Urgent proactive steps needed to manage Covid-19 surge: Jeyakumar Devaraj

 This article is reproduced in full, in the public interest, here because the original is behind a pay wall...

There is light at the end of the tunnel. Our vaccination programme has accelerated to more than 400,000 shots per day, and already around 5 million Malaysians have received both shots and another 5 million have taken their first. Credit should be given to the ministries that have procured and are delivering these vaccines to our population. They are doing a good job in ramping up the vaccination exercise. This is a good sign for the nation – it means that we have the institutional capacity to design and deliver effective programmes when the cabinet commits to these programmes.

However, the end of the tunnel – the attainment of 80 percent vaccination cover for our population - is still several months away. (80 percent of 38 million is 30.4 million – the virus does not discern between citizens and the 6 million migrant workers in the country.) There is therefore the very real possibility that we will witness more surges of Covid infections in places outside the Klang Valley in the next few months as we have not achieved the vaccine coverage level we need to prevent explosive growth of clusters. The genie is out of the bottle, and our current movement control orders (MCOs) are not going to be able to put it back in. It will take a much stricter and prolonged MCO to achieve that, but that would adversely impact the economy and the livelihoods of many Malaysians. We do not have the social capital to embark on such a course. People are already quite irate.

The high number of “sporadic” cases is a clear indication that the virus is circulating in the community. As bringing down the daily infection rate to two-digit figures is not within our reach, the general population must continue to strictly observe physical distancing, double masking and avoidance of crowds for a few more months until we get 30.4 million people vaccinated. Interstate travel should be avoided. This is certainly not the time to let our guard down.

The attempt by the MOH to paint a rosy picture by breaking down newly diagnosed cases by clinical categories is also poorly conceived. A person who is Category 1 on the day of diagnosis could quite easily deteriorate to Category 4 by the end of that week and to Category 5 by midway through the second week of symptomatic illness. It would be more beneficial to the public if the MOH were to include a breakdown by category of the cohort of patients diagnosed three weeks prior as part of the statistics released daily. That would give the truer extent of the problem and motivate people to observe the safety precautions. My assessment is that about 20 percent of cases go into category 4 and require oxygen, 4 percent progress to category 5 and about 1.5 percent die.

So, as the spectre of future spikes is still high, all our states need to prepare for the very real possibility that they might suddenly be beset by a surge in cases.

The phases of Covid-19 infection

To prepare for the proper care of Covid-19 patients in the event of a surge, we first need to understand how the disease unfolds in infected persons and how best to curtail morbidity and deaths. There are two distinct phases in the first three weeks of Covid 19 infection – the first phase is when the virus multiplies in the body, causing fever, headache, cough, body aches and several other symptoms. This “viraemic” phase lasts for about five days before the patient’s immune system produces the antibodies and the killer lymphocytes that attack and smother the virus particles, thus blocking the virus from infecting new cells. In about 80 percent of the cases, the illness ends here, and the patient begins to recover.

However, in about 20 percent of the cases, the patient goes into the second phase – his/her immune system goes into overdrive (the “cytokine storm”) and this overreaction causes damage to the patient’s vital organs – lungs, heart, kidneys and brain. We are still not too sure why this happens, but the effects of immunological “exuberance” can be worse than the initial damage by the virus itself. The overactive immune system also disrupts the normal clotting mechanism in the patient resulting in multiple small clots forming in many organs, causing further damage to these organs.

Doctors treating Covid-19 cases have found that early treatment can limit the damage caused by the immunological phase of infection. Steroids can dampen down the “cytokine storm” and low molecular weight heparin can reduce the tendency to form clots in the blood vessels. However, these interventions have to be given before multiple organs have been damaged. You have got to catch the “cytokine storm” early and nip it in the bud.

Early intervention will reduce the need for ICU admission. Waiting for the patient to develop oxygen desaturation before initiating steroids and heparin is rather late. For the best results, we need to look for the early signs of the cytokine storm and abnormal clotting – and these can be found via blood tests. The cytokine storm will consume cytokines (obviously) – and the levels of a group of substances in the blood – the complements – will drop. Similarly disseminated clotting all over the place will consume platelets and clotting factors such as prothrombin and result in elevated D Dimers (a breakdown product arising from clots within the bloodstream).

You might wonder why not start the steroids and the heparin the moment Covid-19 is diagnosed. We can’t, because we need the immune system to bring the viraemic phase under control. And also in 80 percent of cases, the body knows when to stop. So our strategy should be to identify as early as possible the 20 percent of cases who go on to the second phase – the immunological phase of the illness.

