KUALA LUMPUR, Oct 26 — A lockdown is simply a temporary measure to reduce an overload of Covid-19 cases in health facilities as it cannot eliminate virus transmission, health experts said.
Former Health Minister Dzulkefly Ahmad, who is also head of Selangor’s Covid-19 task force (STFC), stated that any movement restriction measures in public health in the midst of a pandemic, or a resurgence of outbreaks, has an important role to contain the coronavirus, but he emphasised that lockdowns alone will never cut down virus transmission in the country.
“l need to stress that lockdowns do not end the pandemic. We do not exit a pandemic with lockdowns. It can only be achieved through the arrival and use of a vaccine or an antiviral agent against the disease of coronavirus infectious disease 2019 or Covid-19,” Dzulkefly told CodeBlue in an interview.
“Theoretically, lockdowns are a last resort and must be resorted to, tactfully and judiciously, with unambiguous guidelines and standard operating procedures (SOP),” said Dzulkefly.
International experts have previously stated that a lockdown is just a temporary measure to slow down the virus transmission and without herd immunity against Covid-19, cases would spike again once economic and social activities resume.
According to Dr Mustapha Kamal from the Covid-19 response unit in Sungai Buloh Hospital, Malaysia’s main Covid-19 hospital located in Selangor, a lockdown will help to flatten the Covid-19 epidemiological curve, as a fraction of Malaysians hardly comply with home quarantine measures.
“It has been said and proven during the second wave where we have seen the curve flattening, as per number of cases decreases. We are hoping with the MCO, the number of cases decreases again. Though, it must be remembered that MCO in the long run might jeopardise our country,” Dr Mustapha told CodeBlue.
He said a nationwide lockdown, like the first phase of the MCO implemented in March, would slow the increase in the number of Covid-19 cases nationwide.
“Slowly, Penang, Melaka, Negeri Sembilan have already turned into red zones in big cities,” Dr Mustapha said, when asked about the significance of a nationwide lockdown compared to a targeted lockdown.
“I think now is a good time to implement the lockdown given that the numbers have dramatically risen ever since the Sabah election. We really need to cut down the spread as it swallows a lot of government budget for managing asymptomatic positive cases.”
CodeBlue previously analysed the Covid-19 sporadic cases in Sabah and identified that about nine in 10 sporadic cases nationwide were detected in Sabah daily from October 1 to 14.
Dr Mustapha also indicated the severity of Covid-19 transmission in Selangor, as Sungai Buloh Hospital beds are getting full with coronavirus patients.
“We have a lot of patients. Almost all wards in the national leprosy control centre (PKKN) are open. In MOH Training Institute (ILKKM) a few wards will be opened. However we are anticipating full houses should the numbers keep on triple digit each day.”
At the same time, former Malaysian Medical Association (MMA) president Dr Milton Lum said lockdowns are usually implemented at the beginning of an epidemic when the health care system is not prepared to encounter widespread disease outbreaks.
Dr Lum also told CodeBlue that a lockdown is helpful during a lack of resources, such as overloaded hospitals or obvious and rapid community transmission.
“The objective of lockdown is to help the authorities to buy time to suppress the numbers of cases rapidly by improving the health system’s capacity to deal with the situation, such as equipping personal protective items (PPE) and staffing,” Dr Lum said in an interview with CodeBlue.
“Lockdown is also aimed to implement and adapt public health measures to detect cases without delay.”
Dzulkefly, who was also in line with Dr Lum, mentioned that increase in testing and other effective contact tracing measures are inevitable in a lockdown to curb virus transmission among the public.
“Given that total elimination of the virus is going to be impossible, another lockdown is a temporary measure accompanied by a comprehensive strategy to minimise the number of infections and deaths through strengthening public health system, better testing strategy with rapid result turnaround time, advanced contact tracing like isolating before results are out, and clinical case management, including availability of intensive care unit beds,” Dzulkefly said.
