We are indeed living in a new era where we saw medical science becoming the forefront of helping millions of people around the world to be tested, contain & recover from a deadly virus outbreak although unfortunately as to todate 89,900 people have died from the coronavirus.
Today will be D-Day for Malaysia – we will know whether the lockdown that has been put in place on the 18th March 2020 will be extended or not. Given the number of red areas and the number of active cases still under the care of the Health Ministry, it is very likely that the lockdown will be extended further.
The Academy of Medicine of Malaysia who is an institution for professional development and postgraduate education of medical specialists in the country and the region had strongly recommended that the movement control order (MCO) which was implemented from March 18 to be extended to and beyond the Hari Raya Aidilfitri season – there is a high risk of spreading the virus, particularly to the elderly, in the case of a ‘balik kampung’ exodus.
If we are looking at the active cases, the graph indeed started to flatten with 121 recovered today against 109 new cases. However, it is still at a very preliminary stage of the flattening and will take to reduce further.
And there is a possibility of recurring infection from those who have recovered – Korea’s Centers for Disease Control and Prevention recently reported that 51 patients classed as having been cured in South Korea have tested positive again. Image source: Outbreak.Org
But then again, the question that has been raised is whether Malaysia has done enough testing to safely say that the number of a new infection is indeed contained and started to flatten.
The number of testing is critical to know if we have identified all potential carriers and quarantined them whilst all those tested negative are asked to stay at home, exercise social distancing and take the necessary precautions when they have to go out to buy the essential items.
If the rate of testing is low, this could mean we still have potential carriers out there who may be infecting others and cause more cases to be reported in on a daily basis.
Based on the total number of testing and the number of testing per thousand people done todate against other sample countries, the number of testing done in Malaysia does not look too impressive. We may need to do more testing so that the coverage is wide enough to contain the virus.
And test per thousand people trend:-
On social media, there are several posting comparing the number of cases between Canada & Malaysia especially after the start of lockdown.
The claim is that Malaysia is better at the containment of the coronavirus. However, there is a difference between the number of testing done between the two countries which shows that we are still far from achieving the numbers that Canada had achieved.
This could be a potential time-bomb and actually makes the extension of the lockdown more critical.
However comparing the number of testing within ASEAN (except for Singapore perhaps) we are performing much better than the rest on the number of testing done per thousand people although, in terms of the total numbers, Vietnam has surged in front with more than 70,000 tests done as at 3rd April 2020. Be mindful that Vietnam only had 255 cases reported with zero fatality and 127 recovered patients.
And test per thousand people:-
Graphs sources: Our World in Data
Having seen the trends & graphs, there is this interesting comment from Dr Amar Singh who is a senior consultant paediatrician in Malaysiakini:-
There are many individuals who have expressed reassurance with the small number of daily new coronavirus cases reported and the slow growth of our epidemic. I have seen many posts on various social media regarding this, often with some comparison with countries doing worse than us. But this is false reassurance if you look at the bigger picture.
First, recognise that our testing numbers are limited. The Ministry of Health (MOH) only does what they call “targeted” testing and does not test widely outside of that criteria.
Except for one outstanding day (March 27), our test availability is generally between 1,500-3,500 cases each day. We have been informed by MOH that currently, we can do 11,500 tests each day. However, only about 20 percent of these tests are used to look for the spread of the virus in the community.
Secondly, remember that our testing capacity is limited by many challenges. The large number of pending results each day indicates we are having difficulties with getting tests done.
All this indicates problems with testing ability, the supply of reagents and turnaround time. Despite 34 laboratories in action (private laboratories and hospitals have been recruited to support testing and currently more than 20 are able to do so) we still have more work to do to clear our backlog of tests and improve tests turnaround time.
Thirdly, remember that because we do “targeted” testing, we may miss coronavirus infections in other settings.
We have also not been testing unlinked pneumonia deaths routinely and may have underestimated the real number of Covid-19 deaths in the country.
Hence the correct answer is, “We don’t know how big our epidemic is” but it is definitely bigger than reported numbers. Our limited testing number and criteria do not allow us to have a clear grasp of the spread of the virus.
The extension of the lockdown after the 14th April 2020 will surely add the pressure of the economy where a large number of businesses have been closed, travelling restricted and a large of a number of people lost their job & source of income.
However, if we have yet to hit the peak of coronavirus infections and we still have carriers in the open, then it is only prudent to extend the lockdown to given enough time and space to the medical front liners to test and contain the number of coronavirus in the country.