988《時事一百度》2021年1月29日點評

 

1） MCO压平曲线及筛检冠病迷思

- 听说MCO即将要结束不再延长，然后进入CMCO，请问MCO有达到政府的目标压平曲线控制疫情吗？下周已经可以安全松绑了吗？

答：下週可安全鬆綁？開什麼玩笑？

來我們先看疫情最新發展數據：

昨天的確診病例數字是4094，是目前的第二高紀錄，過去一周的平均是3666。兩個星期前我上節目的時候，那時才剛落實行管令，當時的一周單日平均確診數字是2770。近來看到的每日確診數字不是3千就是4千，我們的活躍病例昨天是新高，大約4萬3千；紅區有101個縣市，大約是全國的三分之二正面臨疫情災難。活躍感染群數字昨天也是新高，有372個，而近來每天的確診病例裡，高達八成的病例並不屬於現有的活躍感染群，這也意味著社區傳染還是很猖獗。看到這些觸目驚心的數字，再加上我國的醫療系統特別是前線醫護人員已頻臨崩潰，這個時候要鬆綁讓人隨意出門趴趴走跨州跨縣？那將是相當不負責任的做法。

你問我到底MCO是否有協助政府壓平曲線？如果你用衛生部公佈的R（基本感染數）數字來看，是的，這個曲線似乎正壓平。若從每日確診數字和活躍病例來看，是否已壓平了疫情曲線就還言之過早。但曲線上壓平是一點，那只意味著沒變得更糟糕、惡化下去，但政府當務之急是要確保能壓低和壓下曲線！

上週衛生總監諾希山說若疫情數字未見改善，他建議加強行管令。上週也傳貿工部透露風聲說政府還會延長行管令。怎知道這個星期一衛生總監就U轉了，轉口風說MCO不會再延長，因為要保經濟。

若以目前的疫情發展來看，下週要鬆綁行管令似乎相當不理性。我認為，即使沒有再加強行管令，特別是正當疫情未見顯著好轉之際，延長MCO應該已是最低限度的要求了。大家還需再忍耐一下、更努力做好本分，協助國家度過疫情難關，大家才會一起安全。

- 一些商家、经济学者甚至是医药界人士也提出替代方案，允许经济和行动松绑，同时大力推广全民筛检作为重启经济和公共卫生的必要措施。请问这个建议和说法有根据、可行吗？

答：我認同，平衡經濟和公共衛生需要是必要的。我也認為，一旦疫情不受控制，即使沒有外在的限制如行管令，經濟也必定會遭受衝擊和損失。這個邏輯很簡單：我國相當大層面的經濟活動需要勞動力來操作，一旦有更多員工生病了、或必須被隔離而缺席工作崗位，或因有員工確診商店、工廠或企業必須停止營業操作，這些成本可能不少於目前MCO 2.0限制下的規定。過早的經濟和行動鬆綁會導致MCO的前功盡廢：看看去年12月初過早解除跨州跨縣禁令和外出人數限制，導致今天的局面。

所以，任何替代方案，必須回到傳染疾病學的原理，是否它真正有效減少疾病的傳染？所謂的要平衡經濟的考量，前提必須也建立在疫情受到控制的基礎上，這算是反映某個程度的‘績效’制：比如說經濟鬆綁因為疫情已明顯受到控制，反之加緊行管令因為疫情惡化。

至於更廣泛的全民篩檢是不是一個必要的措施？我的看法是，若不是被追蹤病例或在加強行管令區的居民，一次性的篩檢沒有意義。為何我這樣說呢？首先，各位必須了解篩檢的局限：受感染的前幾天不會被RTK Antigen或RT-PCR檢測方式偵查到陽性；再來，如果一位無症狀患者康復後，依然會被RT-PCR偵查到陽性，不代表他還有感染力，而他就必須承受10天指示居家隔離，若他是自僱人士就被迫斷糧了。

如果說一次性的篩檢沒有意義，那麼到底要篩檢多頻密才有用呢？每個星期，每兩周還是每個月？如果你是高風險群，僱主幫你承擔篩檢費用，這無可厚非。僱主確實有義務和道德責任承擔啦，因為工作的需要，你必須外出與人接觸增加染病風險。

- 近来看到某某议员也通过某某诊所和医院，推销70或80令吉的RTK Antigen检测盒筛检配套，也收到私讯广告推销某些品牌的检测盒寄去家里自行检测，这样做有问题吗？

答：首先讓我回應後者：各位千萬不要自己購買檢測盒居家自行檢測。因為獲取樣本進行檢測必須是由有經驗的醫護人員來執行。自己或家人不懂如何正確刮取喉嚨樣本的話，結果出來是假陰性（false negative）就不足為奇；再來的風險是，你可能把協助你的家庭成員暴露在受感染的風險當中，因為當你張開嘴巴的時候，他必須近距離直接面對病毒傳染的來源。衛生總監諾希山前幾天也說明了，這些廣告推銷是非法的，因為任何醫療產品廣告必須獲得衛生部醫藥局批准，一般上要求非常嚴格。

