THE country was ordered to go into full lockdown on June 1.

Since then six states, namely Perlis, Kelantan, Terengganu, Perak, Pahang and Penang have recovered and bucked the epidemic trends to move on to phase 2 of the national recovery plan (NRP).  However, Selangor, Kuala Lumpur, Negri Sembilan and Malacca have gone in the opposite direction, reporting worse Covid figures now than before the lockdown. 

Many wonder if the full lockdown measures have been ineffective in curbing the disease spread, based on what they see in the national trends. Recent news about surging new cases and deaths, as well as certain healthcare crises in some public hospitals in the Klang Valley have further dented public confidence in the government’s ability to handle the pandemic. It is right for the public to show concern and the authorities should pay attention to this, but in reality, what can the reports tell us about the effectiveness in the measure? Are the measures ineffective in themselves or are they failing because of poor execution?

Under MCO 3.0 and full lockdown conditions, especially amid an existing ban on inter-district and interstate travel, one should view and treat the disease outbreaks in the community as local events. Hence, to evaluate the Covid situation in Malaysia, one needs to go down to the district-level to see if the local authorities have carried out their duties properly and effectively to prevent and control disease. Due to varying socio-demographic, economic and epidemiologic conditions in different localities, it is important that we recognise and understand the nuances of local disease transmission patterns to find out what actually went wrong, or right.   

Let us delve into the numbers.

Selangor and Kuala Lumpur are the national trendsetters, taking 60% or more share of the total cases since July 7 (figures 1 and 2). Some say these are the state and territory with a large population and high density, hence disease transmission is made easier. However, if we look at the numbers of cases per 100,000 population (seven-day moving average), Labuan (72.0) and Negri Sembilan (70.7) actually performed worse than Selangor (66.0) and Kuala Lumpur (65.9) on 13 July (figure 3). The disease transmission downtrend since the beginning of full lockdown was reversed around June 25, and now in some states we can see the number of cases is shooting up again, and aggressively so.

Then came the EMCO for a larger part of Selangor and some KL areas starting July 3.

This does not mean that the full lockdown did not work as shown by the states that have since progressed to NRP phase 2. Perlis (-85.0%), Kelantan (-79.7%), Terengganu (-65.1%), Sarawak (-51.0%) and Penang (-44.3%) show significant reduction of daily new cases compared to their starting point on June 1 (figure 4).

However, this was not the case for Selangor (+81.1%), Putrajaya (+72.8%), Kuala Lumpur (+71.9%) and Negri Sembilan (+71.5%), which saw themselves in a much worse situation than they were in on June 1, with many new clusters and surging cases.

If we look at the district level, 97 out of 159 districts (or 61%) have successfully turned the figures around and improved on the 14-day local transmission cumulative cases (figure 5). Sixteen districts also moved out of the red zone. On the other hand, 61 districts (38%) got into deeper trouble with worsened records since June 1.

So the full lockdown measures did work for some states but not be for others. Just to showcase the different effects and outcome, the district case status profile can be clearly distinguished for the two sets of selected states (figure 6).

To better understand why the outbreaks in Selangor and Kuala Lumpur got out of hand even under a full lockdown, one has to dig deeper looking into the new cluster analysis to find out the sources of disease transmission. This information provides insights on how the cases came about, and why this happened. Three districts in Selangor top the nation’s chart for the most new cases: Petaling, Hulu Langat and Klang. Looking at the new clusters associated with these districts, one can see that some clusters are clearly cross-district and they are mostly workplace-related.

Workplace clusters dominate most of the new clusters, having a lion share of 81.4% (Table 1). This is the main source for the continuing local disease transmission for the affected states, because most likely people contracted the virus at their workplace, then brought it home and infected other family members. Some would also go out to run daily errands, spreading the infection to the community.

The health authorities did initial testing for the clusters when they were first reported, and normally the positivity rate would be much higher than the daily national rate (table 1). So, if the government goes hard on testing in more workplaces currently in operation, we should expect the positivity rate to stay high and more new cases to be discovered and reported. There is evidence that the health authorities have been working hard in contact tracing on new cluster discovery and close contacts. The number of confirmed positive cases from the contact tracing sources is on the rise from 2,696 on July 1 to 4,896 on July 13 (figure 7). Thus, for the short term, we may not see the reduction of new cases in the national total. If the daily cases are to be the deciding factor for transition to the next phase of NRP, residents in Selangor, Kuala Lumpur and Negri Sembilan may have to struggle and suffer for a longer time.

When examined, the categories and profiles of the top 20 new clusters in Selangor and KL from June 1 to July 10 (table 2) are mostly at construction and industrial sites. They are also shown to be labour intensive worksites. The positivity rates for many of such clusters are more than 50%. This shows how easily people can get infected and infect others in the community.

In tilting the balance towards the economy, the International Trade and Industry Ministry has been too lenient in allowing various so-called “essential services” sector to be operational in the Klang Valley during the full lockdown period. Therefore the ministry and the employers, are answerable to the workers and the community for the virus spread.

So, maybe it is high time for us to ask and care about the working and living conditions for the people operating within these sites. I am in favour of targeted (and regular) mass testing in higher risk areas and industrial sectors, until the disease outbreak situation for the locality is under control.

It is hard to blame people for the tendency of responding to the headline national numbers that becomes the basis of perception or judgement about the failure of the full lockdown and now EMCO measures. But disease control and management is never an easy task, especially if left solely to the health authorities. Often people conveniently forget that we need a whole-society approach in dealing with the disease threat. Even if the fragmented and confusing government responses oftentimes do not help the case, members of society have to help and care for each other and maintain solidarity to resolve the century’s biggest calamity. It is already happening. Together, we can. – July 15, 2021.

* Dr Lim Chee Han reads The Malaysian Insight.

* 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.