80% community immunity is not enough, Minister (Part II)

Dr Musa Mohd Nordin, Paediatrician
Asst Prof Mohammad Farhan Rusli, Public Health Physician

There are essentially four tools to tame the pandemic. These are:
1. Vaccines
2. A National Testing Policy that pivots on rapid test kits
3. Improving indoor air
4. Pandemic trio of masks, physical distancing and hygiene

In Part I, we deliberated on ramping the vaccination rates to at least 90% of the population, whereby a large enough critical mass in the country is immune, thereby conferring indirect protection to the unimmunized cohort of the population. [1]

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. [2]

An equally critical prerequisite before we transition from the pandemic to the endemic phase, apart from the vaccination rate, is to ideally stop the transmission of the virus as in the Zero COVID-19 Strategy of China, NZ and at one juncture, Australia. [3]

Malaysia lost this plot since October 2020, and should now endeavor to mitigate the viral transmission to an acceptable baseline rate. This would mean the authorities would need to agree upon the maximum numbers of hospitalizations, ICU admissions, fatalities and the chronic numbers of Long COVID cases which is “acceptable and tolerable” [4]

In the Australian model, with 90% of adults vaccinated (to help explain the Health Minister weird concept of “adult herd immunity” [5]), they anticipate:

77,000 hospitalizations
21,000 deaths

However, with 90% coverage of the population (adults, adolescents and children), this “tolerable” numbers are reduced to:

31,000 hospitalizations
10,000 deaths

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

18,000 hospitalizations
5,000 deaths
40,000 Long COVID

We need excellent data collection and analytics for this kind of modeling 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 …” [6]

On 30 January 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 …” [7]

These are all symptomatic of the failures of the MOH’s 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). [8]

This is a critical public health intervention program with a national testing policy that pivots on rapid test kits in order to safely transition to the endemic phase with tolerable case numbers, hospitalizations, BIDs, deaths, and Long COVID burden.

With the lackluster reporting system and sub-optimal FTTIS program, it would not be wise to rush into the endemic phase, with the minister’s below par “80% adult herd immunity”

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 Performance Indicators must be set for the rapid and accurate reporting of data, hence digitalization with 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 records 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 BID’s.

Regardless of case backlogs, the deaths are not declining, BIDs are persisting and the final fatalities features 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’ve alluded to as the raison d’etre of the FTTIS program

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

Working on behalf of the National Health Service (NHS) England, the researchers examined approximately 17.5 million records of individuals. 17,063 died from COVID-19 and 134,316 from other causes. [9]

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 marginalized population among the B40s and Bukan Warga Negara among the 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. [10]

REFERENCES:

80% community immunity is not enough, Minister (Part II)

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