HEALTH experts are questioning Putrajaya’s logic over the imposition of a conditional movement-control order (CMCO) on most states, asking what is its “end game” with the decision.

They said the daily figures did not show significant change in most states, with some even registering a low rate of infections.

While the lockdown in Sabah and Labuan makes sense, there are no significant changes in cases in the rest of the country that merit a partial lockdown.

Describing the decision to implement CMCO as “drastic and outrageous”, one medical expert questioned if the CMCO was the only way to curb the spread of the coronavirus.

They are commenting on Putrajaya’s decision to implement CMCO on all states, except Perlis, Kelantan and Pahang for four weeks until December 6.

Former deputy director-general of health Dr Lokman Hakim said there are significant changes to the Covid-19 infection rates in the states involved.

“Weekly incidents in Malacca, Sarawak, Johor, Perak and Terengganu are too low, similar to the low infection rates in Pahang and Kelantan, but yet these states are subjected to the CMCO,” said Lokman, who served the Health Ministry for 32 years before retiring in 2017.

“I do not understand why CMCO is implemented throughout the country, except Kelantan, Pahang and Perlis and up to a month at a time. On what consideration was this drastic action taken?”

Lokman, who is currently a professor of public health at the International Medical University, said even if the “outlier” state (Sabah) is removed, Covid-19 case incidents in Malacca, Sarawak, Johor, Perak and Terengganu are low below five per 100,000 population per week.

“For those who understand the science of epidemiology, the decision to implement CMCO based on such figures is too drastic and outrageous. Even Kedah, which has shown a significant downward trend, is also subject to the same action.

“Is the enhanced movement-control order (EMCO) in problematic districts or neighbourhoods unworkable, which of course has a more moderate economic impact than CMCO as a whole?

“The question arises what exactly is the ‘end game’ that you want to achieve through this action? Do we want to immediately stop the spread of this virus through movement controls?”

Lokman said if that is the goal, then it would be “something impossible” to achieve within six months without the availability of effective vaccines and drugs.

“If implemented (CMCO) for six months, I guarantee the Malaysian economy will be paralysed.”

He said if Putrajaya only wanted to reduce the number of cases, then what are its plans.

“If the rate of infections in Johor of between 0.2 and 1.5 per 100,000 population per week is already considered high which warrants CMCO, what is the figure to be achieved before this control is removed? 0.5 per 100,000 population?”

Lokman said the determination of this “end game” is important to measure the success of an action, adding that the rationale for setting this figure must be evidence-based public health intervention.

While there may be epidemiological evidence that only the government would know and cannot reveal, Lokman said he hoped it is solid evidence.

“I and several other public health experts have repeatedly suggested that the method of managing this epidemic be reviewed.

“Cost-effectiveness should be used as a basis in decision-making. More cost-efficient methods avoid wastage to achieve the same results.”

Minister in the Prime Minister’s Department Mohd Redzuan Md Yusof told the Dewan Rakyat in a written reply yesterday Putrajaya decided to enforce CMCO in the seven states after a drastic rise in Covid-19 cases.

“The decision was made following the Health Ministry’s case report dated November 6 when 1,755 positive cases were detected in a single day,” the minister said.

“The government felt a stricter approach was necessary before the situation became worse.”

The Academy of Medicine of Malaysia (AMM) expressed surprise over the decision to impose a blanket CMCO and urged Putrajaya to adopt a “middle path”.

They said the government must explain the science behind its decision to impose a blanket CMCO in the Klang Valley, Kedah, Perak, Malacca, Negri Sembilan, Johor and Terengganu, despite the improving R figure, the basic reproductive number.

“There are other ways to contain and mitigate the spread of Covid-19 without enforcing a blanket CMCO,” it said in a statement yesterday.

“We must adopt the World Health Organisation (WHO)’s recommended ‘middle path’ and learn to coexist with the virus, minimise suffering and deaths without stopping and restarting the economy and public life.

“If Malaysia is to beat Covid-19, we must first learn to live with it.”

Consultant paediatrician and neonatologist at KPJ Damansara Specialist Hospital Dr Musa Mohd Nordin in an article on codeblue.com asked what sort of matrix was being used by the National Security Council and Health Ministry when deciding the need for a control order.  

“We searched high and low for the science mandating an extension of the CMCO but it is not forthcoming from either the NSC or the MOH,” he said.

Musa said absolute numbers of Covid-19 cases in any one state are not a useful parameter for the sake of comparison between states. They need to be expressed as a proportion of the state’s population.

“This is a basic statistical tool for meaningful comparison,” he said.

“Thus, CMCO alone, without large-scale data-driven testing to detect cases early, swift contact tracing and isolation, would not be sufficient to contain Covid-19.

“Rather, it may just lead to a longer lockdown, or the nation will be trapped in cycles of lockdowns and openings that will ravage the economy, negatively impact the education of our children, impede access to healthcare for non-Covid-19 patients and mess terribly with our mental health.”

The number of Covid-19 infections breached the 42,000 mark yesterday when another 869 cases were reported. Six victims died, bringing the death toll to 300.

To date, Sabah with 21,189 cases, is the state with the highest number of infections follow by Selangor (6,523) and Kuala Lumpur (3,216). – November 11, 2020.