LETTER | CMCO: Emphasise 'focused protection' and 'targeted approach'

LETTER | On Nov 7, Senior Minister Ismail Sabri Yaakob announced that all but four states (Perlis, Pahang, Kelantan and Sarawak) in Malaysia would be placed under the conditional movement control order (MCO) for four weeks from Nov 9 to Dec 6.

Following this announcement several professional bodies and individuals voiced their opinions and suggestions in the media. Many were of the opinion that since incidence rates are high in some areas and not in others, a more targeted approach to the MCO should be implemented instead. 

They also highlighted the need to continue health promotions via strong messages to comply with standard operating procedures (SOPs) as compliance among Malaysians have become lax nine months into various levels of the MCO.

As of Nov 11, the case fatality rate is 0.7 percent, which is better than on April 9 when it was recorded at 1.58 percent. Most of the deaths were among those aged above 60 years old, mostly with underlying co-morbidities. As at Nov 7, the infection rate had reduced to 1.0 from 1.5 recorded at the start of the third wave in September.

At the same time, the statement by the Academy of Medicine Malaysia on Nov 10, highlighted the fact that the incidence rate is not the same for all states. The rates are higher in Sabah, Labuan, Negeri Sembilan and Penang, whereas Selangor, Putrajaya, Penang and Kuala Lumpur are exhibiting a decreasing trend.

The Academy of Professors Malaysia (APM) is concerned with reference to the current conditional MCO; whereby we view that the restrictions in place are too strict and if prolonged can lead to economic, social and health hardship for members of the public. 

Of particular concern is the care of patients with chronic diseases such as cardiovascular, cancer, endocrine and cerebrovascular diseases who do not come for follow-up or who are brought in too late to be saved. 

In 2018, a staggering 18,267 people died in Malaysia from ischemic heart disease averaging 50 deaths a day which happened without any restriction to movement or healthcare.

The World Health Organisation (WHO) does not advocate lockdowns as the primary means of controlling Covid-19. The exception is when there is a need to buy time to reorganise, regroup, rebalance resources and to protect health workers who are exhausted. 

WHO also reiterated that lockdowns only made the poor poorer and there are concerns of world poverty doubling and child malnutrition in 2021.

Studies have shown close exposure to working-age household members and neighbours have been associated with increased Covid-19 mortality among older adults. This points to the fact that focused protection to protect such groups should be the strategy, not a national lockdown as practised in many countries.

Added to these concerns is the impact on mental health from anxieties, fear, worry and stress due to uncertainty imposed by the MCO especially on employment, schooling and lack of social contact. People are not meant to be isolated, their life is based on face to face interaction and community integration, therefore depriving them of this may lead to other problems.

The Great Barrington Declaration on Oct 4 signed by nearly 6,000 scientists and medical experts across the globe as well as 50,000 members of the public argues that lockdown policies in place until a vaccine is available would cause "irreparable damage, with the underprivileged disproportionately harmed." 

They pointed out the risk from coronavirus is 1,000 times greater for the old and infirm, with children more at risk from flu than Covid-19.

With reference to these concerns, APM would like to propose the following measures:

1. Red zones for localities with more than 40 new daily cases should continue to be under the enhanced MCO but the rest of the country should return to the recovery MCO. Perhaps these acronyms could best be replaced with number codes in order to avoid the misconceptions.

2. The continued detection of localised outbreaks (clusters) should continue. However, since Covid-19 infection survival rate is 99.9 percent for healthy people under 70, to achieve an optimal balance between health, social wellbeing, and the economy, the emphasis should be on “focused protection” and “targeted approach” for those at risk while allowing the less vulnerable to work and go to school.

a. Young and healthy adults and children above the age of 12 should be allowed to go back to school and work.

b. People with co-morbidities regardless of age and the elderly should stay at home.

c. People who go to work and school should be taught how to clean themselves and how to approach vulnerable family members when they return home. These measures should be taught via the media, at the workplace and at school. 

3. As advocated earlier, people should be taught and continually reminded on carrying the responsibility of protecting themselves against Covid-19 by practising the 3W and 3C as the daily norms.

The public should also be educated of the level of risk of getting an infection from activities so as to avoid those high-risk activities. For example, avoid bars, indoor close contact meetings and parties and eating in crowded indoor restaurants. 

Outdoor activities with social distancing are generally low risk and since we need the sun to produce vitamin D, exercising outside should be encouraged.

4. The SOPs need to be well defined, complete and accurate to avoid confusion. For instance, the misunderstanding on the usage of masks during fueling at petrol stations, and the restriction of travelling together and eating at a table in restaurants, while the group may be from the same household, hence sharing the same living environment and air. 

Such restrictions may further increase the risk of depression, lethargy, and family discord of being cooped up for too long.

5. Nutritional education on the right food would assist the development of a stronger immune system. Get nutritionists and dieticians on board in the media to tell people what to eat, how to prepare and cook and when to eat which are all as important as showing people how to exercise in the morning.

6. The creation of platforms for people with mental health issues to reach out to either a university or healthcare service provider on an organizational or individual level, and if possible make it free so that anyone can get help when needed.

7. The message of keeping the vulnerable and high-risk groups safe should be constantly reaffirmed and resonated to the public via the media and to communities. It is important to make sure that people above 70 and anyone with chronic diseases do not get infected.

We believe everyone should learn to live with Covid-19, fear it, be cautious of it, but “live with it” because life has to go on calmly, and surely it can.

To all the frontliners, especially those in the health sector, we would like you to know that members of APM and the rakyat fully appreciate your contributions and sacrifice, you have gone beyond the call of duty to serve the nation despite all the difficult challenges.

The undersigned for APM:

Daeng Nasir Daeng Ibrahim, APM president

Dr Adlina Suleiman, head of APM's medical and health cluster

Jamal Othman, APM's head of economics and social wellbeing cluster

The views expressed here are those of the author/contributor and do not necessarily represent the views of Malaysiakini.