SINGAPORE – Health experts are calling on Malaysian Prime Minister Muhyiddin Yassin’s government to review its Covid-19 strategy as the nation battles a deadly third wave that has seen record daily infections rise since the controversial declaration of a state of emergency last month.
Warning that the country’s healthcare system risks being overwhelmed, the premier declared emergency rule on January 12 in a move that critics and opposition parties cast as an attempt to cling to power after his government’s razor-thin parliamentary majority was eroded by defections.
While the maneuver has given Muhyiddin a political lifeline, the Covid-19 resurgence has continued unabated with new cases climbing sharply since authorities tightened restrictions under a movement control order (MCO) covering all states in the country except Sarawak, which is under less severe curbs.
With intersecting health, political and economic crises in play, the government is under pressure to bring the worsening outbreak under control while simultaneously limiting adverse effects on the nation’s recession-hit economy. But its approach so far, observers say, has fallen short of protecting lives while preserving the livelihoods of Malaysians.
“Experts believe the current MCO is not really working and needs to be localized and focused to cover specific high-risk areas. But it seems like the government has lost its direction. That’s how the public and health professionals see things now,” said Zainal Ariffin Omar, president of the Public Health Physicians Association of Malaysia.
Data from the Health Ministry’s National Institute of Health (NIH) showed that Covid-19 infectivity was higher on February 1 than when the latest MCO took effect on January 13, with its effective reproduction number, or Rt, at 1.15, meaning every 100 coronavirus patients are infecting 115 others, up from an earlier estimate of 1.13.
Approximately 9.3 deaths due to Covid-19 were recorded per day in January, a rate 2.6 times higher than what was reported in November and December, totaling 289 fatalities. Total cases now stand at 231,483 with 826 deaths, a significant increase over the 144,518 cases and 563 deaths recorded when the MCO entered force.
With national health metrics painting an increasingly bleak picture of the government’s pandemic management, local medical experts have been speaking up with recommendations for strategies to manage the rising number of cases. So far, however, experts say there are no signs of a policy course shift.
“The government hasn’t really involved people outside the health ministry, academics from the universities and professionals. It has to listen to people and get professional bodies, experts from outside of the ministry to come together for discussions on forming a better strategy than we have now,” Zainal added.
Zainal, a former World Health Organization (WHO) consultant for non-communicable disease prevention, was one of 46 health experts who signed an open letter to Muhyiddin last month calling on the government to ramp up its early detection testing regime and form an independent Covid-19 task force comprising medical and economic experts.
In a written response to the letter, the premier said many of the concerns raised and proposals made had already been or were in the process of being addressed, adding that his administration’s primary focus is to manage the nation’s response to the pandemic and mitigate its stark social and economic consequences.
When a two-month nationwide MCO was imposed last March, authorities were able to contain the country’s viral second wave, albeit at a steep economic cost. An estimated 2.4 billion ringgit (US$550 million) in daily losses occurred while activity-curbing restrictions were in force, amounting for total losses of 63 billion ringgit ($14.6 billion).
In contrast to the earlier MCO, which saw Covid-19 cases drop to single digits with almost all economic activities ceased except for essential services, current standard operating procedures (SOPs) defined by authorities have allowed for more economic sectors, retailers and night markets to operate in accordance with social distancing rules.
“Various factors have led to different transmission outcomes compared to last year,” said Jahizah Hassan, president of the College of Anaesthesiologists and member of Malaysian Health Coalition. “The MCO restrictions this time around are not like the first MCO where everyone is required to be at home except for essential service workers.”
Infectivity rates continue to be high across states and territories, despite an inter-state travel ban. But with more businesses and sectors operating as usual, workplace clusters have emerged as a key source of infection, affecting factories, palm oil plantations, learning institutions, private companies and government agencies.
“Transmission among foreign workers and in prisons are also much higher this time around. This was not evident during the initial MCO because they were not being tested then and many economic sectors were closed,” Jahizah added. “Now many of them are positive mainly as a result of overcrowding in their dormitories or hostels.”
The current MCO period has already been extended twice and is set to last until February 18. In anticipation of a phased vaccine rollout slated to begin at the end of February, the government is loosening more restrictions on economic activity with barbershops, hair salons and car wash services permitted to operate from February 5.
Finance Minister Tengku Zafrul Abdul Aziz has ruled out another full lockdown, even if the pandemic proceeds along a “worst-case” scenario trajectory. “I believe we as a country cannot afford a total lockdown of economic sectors. The long-term impact, the economic scarring will be very detrimental,” said the minister in a recent interview.
While reopening is arguably difficult to justify amidst the swelling national caseload, authorities intend to enforce better compliance with more stringent SOPs through stiffer fines and penalties, including jail for certain offenses. Business owners could also be penalized and forced to close over SOP breaches under the proposed stricter rules.
Bringing more severe penalties into force will require amendments to existing laws, under which the maximum penalty is a fine of 1,000 ringgit ($245). With parliament suspended under emergency rule, the government can propose and pass legislative changes through an emergency ordinance with approval from the constitutional monarch.
“We need to be science-based with our daily SOPs, rather than resort to harsh measures,” said Amar-Singh HSS, a senior consultant pediatrician based in the Malaysian city of Ipoh. “Heftier fines, extended MCOs, increased public blaming are counterproductive and also harmful to the poor and those that have lost their livelihood.”
Authorities have also been criticized for newly-announced SOPs banning house-to-house visitations ahead of Chinese New Year on February 12, which politicians on both sides of the aisle have criticized as flawed.
Some have reportedly even joked about exploiting loopholes to hold family gatherings at barbershops and night markets that have been given the green light to operate.
Malaysia is due to receive one million doses of the Pfizer-BioNTech vaccine, quantities sufficient enough to immunize just 20% of the population, later this month. Initial plans to vaccinate 70% of the population within the first quarter of 2021 have been drastically revised down as health authorities scrutinize the efficacy of a range of vaccines.
Authorities say they aim to vaccinate 80% of the population, around 27 million people, by the first quarter of 2022 to achieve herd immunity. Medical and non-medical frontliners will have priority access to the shots during the first phase, followed by senior citizens and individuals with comorbidities, then eventually the general population.
In any case, NIH data suggests that Malaysia’s Covid-19 crisis will get worse before it gets better. According to its projections, the country is on track to record 8,000 new daily cases by the first week of March and 10,000 daily new cases by the second week. Case numbers are only expected to fall to more manageable double-digits by May.
“Targeted lockdowns and large-scale testing and isolating may be the answer after the current MCO is over, but it’s best to decide based on available data as things remain fluid. Lockdown is only one of the measures in the larger Covid-19 strategy,” said anesthetist Jahizah. “The government must find a balance.”