The immunological overreaction usually kicks in about one week after the start of the viraemic phase, but we cannot use the date of onset of symptoms to determine when the viraemic phase started. Some people have very minor symptoms during the viraemic phase and then develop devastating complications in the subsequent immunological phase. This, I think, is the reason behind the spate of brought-in-dead cases. Their immunological overreaction caused a life-threatening complication such as a heart attack, or pulmonary embolism although their initial illness was relatively mild. The incidence of this phenomenon seems to be higher with the current Covid-19 variants in the population.

We have to arrange for the management of any future surge in Covid 19 infections based on this understanding of the natural history of the illness, and the fact that when a surge occurs, admitting every case to hospital is not an option as we would be out of hospital beds very soon.

The action plan

First of all, we need to build capacity for outpatient screening for Covid-19. This should be by a drive-through method as that will reduce exposure of other people to suspected cases. People who suspect they have Covid-19 infection should call their nearest Covid-19 Assessment Centre (CAC) to get an appointment to come for a drive-through nasal swab test or a saliva antigen test. If they do not have their own transport, then the CAC should send a mobile lab team to collect the sample. I would think that the rapid antigen test that looks for specific Covid-19 antigens is good enough to make the diagnosis in this pandemic setting. The RNA PCR test (which has a mechanism to multiply the viral RNA) is more sensitive, but takes far longer (24 to 48 hours compared to 4 to 6 hours for the antigen test) for the result to be known.

Ideally, all diagnosed cases should have a blood test done to assess complement levels, platelet counts, prothrombin time as well as D Dimer levels. As we do not want these patients to come to hospital for their tests, we need to send properly attired mobile units that can go to their homes, draw their blood as well as take nasal swabs for household contacts, and teach them how to take their own pulse rate. Personal protective equipment is of crucial importance here, because this is the phase when Covid-19 patients are most infectious. By the time patients develop immunological overreaction and get admitted to hospital, their viral load is much lower and they are far less likely to transmit the infection to others.

Those who are asymptomatic or minimally symptomatic can be allowed to quarantine at home together with their household contacts. Theoretically, it would be ideal to quarantine all the household contacts separately but that would require a lot of resources, and it is uncertain how helpful such a practice would be in reducing intra-household transmission. It appears that Covid-19 patients start emitting the virus about 24 hours before the onset of symptoms. And it usually takes another 24 hours or more after the onset of symptoms before the diagnosis is confirmed by tests.

This means that household contacts are exposed to the virus for more than 48 hours prior to any attempt to isolate the index case in that household. Is isolating family members separately worth the effort? MOH data comparing the rate of household transmission in patients who were removed to quarantine centres with that of patients asked to quarantine at home would be useful in deciding this issue. Can we get some epidemiologists in our universities to look through MOH data to quickly throw some light on this issue? We should be guided by the empirical data for this. My gut feeling is that separate isolation of household contacts will not reduce transmission rates to household members significantly. Perhaps we should still offer older family members who are not fully vaccinated the option of a single-room hotel stay for a week.

The Covid 19 Assessment Centres (CAC) should follow up on the home quarantining patients everyday via phone calls. The CACs should set up teams including general practitioners, retired doctors and nurses who would each be assigned 10 to 20 patients to follow up every day via phone calls. The caller should screen for danger signals – shortness of breath, heart rate of over 110/min, confusion and/or persistence of symptoms for more than a week. The caller should also ask regarding the situation of other family members in the household and whether any essential provisions are needed, for example, long-term medicines that family members are already on. There must be a simple format to report back to the coordinator of the home quarantine programme at the CAC. There should also be a mechanism set up where essential provisions are delivered to the homes of the quarantining patients if required – perhaps Rela or even the army can be involved in this. If the patient being monitored at home develops any of the danger signs he/she needs to be brought to the next level of care for assessment.

The next level of care would be the make-shift hospitals that have been set up in convention halls, schools and stadiums. More such venues should be readied in other states. Here, clinical examination, pulse oximetry, blood tests (including those mentioned above) and if warranted, a chest XRay would help ascertain whether they have pneumonia (which would make them category 3). The National TB Control programme had a number of mobile XRay units mounted in specially designed ambulances. We should quickly procure a few of these to serve the field hospitals. Category 3 cases can be managed as inpatients in the makeshift hospital.

