SABAH should brace for a complete lockdown while an extended conditional-movement control order (CMCO) in the Klang Valley should not come as a surprise, said health experts.

As the number of Covid-19 cases increases daily in these areas, epidemiologist and public health expert Prof Dr Awang Bulgiba Awang Mahmud said the trends emerging showed transmissions within the community.

It may take weeks for the number of cases to drop, he said.

Sabah currently accounts for one third of the country’s total caseload, which has breached 22,000, and one third of fatalities at 199 as of yesterday.

The third wave of the pandemic, which began last month, saw around 10,000 new cases in the first 18 days of October – figures equivalent to the first seven months of the pandemic.

“It will take four to six weeks for any sustained decline in new cases to be seen in Selangor.

“It will take even longer (six to eight weeks), to bring the situation in Sabah under control, assuming we mobilise every resource we have,” he told The Malaysian Insight.

The situation in Sabah is more critical as the state has reported many unlinked cases, indicating that community transmission is widespread there, said Awang Bulgiba.

The key to stopping new cases in Sabah from completely overwhelming its healthcare facilities is to stop widespread community transmission. In this regard, a full lockdown is justified.

“The window to accomplish this is closing rapidly and we need to do it now.

“The only more stringent option left for Sabah is a full movement-control order (MCO). In view of the numbers, this option is becoming more and more likely,” he said.

As for Selangor, the country’s richest state, it has the benefit of having more resources.

“However, an extension of the CMCO looks likely if we do not see a sustained drop in new cases and the number of recoveries exceeding new cases.”

For two weeks, Sabah has been recording the highest number of daily cases. Yesterday, it again topped other states, recording 535 out of the total 732 new infections.

Sabah now has 9,281 cases since the onset of the pandemic.

Selangor has 3,965 cases since the pandemic began and is reporting an increasing number of cases daily.

The CMCO in Sabah is from October 13 to 26, while the partial lockdown in Selangor, Kuala Lumpur and Putrajaya is from October 14 to 27. Labuan is also under CMCO from October 17 to 30.

Epidemiology and biostatistics expert Dr Malina Osman also agreed an extended CMCO in Selangor is likely.

She said the active case data for the past few weeks (in Selangor) show an ascending and worrying trend.

“In terms of active cases recorded in the past two to three weeks, we observe an ascending trend.

“The extension is inevitable. We would most likely need at least five to six weeks,” she said.

Botched handling of Sabah returnees

An angry public is blaming politicians and the Sabah elections as the cause of the third wave.

But Galen Centre for Health and Social Policy chief executive officer Azrul Mohd Khalib said the outbreak in Sabah was already widespread in the community even before the elections.

“The state polls likely acted as an accelerant, which increased the number of opportunities for people to get infected, particularly during campaign activities, where the standard operating procedure was not strictly observed by politicians and people generally.”

As such, strict orders for 14 days of mandatory quarantine for those returning from Sabah to other parts of the country should have been issued early, both Azrul and Awang Bulgiba said.

“The 14-day quarantine would have been absolutely beneficial in controlling the spread of infection, particularly politicians who would have met and engaged with far more people than the average person.

“This was a decision that should have been straightforward to make,” Azrul said.

Awang Bulgiba also said the government’s initial decision to impose only home surveillance orders (HSO) on Sabah returnees beginning September 27 and not the full quarantine was wrong.

Sabah was already seen as a high-risk place and the subsequent decision to impose a full quarantine came too late, he said.

“The HSO initiated on September 27 was never a good option as it was not a proper 14-day home quarantine.

“When it was changed to a 14-day home quarantine on October 11, it was already too late as more than 400 returnees had already tested positive, with some of them already in contact with people before they were tested,” Awang said.

He previously urged the government to impose a mandatory 14-day quarantine in designated quarantine centres for everyone returning from Sabah, which he felt was the best option.

Masks, washing hands

When asked if reintroducing MCO would be a good option to curb the spread, Malina disagreed, saying the economic impact would be too costly.

A balance must be achieved, she said, and suggested the current strategy of combining the CMCO and a targeted enhanced MCO or TEMCO, for high-risk areas.

Economic activities in green zones should be allowed, she added.

“We cannot afford another round of MCO but the government has to consider a balance of economy and livelihood.

“Other than green zones, TEMCO should be implemented in affected areas, while other areas should remain under CMCO,” she said.

Although the most effective in breaking the chain of transmissions, a full MCO would be drastic and present many setbacks, said Azrul.

“Unfortunately, when it comes to something as infectious as Covid-19, it (MCO) buys time but it is pointless if people do not understand why it is necessary to comply with safe practices, such as wearing masks, cleaning hands and work surfaces.

“After the lockdown, the cases will simply go back up, as we have seen.”

Azrul said a lockdown will also cripple the economy, increase unemployment, decrease revenue, and reduce the ability of households to be resilient and withstand the effects of such a move.

“Arguably, it could even increase people’s vulnerability to infection as they become more desperate, take more risks and are less able to afford to take precautions,” he said.

Azrul believed the coronavirus is probably already present in many communities and would be detected if Malaysia tested on an even larger scale.

“If we implemented large-scale population screening, chances are we will find the disease already present in many communities around the country.

“Compliance with SOP is the key to an effective and sustainable Covid-19 response. We need people to cooperate and help prevent cases by taking care of themselves and others around them, beyond the eyes and vigilance of law enforcement.

“We need to take responsibility and not only do so under threat of punishment or penalty,” he added. – October 22, 2020.