1. Can you help explain why lockdowns are set based on 2 weeks, and not less or more?
The objectives of a lockdown, the most extreme form of physical distancing is to:
– break the chain of transmission of the Coronavirus by keeping the Ro (Reproduction Number) below 1
– it helps to mitigate, slows down, but not necessarily stopping the epidemic spread
– this will reduce the demands on the healthcare services and not overwhelm the capacity of the hospitals and ICUs
– it will allow our Health Care Workers and other front-liners a breather
– and allow the vulnerable among us, the senior citizens, those with co-morbidities, the OKU, those in nursing homes a fighting chance to survive the pandemic
A total Lockdown with a combination of quarantine of the entire population, closure of virtually all social, academic, economic, religious activities is predicted to result in a reduction in hospital and critical care requirements within 3 weeks of its introduction.
In my opinion, the 2 weeks period is an arbitrary and random number picked by the National Security Council (NSC) to give some semblance of authority and control over the pandemic management.
2. We need to work effectively in order for the next 14 days to yield some encouraging results. What should the government be doing concurrently to help bring the surging number of COVID cases down?
We need to work not just effectively, but also efficiently, smartly, quickly and scientifically.
We must fully utilize this 2 weeks “circuit-breaker” to RESET our public health strategies to ensure that the lockdown is optimized with science-based anti-COVID-19 interventions, sanitized from all forms of political nuances.
There is a critical need for 2 major interventions:
– Firstly a Rapid Response Find-Test-Trace-Isolate-Support (FTTIS) pandemic management.
– And secondly a Warp Speed Vaccine Rollout Program to achieve population immunity.
3. How best can authorities carry out mass testing during the lockdown?
The big boys in the MOH must first descend from their Putrajaya Offices to Ground Zero and see first hand how Triaged Mass Testing is done.
With the SELangkah app, the hot spots are identified. These are the areas which Artificial Intelligence and Machine learning have predicted a high concentration of positive COVID-19 cases.
A team of 30 in PPEs are dispatched to the Hotspot which can cater up to 2,000 persons. From registration right to the last stage of informing results the work process is completely digitized.
Testing is undertaken with RTK-Ag. Results are obtained as early as 30 minutes and within 2 hours is uploaded onto the persons HP and is then fed into SIMKA (Sistem Keputusan Ujian Makmal Kesihatan Awam Kebangsaan) also known as the Public Health Lab Information Systems
If a person is COVID-19 positive, he is advised to report to the nearest Pusat Kesihatan Daerah (PKD) or the nearest COVID-19 Assessment Centre (CAC)
With the digitized and automated app, all his close contacts will be advised to act accordingly either to quarantine for 10 days or access the nearest COVID-19 Testing Centre.
This digital work-flow unlike the MOH’s manual work processes will unburden the HCW, relieve them of laborious paper-work and save them from calling up 400-600 close contacts per day.
The lockdown respite must be effectively used to clear up the backlog of contact tracing, enhance backward and forward tracing with digitized and automated FTTIS and to ensure that the epidemiological link is detected so that we may return to mitigation and containment.
4. The government announced that it is planning to set up free Covid-19 Rapid Test Kit Antigen community screening test centres, including drive-throughs. In trying to achieve mass testing, do you think it should be done country-wide, and perhaps have RTKs made more accessible to the public?
Finally, the MOH has agreed to utilize the RTK-Ag instead of its chronic obsession with the slow, expensive and laboratory based PCR test kits. Better late than never!
My hospital was probably the first private hospital to offer the Drive-Through COVID Testing, which we emulated from the South Korean experience.
And if you remember when the super-spreader COVID-19 CASE NO.26 infected over 140 persons, it was our COVID-19 Mobile team that drove to the GLCs and tested all their panicky employees due to their close contact with CASE NO.26
Since March last year I have pleaded to the MOH and the National Security Council to cap the prices of surgical masks, PPEs, PCRs and RTK-Ag.
It fell on deaf ears. I suspected politically connected cronies selling all these basic COVID-19 necessities were laughing to the banks.
RTK-Ag are simply unaffordable, costing between 150-400 ringgit when the cost price is only 20-30 ringgit.
The Selangor state government made it free to all in the B40 group. And others could readily access them at SELCARE clinics and clinics designated by Members of Parliament at 50-75 ringgit per test.
Empowering the rakyat to do self-testing at home would truly be a game changer which I am afraid the NSC, MOH nor the rakyat is ready for it.