If the patient has low oxygen saturation (hence qualifying for Category 4) or any laboratory evidence of immunological overreaction, he/she will require immediate commencement of treatment at the field hospital itself – oxygen therapy, steroids and low molecular weight heparin as indicated, while admission to a hospital is arranged.

Being prepared for possible surges

I think it would not be an overreaction on the part of the authorities to make the preparations that I have sketched out above. A lot of effort would be required to ramp up the capacity of the CACs. More staff would need to be hired to handle each of its various responsibilities as described above.

Current SOPs will have to be upgraded to meet the new responsibilities of the CACs. The aim is to move a large part of Covid-19 management out of the hospitals so that the hospitals can concentrate on the more ill patients. This strategy also is aimed at catching the deteriorating patients early so that their slide to a more critical stage of the illness can be arrested.

We need to develop these capacities now so that if a surge were to happen, we have the ability to handle it. Our case fatality rate (CFR) for Covid-19 has soared from 0.38 percent in 2020 to about 1.8 percent currently. CFR refers to the percentage of diagnosed Covid-19 patients who die. Part of the reason for the higher CFR now could be that the current strains are more vicious. But the fact that our hospitals are overloaded and treatment to dampen the cytokine storm is not started soon enough is also a factor.

Let’s take all the steps we can to reduce ICU admissions and to bring the CFR down to lower than where it was in 2020. The government has shown that it can implement programmes effectively if it sets its mind to it – witness the vaccination programme. Let’s hope some of the above suggestions are acted upon, they would save us a lot of pain.

Dr Jeyakumar Devaraj is Parti Sosialis Malaysia chairperson.

Source: Malaysiakini, July 23, 2021. Read here

Suspend HIDE information announcement immediately, shopping mall operators and retailers tell MOSTI

‘The statement [by The Malaysia Shopping Malls Association, Malaysia Retailers Association and Malaysia Retail Chain Association] claimed that the HIDE assessment is grossly unfair to shopping malls and retailers which have invested so much on safety and control and adhered to Covid-19-driven SOPs as determined by the authorities. "The earnest and diligent adherence to the SOPs at shopping malls would appear to have, unfortunately, back-fired and inadvertently punished the malls. 

"We understand that the national [Covid-19] infection rate is 1.3% and from our own statistics, shopping malls’ infection rate is significantly below the national average,” the statement claimed. Citing data from the Health Ministry, the statement said the ministry’s data shows that factories, communities and construction sites constitute the top three locations where Covid-19 incidence is detected at 48.06%, 12.5% and 11.56% respectively.

‘As the ministry’s data shows that shopping areas only comprises 4.78%, the statement said clarification needs to be accurately provided as to the incidence of Covid-19 infections in shopping malls and areas. "It is obvious the HIDE information is incomplete and skewed and portrays a completely different picture than the real situation. "The information is incomplete as only those premises and operations that diligently comply with the SOPs and MySejahtera recording are data-mined. "Those sectors that do not comply and blatantly flout the SOPs are not evaluated for lack of data and thus do not appear as a hotspot, despite being so,” the statement claimed.’

Read here (The Edge, May 8, 2021)

US CDC issues ‘Interim public health recommendations for fully vaccinated people’

Fully vaccinated people can:

• Visit with other fully vaccinated people indoors without wearing masks or physical distancing
• Visit with unvaccinated people from a single household who are at low risk for severe COVID-19 disease indoors without wearing masks or physical distancing
• Refrain from quarantine and testing following a known exposure if asymptomatic

For now, fully vaccinated people should continue to:

• Take precautions in public like wearing a well-fitted mask and physical distancing
• Wear masks, practice physical distancing, and adhere to other prevention measures when visiting with unvaccinated people who are at increased risk for severe COVID-19 disease or who have an unvaccinated household member who is at increased risk for severe COVID-19 disease
• Wear masks, maintain physical distance, and practice other prevention measures when visiting with unvaccinated people from multiple households
• Avoid medium- and large-sized in-person gatherings
• Get tested if experiencing COVID-19 symptoms
• Follow guidance issued by individual employers
• Follow CDC and health department travel requirements and recommendations

Read here (US CDC, Mar 8, 2021) 

Finding an ultimate vaccine to fight the mutating “emperor” virus

‘We are commenting on the shocking CNN website report (March 2), headlined “All our recent progress with COVID-19 could be wiped out by variants, CDC director says”. The first two paragraphs (below) are enough to sum up the CNN report: “The US is at risk of losing all its recent gains in the battle against COVID-19 as highly contagious variants take advantage of Americans getting lax with safety measures... “Please hear me clearly: At this level of cases with variants spreading, we stand to completely lose the hard-earned ground we have gained,” said Dr Rochelle Walensky, director of the US centers for Disease Control and Prevention (CDC).”...

