INCREASE in sporadic cases and population density are the main reasons why Selangor has consistently topped the charts for new Covid-19 infections nationwide.

Former health minister Dr Dzulkefly Ahmad, who is currently the head of the Selangor Task Force for Covid-19 (STFC), told The Malaysian Insight that 80% of infections in the state are sporadic cases.

Sporadic cases are those that are not linked to any clusters, making tracking and testing much more difficult.

Dzulkefly said although the state has developed its own artificial intelligence (AI) data collection system – Acura – for Covid-19 last year, it could not reach its full potential due to lack of data from the Ministry of Health.

Selangor, which has a population of more than six million, recorded 147,829 cumulative Covid-19 cases as of yesterday, the highest in the country since the start of the pandemic in March last year.

This figure makes up 30% of the 453,222 cumulative cases recorded nationwide in the same period.

At the start of the month, Selangor was recording more than 600 infections daily. This figure has consistently gone up, surpassing the 1,000 mark on May 2.

Yesterday, the state set another record by reporting 2,082 new infections out of a total of 4,765 cases.

There are currently 5,861 active cases in the state, while its death toll stands at 443.

The Malaysian Insight spoke to Dzulkefly to get a better picture of what is happening in Selangor and his thoughts on the third movement control order (MCO 3.0) that has been imposed by the federal government.

Q: What are the difficulties in tracking sporadic cases since they are not linked to any clusters?

A: Sporadic unlinked to clusters (cases) require mass community active case detection so that you get to isolate them fast and not allow them to roam around and infect others unknowingly.

They (the virus) are smart and, worse, they mutate in order to survive and escape the onslaught of both neutralising antibodies and cell-mediated immune mechanisms.

Q: What measures can be taken to better track sporadic cases?

A: We must intensify and speed up antigen rapid test kit (RTK-Ag) testing, based on our find, test, trace, isolate and support (FTTIS) strategy, and vaccination.

Only then can you outpace the virus. Otherwise, you will always play “catch-up” with them.

Q: Selangor developed its own AI data-gathering system for Covid-19 last year. Why was it not successful in identifying hotspots and potential clusters?

A: STFC, through our AI partner Acura, developed an equivalent of HIDE (Hotspot Identification for Dynamic Engagement) almost a year ago.

With that, we were capable of doing targeted community screening and predictions, even around perimeters of outbreaks in industries, construction sites and so on. But that is assuming we get total cooperation and commitment from the Ministry of Health (MOH) to share epidemiological line listing data.

Improving granularity of data by integrating with MySejahtera should enable Acura to increase its effectiveness and functionality, something STFC could only dream to have.

Q: Is MCO 3.0 necessary?

A: The abrupt manner the PM (Prime Minister Muhyiddin Yassin) made the announcement on MCO 3.0 speaks volumes of the huge admission of failure on the part of the Perikatan Nasional government of MCO 2.0 and its handling of the still raging third wave of the Covid-19 infections in Malaysia.

Going by the obvious signs that the public healthcare facilities, especially the intensive care unit beds and ventilators in Covid-19 hospitals will soon be overwhelmed, what choice does the prime minister have?

In that sense, no one would disagree with the MCO. But it must be done fast, rigorously and effectively and not be allowed to be prolonged or extended.

The only things left to be said is, why have they left it to reach this pathetic state? Going by most matrices, inter alia, the incidence rate per 100,000 population, Malaysia is about the worst in Asean on most scores, except case fatality rate.

Q: Where do you think the government has failed in its handling of the pandemic that we are now in this state?

A: A big portion of the failure (in handling the pandemic) is due to MOH not heeding and being responsive to the many critical suggestions of expert groups, especially epidemiologists and infectious disease clinicians and both public health and medical-based professional associations.

We could have handled it far better if only we had listened to the need of beefing up the capacity of the human resources, to execute the various taskings of contact tracings and managing quarantine, better still, digitalising and automating the contact tracing with FTTIS protocols with MySejahtera, which is almost semi-manual when it comes to the actual task of contact tracing.

Not the least was the constant reprimand to shift to RTG-Ag, from the perspective of identifying those potentially infectious people earlier, isolating and treating them, even if they are asymptomatic. It will be faster, both in speed and volume, while offering a cost-effective alternative. On both scores, the technocrats and bureaucrats failed miserably to advise and shift to utilising RTK-Ag testings.

To make matters worse, the political leaders, that is, the ministers, do not have expert think-tank groups to provide checks and balances to the MOH top brass.

That’s the way I managed the MOH before, so everyone will be on their feet. The buck stops with the political leaders. They must be very well informed themselves first of latest updates, therapeutics, vaccines and even clinical management protocols of patients.

Q: Are current Covid-19 standard operating procedures sufficient in curbing the spread of the virus?

A: (The government must implement) Strategic approach, beyond just observing the SOP, in addressing both the sporadic cases and the various clusters in workplaces, detention centres, old folks’ homes and, finally, schools.

Simply put, we must “outpace” the rate of transmission of the virus by accelerating or expediting the entire workflow of FTTIS and vaccination and not allow them (potential virus carriers) to roam around to infect others. So, beyond washing hands, physical distancing and using face masks, we must put in place a clear strategy of outpacing the rate of transmission.

This was where, among others, the weaknesses and failures of MCO 2.0 were. Besides, we didn’t know how to open up tactfully and did it hurriedly, thinking that we had won.

While we are so eager to open up our economy and life activities for our livelihoods, we must not let our guard down fast enough as to endanger our new-found freedom.

If leaders are clueless about the difference between strategic approach and mere observation of SOP or tactical measures, I fear we will have to keep locking down periodically, whenever numbers escalate again and again.

That will be most regrettable and damaging to our country’s economy and the livelihoods of the rakyat, not the least will be the lost generation of students who have to take the worst brunt of the failure of the pandemic management.

We are not safe until we achieve herd immunity – the real and true silver bullet. The vaccines must achieve their endgame of serving their raison d’être. – May 13, 2021.