One of my colleagues as part of the Safe@Work initiative developed originally by the Selangor Task Force POIS Initiative (Prevention of Outbreaks at Ignition Sites) is already spearheading the saliva self-testing with RTK-Ag with a few manufacturing factories in Klang. The factory workers are supervised on how to administer the test and are required to do the test twice per week. This is the way forward, to empower our rakyat, to empower self-risk assessment and to act responsibly. Instead of the name and shame, compound and fine and the punitive methods of the present political governance.
The HIDE (Hotspot Identification Dynamic Engagement) big data analytics should be able to pin-point the Hotspots (like the SELangkah app) and direct the MOH to do targeted mass testing.
5. The aim is to have 1,000 GP clinics to administer COVID-19 vaccines by 30th June. How much will this help the existing NCIP?
GP and Family Physicians have been vaccinating adults before the top guns in the MOH and JKJAV were even born. They immunized our parents and grandparents with the Pneumococcal, Meningococcal, Influenza, Chicken Pox, Shingles vaccines which the MOH hardly ever did.
Not only they have the know how, the skills and experience, they also have a wide network of clinics right across Malaysia and most importantly they enjoy the trust and confidence of their clients which is more like family to them.
One lady in responding to my tweet on GPs administering the COVID-19 vaccine wrote and I quote:
“My grandma who is 81 years old did not want the vaccine despite everyone in the family telling her to get it. Her GP convinced her and did the registration for her on the spot.”
This is beauty and the legacy of the Family GP, the Family Physician since time immemorial.
And I trust them to take our Program Imunisasi COVID-19 Kebangsaan (PICK) to the next level.
6. In trying to ramp up vaccination, what do you make of the argument that mega vaccination facilities will only defeat the purpose because it encourages crowds which poses a risk of COVID-19 transmission?
I remember my paediatrician colleague in CHOP, Children Hospital of Philadelphia, Dr Paul Offit, who also sits on the ACIP (Advisory Committee on immunization Practices) of the FDA, who was very concerned that the pick up rate of vaccination in the early days was terribly slow. He actually recommended that they open up the huge community halls, the football stadiums, the churches, the synagogues and mosques to ramp up the vaccine rollout program.
Now in Arizona, they’ve got the US army to assist at a 24/7 most efficient and effective Vaccination Centre doing 8-9 thousand vaccinations per day with a capacity for 12,000 vaccines per day.
This is WAR! We need COVID-19 precision, disciplined, even regimented logistics. And who best to provide the state of the art logistics than the boys in uniform.
To the MOH and JKJAV I would say – Do not be too proud to admit that you’ve lost the plot and require the assistance of other experts to get you out of the rut. Besides, plagiarism is the highest form of flattery. There are so many working vaccination models for you to choose from and imitate to suit our local circumstances.
The over-crowding at the Vaccination Centres is simply a logistical issue which can be solved outright, if they would only think through their work flow processes. Let me give an example:
I’ve been twice to the largest and busiest CAC at the Stadium Malawati in Shah Alam. 1200 – 1600 people were lined up and many packed in the Stadium in the toxic air. I advised the senior doctors to get out of the stadium, move along the crowds and/or create marquees outside the stadium and do the assessment in the cleaner air in the open space outside the stadium. And the following day the crowd was cleared by 2pm and they did not need to stretch their assessment until 6-7 pm.
7. Do you think, like in the first MCO, this lockdown will extend beyond the 2-week mark?
George Santayana, the Spanish philosopher once said:
Those who do not remember the past are condemned to repeat it.
The political and health leadership created this mess in September last year when they forced the Sabah state elections and condemned Sabah to its worst epidemic ever.
The MOH and National Security Council which everyday pleaded to the rakyat to follow SOPs did not follow its own SOPs and did not retest nor quarantine the Sabah returnees resulting in spillovers into Semenanjung Malaysia and unleashed the 3rd COVID-19 tsunami.
For the past 8 months despites all the variables of MCOs and the EO (Emergency Ordinance), the Darurat, the MOH and the NSC has failed to tame the coronavirus.
And yet, despite the painful lessons in Sabah and the deadly 3rd COVID-19 Wave, the minister has the audacity to say that 2 million vaccines are being channeled to Sarawak to enable it to soon hold its state elections. This is Not COVID-19 Science. This is COVID-19 Politics and with this brand of political governance, the nation is doomed to a vicious cycle of lockdowns and COVID-19 waves.
So my short politically incorrect answer is the lockdown will extend beyond the 2 weeks period.
Dr Musa Mohd Nordin
2 June 2021