再來，就如之前我所說的，全民篩檢有其局限和弊病，一次性檢測無助於防疫，反而增加了自己的虛假的安全感（false security）。那些推銷的RTK Antigen檢測配套，價錢也不菲；要知道若根據PERKESO的配套，僱主僅需繳付僱員40令吉，為何那些議員們可以推銷70到80令吉的配套？我只能說，這看來是一門好生意。

這個點子的另一問題是，把原本不受感染而在行管令下居家安全的人，因為被議員配套吸引而去診所或醫院作檢測，這些地方卻是染病高風險地方。其實，若不是被追蹤病例，根本不需為了檢測而為自己增添風險，不是嗎？

- 还有，最近有消息传出说公寓管理单位要求住户自行做检测，一些则要求外籍移工而已作筛检，请问这有必要吗？是否有助于防疫和抗疫？

答：我確實有看到昨天下午國防部高級部長依斯邁沙比裡說公寓管理有權這麼做來保護住戶。我必須說，他的說法沒有事實根據，這樣只會鼓舞和助長公寓管理層落實這個無效用的措施，給住戶增添不必要的麻煩和財務負擔。

再說，本來行管令的用意就是叫人留在家裡啊！即使被揪出是陽性後，不被允許居家隔離這還像話嗎？住戶之間的互動一般就不多了，平時要碰面也不太容易。最大風險的地方不外是電梯，還有常接觸表面如入口處大門手把按鈕，和電梯按鈕。管理層不時去消毒就好了，電梯裡面要求住戶帶口罩就ok了，何必勞師動眾叫全部人去篩檢呢？

2）安华入禀法庭挑战紧急状态不开国会

- 安华挑战慕尤丁和政府的根据是什么？

答：安華以他身為國會在野黨領袖的身份，通過行動黨國會議員藍卡巴星代表，入稟法院申請司法審查（judicial review）首相慕尤丁給予最高元首的勸告不合法也不符合國家憲法，特別是針對在緊急狀態時暫停國會這事宜。所以，首相的勸告導致2021年緊急條例下的第14條，安華要求法院宣告不合憲法。

- 今年1月14日颁布的紧急条例里面有说明国会一定不可以开吗？到底应该要怎样解读？

我們來看回緊急條例的第14條說了什麼：

14. (1) Bagi tempoh darurat berkuat kuasa—

(a) peruntukan yang berhubungan dengan memanggil, memprorog dan membubarkan Parlimen dalam Perlembagaan Persekutuan tidak mempunyai kesan; dan

(b) Parlimen hendaklah dipanggil, diprorog dan dibubarkan pada suatu tarikh sebagaimana yang difikirkan sesuai oleh Yang di Pertuan Agong.

(2) Mana-mana mesyuarat Parlimen yang telah dipanggil sebelum tarikh permulaan kuat kuasa Ordinan ini tetapi belum diadakan adalah dibatalkan.

我來翻譯好了 – 在緊急狀態落實當兒，在憲法下的有關召開、休會和解散國會的任何法律條規皆無效；國會何時要召開、休會和解散，最高元首有權斟酌何時最為恰當如此做。

在緊急條例之前已決定和編排好的國會召開日期，也將被取消。

好了，我認為安華的解讀緊急條例裡表達暫停國會的意思，我覺得這還蠻有爭議性，因為第14條沒有說國會一定不可以開，而是決定權在於最高元首…當然是要在首相的勸告下行事啦！慕尤丁在緊急狀態頒布那天的公開致辭演說裡的第21點就直接表明國會和州議會在緊急狀態下都不會召開和進行，直到最高元首決定日子。若針對講詞，安華的控狀解讀就比較明顯有利於挑戰。

當然，安華的控狀裡提出在緊急狀態之下暫停國會不合法，在憲法下其實是有根據的。因為吊詭的是，緊急條例在最高元首名字下有小句留尾說：[Akan dibentangkan di Parlimen menurut Fasal (3) Perkara 150 Perlembagaan Persekutuan]

這條例將根據聯邦憲法第150條例第三段，提呈給國會。這確實是過去的程序，但國會如果不召開直到緊急狀態結束後怎麼辦？到時國會還有辯論這條例的必要嗎？要知道過去國家有4次處於緊急狀態，國會依然運作通過特別的法案針對緊急事故。

- 国会重开对于安华和希盟领袖来说，有什么作用? 为何他在记者会上强调他有什么人数反对紧急条例，还要说拥有朝野两边的支持，用意何在？

答：人家說安華是“人數”哥其實是有道理的。就政治意義和正當性而言，安華一直強調人數就好比表示自己其實才是多數領袖，換句話白話一點說：“我才配做首相，慕尤丁已失去多數支持，沒有正當性”。

