Persatuan Pakar Perubatan Kesihatan Awam Malaysia or The Malaysia Public Health Physicians’ Association (PPPKAM) had submitted a proposal to Ministry of Health to share some ideas on possible strategies for the country to exit out of the Movement Control Order (MCO) in an acceptable and orderly manner. Up till noon 9 April 2020, about 65 deaths from COVID-19 have been recorded nationwide, despite being in Day 23 of the MCO, whilst enhanced MCO are also being applied at several locations with high caseloads.
Even though the outbreak has already spread to all states, there are still many districts or administrative localities that are spared, and thus labelled as ‘green’. These ‘green’ zones have not recorded any positive case of COVID-19 for the last 14 days.
Our main public health objective is to maintain and aggressively widen these ‘green’ zones, that will then help flatten the COVID-19 epidemic curve. This effort is expected to slow down the acceleration and subsequently plateau the number of COVID-19 cases, as the country awaits availability of effective vaccine. Directly, it will lessen the burden and demand on our healthcare services, and indirectly, it would protect the population at risk and simultaneously minimize economic challenges and social stresses.
This proposal resulted from brainstorm discussions among Public Health experts of the PPPKAM, taking into consideration pointers made by Dr Amar Singh in an article published in the Malay Mail on 7 April 2020. We are optimistic that the lives of Malaysians will return to a new normal earlier than anticipated, assimilating a lifestyle that is healthier and better than before the COVID-19 outbreak.
PLAN OF ACTION
The propose plan is to phase out the MCO in 3 stages; ensuring public acceptability and sustaining the attainment of COVID-19 control measures.
- Immediate Plan
Credits to the Ministry of Health (MOH) and all other relevant government agencies whose efforts had successfully reduced the infection gradient with declining numbers of COVID-19 new cases and mortality, compared to other countries, including developed nations.
However, PPPKAM predicts that case incidence can further be lowered with the following actions:
- a. Collection and optimal sharing of quality data between the Ministry of Health and professional experts from academic institutions and non-government organisations (NGOs), with conditions applied. This is to ensure protection of personal data confidentiality and to safeguard the interests of participating parties.
- b. Risk communication currently ongoing is commendable yet could be further strengthened with healthcare workers and other parties functioning in solidarity to effectively educate all segments of the community. MOH has executed its responsibility very well by making daily announcements about the current situation alongside the progress of outbreak management.
- c. Maintaining two-way communication channel via social media, between the authorities and the masses is necessary for constructive community engagement. Although this will run risks of fake news dissemination etc, it has become inevitable and should be kept open so that information concerning grievances and problems at the ground can rapidly reach the government for quick implementation of remedial actions.
- d. COVID-19 surveillance activities especially within the red zones or hotspots need to be heightened by incorporating more vigorous steps and increased capacity to detect positive cases, both symptomatic as well as asymptomatic ones. Volunteer assistance and input from members of authentic civil societies should always be welcomed and encouraged.
- e. Comprehensive notification of positive COVID-19 cases with essential information that include accurate records about timelines as well as proper classification, monitoring and management of person under surveillance (PUS), person under investigation (PUI), identification of severe acute respiratory infection (SARI) and Influenza-like illness (ILI) must continuously be done and improved.
- f. Contact tracing and monitoring can benefit through extensive use of available telecommunication technology like the MySejahtera application and allocating unique QR codes for every affected individual.
- g. Enhancing the utilization of Precision Public Health by focusing on control measures with risk assessment framework like zoning, simulation models and correct epidemiological predictions.
- Short-Term Plan
- a. Create safe zones by identifying existing ‘green’ zones where there is no new case of COVID-19 detected for the past 14 days, within the boundaries of a geographical area.
- b. Controlled relaxation of the MCO can be applied, where communities staying in ‘green’ zones can be allowed to move freely within their designated locality. Public amenities can be opened in stages, perhaps beginning with businesses, offices, properties of the municipality like parks, followed by religious institutions, schools and other education facilities and finally organisation of public and private events. Any events involving crowds of more than 500 persons should require approval of the authorities.
- c. To secure the ‘green’ zones, there should be community empowerment where local members will assume the vigilant role as ‘eyes and ears’ of the MOH. The health authorities can be quickly alerted whenever an adverse event related to COVID-19 occurs. The availability of KOSPEN and COMBI members at the ground should be fully utilised.
- d. Every member of the ‘green’ zone community must adopt a new norm in their daily living. The discipline of reducing the likelihood of infections i.e. maintaining high level of hygiene (personal and environment) and social distancing must be continued. Other healthy lifestyle practices must also be made a routine. Focus should be given towards increasing and maintaining the level of individual’s immune system through balanced nutrition, stress management, physical activity and abstinence from addiction.
- e. All means of access into the ‘green’ zones will be restricted by setting up stringent guards. People from the ‘green’ zone who left the area will be subjected to scrutiny and precautionary measures upon returning to the ‘green’ zones.
- f. Start expanding ‘green’ zones through efforts of intensified health promotion on breaking the chains of infection. All non-green zones (i.e. yellow, orange and red) must work diligently to achieve ‘green’ zone status before the MCO in their respective zones can be relaxed or lifted. Progress made by successful communities would serve as motivation for those in the non-green zones.
- g. For sustainability of the ‘green’ zones, technologies that can monitor the adherence and effective implementation of MCO should be more widely used. It is for active surveillance and prompt action in any violations.
- Long-Term Plan
- a. Establish a clear profile of the community, particularly identification of vulnerable groups like the elderly, the very young and the infirm.
- b. Acculturation and perpetual implementation of healthy life practices will now become habitual, i.e. a new norm for the whole society. These are:
- i. Discouraging common cultural practices like handshakes, hugs or close body contact amongst family and friends.
- ii. Continue practising good personal hygiene like proper and frequent hand washing, social distancing, wearing of face masks especially for those with respiratory ailments and maintaining overall cleanliness of the body and the environment.
- iii. Compliance to medical treatment and advices for all morbid conditions especially chronic diseases among community members.
- iv. Adoption of healthy lifestyles as the new normal, that will benefit the status of personal immunity, like taking balanced nutrition, good management of stress, carrying out regular physical activities and abstinence from addictive behaviour.
- v. Reduce the size of gatherings or limit the number of invitees for any events to less than 500 people only. Any crowd of more than 500 will require approval from the health authorities.
- vi. Maintain the sanitation of surrounding environment for public places like religious institutions, children nurseries, kindergarten, schools, collages, old folk homes, markets, and malls.
- c. Continuous disease surveillance from rumour & event-base notifications.
- d. Sero-prevalance studies among the community in the ‘green’ as well as non-green zones to determine their protection status against COVID-19. Serology testing will also identify the burden of disease at the studied zones. Those with low or zero levels of COVID-19 antibodies are at risk of future infections and should thus be eligible for vaccination, when a vaccine then become available.
This plan of action is strategically crafted to support and boost the control measures already taken by the Government of Malaysia against the COVID-19 pandemic. We at the PPPKAM stands solidly behind the MOH as partners in ensuring public health, today and in the future.
“BERBAKTI KE ARAH KESEJAHTERAAN MASYARAKAT”
DATO’ DR. ZAINAL ARIFFIN BIN OMAR
Persatuan Pakar Perubatan Kesihatan Awam Malaysia
9 April 2020