‘With new variants, serious doubts are suggested by the CNN report on whether this “vaccine” [mRNA], the first in the global market, would work, even if safety factor is put aside. Nevertheless, there are safe and workable vaccines, using tried and tested technologies like using inactivated or attenuated virus from nature to stimulate the body to produce anti-body response. Even the adenovirus viral vector technology, tried and tested for Ebola, appears to be safer than mRNA.

‘There are also safe and good alternatives, like the anti-viral “broad spectrum” drug Ivermectin, which can destroy the new variants. In the meantime, it is vital that we improve our body immunity against COVID-19 by taking Vitamin C with zinc, Vitamin D, minerals and trace elements needed, explore proven traditional and complimentary medicines, and maintain established standard operating procedures (SOPs) of physical distancing, wearing surgical masks and personal hygiene in public places.’

Read here (Focus Malaysia, Mar 4, 2021)

Ground SOPs in science: The Academy of Medicine of Malaysia

‘The Academy of Medicine of Malaysia is troubled by the introduction of the Prevention and Control of Infectious Diseases (Exemption) Order 2021, which states that Cabinet ministers returning from official overseas visits must only quarantine for 3 days instead of the mandatory 10 days for inbound travellers. The Health Minister clarified that only Cabinet ministers who travel in a ‘bubble itinerary’ will undergo 3-day quarantine. Moreover, this move is intended to open up the economy as the policy will eventually be applicable to foreign dignitaries and business travellers.

‘We, the Academy of Medicine of Malaysia, wholeheartedly oppose the Exemption Order as well as any plans to extend the 3-day quarantine rule to other travellers.

‘We wish to remind the government that all standard operating procedures (SOP) must be grounded in science. The quarantine period for inbound travellers is set at 10 days based on research which shows that the risk of transmission is extremely low (~1%) after 10 days with monitoring and testing in place. The incubation period for Covid-19 is on average 5 to 6 days but can be as long as 14 days. Therefore, three days is insufficient to detect symptoms. There must be an evidence-based, public health explanation for the government’s decision to reduce quarantine days.

‘The effectiveness of so-called ‘travel bubbles’ are also still in question as new variants of Covid-19 with increased transmission capability spread rapidly around the world. There is insufficient data on the mutations to develop robust protocols for safe travel. We understand there is urgency to restart the economy for the benefit of Malaysians and businesses that are struggling, but this can only be done by bringing the pandemic under control first. The government must not open up our borders to ‘bubble’ delegations and risk bringing in new variants that could overwhelm our health system.

‘We call on the government to revoke the Exemption Order and—until there is scientific evidence that suggests differently—enforce a 10-day quarantine for all.’

Read here (AMM press release, Feb 10, 2021)

Movement control orders are not the way to defeat Covid-19: Academy of Professors Malaysia (APM)

Here are their suggestions in seven parts:

1. Red Zones with more than 40 new daily cases should continue to be under EMCO, but the rest of the country should return to RMCO. Perhaps these acronyms could best be replaced with number codes in order to avoid the misconceptions.
2. The continued detection of localised outbreaks (clusters) should continue. However, since the Covid-19 infection survival rate is 99.9 per cent for healthy people under 70, to achieve an optimal balance between health, social wellbeing, and the economy, the emphasis should be on "focused protection" and "targeted approach" for those at risk while allowing the less vulnerable to work and go to school. (a) Young and healthy adults and children above the age of 12 should be allowed to go back to school and work. (b) People with co-morbidities regardless of age and the elderly should stay at home. (c) People who go to work and school should be taught how to clean themselves and how to approach vulnerable family members when they return home. These measures should be taught on media, at the workplace and at school.
3. As advocated earlier, people should be taught and continually reminded about carrying out the responsibility of protecting themselves against Covid-19 by practicing the 3W and 3C as the daily norms. The public should also be educated on the level of risk of getting an infection from activities so as to avoid the activities that are high risk, for example avoiding bars, indoor close contact, meetings and parties, eating in crowded indoor restaurants, etc. Activities outside, with physical distancing, is generally low risk and since we need the sun to produce Vitamin D, exercising outside should be encouraged.
4. That the SOPs need to be well defined, complete and accurate to avoid confusion. For instance, the misunderstanding on the usage of masks during fuelling at petrol stations, and the restriction of travelling together and eating at a table in restaurants, while the group may be from the same household, hence sharing the same living environment and air. Such restrictions may further increase the risk of depression, lethargy, and family discord of being cooped up for too long.
5. That nutritional education on the right food would assist the development of a stronger immune system. Get nutritionists and dieticians on board in the media to tell people what to eat, how to prepare and cook and when to eat is as important as showing people how to exercise in the mornings.
6. The creation of platforms for people with mental health issues to reach out to either at the university, healthcare, organisational or even individual level and if possible make it free so that anyone can get help when needed.
7. That the message of keeping the vulnerable and high risk groups safe should be constantly reaffirmed and resonated to the public via media and to communities. It is important to make sure that people above 70 and anyone who has chronic diseases do not get infected.