可是，安華要注意的是，他的人數意義解讀可能差之毫釐謬以千里：確實有多數的議員反對國盟政府支持的緊急狀態，不代表大部分的這些國會議員都支持安華做首相。相信他知道支持的局限在哪裡，所以當然他也沒有說明有關做首相事項，但他確實還是有意‘抽水’突出他為主要領袖的形象啦！

至於為何需要國會？當然就國會議員和政府內閣成員職責而言，他們必須通過國會履行選民的民主委託，同時監督和辯論政策法案。這些都是檯面上的理由啦！具體而言，就如我兩周前所說的，緊急狀態不會讓慕尤丁的政治對手束手就擒、安靜下來，他們肯定會有更多政治動作威逼這個普遍上被視為弱勢和跛腳鴨首相慕尤丁。大概大家可以想象，如果能召開國會，政客們肯定會利用機會倒慕，以達到各方的政治目的和盤算。他們應該沒有疫情災難當前所謂的‘團結’（solidarity）和‘體育精神’（sportsmanship）這回事。

- 还有什么人马现在也加入行列入禀法庭挑战政府？他们之间有什么控诉上和策略上的分别？

答：據我所知，已經申請入稟挑戰慕尤丁的，還有希盟的三人組和鬥爭黨領袖凱魯丁。我也聽聞公民社會組織蠢蠢欲動要控告政府，推翻緊急狀態決定。希盟三人組的控狀理由與安華相似，但還加上了要求法院宣佈憲法條文阻止法院檢討緊急法令其實有違憲法精神和地位。他們要求國會重開來檢閱緊急條例。凱魯丁的控狀主要環繞在首相已失去了多數支持，如何還可以勸告最高元首頒布緊急狀態，同時他如何能阻止國會召開？

- 你如何预测结果：紧急状态会持续到8月吗？国会会在紧急状态下重开吗？

答： 維持緊急狀態的正當性主要與疫情發展掛鉤，因為這正是首相慕尤丁的1月12日緊急狀態致辭的重點和提出的正當原因。除非政府有意不要那麼快壓下疫情，不然如果下定決心的話，應該可以在兩到三個月內壓低至一個安全水平。那麼，到了5-6月的時候，慕尤丁就得面對更大的政治壓力。而所謂緊急條例下成立的獨立委員會可能會‘勸告’最高元首取消緊急狀態。如果那能成事，我看很快我國就得要面對全國大選了，因為巫統已迫不及待要逼宮慕尤丁解散國會，不然就拉倒他。我看他也沒有太多其他的選擇…所以我目前只能期望他不要拿疫情和人民的健康和生命為他的政治賭注綁架起來！那是我的最大擔憂。

3）环形疫苗接种圈定首批接种对象

- 什么是环形疫苗接种？这个与全民疫苗接种策略有什么不同？

答：環形疫苗接種是一種疫苗接種策略，先為那些最有可能被傳染的人先打疫苗接種，以期望這些被追蹤病例的人士可以成為一環一環的免疫人墻阻止病毒在社區擴散。要知道新冠病毒的傳染管道主要通過人與人之間的密切接觸有關，而這些被追蹤要求先去疫苗接種的人就是與確診患者最有密切接觸可能的人。

用足球術語來說，就是採取人盯人的戰術，去掉或弱化最大的潛在威脅。歷史上，天花症是這樣被根除的；近代在疫苗劑量有局限的情況下，環形疫苗接種策略也用在對抗非洲西部的伊波拉病毒。

全民疫苗接種策略則不同，這無關直接的感染可能和風險，無需追蹤病例。從科學工藝革新部長凱里的受訪說辭，其實政府要同時進行兩個策略。既然政府要在全國設立大約600個疫苗接種中心，以及有雄心要每天24小時為全國人民注射7萬5千劑疫苗，這可不是容易辦到的事。從這個數目來看，政府有心要根據早前的宣佈，分三個階段為不同風險的群體注射疫苗接種，要在1年半內為超過7成全國人口注射疫苗以達到群體免疫效果。但凱里也宣佈將保留一部分的疫苗劑量用於環形疫苗接種策略，雙管齊下。

- 疫苗接种计划的接种对象的排序阶段是什么？政府计划的接种速度合理可行吗？

答：根據報道，到了二月底，瑞輝公司的128萬劑疫苗將首先抵達我國，這個應足以應付20%國民人口的兩劑疫苗接種需要。首階段，政府會為大約50萬前線醫護和非醫護人員注射疫苗接種，因為他們面對最高的感染風險，但是國家卻最需要他們繼續執勤任務抗疫。

