The
whole country was ordered to go into full lockdown on 1st June 2021.
Since
then until 7th July, 6 states namely Perlis, Kelantan, Terengganu,
Perak, Pahang and Penang have recovered and bucked the epidemic trends, and moved
into the National Recovery Plan (NRP) Phase 2. However, Selangor, Kuala Lumpur, Negeri
Sembilan and Melaka had gone the opposite direction and become even worse than at
the start of FMCO.
Many
wonder if FMCO measures have been ineffective in curbing the disease spread and
subsequently failed the nation, based on what they see in the national trends.
The recent news about surging new cases and deaths, as well as certain
healthcare crisis in some public hospitals in the Klang Valley have further
dented public confidence in the government’s ability to handle the pandemic. It
is right for the public to show concern and the authorities should pay
attention to this, but what can the FMCO and MCO 3.0 measures tell us about
their effectiveness in reality? Or are there any other issues related to
implementation of the measures?
Under
the MCO 3.0 and FMCO conditions, especially when the inter-district and
inter-state travel restrictions are in place, one should view and treat the
disease outbreaks in the community as local events. Hence, to evaluate the
pandemic situation in Malaysia, one needs to go down to the district-level to
see if the local authorities have carried out their duties properly and
effectively on disease prevention and control. Due to varying
socio-demographic, economic and epidemiologic conditions in different
localities, it is important that we recognize and understand the nuances of
local disease transmission patterns to find out what actually went wrong, or
right.
Let
us delve into the numbers.
Selangor
and Kuala Lumpur are the national trend setters, taking 60% or more share of
the total cases since 7 July (Figures 1 and 2). Some say these are the state
and territory with a large population and high density, hence disease
transmission is made easier. However, if we look at the numbers of cases per 100,000
population (7 day moving average), Labuan (72.0) and Negeri Sembilan (70.7) actually
performed worse than Selangor (66.0) and Kuala Lumpur (65.9) on 13 July (Figure
3). The disease transmission downtrend since the beginning of FMCO was reversed
around 25th June, and now in some states we can see the number of
cases is shooting up again, and aggressively so.
Then
came the announcement for EMCO implementation for a larger part of Selangor and
some KL areas starting from 3 July.
Figure1:
Figure 2:
Figure 3:
(*Labuan
is an outlier for most of the period, therefore an exclusion of it makes the
graph more comprehensive to readers)
This
does not mean that the FMCO didn’t work in states such as those that progressed
to NRP Phase II. Perlis (-85.0%), Kelantan (-79.7%), Terengganu (-65.1%),
Sarawak (-51.0%) and Penang (-44.3%) show significant reduction of daily new cases
compared to their starting point in 1st June (Figure 4).
However,
this is not the case for Selangor (+81.1%), Putrajaya (+72.8%), Kuala Lumpur
(+71.9%) and Negeri Sembilan (+71.5%), that saw their situation much worse than
on 1st June, with many outbreaks in new clusters and surging cases.
Figure
4:
If
we look at the district level, 97 out of 159 districts (or 61%) in Malaysia
have successfully turned it around and improved on the 14-day local
transmission cumulative cases (Figure 5). 16 districts also moved out of the
red zone alert. But on the other hand, 61 districts (38%) got into deeper
trouble with worsened records since 1
st June.
So,
FMCO measures did work for some states but may not be for others. Just to
showcase the different effects and outcome, the district case status profile
can be evidently distinguished for the two sets of selected states (Figure 6).
Figure
5:
To
understand better why the infection outbreaks in Selangor and Kuala Lumpur got
out of hand even under FMCO, one has to dig deeper looking into the new cluster
analysis to find out the sources of disease transmission. This information
provides insights on how the cases came about, and why this happened. Three districts
in Selangor top the nation’s chart for the most new cases: Petaling, Hulu
Langat and Klang. Looking at the new clusters associated with these districts,
one can see that some clusters are clearly cross-district and they are mostly
workplace-related.
Figure
6:
Workplace
clusters dominate most of the new clusters, having a lion share of 81.4% (Table
1). This is the main source for the continuing local disease transmission for
the affected states, because most likely people contracted the virus at their workplace,
then brought it home and infected other family members. Some would also go out
to the community to run daily errands spreading it further.
Table
1:
The
health authorities did initial testing for the clusters when they were first
reported, and normally the positivity rate would be much higher than the daily
national rate (Table 1). So, if the government goes hard on testing in more
workplaces currently in operation, we should expect the positivity rate to stay
high and more new cases to be discovered and reported. There is evidence that
the health authorities have been working hard in contact tracing on new cluster
discovery and close contacts. The number of confirmed positive cases from the
contact tracing sources is on the rise from 2696 on 1st July to 4896
on 13th July (Figure 7). Thus, for the short term, we may not see
the reduction of new cases in the national total. If the daily new cases would
be the deciding factor for transition to the next phase of NRP, residents in
Selangor, Kuala Lumpur and Negeri Sembilan might have to struggle and suffer
for longer.
Figure
7:
When
examined carefully, the categories and profiles of the top 20 new clusters in
Selangor and KL from 1
st June till 10
th July (Table 2) are
mostly at construction and industrial sites. From the number of testing, it
also reveals that these are labour intensive work sites. The positivity rates
for many of such clusters are even more than 50%! This shows how easily people
can get infected, transmit and move to other places in the community.
In
tilting the balance towards the economy, MITI has been too lenient in allowing
various so-called ‘essential services’ sectors to be operational in the Klang
Valley during the FMCO period, and therefore they, together with the employers,
have to be answerable for the affected workers and community spread.
So, maybe
it is high time for us to ask and care about the working and living conditions
for the people operating within these sites. I am in favour of targeted (and
regular) mass testing in higher risk areas and industrial sectors, until the
disease outbreak situation for the locality is under control.
It
is hard to blame people for the tendency of responding to the headline national
numbers that becomes the basis of perception or judgement about the failure of
the FMCO and now EMCO measures. But COVID-19 disease control and pandemic
management is never an easy task just relying on the health authorities only.
Often people conveniently forget that, we need a whole-society approach in dealing
with the disease threat. Even if the fragmented and confusing government
responses often times do not help the case, people in the society have to help and
care for each other, keep our solidarity to resolve the century’s biggest calamity.
It is already happening. Together, we can.
Table 2:
This article is also published in The Malaysian Insight "
Hits and misses of full lockdown measures in Malaysia", 15 July 2021: