THE CONSEQUENCES OF OUR RISING COVID-19 CASES - BFM Interview (17 May 2021)

BFM description:

Malaysia's COVID-19 cases have been progressively rising leaving many to wonder what the increase in numbers means in our fight against the pandemic. First - we hear the case numbers updated daily, and they’ve been alarming. We look at what on-the-ground impact this will have on our healthcare system and communities. We then find out what has been happening with the recent headlines of overcapacity and a lack of coordination at COVID-19 Assessment Centres and Quarantine Centres.

Image Source: YuriAbas, Shutterstock

Produced by: Kelvin Yee, Azlyna Mohd Noor, Alia Zefri

Presented by: Lee Chwi Lynn, Sharmilla Ganesan

listen below for the full interview:

https://www.bfm.my/podcast/evening-edition/inside-story/the-consequences-of-our-rising-covid-19-cases

1. We get the daily numbers report from KKM - can you help us put the rising cases in context? What do they actually mean in terms of:

a) The capacity of our healthcare system

b) What our case load may look like in the short term

 

Okay, on the capacity of our healthcare system, this should mean whether we have enough infrastructure or facilities such as quarantine centres, covid hospital beds, ICU wards, ventilators, as well as human resources such as healthcare frontliners and specialists treating the covid patients category 3 and above, as well as health officers to do contact tracing and arrange for testing and quarantine.

So the situation we are in right now is worrying and concerning, because our healthcare system could not cope with daily addition of new covid cases to the level of 3000s - 4000s for much longer, what’s worse, the cases mostly concentrate and hit the Klang Valley hardest, exhausting and depleting fast the local healthcare resources I mentioned before.

Though with the implementation of MCO starting from 6 May for the most severe 6 districts in Selangor (and KL, one day later), we may expect the daily new case numbers to plateau soon by the end of this week. If we go by the observation of past trends following the MCO 1.0 and 2.0, 2 weeks are required to halt the rising trend. We should expect by the end of fourth week only then the daily number of new cases could be going on an obvious downtrend.

 

2. What are some statistics that are particularly concerning at this stage?

 

To me, definitely death toll, number of people on ventilator, number of ICU admission, covid-19 hospital beds and active cases. These are the key indicators directly affecting the public health outcomes (eg. sick, death or alive) and the ability of our healthcare system to cope. We should concern with the age profile of the hospitalised covid patients and the categories of new clusters whether they are work-related or originate from community places.

Currently the statistics also show more severe and acute numbers in those respects, compared to the previous height in Jan-Feb. Some said more than 100 died from COVID-19 in 3 days is akin to living in wartime. ICU wards utilisation for covid-19 and number of people on ventilators are also at record high, these are pretty good predictors for the high death toll in coming days.

In fact, in 26 days, the active case counts doubled from about 21 thousands in 20 April to 42 thousands 2 days ago. Make no mistake, the darkest moment for our frontliners was on 10th February when they had to cope with 52 thousands active cases. We are now probably not too far away from the worst.

3. Specifically, what can we take away from hospitalisation, ICU, and recovery numbers?

 

The number of hospitalisations is normally correlated with the statistics concerning the usage of ICU, ventilator and eventually death toll. Treat this as part of the process, with a certain fraction of patients who could go progressively worse in disease prognosis. However, if our healthcare system is overwhelmed by the COVID demand, then the quality of care might go down, therefore this would in turn risk more deaths than usual.

Recovery numbers might not tell us much , as this is just opposite to death rate, because whoever recovers from the disease eventually they would be registered in the recovery number. But the length for these severe symptoms patients to take to recover and what happened to them aftermath , should be our concern. Recovered persons can show effects of long-covid, and these are well-documented.

 

4. The numbers for cases of Covid-19 related deaths continue to go up and on Saturday we hit a new record high of 44 deaths. What does this signify?

 

We should read together in tandem the numbers for ICU admission and those who need ventilators. Yesterday both numbers were 520 and 272, respectively, these set new records too. This signifies that, at this current stage, the SARS-CoV2 virus seems to be causing more severe diseases and more deadly to those who are infected.