第二階段則是針對高風險群體，例如3百萬名樂齡人士和殘障人士，還有350萬名有慢性疾病的病患，比如糖尿病、血壓高、癡肥、心臟病、氣管呼吸疾病、癌症病患。第三階段就開放給所有18歲以上的國民。

凱里也說會為移工群和所有大馬居民免費注射疫苗，目前正商討如何支付這些費用的機制。

至於接種速度，政府確實有很高的期望和目標，這個要執行計劃起來真的很不容易。據說這些600個疫苗接種中心是要24小時操作才能達到每日接種人數的目標。凱里預料全國各地需要至少7000名人手負責疫苗接種事務。問題是，目前衛生部捉襟見肘人手緊張，因此凱里需要更多的自願人士在社區幫忙。

- 最大的挑战在哪里？政府能获得在预定时间获得足够的疫苗供应吗？

答：剛才已解釋了不少疫苗接種任務執行的挑戰，其他的挑戰包括疫苗運輸通勤和儲存問題——因為瑞輝疫苗很不同，它們是新型的mRNA疫苗，需要比一般疫苗還要冷凍的溫度來儲存和運輸。

確實目前政府需要顧慮的是這些疫苗供應來得及抵達我國嗎？全世界都向這些廠商下訂單，其他國家的人口更眾多，國力更強大，他們可能會搶佔資源。我認為政府同時也向其他藥廠訂購其他疫苗是相當明智的做法，期望政府能在最短的預期時間內為70%人口注射疫苗！

- 人民可以选择要打什么品牌的疫苗吗？

答：我明白一些國民群體會為什麼想選擇一些品牌，和不要另一些：比如說伊斯蘭黨曾有人表示不要中國製造的疫苗因為顧慮含有某些不清真材料；中華膠的華人可能就指定要中國研發的疫苗，拒絕‘美帝’的瑞輝疫苗；當然也有一些人因為聽聞很多誇大的疫苗副作用消息，而不要某些疫苗。

那麼，人民可以選擇嗎？不可以的，政府也表明了這點，但民眾會被告知正在使用的疫苗是哪個。

要知道，疫苗產品屆時也是全球的限量‘時貨’，哪個先到哪個已用完了，沒有人可以說准。那些疫苗中心可能就只有一種疫苗存貨選擇，沒得選啦！再況且政府已提供免費了，我就不曉得以後私人醫療界能買到現貨和人民可以前往要求注射自己要的疫苗品牌嗎？我個人就建議大家，輪到你的時候就不要再拖了，先打先有疫苗保護作用。別擔心，一旦經過我國的藥品管理局(NPRA)檢驗和認證，醫藥產品一般上都很安全。

Unnecessary for condos to force swab test on residents

 Malaysiakini's interview report: Unnecessary for condos to force swab test on residents - medical experts

https://www.malaysiakini.com/news/560750

Third World Network public health researcher Lim Chee Han reminded that the public should not be superstitious towards swab tests but understand the conditions and constraints of getting screened.

He said swab tests have limitations, such as the inability to detect those who are newly infected. For those recently recovered from the virus, there can be a positive result when undergoing RT-PCR tests, even if they are no longer able to infect others.

Lim agreed with Cheong that swab tests could only detect whether a person is infected at a particular moment, and it is too expensive for the public to get tested regularly.

"I can understand why employers have to bear responsibility and screen their workers; this is because their workers have to go out and get in touch with others for work purposes.

"But why is there a need for condominium residents to get tested? After all, the costs are high (unlike pregnancy tests which are easier to conduct and cheap).

"Besides, a one-time test doesn't have much use in curbing the virus," he said.

The management should not carry out mass testing aimlessly, and it will only cost the residents.

"I think contact tracing is more important… unless there is a confirmed case in the building, then they can trace the close contacts and ask them to do swab tests," he added.

...

The Health Ministry previously announced that Covid-19 patients who are in "Category 1 and 2" will undergo treatment and quarantine at home while being strictly monitored by health workers.

Cheong worried that if the condominium management doesn't allow residents who have tested positive to enter, these patients will not be able to quarantine at home.

Agora Society of Malaysia policy researcher Lim Chee Han, a health economics and public health specialist, agreed that such measures contradict the Health Ministry's home quarantine requirement.

He said the ministry is getting overwhelmed because of the spike of confirmed cases, resulting in a slow down of Covid-19 tests conducted and the admission of those positive into hospitals. As a result, an infected person would not be sent to a hospital immediately.

On the other hand, Lim warned that if someone uninfected goes to high-risk places such as hospitals or clinics to get tested, their risk of contracting the virus will increase.

He further explained that a medical paper issued last May found that a Covid-19 patient's symptoms will improve on the fifth day upon symptoms onset; after the 10th day, their symptoms will be gone and they will lose the ability to infect others.

