Noor Hisham S Cry For Help Answered P Gunasegaram

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 PM’s expected announcement on MCO indicates that politicians may be finally heeding professional advice
Health Director-General Tan Sri Dr Noor Hisham Abdullah wants a targeted MCO in Covid-19 red zones. – The Vibes file pic, January 8, 2021BY
P GunasegaramFOR two days in a row, Health Director-General Tan Sri Dr Noor Hisham Abdullah has been warning about a serious explosion in Covid-19 cases, which exceeded 3,000 for the first time on Thursday.
But for some strange reason, the politicians running this country, including the prime minister, are unconcerned, even downright nonchalant. Perhaps, they are more concerned now, with the PM expected to make an announcement on Monday.
Just take a look at the charts from the National Institute of Health that Dr Noor Hisham shared on his Facebook page to get a feel of how bad things really are.
The first chart projects daily cases if the infectivity rate, or R-naught (R0), is at 1.1, which is the current rate. The second is if the R0 increases to 1.2. If the R0 is 1.1, it means that one Covid-19 patient infects an average of 1.1 persons. The infection spreads exponentially. If the R0 is less than 1, the infection is under control, reducing over time. Dr Noor Hisham’s target is a rate of 0.5.
The point to note is this: mathematical projections, which are very accurate for a given R0, show that at a rate of 1.1, there will be 3,000 new daily cases (we hit more than that on Thursday) by the second week of February, 5,000 by the second week of April, and 8,000 by the fourth week of May.
If the R0 rises slightly to 1.2 – a patient infects an average of 1.2 persons – the infection numbers will be dramatically higher, and much faster – 3,000 new cases per day by the fourth week of January, 5,000 by the third week of February, and 8,000 by the third week of March. It shoots beyond the scale of the graph, far exceeding 10,000 cases at end-May. This graphically illustrates the importance of keeping the R0 below 1.
On Wednesday, when we had nearly 2,600 cases, Dr Noor Hisham said: “Our health system has been pressured, and we are at a breaking point because cases are increasing every day. We may not be able to accommodate patients in our facilities.”
Now, if the health system is already at breaking point with 2,600 new cases, imagine how much more severe things will be with 8,000 fresh cases and beyond. Contact tracing will have all but disappeared, allowing the pandemic free rein. It will be like the United States, the United Kingdom, Italy, etc, where health facilities cannot cope with the number of new infections.
It will be a disaster for a country that had been handling Covid-19 pretty well until the September 26 Sabah election and easing of travel restrictions there to enable the backdoor government to win the polls. The chart on cumulative cases in Malaysia takes a sharp inflection up almost exactly at that point.
The subsequent poor handling of the pandemic resulted in a continuing spike in cases. What is needed now is drastic action to plateau the third wave. As Dr Noor Hisham has said: “We are looking into how we can enhance our healthcare system. But the best is not only enhancing our healthcare system... but to reduce the load.” He added that the country needs a circuit breaker, and proposed that the government implement a more targeted version of the movement control order (MCO) to bring down the number of cases.
“Now, I think our strategy will change – we are more localised and targeted in terms of implementation. Discussions are ongoing, and probably, we will make some decisions as soon as possible.”
But are the authorities paying attention? The National Security Council dismissed rumours that the MCO will be imposed in some states. However, this is what Dr Noor Hisham wants: a targeted MCO in red zones, or districts that have more than 41 current infections over a period of 14 days.
Yes, most of Selangor, Kuala Lumpur and Sabah are red zones, and there will be an adverse economic impact on these states, but the alternative is to face a much bigger problem later, which will cost more, much more, not just in terms of economic costs, but in terms of lives and disruptions.
Countries such as Japan, South Korea and Australia that have successfully contained Covid-19 have reimposed or are considering reimposing lockdowns as a circuit breaker to contain the third wave of the pandemic, because they know the move is effective.
Our top Covid-19 fighter needs to be given leeway to do this. After all, before the ill-fated Sabah election, he was doing a great job of containing the virus, earning not only the gratitude and adulation of the whole country, but also gaining international recognition for successfully keeping the disease at bay in Malaysia. We were justifiably proud of him then, but the politicians have spoiled it, as they have done with so many things over so many years.
It is rather peculiar that the PM’s special adviser on public health, Tan Sri Dr Jemilah Mahmood, takes a directly opposite stance to Dr Noor Hisham’s on the preparedness of the health service.
When asked what the government should be doing, she told BFM radio yesterday: “My advice is that we have to have a very clear game plan. Right? That means I don’t agree that the health system is at a breaking point – it is  easy to throw these words around. If you look at the situation in the UK, Italy, the US and all that, people, the health professionals, the health system, will find ways to cope.”
Surely Dr Noor Hisham, as health director-general, knows much more about the preparedness of the service that he oversees than Dr Jemilah, even if she is special adviser to the PM. And does Dr Jemilah want us to go the way of the UK, Italy and the US? Surely not.
Her training is in obstetrics and gynaecology, and she was also in charge of medical charity Mercy Malaysia. Her experience in handling and understanding pandemics is limited compared with Dr Noor Hisham, who has long served as a public health official. The PM should be listening to Dr Noor Hisham rather than Dr Jemilah – in fact, more than anyone else.  
And then, there are those who may think that we can take it easy because the vaccines are effective and we have got supplies secured. We cannot allow the vaccine to lull us into complacency.
Yes, the vaccine, by immunising a large portion of the population, said to be 80%, will bring down the infectivity rate, but it may take the better part of the year to do this. In the meantime, we really do not want the pandemic to get out of control – the signs are there that it might.
The final decision must be a professional one made by professionals, not self-interested politicians who postpone, to the detriment of the country, tough calls that need to be made now, swayed by wanting to give a feel-good factor to the people ahead of possible elections.
They committed that mistake with the Sabah vote, a mistake that we are still paying for. Are we going to make a bigger mistake now? Perhaps not, with the PM expected to make an announcement, even though it looks a bit late in the day. – The Vibes, January 8, 2021
P. Gunasegaram says a problem of science must have a scientific solution. He is editorial consultant at The Vibes

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