Read here (New Straits Times, Nov 14, 2020)

Covid-19: Protecting our children ― Amar-Singh HSS

‘This recent infant death will have alarmed parents and those of us working with children. We want to know how we can protect our children better. The clear message is that we cannot protect our children without controlling the pandemic in the community; these two are intricately linked. I would like to offer some suggestions of what we can do in the face of the extensive community spread that is currently occurring in the country.’

• Improve SOPs at schools, taskas, child care facilities
• Strengthen our contact tracing with data transparency
• Advocate for health support to be ramped up with regards to (1) testing (2) use of rapid antigen detection tests (3) boost of manpower at MOH (4) injection of funds at MOH for equipment, PPEs, etc
• Stop poor leadership by example that hampers population compliance

Read here (Malay Mail, Oct 7, 2020)

US health agency says testing not needed for some exposed to Covid-19, sparking outcry

‘The US Centers for Disease Control and Prevention (CDC) said this week that people who were exposed to COVID-19 but are not symptomatic may not need to be tested, sparking outcry among officials and experts who fear the changed guidance was politically motivated. The advice marks a reversal of the agency's previous position recommending testing for all close contacts of people diagnosed with COVID-19, narrowing the scope of instances where the CDC recommends testing. CNN and The New York Times reported on Wednesday that US public health officials were ordered by high-level members of the Trump administration to push forward with the changes.’

Read here (Channel News Asia, August 27, 2020)

Covid-19 is transmitted through aerosols. We have enough evidence, now it is time to act

‘We should continue doing what has already been recommended: wash hands, keep six feet apart, and so on. But that is not enough. A new, consistent and logical set of recommendations must emerge to reduce aerosol transmission. I propose the following: Avoid Crowding, Indoors, low Ventilation, Close proximity, long Duration, Unmasked, Talking/singing/Yelling (“A CIViC DUTY”). These are the important factors in mathematical models of aerosol transmission, and can also be simply understood as factors that impact how much “smoke” we would inhale.’

Read here (Time Magazine, August 25, 2020)

Covid-19: Getting our SOPs right - Amar Singh HSS and Lim Swee Im

This article discusses a number of issues on SOPs pertaining to Malaysia today:

• How can we best monitor our pandemic when our numbers are low?
• How ready are our testing capabilities for a second and subsequent waves?
• How good are our safe physical distancing measures?
• Optimising masks in Covid-19 prevention
• There is no way for the poor (B40) to comply with this ruling without a government mandated free programme
• Mask etiquette and our leaders

Read here (The Malay Mail, July 27, 2020)

Why is it hard to do what is right?

‘In the fight to contain the spread of coronavirus, Malaysians have split into two camps: the risk-takers and the rule-followers. On one side are carefree people who ignore public health measures; on the other are the anxious ones coming to grips with the reality of life with Covid-19. What a depressing spectacle has been the effect of the recovery movement control order involving public transport and eating out.’

Read here (Free Malaysia Today, June 14, 2020)

No exit strategy until high SOP compliance from Malaysians, says DG

Health Ministry director-general Dr Noor Hisham Abdullah said there needs to be a high compliance rate for the standard operating procedure (SOP) under the conditional movement control order (MCO) as well as a steady two-digit daily new Covid-19 cases before an exit strategy can be discussed. “Before we can discuss an exit strategy – and we are not discussing an exit strategy now, only loosening under the conditional MCO – Malaysians must comply (with the SOP). If they do not comply, we might extend the conditional MCO...’