For those who are asymptomatic, they are considered as recovered patients 10 days after the date of their first positive test.

According to Lim, because of the lack of resources, it may take up to seven days for the Health Ministry to take a Covid-19 patient to a hospital.

Under the ministry's guidelines, a patient can be discharged after 10 days as they are no longer infectious.

Therefore, Lim pointed out that swab tests are not necessary steps unless the patients have very serious symptoms, or do not have suitable conditions for home quarantine.

Lim said that 80 percent of Covid-19 patients are asymptomatic or have mild symptoms.

公寓强制验冠病无防疫作用

《當今大馬》訪談專題報道：公寓强制验冠病无防疫作用，专家担心会弄巧成拙

https://www.malaysiakini.com/news/560753

蒙纳士大学公共卫生及卫生系统研究员张永隆向《当今大马》表示，即使所有住户都呈上冠病检测报告，也无助于防疫。

“筛检结果只能说明，此人受检测时是否有染上冠病。”

“即使一名租客呈上阴性的冠病检测报告，也无法避免他之后可能会染上冠病，进而感染其他住户。”

他说，无论租客是本地人或外籍人士，都无法确保只做了一次检测后，从此再也不会染病。

公共卫生政策研究员林志翰则提醒，公众不应该迷信筛检的作用，而是应该了解在什么场合与条件下才适合去做检测。

他指出，检测有其局限，譬如一些患者刚染病就无法侦查到病毒，也有患者在康复后可能在做逆转录—聚合酶链反应（RT-PCR）检测时侦查到病毒的残骸，但不代表还有传染力。

他也认同张永隆的说法，即筛检只能说明检测者当下是否有染病，但其费用不菲，民众不可能定期检测。

“我可以了解为何雇主需要承担责任，筛检工作单位的员工。这是因为员工为了工作需要而无法避免外出，必须与他人交流和接触。”

“但为什么公寓住户有必要自行做筛检呢？毕竟做筛检的成本不低，不若女性使用验孕棒方便且便宜。而且，只做一次检测没有太大的防疫作用。”

林志翰批评，公寓单位茫无目的地大范围检测，效果不彰，却劳师动众，耗费住户的钱财。

“我觉得更重要的是追踪病例……除非公寓里出现确诊病例，然后追踪接触者，让他们做筛检。”

...

卫生部此前规定，第一及第二级2019冠病确诊者只需居家治疗与隔离10天。

张永隆担心，若公寓管理单位不愿让检测呈阳性的住户进入公寓单位，意味着第一级或第二级的患者无法在家中隔离。

林志翰也认同，公寓单位的举措可能与卫生部的居家隔离要求相抵触。

他说，由于病例剧增，卫生部前线人员已经过度疲劳，防疫工作进度缓慢。

他表示，在这种情况下，即使有人的冠病检测呈阳性，也不会立即送院治疗。

因此，他担心公寓的“法外立法”会造成反效果，即原本没有受感染的人到高风险的医院或诊所筛检，反而提高染疫风险。

他解释，医学界去年5月的一份研究发现，冠病患者出现症状的第5天开始，症状就会改善；出现症状的第10天后，患者会失去症状与传染力，能够康复出院。

至于无症状患者，他们确诊后的10天后，也被视为不再具有传染力。

他表示，由于医疗资源紧张，卫生部往往在患者出现症状的第7天才能安排入院隔离。

根据卫生部的指南，一名冠病患者在出现症状的第10天后，若他们不再有症状，就可以出院。

因此，林志翰认为若没有出现严重的症状，或并非家中不适合隔离，筛检并无必要。

“若出现严重的冠病症状就需要治疗护理，如此一来要求筛检就比较合理。”

他补充，有80%的冠病患者是属于无症状或轻微症状患者。

***

完整的訪談筆答實錄：

1. 公寓是冠病传染或簇群爆发的主要场所吗？多少%的簇群来自公寓？

答：昨天在當今大馬公佈的病例發生的地點，就有7個是公寓的住戶。我不能確定有多少簇群來自公寓，因為去年10月，衛生總監諾希山已表明不會再以事發建築物命名簇群。在這之前以公寓命名的簇群有Menara City One Condominium , Kondo Sierra East, Condominium Hulu Langat.

