Dr Musa Mohd Nordin, Paediatrician
Asst Prof Mohammad Farhan Rusli, Public Health Physician
18 August 2021
As of 17 August 2021, 34% Malaysian are well protected with 2 doses of COVID-19 vaccines.
That’s virtually full protection against severe COVID-19 requiring hospitalization, thus reducing pressure on our presently overburdened healthcare services.
We need to ramp the uptake to other low coverage states to prevent the replay of the messy and ugly Klang Valley experience there. Unvaccinated persons take up more than 95% of our hospitals beds.
We still run the risk of breakthrough infections with a conservative estimate of 0.29% of fully vaccinated persons.
That’s 32,000 breakthroughs, milder than similar infections in unvaccinated persons.
But these may pose a danger to our larger communities within the context of the more transmissible and virulent Delta variant. And we must also be prepared for the Lambda and other VOC that may follow subsequently.
First, they and the unvaccinated may continue to create clusters and outbreaks in the low coverage states and even in the high coverage states, as seen in Sarawak more recently.
Though to a lesser extent, Delta can still be transmitted by the vaccinated person.
Therefore unlike the US, UK and Israel, we have been smart to persist with the mandate on masking, both indoor and outdoors. This would prevent the dispersion of Delta to the unvaccinated, namely the children and to the vulnerable and immunocompromised.
As we’ve seen in the highly vaccinated nations, Chile, Seychelles, Uruguay, Mongolia, UAE, Bahrain, US, UK and Israel, Delta due to it’s ease of transmission can readily unleash another COVID-19 wave.
There is simply too much hope and hype placed in the vaccine basket. We must be holistic in our crisis management and utilize every other anti-pandemic tool at our disposal.
And that is why our failure to ramp our testing to the basic minimum of 250,000 tests per day is not simply helping. At best we were averaging 150,000 tests per day and our positivity rat has hovered around 12-15% which according to WHO means that our pandemic has been out of control since May 2021.
FTTIS is a vital component of the exit strategy and the authorities needs to seriously consider a national testing policy which among others must undertake the following course of action, in the short, medium and long term.
The slow, piecemeal and reactive responses of the authorities in it’s testing protocols has only fostered the sporadic spread of the virus and enhanced the proliferation of the Variants of Concern (VOC).
This has led to an explosion of daily cases of COVID-19, overwhelming our hospital and ICU facilities and the quarantine centres, leading to exponential deaths rates and brought in dead (BID) cases.
The FTTIS framework of action needs to be communicated carefully and thoroughly to the other agencies responsible, notably:
- Ministry of International Trade and Industry’s Safe@Work campaign
- Ministry of Education’s Safe@School policy
- Ministry of Home Affairs’s Safe@Prison protocols and others.
Better ventilation of public amenities should be spearheaded by the Ministry of Human Resources (Akta 446), Department of Safety and Health I close collaboration with the Ministry of Housing and Local Government.
The S of FTTIS, encompasses social, financial, psychological support which should be jointly coordinated across the various agencies, notably:
- Ministry of Finance
- Ministry of Health
- Social welfare department
- State Pusat Zakat and Baitul Mal
- Relevant NGOs.
And for those who are unable to isolate in their homes, better quarantine facilities should be made available by the relevant agencies to prevent the spread and spillover of the infection into the larger community.
On the vaccination front, the JKJAV needs to be more proactive and consider promptly new strategies to best boost our population immunity. These among others include:
- Single dose mRNA and adenovirus vector vaccines in persons post-COVID-19 in a bid to save on vaccine use and supply.
- Heterologous prime boosting vaccine regimens (mix and match of vaccine types) to increase the immune response in the face of Delta
- Consider boosters for those with 2 doses of inactivated vaccines
- Enhance uptake of vaccines in 12-17 year olds and those under 12 with co-morbidities
- Better vaccination of gravid mothers across all stages of pregnancy
- We do not agree with mandatory immunization policies. For the Malay Muslims, whom we think are the majority of the vaccine deniers and hesitant, there is enough provision in the fatwa which states that, immunization is harus (permissible) but it is wajib (mandatory) for those whom the government deem as high risk individuals. But we would like to recommend vaccine mandates which would tie to employment in high risk occupations e.g. HCW, caregivers in nursing care home, prison wardens, army personnel etc …TBC