No Rationale For Klang Valley CMCO
The implementation of CMCO in Selangor, Putrajaya and Kuala Lumpur from October 14 until October 27 was just to pre-empt yellow zones from turning red, according to the Ministry of Health. The federal government has yet to announce if the Klang Valley CMCO will be extended beyond tomorrow.
Red zones are districts reporting 41 local Covid-19 cases or more within the past fortnight; yellow zones are districts with 40 new local cases and below; while green zones have reported zero new local infections in the past 14 days.
“The sudden reintroduction of CMCO as in Selangor, KL and Putrajaya, when cases were previously under control, is hence an admission of failure of other less damaging public health measures which should have been activated much earlier,” said Dzulkefly.
As of October 11, before the implementation of CMCO in Selangor, MOH’s 14-day moving chart showed that only Petaling and Klang districts were red zones. Other Selangor districts, except for Sabak Bernam with zero cases, were yellow, reporting fewer than 41 coronavirus cases. Selangor reported 224 local Covid-19 cases in the 14 days before October 11.
“There has been no sound rationale in the October 12 announcement of a CMCO for Kuala Lumpur and Selangor.”
Dr Milton Lum, former president of the Malaysian Medical Association
“Were health considerations the primary consideration in the decision? Were other considerations predominant and health considerations used as an excuse? The public is owed an explanation by the health care professionals involved in the decision,” Dr Lum added.
Dzulkefly and Dr Lum, however, said that the threshold of cases to implement a lockdown is debatable.
“Determining what threshold of cases to implement a lockdown would be yet another moot point again. But when unlinked cases are on the rise, i.e. community spread, while the cluster cases are similarly showing escalation unabated, it is time for reintroduction of ‘lockdowns’ to arrest the surge,” said Dzulkefly.
According to Dr Lum: “There is no specific globally accepted threshold for implementing a lockdown. The MOH has decided on an area classified as red with. 41 cases or more – why this number was chosen is best answered by MOH.”
Selangor has reported daily tallies of mostly below 100 Covid-19 cases this month, except for four days of above 100 infections. The capital city has recorded below 30 daily Covid-19 infections this month, most days below 10, while Putrajaya has reported even fewer cases.
The Klang Valley outbreak pales in comparison to Sabah, the country’s current Covid-19 epicentre, that has reported over 100 coronavirus infections daily since the start of October, with consecutive daily cases of above 500 since October 18.
Lockdown Measures Must Be Clear, Evidence-Based
The Academy of Medicine of Malaysia (AMM) previously urged the government to enforce a targeted enhanced MCO (TEMCO) in Kuala Lumpur, Putrajaya and Selangor as opposed to a state-wide CMCO.
According to AMM, small-and-medium enterprises (SME), low-income and vulnerable groups who have yet to recover from the first MCO will likely be most affected by the implementation of CMCO in the Klang Valley.
“A lockdown may well be needed, but this should be targeted where spread is actually happening. It should cover sectors and the contexts must be appreciated well. For example, where the risk of spread is high, based on evidence,” Dzulkefly said.
“It should immediately be accompanied by fast and rapid ‘targeted testing’. Good contact tracing, physical distancing and leadership by example, and no double standard, must follow suit, being the best way forward.”
Dzulkefly Ahmad, former Health Minister
“But we must remember that it has a concomitant damaging effect on both lives — mental health, foregone preventive care, missed educational opportunities and livelihoods, especially of the lower income groups and small businesses in the informal sector, because they are ‘crude or blunt’ instruments,” Dzulkefly stated.
“Needless to say that businesses are under severe strain. A simple way to help businesses is to give predictable and clear, evidence-based guidance, so that they can anticipate what measures will be used and in what situation.”
Infectious disease physician Dr Christopher Lee tweeted Friday that STFC has proposed to state authorities a “traffic light” system on movement restriction levels, similar to the one practiced in Ireland that specifies guidelines for visitors, gatherings, bars and restaurants, and transport in each stage of a five-level alert system.
The Malaysian federal government, on the other hand, has various movement restrictions dubbed CMCO and TEMCO, with guidelines changing on a regular basis during verbal announcements by the senior defence minister.