由於出外工作的人終究需要回家，所以若有公寓出現感染病例不足為奇。但如果說公寓住戶因接觸到另一單位的住戶而受到感染的，恐怕並沒有像一般人的想象嚴重或容易。 對比工作單位，一大夥人可能在空間限制下同一時間一起操作。要知道，新冠病毒的傳染方式最主要是通過人與人近距離接觸。在行管令的限制下，公寓住戶之間的社交互動本来就應該不多，也不一定在同一時間會與其他住戶碰面，所以即使公寓裡有傳染病例，應該是住戶出外辦事或工作时不幸地被感染。

一般上，公寓裡最大風險的地方是升降機內，由於窄小密封空間造成住戶之間的人身距離靠近。其他要關注的是入門處手把、升降機按鈕等，但只要住戶記得回家勤洗手，公寓管理層有做好定時的消毒工作，其實也沒有什麼好害怕。 2. 既然大部分感染群是来自工作场所，要求公寓住户做筛检，是否有助防疫？

答：你說的沒錯，日前衛生總監諾希山顯示的數據表示，自從1月6日以來，靠近三分之二的感染群來自工作場所。

我要籲請大家不要太迷信篩檢的作用，要了解在什麼適當的場合和條件下使用比如說RTK Antigen和RT-PCR等的檢測。尤其對於前者，請公眾務必要參考衛生部的新冠指南Annex 4c。大家必須了解這些檢測的局限：比如說，剛染病的前幾天可能這些檢測方式無法偵查到病毒; 早已康復的無症狀受感染者也有可能被RT-PCR偵查到病毒的殘骸，不代表他還有感染力，等。但篩檢的最大問題是，到底需要多頻繁，要做多少次才有效？即使結果正確是陰性的，不代表那人隔天就不受感染，是吧？

我可以了解為何僱主需要承擔集體的責任為工作單位的僱員做篩檢，因為這些員工為了工作需要而不惜出來進行人與人之間的交流和接觸。那麼為何公寓住戶有必要自行做篩檢呢？畢竟做篩檢的成本不低（不如女生的懷孕檢測棒那麼方便使用又便宜），而且做一次並沒有太大的防疫作用。

目前衛生系統已過度操勞疲累了，衛生部也已頒布新措施也呼籲那些無症狀的密切接觸者甚至是確診的一級二級患者自行居家隔離（如果居家條件理想），我怎麼看都不需要一般公寓居民勞師動眾自行自費做檢測，除非衛生部通過病例追蹤鑒定哪座公寓有高密度和高風險如去年3月尾的Kluster Menara City One，該棟樓被EMCO lockdown。 3. 部分公寓的规定是针对移工群体：移工必须交检测报告，才能租房。这造成一些移工无法租房，这会有什么影响吗？

答：這些公寓更加不可理喻，這分明是有歧視的成分。根據我的最新了解，除非那些公寓是某些僱主向人力資源部通報為他們的移工勞力提供的正式住宿地點，這些篩檢還是由僱主負責，和公寓管理單位監督，這就不同。若不是這個情況，一般上，比如說落單和獨立工作的外籍人士住戶，他們不應該被約束。我不曉得這些公寓管理的做法是否合法，我認為非常有爭議性，甚至可以被挑戰。是否這些公寓管理層誤會了Perkeso的外籍移工篩檢政策，還是他們被誤導？ 4. 这是否会抵触卫生部居家隔离（针对一级、二级患者以及密切接触者）的政策？甚至是违反传染病预防及控制法令？

答：我認同說這公寓居民篩檢措施是不需要的，也與你說的最新居家隔離政策相互抵觸，可能還會造成反效果——把原本沒有受感染的人推去高風險地點如醫院或診所進行篩檢，增加接觸到受感染人士的機會，這不僅違反了行管令限制外出的用意，也無助於防疫。 大家應該要了解，除非你有令人擔憂的症狀發作，即使你真的受感染了，80%的情況你是無症狀或輕微症狀的，大約10天后就失去了感染力，檢測結果是什麼已不太重要了也沒有了意義，反而你會增添你的財務負擔和精神緊張，再況且衛生部已過度操勞了無法為你做些什麼，或許結果還是一樣叫你居家隔離而已。所以，何不在這段期間充分地居家隔離，檢測能免則免？

BFM interview: VACCINE INEQUITY WILL AFFECT WEALTHY COUNTRIES, TOO (25 Jan 2021)

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With developing nations struggling to obtain vaccines, the WHO has warned that the failure of wealthy nations to lend a helping hand will affect the economy of the entire world. We speak to Dr Lim Chee Han for some insights. 

https://www.bfm.my/podcast/evening-edition/evening-edition/vaccine-inequity-will-affect-wealthy-countries-too

Text:

1. From an economic standpoint, why is it important that all countries in the world get vaccinated?

CH: In order for the global economy to function at full capacity, it has to take care of the dimensions of global demand and supply of goods and services.

For production of goods and provision of services, the economic output in many parts of the world still requires labour and capital inputs. Before talking about the total productivity factor, one should pay more concern about the health of labour, our workers.

In a world without vaccine as we know by the end of last year 2020, when the pandemic was ravaging and lost control, borders were closed (and are still closed), many areas were under lockdown, many workers were forced to stay home due to quarantine order or at hospital or quarantine centres due to COVID-19. There were also people went unemployed due to pandemic-induced economic downturn. So, from the economic point of view, it is bad, because the labour force is not utilized at full capacity, productivity suffers. Economic inefficiency is obvious and wasteful.

