KUALA LUMPUR: Doctors are scratching their heads over the government's decision to refrain from enforcing a 14-day mandatory quarantine order for returnees from Sabah after Saturday's state election.
The decision to impose only swabs tests and a stay-at-home order (HSO) until the single test results are out has also perplexed medical experts.
They are urging people to be responsible and practise self-regulation, that is, to abide by standard operating procedures (SOP), avoid crowded places, wear a face mask in public places, maintain physical distancing and regularly wash and sanitise their hands.
Epidemiologist Datuk Dr Awang Bulgiba Awang Mahmud, a professor at Universiti Malaya, said he was puzzled by the SOP as the experience through the Sivagangga cluster's index case had proven that a negative first test might not hold and might read positive the second time around.
"So relying on a single test is not good enough."
He said the authorities needed to go back to the old ways of doing things, which included mandatory swab tests on the day of arrival and on the 13th day, and quarantine order at state-designated centres.
All this, he said, should be imposed in the interim.
Dr Awang Bulgiba said home quarantine was only the second-best option as far as containment was concerned.
"The best option is to quarantine returnees immediately in designated quarantine centres, like for those coming from overseas."
"Otherwise, all we need is for someone to test negative, not undergo home quarantine and then infect others because he was carrying the infection but it was not picked up by the first swab.
"Then it will be the Sivagangga cluster all over again."
He said home quarantine orders could be effective only if returnees strictly followed the SOP and were fitted with electronic tracking bracelets, which Malaysia has not adopted.
"We need to be sure that the person undergoing HSO is not exposed to others on the way from the airport to home and undergo strict quarantine in his room at home for 14 days, not even stepping out to mix with family members.
"That is why the HSO is the second-best option as there are many variables that are difficult to control."
He said the risk was that the country may be on the brink of a fast-spreading cluster of infections like the Sivangangga cluster.
"If you remember that index case, (the person who returned from India) initially tested negative, broke quarantine rules and spread the infection.
"He was later found to be positive even though the first swab was negative. So the risk is high."
He said that the real time transmission rate for Sabah, at 1.26 as reported, was unlikely to fall below 1, as new cases were being registered.
Asked whether a sharp rise in active cases like in March was at hand and whether trends mirrored this, he said it all depended on how fast the infections could be detected.
"Since Sept 20, more than 60 infections in the peninsula have been linked to Sabah.
"It all depends on how fast we can nip this in the bud.
"Even though parts of Sabah have been put under a Targeted Enhanced Movement Control Order, cases have spread to other parts of the country.
"If those cases are not isolated quickly, we may have a spike in cases in other states. We have seen dozens of cases originating from Sabah. That is worrying."
Dr Awang Bulgiba said active cases had exceeded 1,000, and "we are still having a net increase in active cases as new infections outnumber discharges, so we need to really break the chain of transmission quickly".
Another concern, he said, was that if most of the new infections were in Sabah, it would put a strain on the state health authorities as it would not be possible to redistribute the cases.
"So the key is to break the chain of transmission and that requires a lot of resources. I am concerned that the district health office staff will be overwhelmed with contact tracing as anyone who has ever done this knows how arduous the task can be."
Epidemiologist Dr Malina Osman reiterated her earlier stand that the least that should be levelled on returnees was a 14-day home quarantine order.
"It should be mandatory for all, regardless of the first test's results, due to the scale of the election, which involved more than one million people, many of whom were travelling across the state."
She said the home quarantine order should also be monitored through surveillance by health officers or agencies under National Security Council.
Dr Malina said home quarantine was only the second best option and should be restricted to those who could not pay for their two-week stay at designated facilities.
She added that Malaysia could be on the brink of a new wave due to an election cluster.
"There should be an immediate travel ban to and from Sabah besides the TEMCO imposed."