Activities just cannot return to normal for at least six months after the MCO period. This is because asymptomatic or mild cases may linger within the community.– TAN SRI DR ISMAIL MERICAN, FORMER HEALTH DIRECTOR GENERAL
This week’s column is longer than my previous ones. So please bear with me.
I’ve heard that the movement control order (MCO) might be extended again till the end of April. The Health Ministry will make a decision on April 10 after reviewing the Covid-19 data.
So far Malaysia has recorded 3,622 cases, with 61 deaths as of yesterday and the figures are not decreasing. Sarawak recorded two more deaths for a total of 12 fatalities while the number of positive cases is now 264, with an increase of 10 yesterday. If the figures don’t decrease, then it’s only appropriate that the MCO be extended further.
The country is taking all the necessary measures to contain the coronavirus; so is Sarawak. In fact, former Institute for Medical Research director and Health Ministry deputy director-general Tan Sri Dr Mani Jegathesan has given the thumbs-up to the measures adopted by Sarawak.
His nephew, Dr Ashok Segar, too, has good words for the state’s leaders and medical authorities for taking quick measures to stop the spread of the virus. Dr Ashok, a medical doctor from Singapore, is residing in Kuching under the Malaysia My Second Home (MM2H) programme.
Now, while I am all for extending the MCO nationwide, I am, however, more concerned about how we are going to proceed after that.
Sarawak is facing an unprecedented health situation as never before. We are literally invaded by a foreign coronavirus, and will face a dilemma of how to proceed after the lockdown.
To logically determine whatever course of action we are to adopt, first let’s study how we got here. Covid-19 is a foreign virus. It is not endemic in Sarawak. This does not mean that in the future, this virus may become endemic here.
All our initial cases were imported with clusters identified among Sarawakians who returned from the Netherlands and Scotland.
The deaths of the family members and a pastor were due to imported cases. There were a further 12 confirmed cases from this family cluster. The 60-year-old pastor who died was linked to 19 cases from the Emmanuel Baptist Church.
Of the initial 91 confirmed patients, all the patients could be linked to six clusters. The largest cluster was traced to the Sri Petaling Mosque event in Kuala Lumpur.
Studying the above, one can come to only one rational conclusion — that the measures instituted by the authorities might not have detected asymptomatic carriers capable of infecting others without displaying any symptom of the disease themselves. Hence the temperature monitoring systems already in place might not have been effective.
These individuals all fulfilled at least one of the following criteria:
- They came from an area where there was already exposure to Covid-19, either a foreign country or Malaya.
- They were unaware that they were carrying the virus.
- They were returning Sarawakians who were already infected but not detected at the points of re-entry.
- The final category was those aware that they were likely to have been exposed to the virus, yet had delusions that due to their faith or other reasons they surely would not get infected or spread the virus.
To fight Covid-19 we must first stop the virus in its tracks. This has been done effectively only in one city and one country — Wuhan, China.
Wuhan achieved this success by a complete lockdown of the city; very much the same way that Sarawak is now locked down. All travel to and from Wuhan was suspended, just like in Sarawak now.
Contact tracing was actively pursued (again just like Sarawak) in conjunction with a compulsory MCO, mandatory social distancing and a stay-at-home order.
How then would Sarawak proceed to achieve a victory against this scourge?
Key to this strategy is studying what others have done or not done:
- Wuhan did not lift its lockdown till it had achieved no new cases. China continued to allow the influx of foreigners or returning citizens from abroad and still shows an ever-expanding number of new infections nationwide with the exception of Wuhan. Most of the new infections detected in China today are among foreign arrivals.
- Similarly, Singapore failed to order a lockdown until recently and is currently still grappling with community spread of the virus; the majority of new cases being imported even now on a daily basis.
Sarawak has only one lesson to learn from this. The MCO must not be lifted till there are no more cases. This must be done regardless of what the rest of Malaysia does.
The transport of goods by land/sea and air will be allowed to continue unabated even with the MCO in place. The only requirement would be for fumigation or spraying of disinfectant by the health authorities.
Uninterrupted cross-border driving should not be permitted. Goods should be unloaded at customs and immigration check points, treated with disinfectant and loaded onto local trucks for further distribution.
What then should Sarawak do when there is no new case?
The MCO can then be lifted with a monitored response to hygiene and social distancing and safety at work; but only within Sarawak.
The lack of good public transport perhaps is a great advantage to Sarawak as this could help prevent a resurgence of the disease.
Taxi drivers should be educated to protect themselves and how to wipe down and keep the passenger areas safe and disease free.
Now for the all-important question: When should Sarawak reopen its points of entry to foreigners, Malaysians and returning Sarawakians?
The points of entry should only be open when we are fully prepared to do rapid corona virus testing on each and every incoming individual at every legitimate point of entry.
This message is further stressed by head of US Institute of Allergy and Infection Dr Anthony Fauci when he declared that we cannot expect to flatten the epidemiological curve by waiting for five days for a test result.
While the rapid test kit is not 100 per cent accurate, bear in mind that if properly used, it can be a useful tool to prevent the virus from returning from abroad as is currently practised in Wuhan.
A person who tests positive should be immediately quarantined until he or she tests negative and can be released safely into the community. This applies only to returning Sarawakians.
Persons who test negative should only be allowed entry in accordance with a strict supervised monitoring of home quarantine for at least two weeks after which they are retested prior to being released from the home quarantine order. Again this applies only to returning Sarawakians.
We must take into account the risks or benefits of home quarantine even if they are supervised. Recent arrests in Sarawak generally showed a propensity for individuals to flout the MCO.
To be effective, lockdown and isolation must be strictly complied with as was the case in Wuhan.
What about our borders with Indonesia, Brunei and Sabah?
Several lessons need to be stressed in consideration of this issue. Patient zero of Brunei attended the Sri Petaling Mosque event in KL. When Brunei instituted a ban on direct flights from KL, the patient purchased tickets to Kuching, Miri and Sabah to hide his travel history. He then entered Brunei as patient zero and went on to infect many.
Borders must be closed. They can only be opened to Sarawakians returning home, and even then, following the strict criteria that I have suggested, until this pandemic abates.
All transient travel by vendors, tourists and others must not be permitted at this time regardless of Covid-19 rapid test results unless they are willing to submit to the 14-day mandatory state quarantine order at their own expense, or whenever they test negative; whichever is longer.
Relaxation of these rules should only be considered after the world pandemic abates.
I hope the state authorities will look into some of my proposals.