Also, the prevalent lockdown policy also would suppress the public demand for more goods and services, this in turn sends a negative feedback loop to the local and global economy. In such gloomy economic climate, investment for certain sectors would go slow or significantly reduced, thus capital inputs would also be affected.

Vaccine is the game changer that most people on this planet eagerly look forward to receive, in the understanding that it will effectively and significantly prevent the spread of viral infection, once the herd immunity could be achieved. This is still a good presumption currently, no one knows if the current crop of vaccines would all produce the efficacy of giving us a long term protection.

Since the global economy is very dynamic, more than ever the businesses would want the borders to be reopened for free movement of people and goods, if many parts of the world are still not vaccinated, it would be unlikely that the world can go ‘business-as-usual’, even the vaccinated persons have to be extra cautious, because the vaccine protective effect is not 100%.

2. This is in a larger sense a picture of how interconnected our global economy is. Could you break down for us how it impacts wealthier nations if developing countries don’t have the same access to the vaccines?

CH: As I have described just now, if the developing countries are still bogged down by the pandemic at uncontrollable rate, majority of the populations would be either sick or quarantined, economy got badly hit, people go unemployed, why do we expect the people in this part of the world still go on buying goods as usual from the developed countries? Surely the global aggregate demands for certain goods would be affected, because developing world is actually more populated than the advanced countries.

What about the outputs of raw materials, intermediate goods and products badly required by the developed countries, if few people are able to work on those? Thus the production lines and value chain in the developed countries would also face disruptions. Even if they don’t, they might have risk due to uncertainties about the pandemic situation in particular countries.

3. It is estimated that a delay in getting the pandemic under control could lower our global economic output by USD4.4trillion. What does this translate to in practical terms across the world?

CH: USD4.4trillion is simply an astronomical number, ordinary folks probably can’t get their heads around it. But if we put it in percentage, it means 5.7% drops of annual global output, compared to the level before the pandemic. Mind you, this is not the worst case scenario projection (USD9.2 trillion). In short, this means further global economic recession.

We also have discussed just now about how interconnected and dynamic is the global economy. Yes, a significant reduction of the global output is the big picture, but we need to scrutinize the effects down to the level of local economic sectors and how this phenomenon could snowball into massive socioeconomic problems in particular locality where the main economic activities are severely affected. We should understand that the pandemic effect hits some sectors at different magnitude and impacts.

4. How much of a priority is timing? In the sense that, does everyone have to be vaccinated at more or less the same time?

CH:When it comes to fighting pandemic, timing is at a premium. The goal is to achieve herd immunity as soon as possible, many countries give a timeline of 1 to 2 years, if they are fortunate enough to get hold of the vaccine orders.

Our Malaysian government gives a timeline of 1 and a half year is sensible though the challenges are huge. Given that we have about 33 million of population, it is practically impossible to vaccinate everyone at ‘more or less the same time’. In my understanding, the government had already set out a plan to vaccinate the population in 3 stages, first priority is given to the most vulnerable and risky populations such as frontliners, elderly and patients with co-morbidity, then come down the priority according to risk level.

That is only the vaccine delivery challenge. We need to talk more about the global challenge of vaccine production, procurement and logistics, too.

5. We see wealthy countries having much better access to the vaccines, and in a sense, leading to some amount of hoarding. Is there a way to get them to share?

CH: According to Duke University’s Global Health Institute, a small group of rich countries — comprising just 16 percent of the world’s population — have locked up 60 percent of the global vaccine supply.

Few days ago, the news reported that 39 million doses of vaccines have been administered in 49 wealthier nations, while Guinea is the sole low-income country on the Africa continent to receive doses, with only 25 people being inoculated so far. This shows the global vaccine inequality and shameful disparity.

Although the COVAX facility led by GAVI, CEPI and WHO, promise to deliver 2 billion doses for the 20% population from the 92 low income countries by the end of this year, only 5 vaccine producers showed commitment so far, one of them is Pfizer, they agreed to provide only up to 40 million doses, far short of the target.

Personally, there should be interventions from the world leaders and authority such as UN and WHO, to ensure the vaccines, as well as other medical products and equipments being shared equitably and efficiently. The time is now.

6. If we could look at some sectors in the economy, which are likely to be more affected without a vaccine?

It goes without saying, tourism-related sector is dying. Also, events-oriented economic activities especially those which involve mass gathering of people, for example, exhibition, concert, football game, even cinema, under SOP they would be only at best operating at sub-par of maximum capacity.

6a) And briefly addressing tourism - will we be able to travel again, if let’s say half the world isn’t yet vaccinated?

