Towards a long term sustainable public health approach to this COVID-19 pandemic.

“Dynamics of the COVID-19 disease transmission should be used to calibrate our policies (SOPs)”

Though the third wave continues, the burden of COVID-19 in Malaysia is still lower than in many other countries. Malaysia ranks 114 globally based on incidence density. We may be amid a pandemic characterized by major waves of outbreaks that waxes and wanes, but the current burden is still manageable.

The implementation of the CMCO appears to have averted any concern of high widespread community transmission. Our SOPS should be recalibrated to make it more sustainable in terms of benefit and cost.

An important characteristic of our outbreaks is that the transmission has been driven by a few large clusters and not due to high widespread community transmission. These large clusters may be due to a more virulent strain of the virus or due to multiple generations of propagation before detection.

It may be time to think out of the box rather than getting boxed in with existing terminologies and explore calibrating the intensity of our Public Health interventions based on maximizing benefit to harm ratios. Here a few insights to various prevention activities.

• There appears to be no need for between-district travel restrictions. Travel restrictions should be based on larger geographical areas for easier implementation and lesser disruption; for example, the creation of 4 regions in Peninsular Malaysia and 2 regions in East Malaysia. When the need arises travel between regions may be restricted.

• Work from home is a useful recommendation, but it should not be made compulsory unless there is high widespread community transmission. There are many barriers to working from home. Effective policies require an evolution of work culture and a conducive home environment. Organizations may have to invest in their workers to prepare them for a more productive when working from home.

• Though there is a low likelihood of a super spreading event, social gatherings should be limited to half the capacity of an enclosed area (up to 100 people) regardless of the occasion.

• National exams such as the SPM and STPM should not be further delayed. In the current schedule, the children in Form 5 and Form 6 have already had to endure a few extra months of learning and associated stress.

• The quarantine period should be reduced for a more sustainable approach to weather this pandemic. The US CDC now recommends shortening quarantine the quarantine period for those without symptoms to either: 1) 10 days without the need for testing; or 2) 7 days with a negative test result on Day 7.

More insights into the Epidemiology of COVID-19 in Malaysia is available here.

*An edited version of this opinion was first published by The Star on the 4 December 2020

Prepared by Prof Dr Sanjay Rampal, Professor of Epidemiology and Public Health Medicine Specialist, University of Malaya. 10 December 2020