Perhaps more studies and research can shed more light on this phenomenon. People may worry if the emerging new virus variants of concern have been spreading widely in the community contributing to this, so far our health ministry is still doing the disease surveillance, they have not suggested so.

 

5. Adequate testing is needed to get a clearer picture of the Covid-19 situation in the country. Are we doing enough testing nationwide?

 

One way to determine if we are doing enough testing nationwide is to see the daily positive rate, which is the number of confirmed patients over the number of tested persons.

Health DG Dr Noor Hisham once said the benchmark for the Health Ministry is: for every positive test, that should be accompanied with at least 10 negative tests. That means if the daily positive rate is below 10%, the Health ministry considers it still a reasonable amount of testing.

For the past week, the average positive rate is 6.8%, higher than the normal period (between 3-5%) when the pandemic was not that serious like these days.

But one has to understand, with the interstate and interdistrict travel restrictions still in place, disease transmission is a local issue. One should ask if the government has done enough testing in places which matter, for example, if they have managed to test most if not all following their contact tracing efforts, and if they go out and test in high risk areas where many hotspots are found?

 

6. One of the major worries is whether our health system can cope with this rise in cases. How would you say we’re doing?

 

Not coping well if the daily new cases keep pouring in, like 3000 or 4000 and above. Hence, the MCO 3.0 is justified given the dire situation we are currently in.

 

7. We seem to be going in and out of these MCOs. In your opinion, are they working, or is it inevitable that numbers will rise again once activities open up?

 

First, we have to ask what is the function and purpose of the MCO. We need to realise that even the strictest lockdown like MCO 1.0 would not eradicate the virus in the country. At most, it would bring down the number of daily new cases to a manageable level at a faster rate for our Health Ministry.

To understand whether disease control measures like MCO could work, we have to go back to the basics of disease transmission. For Covid-19, the viral infection and spread is mostly possible whenever there is interaction and close contact between people.  So logically any broad policy which contains strategies to effectively reduce a significant number of the population going out to interact should help, because the viruses will find fewer people to infect.

The temporary shutdown of social gathering places (restaurants, pubs, cinemas) and banning of social events (wedding banquets, festivals, birthday celebrations, exhibitions, meetings), should remove the incentives for people to go out and interact with one another except for work, food, personal outdoor exercise or running household errands.

So, the public need to have a reasonable expectation that the MCO 3.0 measures would eventually do good to reduce the alarming disease burden and patient load, not really to the level that we could see double-digit low daily new case numbers. 

But it is true that once the government relaxes the restrictions, opens up and allows more social activities, the number will probably go up again if the local community's viral burden and threat is still present. That situation might only change if more in the population are vaccinated, and the rest do their best in complying with the SOPs.

 

8. How accurate of a picture are we getting from the Health Ministry’s daily reports? What are some facts we simply cannot discern from the data?

Health ministry’s daily reports will give you a big picture about what is happening overall in the country, if more clusters and cases have been discovered and whereabout. These should give us some sense about how the government is responding to the pandemic.

Like I said before, with MCO, now disease transmission should be treated as a local issue, thus one must pay more attention to the statistics for your own district and state, and maybe follow the cluster reports about cases in your community.

You correctly identified, there are limitations of data. Even with the MySejahtera data technology, they could not tell if we really have close contact with any confirmed patient, cannot tell if people do behave accordingly like wearing masks properly or keep their safe physical distance. In the end, phone is just a proxy. The HIDE data is fuzzy and may not be even useful for the public.

 

9. For the layperson, how can we make sense of all this data in a meaningful way that helps us stay safe?

Public should pay more attention to the local data to estimate the community risk, but no matter what, we should not let our guards down and comply with SOP and personal hygiene more strictly and carefully. One can easily blame the government but it is ourselves who are responsible for preventing the virus spread. If you can see that the trends are worsening in the state, district and place where you live, you may even want to adjust your lifestyle and workstyle, go out only when necessary.

Understanding and following the national trends from the Health Ministry daily reports and government communications, could help you become more informed, hence make even better judgment and appropriate behaviour, contribute your part in slowing down the pandemic.