I urge all government departments to heed the Director-General for the Ministry of Health Dr. Noor Hisham Abdullah’s advice not to relax restrictions under the Movement Control Order prematurely.
I believe, without extensive testing mechanism in place, the availability of effective antiviral treatment and vaccine, meticulous planning of strategy against another possible spike after reopening of economy, it is premature to call for relaxation or an end to MCO and an full reopening of economy.
We have to learn from Singapore’s experience wher ether has been an exponential spike of in Covid-19 cases in the last one week with 728 new cases reported on Thursday 16th April, 623 on Friday 17th April. Singapore’s latest clusters concentrate mostly among foreign workers living in crowded dormitories. The Singapore experience has shown us that the foreign workers, who often live in extremely cramped and unsanitary conditions, are even more vulnerable to the spread of Covid-19 pandemic.
In an effort to prevent another exponential spike in Covid-19 cases and crush the pandemic, Malaysia has to extend amnesty to illegal foreign workers in this crtitical pandemic period, and make Covid-19 testing and health care available to both local and foreign workers before reopening the industries.
It is premature for the Ministry of International Trade and Industries to announce plans to reopen the industries and offer only back-to-work screening to Malaysia workers by SOCSO without extensive testing mechanism in place, the availability of any effective antiviral treatment and vaccine, meticulous planning of strategy against another possible spike after the reopening of economy.
Even though the Ministry of Health has approved a Covid-19 antigen-based test from South Korea with a sensitivity of 84.4% and 100% specificity, there is still a dire need in search of a rapid test kit with high accuracy of nearly 100%. The Ministry of Health could consider a combined antigen-antibody test kit to increase its accuracy in diagnosing Coivid-19 and impose other clinical guidelines and testing for screening workers before allowing them going back to work.
PCR is the confirmatory test but it is time-consuming and costly, and has already constrained our health resources. but has only 70 to 90% sensitivity. It it is only sensitive in the first few days of infection. According to a study done in China, if it is done in combination with antibody serological testing, the combined sensitivity would go up to 98% . This finding should alert our researchers, clinicians and policymakers to look into developing and validating a more accurate combined antigen-antibody-based rapid test kits for extensive screening among the workers and general population before a gradual, step-wise opening up of economy and industries.
I agree with the Director-General of Health Ministry that, when the PCR testing facilities cannot cope with the demands for extensive testing, a combined rapid antigen-antibody testing of high accuracy will effectively compliment the PCR testing system and help front liners to triage the patients at the point-of-care, such as deciding whether to release non-infected persons from medical quarantine or allow seemingly healthy workers back to work or any of these for further PCR testing.
In addition, a recent study in Iceland also reveals that there are 43 distinct clades of Covid-19 identified in Iceland,which is a fact that should not be ignored especially regarding the the extraordinary speed of mutations of the virus. Knowing the genomes of the various strains of the virus prevalent in Malaysia is crucial in developing effective antiviral treatment and vaccines.
Genome analysis would also help in inventing and testing the accuracy of a combined antigen (meaning a test using reaction to usually the viral capsular protein) and antibody rapid test kit. We should use the opportunity arising from this crisis to strengthen our research capacity in genetic research by analyzing all possible strains of Covid-19 found in Malaysia which would be crucial in developing vaccines against the virus and validating the efficacy of a rapid test kit by knowing the details of its pathogenesis.
Extensive testing is necessary because there is still a possibility of resurgence of Covid-19 pandemic as the medical scientists are not sure whether they would be able to invent an effective vaccine in the next one to two years for massive worldwide use.
It has been aslo reported that there are more than one hundred “reactivation” of previously Covid-19 infected cases in South Korea. This has further complicated the continuous containment of the pandemic. It also has made the reopening of businesses and industries in the near future bleak unless we are confident with mass testing measures and a drastic change of production methods.
The government and employers have to initiate training workers in sanitation and protective measures before going back to work such as compulsory mask wearing at work and after work, hand washing, keeping a constant social distancing, self monitoring, frequent bathing before and after work, improving workers working conditions to prevent any further outbreaks.
On the other hand, employers have to be trained and advised to upgrade working conditions including improving ventilation at workplace, providing adequate sanitizers,clean living conditions and adequate sanitary facilities for workers, enforcing social distancing and regular testing of workers with or without symptoms.
The government is urged to provide incentives for employers to increase automation of their production lines and further the country’s efforts in promoting industry 4.0 in which more people would be able to work from home or remote location by minimizing social contact but increase accuracy in production quality. Besides salary subsidies, workers should be provided allowances for further online vocational training to prepare themselves for a new working environment in Industry 4.0 in the post-Covid era.