Expert calls for surveillance system to track community transmission

Ragananthini Vethasalam

While lax compliance with health and safety guidelines and imported infections are the contributing factors to a recent spike in coronavirus cases, the authorities also need to keep track of community transmissions. – The Malaysian Insight file pic, July 31, 2020.

MALAYSIA needs an outbreak-surveillance system that can warn the authorities early about Covid-19 transmissions in a community, said epidemiologist Prof Dr Awang Bulgiba Awang Mahmud.

He said lax compliance with health and safety guidelines and imported infections are the contributing factors to the recent spike in coronavirus cases.

However, local transmissions are a cause for concern and must be taken seriously.

“Imported cases and lax compliance are the main reasons (for the spike) but the fact that we have not been aggressively looking for community cases makes it more likely for spikes to happen,” he told The Malaysian Insight.

“A more advanced real-time surveillance and warning system needs to be in place.”

As the Health Ministry has developed the e-Covid system to collect and collate data on all the patients in the country, he said, it should expand the system to all its clinics to do what is termed “syndromic surveillance” on influenza-like illnesses (ILI) and severe acute respiratory infections (SARI).

“The data should be fed in real-time to the CPRC in Putrajaya so that the information is no more than 24 hours old. Any unusual increase in ILI or SARI cases in that day for any district should trigger an alert so that a team will immediately assemble to investigate this unusual occurrence and perform screening for Covid-19 in that locality.”

The incidence of such cases can be used as a predictor to forewarn of impending new cases which can then be nipped in the bud before widespread community transmission occurs.

Malaysia last reported zero locally transmitted infections on July 8. Since then, more local transmissions, including 25 active clusters, have emerged in the country.

The growth was highest on Tuesday at 39 new cases, the most in a day since June 15, when 41 new cases were reported in 24 hours. Malaysia had seen several days of daily cases in the single digits during the period.

Malaysia needs an outbreak surveillance system that can warn the authorities early about Covid-19 transmissions in a community, says Prof Dr Awang Bulgiba Awang Mahmud. – The Malaysian Insight pic, July 31, 2020.

Most of the new cases are in Sarawak, which had 57 cases as of July 28. Of these, 53 were in Kuching, which is once again a red zone (classification for districts with 41 cases and more).

On Wednesday, however, new infections dropped to two in Malaysia – one in Kuching and the other 60km away in Serian.

Awang Bulgiba said the reasons for the spike in Sarawak are the same as for elsewhere in Malaysia – imported cases and lack of compliance with guidelines.

“There is already some community transmission, which has not quite gone away, so non-compliance (with guidelines) will result in cases flaring up again.”

A total of 192 new cases were reported between July 19-29.

Awang Bulgiba does not think that another movement-control order (MCO) is warranted at this juncture.

During the MCO which was enforced on March 18, new daily cases were reported in the 100s and 200s, before tapering down to high double digits.

He said the authorities could take a localised approach and only impose movement restrictions in areas with a high infection rate, much like how the enhanced MCO was applied.

Director-general of health Dr Noor Hisham Abdullah recently warned of a third wave of infections should people persist in ignoring the health and safety guidelines.

He likened the newly identified clusters to “burning embers” and those who disregard the rules as fuel that feeds the fire.

“If we get 2,000-3,000 cases a day, our hospitals will be crowded within a week. We might not have the capacity to treat everyone,” Noor Hisham said.

Transmission could be reduced by 60% if everyone wore a mask in public and practise social distancing, he said.

Noor Hisham warned that people could once again be ordered to stay home if compliance with guidelines remained poor. – July 31, 2020.

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