KUALA LUMPUR: As increasing Covid-19 infections wreak havoc on the country's healthcare system, experts are saying that a full lockdown, similar to the first Movement Control Order, may be the way to curb further spread of the coronavirus.
Science, Technology and Innovation Ministry's (Mosti) Covid-19 Epidemiological Analysis and Strategies Task Force chairman Datuk Dr Awang Bulgiba Awang Mahmud said such a lockdown was necessary for Selangor, where healthcare services appeared to be on the brink of collapse.
"There is a real danger of an exponential increase in cases, the likes of which we have never seen before, and this could completely overwhelm our healthcare system. We are probably on the brink of something like that."
He warned the country could go the way of Thailand, which registered a record 9,635 cases on Monday following a sharp increase in infections over the past few days.
"It can happen in Malaysia too. Our positivity rate is above the five per cent threshold, which is indicative of inadequate testing. We are possibly detecting less than half of the cases in the community.
"The result is a high proportion of sporadic cases, so there is a real danger of a catastrophe happening. If most of the cases in healthcare facilities were category 2 (mildly symptomatic), it would not overwhelm our services.
"But the proportions of Category 3, 4 and 5 (moderate to severe) cases are now uncomfortably high, and many ICUs are now close to full capacity."
Dr Awang Bulgiba also said it was proving almost impossible to trace and test every known contact of infected persons. The epidemiologist said this was compounded by the number of asymptomatic carriers, a demographic he long considered a threat due to the belief that they outnumbered those with symptoms.
The Universiti Malaya professor further said that a publication in the Journal of the American Medical Association had confirmed this.
With these "silent-carriers" thrown in the mix, Dr Awang Bulgiba said the infection was "now well and truly entrenched in the community", and was spreading asymptomatically.
"The many healthcare facilities in Selangor are in danger of being overwhelmed, and the public healthcare system badly needs a breather. We also do not know why Categories 3, 4 and 5 cases are so high.
"I suspect we are dealing with variants which may have a longer infectious period (which means the 10-day quarantine is insufficient), is more transmissible (higher viral load and lower cycle threshold value on reverse transcription polymerase chain reaction) and more deadly (hence, the rise in proportions of Categories 3 to 5 cases and number of deaths).
As to how long this strict MCO should last, he said: "If these variants have an infectious period of up to 21 days, then it is likely that a lockdown lasting three months might be necessary.
"Singapore has instituted a 21-day quarantine for travellers from Malaysia — I suspect it has something to do with a longer infectious period for cases originating in Malaysia," he told the New Straits Times.
He, however, said in states where infections could be contained via aggressive contact tracing and testing (boosting it five to 10 times more than current rates), things could remain as they were.
But he warned that systems to monitor cases and trends had to be in place to raise the alarm so that authorities could impose a harsher lockdown if required.
This, he said, was especially crucial due to the mass inter-district and interstate movements over the past weeks, which coincided with Hari Raya Aidilfitri.
Dr Awang Bulgiba said the authorities had to be vigilant by looking out for infections among workers and ensuring that workers' living conditions have been improved with the implementation of the Workers' Minimum Standards of Housing and Amenities (Amendment) Act 2019.
He also said it had to institute syndromic surveillance, have better real-time data analysis, conduct more genomic surveillance, as well as utilise big data effectively, while introducing better indicators and planning strategies by revising the country's Pandemic Preparedness Plan. Dr Awang Bulgiba, who also heads the Independent Covid-19 Vaccination Advisory Committee under Mosti, said the country also needed to accelerate its sluggish vaccination drive.
"States with very high incidence rates per 100,000 people should be given priority in the vaccination programme. Aggressive vaccination has been shown to work in England and Scotland."
Malaysian Public Health Physicians Association president Datuk Dr Zainal Ariffin Omar said a full-scale lockdown was now needed as the situation in Selangor was out of control. He said the state needed time and space to re-calibrate and reorganise its resources and strategies.
"The government should mobilise all public and private resources, non-governmental organisations and the community to implement the 'find, test, trace, isolate and support' (FTTIS) system, besides self-qurantine and community policing on SOP compliance.
"This is especially so in selected high-risk localities, workplaces, schools and universities."
Universiti Putra Malaysia epidemiologist and biostatistician Dr Malina Osman agreed that it was crucial for a full-scale lockdown in Selangor and other states that were showing similar case and ICU trends.
She said it had to be done for at least two weeks and reviewed before the end of the period by the National Security Council.