CH: Have you heard about a thing called ‘green bubble’ travel zone? That’s when both sides of countries got the pandemic under control within their own borders, then the bilateral cross-border movement could be made possible. Vaccination would likely help to achieve the desired effect of controlling the disease transmission, but even without that, some countries such as Taiwan and Vietnam can show that they could handle the pandemic very well.

Yes, we will be able to travel again one day on the aforementioned conditions, but perhaps we still have to observe the SOP wherever we go. The world is still not safe until all is safe.

7. Does the Covid-19 pandemic point to a place where globally we do need to have our health systems more in sync?

CH: The design of health systems could vary from country to country, and would likely to stay so, due to historical path-dependence factors for respective countries. It is very complicated to ask the health systems to ‘sync’. The set up is probably very much embedded into the social and culture of a particular country, take an example, NHS in the UK.

So, I would say rather say, information and knowledge sharing, resources sharing and more cooperation would be more tangible for many countries to come together, especially when facing global pandemic health threat.

Contact tracing and asymptomatic close contacts at home

 It is very unfortunate that our MOH already came to the stage where they could hardly keep up with the close contact tracing. They might have worked way past their capacity given what was reported in the news. The challenging situation could be very real and daunting - the average daily positive cases for the past 7 days is 3405 (13-19 Jan) , imagine if one newly confirmed patient has been in touch with 10 persons which could be later identified as close contacts, just on the number of phone calls alone, the ministry has to make over 30 thousands of calls a day!

It is not only the initial phone calls, the MOH officers also have to evaluate and follow up the situation for each and every close contact, and make logistical arrangements for them if required, for example, pick up for quarantine/treatment or arrange for testing.

The amount of workload should not be underestimated, while the number of officers and teams might not get expanded that quickly even if the MOH has done 'redeployment' to help out with the impending COVID-19 disease control tasks. Trying to tackle the overwhelming workload that creates more and more backlog is just not working for the system , in fact it stops making sense anymore (eg. being contacted after one is recovered).

The new directive for asymptomatic close contacts to stay home quarantine without testing may have saved considerable work burden for the MOH and actually this is also in line with the WHO guideline "Home care for patients with suspected or confirmed COVID-19 and management of their contacts" issued on 12 August 2020, Still, this directive does not excuse the task for our health authority to identify, inform, evaluate and follow up with the close contacts. Thus, the backlog of close contacts not made it in time for tracing, this will become a big problem.

Recently, many also probably have heard from someone who had been infected, that he/she had to make personal communication first to notify those who are potentially at risk as close contacts, so that the latter could get prepared to self-quarantine before MOH could tell them so. Some of the contacts could barely live with the fear and uncertainty hanging on their head, decided to go first seek for COVID-19 testing in private settings. Even delayed contact from the MOH could leave many members in the community in great anxiety, and some may make the wrong decision and action for themselves, aggravate the situation.

Public should also understand the rationale for the new directive (on asymptomatic close contacts to stay home), it may not be the most desired thing for the MOH to do, but it could be the temporary solution at the moment. The MOH could no longer scrutinise the movement of the close contacts, hence it is imperative that once the close contact is being identified and notified as such, he or she plays the part of keeping others safe by observing the home quarantine.

It does not mean that asymptomatic close contact should simply go out and break the home quarantine order (given that the person won't even get a pink bracelet on his/her hand to be identified with), the whole community and the health authority would have to count on them having the discipline to observe the quarantine order. The Sivagangga cluster back in August 2020 already informed the nation the cost of personal indiscipline to the communities. Fortunately the plan ('new directive') could work better due to MCO 2.0 being imposed now, such that those close contacts should have no good reason to go out of the house anyway.

KKM should try expanding the local contact tracing teams especially in districts/areas with greater disease burden. If necessary, they should source help from the community and train more volunteers on the tasks performed for contact tracing.

It is true that only if the contact tracing system is still intact, the government could stand a better chance to get the pandemic under control and flatten the curve. The more close contacts not being traced , the greater the risk for community transmission unchecked.

For the time being, stricter MCO may need to be implemented if the situation in the coming weeks is still not yet under control, the government has to look into reducing further number of people going outside and get exposed in the community.

Inputs given above for the final Malaysiakini article:

Experts: Rope in more people to help with contact tracing

https://www.malaysiakini.com/news/559903

...Monash University Malaysia public health and health systems researcher Mark Cheong echoed the Gopeng MP’s proposal, saying other ministries could also contribute human resources.

“The government may want to consider reassigning manpower and resources from other ministries and government agencies to perform contact tracing operations,” Cheong said.

To further target its response, health economist Lim Chee Han proposed that the ministry trains voluntary contact tracers to be placed in red zones.

“The ministry should try expanding the local contact tracing teams, especially in districts or areas with a greater disease burden.

“If necessary, they should source help from the community and train more volunteers,” said Lim, the Third World Network public health researcher.