Second Wave Unlikely But Stay Alert

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PETALING JAYA: Come Wednesday, Malaysia will resume even more social and business activities under the recovery movement control order (MCO)
While some countries have seen a resurgence of cases after easing their lockdowns, infectious disease experts say any possible emerging clusters in Malaysia will not be a “second wave”
They also think that it is unlikely for any outbreak to lead to conditions under the first phase of the MCO and have suggested ways for the government to keep a lookout
Universiti Sains Malaysia medical epidemiologist and biostatistician Assoc Prof Dr Kamarul Imran Musa said he would encourage the government to step up on “sentinel surveillance”.

He said under the current passive surveillance system, sick patients or individuals would go to hospitals or clinics to be tested and if they turned out positive, the results would be notified to the Health Ministry
“In active case detection under sentinel surveillance, you go out to look for cases but this is not done on a large scale. This is carried out on a small scale but scattered throughout the country
“They will go to schools, institutions, universities or other areas they may think are places of high risk, and sample, for example, 100 or 200 people on a regular basis
“From there, they will know how many are positive or negative or whether there are new cases or clusters, ” he said
Sentinel surveillance, said Dr Kamarul, must intensively gather data from private and public sectors, such as hospitals, schools, old folk’s homes and immigrant settlements
“We should also encourage private premises or firms to regularly screen their workers, ” he said
Dr Kamarul said there would be a few new clusters of Covid-19 outbreak in the future but did not believe that Malaysia would see a huge outbreak like a ‘second wave’
“Our testing capacity is good and our public health response is quick. The experience gained in the past few months has also made our public health workers ever more ready to control and prevent future Covid-19 outbreaks, ” he said
Several countries in the world, such as South Korea, China and Portugal, have experienced a second wave of infections and reimposed lockdowns
In the United States, it was reported that Texas had become the first state to revive lockdown measures after new daily infections surged to almost 6,000 cases
Last Wednesday, Health director-general Datuk Dr Noor Hisham Abdullah had said that the country could expect to achieve zero Covid-19 cases by mid-July if everyone adhered to a standard operating procedure (SOP), such as social distancing and hand hygiene
Dr Kamarul believed that it would be unlikely for the government to reimpose conditions under the first phase of the MCO should there be a spike in cases but would instead resort to enhanced MCO in the area with Covid-19 outbreak
He is of the view that Covid-19 spreads efficiently in conditions that promote “close spaces, close contacts and verbal communication”
The public, added Dr Kamarul, must thus be careful as infected individuals had a higher chance of spreading the disease to others in such environments
To prevent outbreaks, the government, he said, must minimise infection risks by ensuring the optimal screening of suspected Covid-19 people and efficient contact tracing, quarantining individuals from high risk areas, and isolating suspected cases
The government, he said, must also constantly engage with the public to ensure awareness and good hygiene practices
Malaysian Public Health Physicians’ Association president Datuk Dr Zainal Ariffin Omar also believed that there would not be a “huge second wave” but rather a few clusters of cases
Such clusters, said Dr Zainal, would likely emerge from construction sites, night markets and at places with mass gatherings like social events
Dr Zainal said the government should also enhance surveillance at district levels, ensure the strict enforcement of regulations at border entry points, as well as work closely with the undocumented communities
“I do not think there will be an MCO for the whole country (if there is a spike in cases) but it will be very localised. The parameter is not on the number of cases but the clusters of local transmissions, ” he said
However, infectious diseases specialist Datuk Prof Dr Adeeba Kamarulzaman said with Covid-19, it was difficult to foresee what was going to happen, adding that it was more important to “continue to be vigilant”
“We have to continue to test and look for possible mini outbreaks in the most vulnerable groups and isolate those who are infected and their contacts
“Thus far, most of our infections have been in clusters that we need to continue to keep a close eye on
“We must also continue to practise physical distancing, ensure hand and environmental hygiene and wear masks in public spaces
“We should also probably continue to close our borders to countries where the pandemic is still not under control, ” she said
Restaurants, Dr Adeeba pointed out, would be a “less likely cause” of an outbreak if they followed the SOP, adding that instead, cluster outbreaks had been seen in wet markets, and in the living spaces of foreign workers due to the “crowded and less desirable” conditions
Asked on what would lead to the first phase of the MCO being reimposed, Dr Adeeba said what was more prudent was for the government to continue with enhanced MCO
“I am not sure that our economy can withstand another nationwide MCO nor would that be necessary, ” she said. - Star

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