April 27, 2020.
Recollections & Reflections
AS more and more cities and countries ease down on their lockdown restrictions as the first step towards reviving an economy that has been at almost a complete standstill for several weeks, all medical and scientific experts agree that the way forward is to ramp up testing and contact tracing to ensure that everyone who is infected and in contact with a carrier is identified, isolated and quarantined. Fail to do that and you can expect a second wave and third wave to hit before you even knew it.
The call is for governments to conduct as many tests as possible. This is what is meant as mass testing, not that an entire country’s population must be tested, as alluded to by Malaysia’s Health director- general Dr. Noor Hisham Abdullah at his recent daily press conference when the question of testing was put forward. No country has done that and no one is expecting any to be able to do it, no matter how superb the healthcare system, facilities and expertise.
Noor Hisham has always explained that Malaysia’s approach is that of targeted testing at hotspots and this has brought good results. No one can dispute that and no one has but in so doing, while almost ignoring the rest of the country, you will surely miss some among the general community who may be carriers. Even if only one carrier is detected from 1,000 people tested that is good enough because we will never know how many people that carrier may have gone to infect if he wasn’t detected in the first place.
What happened in San Francisco recently, as reported late Friday by CNN, when random testing of about 200 people in the streets found 67 people, most of whom showed little symptoms, positive should be a constant reminder to everyone not to assume anything where Covid-19 is concerned.
Contact tracing is tough when you’re doing it manually
If you are not using an app via smartphones to contact trace, which reduces the number of people required for the job, the exercise becomes labour intensive. The United States faces this problem and Britain recently decided that it had to train people to become tracers but later shifted to using an app. So too Australia, where concerns were expressed earlier due to privacy issues.
The fact that Malaysia is taking steps to increasing its testing capacity and the number of laboratories to run through the results simply means that it knows how critical testing is, regardless whether it is targeted or mass testing.
Experts also agree that when testing is limited, the number of infections cited officially may not be correct and could be a poor indication of the true number. Doubts have been expressed about this situation in Malaysia.
And while Singapore has to work doubly hard to try and stem the spread of transmission through its foreign labour dormitories after being hailed all over the world as a success story, there are countries not too far away from Malaysia that have done well so far.
Vietnam a success story so far but little is acknowledged internationally
The surprise package is Vietnam, a country of 95 million people which in recent times has emerged as one to watch, especially from the economic perspective.
As of yesterday Vietnam recorded only 270 cases with no death. A large majority – 225 – have recovered, and that’s a rate of 83.33%. Experts attribute its success to a combination of mass mobilisation of the public healthcare system, security forces and robust public education campaign. The country also has the advantage of learning from the 2003 SARS crisis but unlike most other countries, does not adopt the mass testing approach.
Instead border and airport controls were imposed as early as January 11 after the first death was reported in China’s Wuhan, the first epicentre of Covid-19, and by January 31 a national steering committee was in place. The bottomline is Vietnam’s swift and decisive response.
Vietnam has also exported hazmat suits, surgical masks and ventilators while importing rapid test kits from South Korea and building a new 300-bed hospital so that it will not be caught unprepared should there be another wave,
Another success story to date in Asia is Taiwan, which like Vietnam, made sure it was prepared for something like this after the SARS experience. It has reported only 429 cases so far from a population of 24 million, with only 6 deaths and 290 recoveries or 67.59%.
Because of its proximity to China, the island nation closed its borders early to visitors from there, Hong Kong and Macau. Face and surgical masks were rationed and data technology used to identify and track suspected cases and those at high risks. The wider strategy? Quick preparation and early intervention
As for South Korea, its success is often credited to its rapid testing of the community at large, via drive-through or walk-through sites. Physical distancing has been the norm for the most part and during recent elections, voters had their body temperatures checked, made to sanitise their hands and provided disposable plastic gloves before being allowed to vote.
Malaysia has done reasonably well too, with a relatively low fatality rate and high recovery rate of 67.9%.
But you sense that the health ministry tends to go on the defensive when certain misgivings are raised by doctors and others. The question of supply of personal protection equipment was a case in point. When this was highlighted by a doctor Noor Hisham said it was not about stocks but rather a delivery and logistical problem, only for him to state a week later that the country had PPEs to last only for a further two weeks. Also dismissed are calls to adopt mass testing.
If Noor Hisham and his team are right on their testing approach Malaysian will be eternally grateful but if they are wrong, god knows how this pandemic is going to blow in our faces. For everyone’s sake let’s pray that this does not happen because that can leave the country’s economy and its peoples in ruins.