By Dr Dhesi Baha Raja Selva Raja
The 3rd iteration of the Movement Control Order (MCO) has just been intensified. It is as such an opportune time for us to take cognizance of our control measures so far and in doing so realign our response measures to COVID-19. We present six key priority areas within which said realignment must take place.
Public health control measures remain the bedrock of the pandemic playbook. As such, test-trace-isolate systems must function at optimal capacity at all times during a pandemic and must strive to remain ahead of infections curve. Despite its criticality, increase in testing capacity has failed to keep pace with infections whilst alternative testing modalities such as the use of rapid antigen-test kits have also been sluggish. The current scale of genomic fingerprinting for variants of concern (VOC) also appears to be carried out via sentinel sampling- the scale of which maybe far too small to accurately deduce the propagation of VOCs in the country. Additionally, contact tracing capacity has remained static and less leveraged on digital contact tracing. In this regard, more must be done in ensuring public health action keeps pace with propagation of the virus. It is most critical to increase test capacity which can include scaling up the use of antigen test kits. These should be implemented via the use of testing booths and existing healthcare facilities such as general practitioner (GP) clinics. Wastewater surveillance as an adjunct for tracking VOC must also be considered as current mechanisms do not appear capable of tracking its propagation. Additionally, it may be necessary to scale up contact tracing mechanisms via the development of dedicated contact tracing centre akin to large call-centres. Finally, syndromic surveillance using crowd-sourcing of data alongside sentinel site surveillance must be considered as a solution for getting ahead of the curve.
Digitalisation is another key agenda within the response. Public health control measures must co-exist within a digital ecosystem of data collection and data analytics for timely and precise decision making. A low-cost and rapidly scalable solution that would enhance current surveillance efforts would be the use of micro-electronic medical records within the MySejahtera ecosystem. This can be a module within the ecosystem that uses the unique record in indexing an individual to a single record within a system that tracks said individual’s healthcare visits, test results and vaccination status. This data can then be deidentified and layered onto maps for analytics that can increase accuracy of public health measures.
Healthcare capacity has also been overwhelmed in the last several weeks. Bed capacity, intensive care unit beds and ventilators have been in short supply- resulting in a shifting to alternative strategies of triaging cases into one of five categories. However, issues in the implementation of COVID-19 assessment centres (CAC) model have been problematic- stretching the capacity of a health system already spread thin. This has also potentially led to a spike in cases brought-in-dead. A potential solution to this problem is to leverage on triaging solutions outside the Ministry of Health (MOH) such as health-related non-governmental organisations and GPs. These triage centres can then be connected to a centralised command centre that can further enhance home care and monitoring utilising tools powered by the internet of things. If implemented well this could potentially also reduce the number of unnecessary admissions to healthcare facilities whilst ensuring prompt admission for patients that require care.
Central to a successful response is a whole of society approach. Current approaches in dealing with the community have been largely paternalistic and have created a great deal of mistrust within communities of science and of government. Reversing this trend will require a great deal of commitment from all sectors including politicians regardless of political leaning. These efforts must treat communities as partners and not consumers. Behavioural scientists must be engaged in developing simple modules that leverage on building relationship between science, government and communities and in doing so decrease resistance to the transference of important knowledge on the disease- such as its symptoms, an individual’s response if COVID-19 is suspected, and prevention measures. Additionally, this would also increase the uptake of vaccines by reducing hesitancy and reducing barriers to access such as tech illiteracy. A part of the issue with communities and trust, has been the lack of transparency in data. In this regard, data must be made to all parties. This act in itself is likely to increase trust in government and science.
The vaccination campaign has also been critical. Developed countries that have rolled out vaccines effectively and rapidly have all begun reporting reductions in incidence and mortalities. It is beyond any doubt that the vaccination campaign is critical to us overcoming this pandemic quickly. Bottlenecks within the global supply chain have certainly slowed the pace of the local vaccination campaign. As the campaign cannot be implemented intravenously everywhere the focus must be on preventing deaths. Vaccines, regardless of personal preference, must be rapidly rolled out into communities with priority given to all localities with high incidence and individuals with increased risk factors. These high-risk individuals tend to be older and may have barriers to access. Access must be simplified as much as possible in this regard- to the point of simply allowing walk-in vaccinations for this population which may also attenuate the issue of missed appointments. Additionally, the blinding of vaccines may further reduce these missed appointments.
Finally, there needs to be an increased focus on leadership. State health departments are currently overwhelmed and as such cannot be expected to lead the thrust in many of the priorities here. State command centres-must be empowered to take up the role in pushing these priorities within each state. A clear mandate must be given to these centres in managing pandemics within each state.
The current MCO is akin to a pause button. As cases reduce over the coming weeks, we must utilise this as an opportune moment to reset and realign our response to the pandemic. Only if these priorities are efficiently carried can then the economy and other sectors such as school be reopened. We are at a crossroads yet again- we must choose to make conscientious decisions that are free of politics, ego and personal interests for the sake of the safety of our community.
* This is the personal opinion of the writer or publication and does not necessarily represent the views of Science Media Centre Malaysia
**All previous posts about COVID-19 here: https://sciencemediacentremalaysia.com/tag/covid-19/
Dr Dhesi Baha Raja is a Public Health Medicine Specialist and award winner of the Pistoia Life Science King’s College London & MIT Top 10 Innovator Under 35.