Adaptive policy on Covid-19
AS of June 24, there were 8,590 confirmed cases of Covid-19 in Malaysia. About 99.9% of our population is still susceptible to this disease, and even if we eradicate it in our country, an imported case may cause another outbreak.
The government has done an excellent job in controlling the current outbreak, but we have to accept that the next significant one may happen anytime in the future.
The ongoing pandemic is akin to the Atlantic hurricanes, where devastating storms start as mild tropical rainstorms off the west coast of Africa and move slowly across the Atlantic Ocean to the Gulf of Mexico. New storms continue to develop as long as the environment is conducive for their propagation.
Malaysians are currently experiencing the calm associated with being in the eye of a storm.
The Covid-19 pandemic is a timely reminder of our vulnerability as humans to the force of Mother Nature. The evolution of public health (medicine) over the past century has allowed us to prevent and control many diseases successfully.
As our life expectancy and quality of life increased, so did our confidence in our ability to ward off suffering and death.
However, the evolution and trajectories of Covid-19 remind us that future outbreaks are inevitable, even possibly by other viruses.
Acknowledging our vulnerability demands humility but will allow us to mitigate this pandemic better.
We need to let go of our fear so that we can make better-informed decisions. Covid-19 is no different from many other deadly infections in the world, including Ebola, dengue and tuberculosis. The only difference is that we have accepted the baseline risks of these other diseases but not those for Covid-19.
But a lot has been learnt over these last few months, and we have time and hindsight now to forge the SOP for preventing and controlling Covid-19.
The SOP should be adaptive and account for the intensity of community transmission. One possible gradation of community transmission is nil (imported cases only), low, medium and high. The threshold for these gradations should be scientifically calibrated and based on community transmission independent of imported and artefactual contained clusters. The intensity of preventive measures should then correlate to the intensity of community transmission.
The pillars of prevention (hand hygiene, social distancing, restriction of movement and use of face mask) should be applied based on intensity of community transmission.
The implementation of intense preventive measures during periods of zero or low community transmission is not beneficial as it leads to loss of trust in the community and higher non-compliance. It’s more important to acknowledge that there will always be a baseline risk of Covid-19 even when the healthcare system is fully primed to prevent it.
There is also a need to emphasise evidence, feasibility and sustainability in our new policies. For example, the World Health Organisation is promoting a risk-based approach to the use of face masks by the general public. Scenarios that mandate the use of face masks include when the community transmission is high or when public health measures such as quarantine, testing, isolation and contact tracing have been overwhelmed.
Our policies should also accommodate vulnerable populations. We must balance the benefit, harm and feasibility of the different preventive interventions.
The effect of an intervention depends on the population characteristics, environment and disease transmission dynamics. A policy may have a disparate impact on different strata of the populations based on their prevailing socio-economic resilience. Thus, interventions should take the different benefit-harm ratios across various subgroups of the population into account before implementation.
Malaysia and many other countries are now recovering from the first global wave of this pandemic. We are in this for the long term, as our populations remain highly susceptible in the absence of herd immunity, and we must learn to co-exist with this new coronavirus.