Read here (Malaysiakini, May 18, 2020)

No shortcuts and people must get used to a new way of living, warns WHO's chief scientist

‘It is critically important for governments to present facts in a way that people really understand what the Covid-19 coronavirus is, and the logic behind some of the measures put in place, said Dr Soumya Swaminathan, chief scientist at the World Health Organisation (WHO). When countries open up, their basic principle must be to test people with symptoms, identify the contacts and quarantine them until they are free of the risk of getting the disease, she said in an interview. "Those basic principles will have to be actually followed by governments and cities everywhere. There's no shortcut to that," she warned.

Read here (Straits Times, May 18, 2020)

Guide for Covid-19 prevention in aged residential care facilities — Amar-Singh HSS, Vivienne Yong and Liew Tuan Hock

‘Older individuals in residential care need to be shielded from the risk of getting coronavirus infection. The key will be to try and create a bubble (a shield) in which the residents and staff live and operate, so as to minimise new individuals and infection entering the group. This guide and standard operating policy (SOP) aims to help offer ideas and initiatives that could be taken.

‘The guide covers the areas to consider with suggestions for improving Covid-19 prevention. It looks at policy, staff, residents, healthcare workers/therapists and visitors policies. The guide will be useful for nursing homes, old folks homes, retirement villages, palliative care facilities and also relevant to other residential care facilities for any age. It is relevant to non-governmental, private and governmental facilities.’

The full Aged Residential Care Facilities Guide is available for download and use from this link.

Read here (Malay Mail, May 18, 2020)

Chow: No feedback was collected from the states on CMCO

‘No feedback was collected from the states on how the conditional movement control order (MCO) and standard operating procedure (SOP) should be done, the Penang Chief Minister has claimed. Chow Kon Yeow said as a result, the state government decided not to allow businesses to resume operations yesterday.’

Read here (The Star, May 5, 2020)

Defiance of the 9 States – The whirling wheels of Malaysian federalism

‘On 1st May 2020, Prime Minister Muhyiddin Yassin announced that the MCO would be substantially lifted come 4th May 2020. The MCO will hence be superceded by a Conditional Movement Control Order (CMCO).

‘In a stunning development, as many as 9 states have said they will not be following or complying fully with the Federal Government’s ease of movement and resumption of businesses at 100% capacity under the CMCO.

‘Is it unconstitutional for these States to not follow or fully comply with the Federal Government’s CMCO?’

Read here (Malaysian Public Law, May 2, 2020)

MITI urges state governments to follow Putrajaya's decision to relax the MCO

‘The Ministry of International Trade and Industry (MITI) today urged state governments to cooperate with the federal government's decision to implement the Conditional Movement Control Order or CMCO that allows almost all sectors of the economy to resume operations after almost two months of suspension under the MCO.

‘Failure to do so may result in the state governments facing the possibility of legal action from various parties, particularly industry players, Minister of International Trade and Industry Datuk Seri Mohamed Azmin Ali cautioned in a statement today.

‘As it is, Mohamed Azmin said various industry associations, including the Federation of Malaysian Manufacturers and the Malay Chamber of Commerce of Malaysia, have issued statements calling for state governments not to stop companies from resuming their operations from today, the first day of the CMCO.’

Read here (The Edge, May 4, 2020)

MMA: Public now the ‘frontliners’ in Covid-19 fight

‘Members of the public will now play the most important role in combating the Covid-19 pandemic, says the Malaysian Medical Association (MMA). Its president Dr N. Ganabaskaran said with the announcement of the conditional movement control order (MCO) by Prime Minister Tan Sri Muhyiddin Yassin, the public must remain vigilant as the health crisis continues.

“As most businesses will resume operations on Monday (May 4), the public will now play the most important role in fighting the Covid-19 pandemic... The general public must now take on the role as frontliners, in battling the pandemic in public places by being disciplined in observing social distancing, personal hygiene and comply with the standard operating procedures (SOP) at all times or we can easily slip back into the ‘old norm’.’’

Read here (The Star, May 1, 2020)

Conditional MCO might cause third wave of infections, say health experts

Health experts are voicing concern over the move to ease the movement control order (MCO) by allowing businesses to reopen starting next week, warning that this might lead to new waves of Covid-19 infections.

Azrul Mohd Khalib, the executive director of the Galen Centre for Health and Social Policy, said people might be confused over the standard operating procedures (SOP) given the short time frame for preparation, warning also of non-compliance by others.

Read here (Free Malaysia Today, May 1, 2020)