THE authorities need to adopt a slew of measures, in addition to enforcing a strict and long movement-control order (MCO) to flatten the Covid-19 curve, said health experts.

Epidemiologist Prof Dr Awang Bulgiba Awang Mahmud of Universiti Malaya said any “half-baked” movement restrictions will not be able to rein in the infection rate.

“The MCO needs to be strict and long enough for it to work. A half-baked MCO will have no real effect on the contact rate. The reasoning behind a lockdown is that reducing movements will reduce the contact rate,” he told The Malaysian Insight.

The Science, Technology and Innovation Ministry’s Covid-19 epidemiological analysis and strategies task force chairman reiterated that two weeks won’t be sufficient to reduce the infection rate.

“So, if we have a long enough MCO, like six to 12 weeks, transmissions will greatly reduce and the number of new cases will show a sustained decline.”

Prime Minister Muhyiddin Yassin reinstated the MCO in six states – Penang, Selangor, Federal Territories (Kuala Lumpur, Putrajaya and Labuan), Malacca, Johor and Sabah – from January 13 to 26.

The conditional MCO is being enforced in Pahang, Perak, Negri Sembilan, Kedah, Terengganu and Kelantan while Perlis and Sarawak, which have the fewest active Covid-19 cases currently, will remain in the recovery MCO phase.

The prime minister said the latest measure is necessary as the public healthcare system is at breaking point, with an acute shortage of medical front-liners and beds at intensive care units.

Health policies specialist Dr Khor Swee Kheng said Malaysia needs a combination of measures to shorten the MCO period.

“There are two major differences between the MCO in January this year and March last year.

“The cases are in four digits now. Back then, they were in three digits. We are testing more now than we did back then. These two differences mean the MCO could potentially be extended to flatten the curve.

“MCO comes at great cost and should be a last resort. Malaysia needs a combination of other measures to shorten the MCO duration, such as stronger contact tracing, clearer standard operating procedure and fairer enforcement.”

Khor said it is also important to reduce dependence on daily new cases as the sole metric to measure success in handling the pandemic.

“It is helpful, but inadequate to convey the complexity of a pandemic. We need a set of transparent metrics like daily tests, share of positive tests, bed utilisation rates (by ICUs, general wards and low-risk centres), case fatality rates and R-naught,” he said.

Awang Bulgiba said the MCO guidelines must not only be clear and consistent – there should also not be any double standards in the implementation.

“I have suggested this many times before. Get behavioural scientists to advise how to change people’s behaviour and get communication specialists to craft clear messages.

“Authorities may just end up squandering the time they bought with the second MCO if they do not address pertinent issues they failed to look into previously.

“My only concern is whether the authorities will squander the time bought this time with MCO 2.0. The first MCO, we bought time but squandered it and did not address many issues I had long ago raised like migrant workers, implementation of the amended Workers’ Minimum Standards of Housing and Amenities Act 1990, syndromic surveillance, better data analysis, better indicators, scenario planning, a revision of the pandemic preparedness plan and so on.”

He added that there is a need to institute steps that will prepare the country for the next wave of infections.

Director-general of health Dr Noor Hisham Abdullah said on Wednesday that two weeks of the stringent MCO will not be able to bring down the number of cases.

He said the authorities can prevent a spike if they extend the lockdown to four weeks.

“We need the cases down to 1,000, or if we can bring them down to fewer than 500, then we will be able to treat and accommodate cases at hospitals.

“After the MCO we can start the conditional MCO. We expect to flatten the curve in five or six months.” – January 15, 2021.