TWO months have passed since the beginning of the third wave of Covid-19 pandemic in Malaysia.

As of November 21, when 43,512 confirmed cases had been recorded, four times greater than the initial number before the third wave, which was 10,167 on September 19.

Yet, people are starting to lose patience, because the daily new cases have not dropped although some key areas, such as Sabah and Klang Valley, were put under conditional movement control order (CMCO) as early as October 13 and 14 respectively.

Forty days after the CMCO, there were 1,039 new cases on November 21, making the government’s disease control performance and effort seem “stagnant” to the public eye, ever since the country first experienced four-digit daily cases on October 24.

The finger was pointed at the CMCO’s “failure” to contain the disease and two polar responses followed: one voice was calling for the government to let go of state-wide blanket CMCO, while the other expressed a wish for the authorities to impose a stricter MCO to break the infection chain more effectively in a shorter period.

For starters, why should it be expected for CMCO measures to yield a similar outcome as the first movement control order (MCO) back in March?

At the height of the second wave of the epidemic, the daily cases peaked at 235 as compared to 1,755 for the third wave, which is seven times greater.

Now the question is, if the first MCO took 34 days to suppress the daily number to less than 50 cases, then how long would CMCO, now facing the greater third wave challenge, take to achieve the same?

Thus, even if the authorities were to impose a stricter MCO, one should also not expect the number to drop in a short period.

Finance Minister Tengku Zafrul Tengku Abdul Aziz mentioned in his Budget 2021 speech that the country suffered economic losses in the range of RM2-2.4 billion a day when the economy was shut down due to the strict MCO.

The economic repercussions can still be felt today due to the lockdown policy. Just ask those businesses that are forced to close down, as well as more than 700 thousand people who lost their jobs and become unemployed.

As revealed by director-general of health Dr Noor Hisham Abdullah, decision makers sitting in the National Security Council were asked to take into account “life and livelihood”, ensuring a balance between health and economy before deciding on any measure.

The health of our economy is no longer the same as what it was in March; in fact, it has even become more vulnerable than before.

Unless absolutely necessary, strict MCO – if imposed again on the Klang Valley, the nation’s economic hub – could pose another shock and disaster to the already struggling businesses and freelancers or part-timers.

However, the Health Ministry does have a trick up its sleeve, namely enhanced movement control order (EMCO) in specific targeted areas, if the authorities see fit to effectively clamp down a certain high-risk area.

It is categorically wrong to say that the CMCO is not effective at all. Sabah seems to have benefited from the measures, what with new daily cases declining, compared to the situation in early November.

Although Klang Valley and Negri Sembilan are now increasingly facing the epidemic, the cases are still under control because they have not spiked and doubled in number every few days, as witnessed across the world, where they also face a greater new wave of pandemic.

Italy, France and the United Kingdom recently experienced their new peak around November 14, recording more than 80,000 thousand daily new cases. Malaysia will never approach that uncontrollable stage.

On the contrary, since early November the R values have been hovering around 1.00, which indicates that the epidemic in Malaysia is stabilising and under control, even if the new daily cases number has not yet shown a significant drop.

To examine the effectiveness of any lockdown measure, epidemiologists often use the ‘DOTS’ concept to explain how easily a particular disease can be spread via the four main determinants:

D: Duration. It usually indicates infectious period, but we are also concerned with the incubation period. As we have not found a cure or a vaccine for now, nothing can change the dynamics when one gets infected.

The usual tool used to control the ‘D’ is for the government to impose a quarantine and isolation policy for the high-risk suspects and positive patients, respectively; at the same time, the government will perform more targeted screening, so that it can possibly detect the positive cases and remove them temporarily from the community.

O: Opportunity. It means how many contact encounters have been made during the infectious period. This is the part where various forms of an MCO play a huge part in reducing possible number of interactions and contacts.

Various levels of strictness in measures would determine how many people can go out and, in turn, how many social interactions occur as a result.

Take public transit usage in Kuala Lumpur region as a proxy, and benchmark March 4 as the pre-MCO normal traffic.

The first MCO managed to reduce the volume of commuters by 94% but the current CMCO could reduce at most 73%. That means more than a quarter of people are still out there interacting with each other.

There is no coincidence that 41% of active clusters are work-related, and it may take a longer period to suppress the daily curve.

T: Transmissibility. It indicates how a particular infected individual interacts with other people. Covid-19 is a disease spread by close contact, and it has to transmit via respiratory (micro) droplets.

That explains why the government has to establish many SOPs for various places, so as to keep people safe from a physical distance (>1m), while mandating people wearing a face mask in certain public spaces.

S: Susceptibility. It means how easily someone can become infected, but it also has another dimension of who are among those infected would face fatal consequences, such as death.

Elderly and young children as well as chronic illness patients are the most vulnerable to infection.

Therefore, during a stricter MCO, the government would normally order to shut down schools, day-cares and nurseries, while banning many non-essential social activities, such as the entertainment sector.

Yes, CMCO is understandably performing underwhelmingly. Lockdown could be the most effective measure to slowdown the chain of infection (as it addresses the ‘O’ and ‘T’ in the DOTS concept).

The tagline “Just Stay Home” is easier said than done, as many people cannot survive without seeking income from going outside.

It is true that the World Health Organisation and many health policy institutions do not recommend “lockdown” as the definitive long-term measure.

However, the health authority should adjust the strictness of MCO measures according to the severity of the epidemic.

Thus, it is sensible that the government recently ordered the CMCO to be lifted in four states (Kedah, Malacca, Johor and Terengganu) ahead of schedule, while putting Kelantan back to CMCO because the Health Ministry has identified greater risk of disease spread.

We should expect the Klang Valley CMCO to be the last to be called off. – November 23, 2020.

* Lim Chee Han is a founding member of Agora Society and a policy researcher. He holds a PhD in infection biology from Hannover Medical School, Germany, and an MSc in immunology and BSc in biotechnology from Imperial College London. Health and socioeconomic policies are his concerns. He believes a nation can advance significantly if policymaking and research are taken seriously.

* 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.