coupled with the risk of more virulent variants, is a recipe for a larger humanitarian crisis."

He called for more comprehensive genomic surveillance to detect the variants in the community. 

He said the total lockdown was not comprehensive as a number of economic sectors were allowed to operate, hence presenting the risk of transmission.

"With certain sectors allowed to operate, public health measures such as active and passive detection of cases, screening of at-risk groups, contact detection and quarantine management should be enhanced."

He said active case detection should be prioritised and the vaccination rate accelerated. 

"The people's mental health has been severely affected, leading to reported suicide cases.

"The vaccination rate is also slow, burdened with various logistical and supply issues. The Covid-19 National Immunisation Programme needs to take a risk-based approach, targeting densely populated areas with economic activities in major cities. 

"Prioritise the elderly aged above 50 years and those in the Klang Valley. If residents here are protected, we expect over three-quarters of cases could be prevented, besides reducing the risk of spreading to other states."

Meanwhile, consultant paediatrician Datuk Dr Amar-Singh HSS said it was pointless to extend the total lockdown without supporting the population.

Additionally, he said, massive community testing ought to be conducted and the vaccination rate should be accelerated nationwide. 

"Besides that, we must also significantly improve indoor ventilation (to reduce the potential of airborne transmission of the virus) as well as simplify the SOP for businesses (the key essentials)," he tweeted. 

Manipal University College Malaysia Community and Occupational Medicine's Professor Dr G. Jayakumar said a targeted approach of a total lockdown or EMCO based on geographical regions or workplace sectors was a better solution. 

"The lockdown has been inconsistently handled with hardly any difference in outcome from a month ago. We need to restrategise our containment approach in the context of public health and by weighing the economic impact in a consistent manner. 

"We should be cognisant of economic hardship, which is on the brink of collapse in many sectors. Mental health issues and hardship to the people are seen in enormous proportions. SME Association of Malaysia in early June reported that about 100,000 companies have ceased operations since the first MCO and they predicted then that another 50,000 will fold at the end of the total lockdown of six weeks.

"The major contributors of the new clusters are the workplaces, especially the manufacturing industries. Enforcement of SOP by the workplaces will have to be stepped up."

https://www.nst.com.my/news/nation/2021/06/702876/restrategise-covid-19-measures