EPIDEMIOLOGISTS are attempting to model quantitatively the course of an infectious outbreak by plotting the number of cases over time in a curve-fitting exercise whose shape reflects parameter values, like the reproductive number (the average number of secondary cases produced by an existing infected case) and the incubation period (the duration between exposure to an infectious organism and the emergence of symptoms that come to attention).

Such exercises have been undertaken by researchers at University of Hong Kong, Imperial College (London) and the National University of Singapore, among others.

It was on the basis of such fitted epidemic curves that Dr Bruce Aylward, team leader for the World Health Organisation-China Joint Mission on Coronavirus (February 16-24) assessed that the Chinese government may have averted hundreds of thousands of additional infected cases through their extraordinarily robust containment efforts in Wuhan, Hubei, and other cities and provinces.  

The mainstays of these containment efforts were isolation and treatment of virus positive cases, contact tracing and quarantine of close contacts who were untested or who tested negative, massive social distancing in various forms, all carried out in unavoidably disruptive ways, but which nonetheless allowed for the basic living essentials and needed care, by and large, to be delivered.

Malaysia, however, has specific demographic characteristics that are not easily modelled in such simulations of epidemic dynamics, most specifically, the large pools of undocumented migrant workers (easily a million in the Klang Valley) who have strong incentives to avoid contact with government agencies, and hence make contact tracing that much more difficult in an outbreak situation.

Nonetheless, most fatalities and severely ill cases that might occur among undocumented migrants presumably would come to attention at some point, but this would be much delayed, which greatly complicate efforts at containment and mitigation, not to mention treatment.

The Citizens’ Health Initiative knows that our Health Ministry is aware of these potential spillover scenarios, through previous discussions with Dr Chong Chee Kheong (previously director of disease control, currently deputy director-general for public health) as well as via recent communications with senior officers of the WHO and UNU-International Institute for Global Health in Kuala Lumpur.

What is less clear though are the proactive measures and contingency plans the Health Ministry may have for coping with such scenarios.

Are there, for example, initiatives to engage more closely with those channels of healthcare access that undocumented migrants resort to when in need of care, such as voluntary clinics run by Tzu Chi, Pertiwi Soup Kitchen, Teddy Mobile Clinic, Global Doctors Hospital, Mont Kiara etc (assuming they also cater to unsuccessful asylum applicants and undocumented migrant workers in addition to refugees)?

These laudable endeavors operate as de facto “safe(r) spaces”, which could supplement the Health Ministry’s efforts in outreach and communication with marginalised communities, especially those who need some assurance of sanctuary when accessing needed care.

Beyond that, civil society organisations, migrant networks and communities, UN agencies and, indeed, embassies of labour-sending countries could assess the informational and health communicational needs of the respective migrant communities, and translate and disseminate useful, actionable information for individual- as well as community-coping responses.

How might we know if the Covid-19 outbreak in Malaysia has spilled over into the undocumented migrant population?

At the moment, the Health Ministry is relying on their existing sentinel surveillance for influenza-like illnesses (ILI) and SARI (severe acute respiratory infections) to also detect sporadic cases of SARS-CoV-2 positives as a red flag for community viral transmission with no traceable contact history. This could be how infected undocumented migrants might directly or indirectly come to attention.

Somewhat reassuringly, the sentinel surveillance so far has not detected any sporadic cases (the reported first instance of a presumed sporadic case has now turned out to have a contact history traceable to a known infected case). 

We should treat this as a wake-up call for the urgency of an “all of government” effort led by the prime minister to respond proactively to an escalating emergency. We should not need the tabligh incident at the Seri Petaling Mosque to drive home the urgency for proactive measures by a health minister or D-G who might have felt constrained in proposing bans on large religious gatherings, sporting events, school and university closures.

The prime minister needs to step up and take charge with the overarching authority of his office. – March 13, 2020.

* Chan Chee Khoon is a part of the Citizens’ Health Initiative.

* This is the opinion of the writer or publication and does not necessarily represent the views of The Malaysian Insight. Article may be edited for brevity and clarity.