Commentary: Hits and Misses of FMCO measures in Malaysia

The whole country was ordered to go into full lockdown on 1^st June 2021.

Since then until 7^th 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 25^th 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 1^st 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 1^st 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 1^st July to 4896 on 13^th 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: