List of banned activities during conditional MCO

The government has decided to reopen the economy from May 4 but some sectors will either still be barred from resuming business or subject to many conditions and a conditional movement control order (MCO) will be imposed.

This story contains (1) the list and (2) a number of related news stories pertaining to the conditional MCO announced by the Prime Minister on May 1, 2020.

Read here (Malaysiakini, May 1, 2020)

Major challenges remain in Covid-19 testing

‘The phrase “when we have adequate testing” has become the siren song within many conversations around return, namely in reopening the economy. Unfortunately, many of these conversations do not fully consider some critical issues around availability, test characteristics, and — importantly — test strategy. These issues suggest a need to rapidly consider other methods of protecting the population during reentry that can be implemented to complement testing. Such protective methods could include physical barriers, universal masking (while acknowledging supply-chain issues with personal protective equipment), and physical distancing in public spaces.’

Read here (Mckinsey & Co, May 2020)

The ‘terrible moral choice’ of reopening

‘Coming to terms with the new normal is hard. Our actions will reshape relationships, as we’ll no doubt be more inclined toward quick judgments if we think our friends and relations are acting out of self-interest rather than the greater good. We’re all living in a science experiment—and a political and social-science experiment as well.’

Read here (The Atlantic, April 29, 2020)

There is no exit from coronavirus, only containment: A perspective from India

‘Devi Sridhar, the chair of global public health at Edinburgh Medical School and director of the Global Health Governance program, recently tweeted on the three options open. Sridhar wrote: “There are few short-term options. 1: Let the virus go and thousands die. 2: Lockdown and release cycles which will destroy economy and society. 3: Aggressive test, trace, isolate strategy supported with soft physical distancing.”

‘Having said that, the horrifying twin-reality still remains to be that an end to lockdown will by no means represent a return to normality, and, equally, a second, far more destructive wave is virtually an unavoidable possibility, notwithstanding the infection-reducing social distancing as a “new normal” in our daily life.’

Read here (Indian Punchline, April 29, 2020)

Managing expectations on Covid exit is the new challenge

“Exit strategy” is a complete misnomer. Without a vaccine or a proven therapy there is no exit from coronavirus, only containment. And there is no settled strategy. Governments across the world are either persisting in lockdown or pulling themselves out in different ways and at different speeds.

Read here (Irish Times, April 29, 2020)

Learning how to dance - Part 3: How to do testing and contact tracing. Tomas Pueyo

‘Thankfully, a set of four measures can dramatically reduce the epidemic. They are dirt cheap compared to closing the economy. If many countries are enduring the Hammer today, these measures are the scalpel, carefully extracting the infected rather than hitting everybody at once. These four measures need each other. They don’t work without one another:

• With testing, we find out who is infected
• With isolations, we prevent them from infecting others
• With contact tracing, we figure out the people with whom they’ve been in contact
• With quarantines, we prevent these contacts from infecting others

‘Testing and contact tracing are the intelligence, while isolations and quarantines are the action. We’ll dive into the first two today — testing and contact tracing — and the next two will be covered next.’

Read here (Medium, April 28, 2020)

Germany's Covid-19 infection rate rises after lockdown lifted

‘The rate at which the coronavirus is spreading in Germany has increased following the easing of lockdown restrictions. Authorities say the “R” factor, which measures the average number of people that an infected person contaminates, is now close to the limit of target levels. It had been at around 0.7 on April 20th when Germany eased restrictions on movement and economic activity. Now it is at 0.96, said Lothar Wieler, the head of the Robert Koch Institute.’

Read here (Euronews, April 28, 2020)

Unified in coronavirus lockdown, India splinters over reopening

‘For five weeks, Indians of all stripes have united to zealously conduct a nationwide lockdown, the largest and one of the most severe anywhere. But as the central government has started lifting restrictions in areas with few or no known cases of the coronavirus, officials are now facing a new challenge: persuading fearful residents, and their leaders, to consider a partial reopening.’

Read here (New York Times, April 28, 2020)

All-of-government, whole-of-society involvement needed to fight virus

‘To enhance efficacy and minimise disruptions, an ”all of government“ approach at all levels needs to be developed, involving much more than public health and police enforcement authorities. Human resource, social protection, transport, education, media, industry, fiscal and other relevant authorities need to be appropriately engaged to develop the various required transitions and to plan for the post-lockdown “new normal”.

‘Another condition for success is “whole of society” mobilisation and support. Government transparency and explanations for various measures undertaken are important for public understanding, cooperation, support and legitimacy. The authorities must also realise how measures will be seen. Singapore’s apparent early success, for example, was not what it seemed as it had overlooked official disincentives for possibly infected migrant workers to cooperate...’

Read here (IPS News, April 28, 2020)

Businesses allowed to operate during MCO can go full capacity tomorrow (April 29)

‘All economic sectors that have been allowed to operate during the movement control order (MCO) period can ramp up their operations to full capacity starting tomorrow, said International Trade and Industry Minister Datuk Seri Mohamed Azmin Ali. In a statement, Mohamed Azmin said this was decided in the National Security Council meeting today, which discussed the recommendations of the Economic Action Council following the latter's own meeting yesterday. The meeting yesterday reviewed the studies and recommendations by the Ministry of Finance, the Ministry of International Trade and Industry (MITI), Bank Negara Malaysia and national sovereign wealth fund Khazanah Nasional Bhd.’

Read here (The Edge, April 28, 2020)

Health and economy will suffer if MCO lifted too soon

‘Noor Hisham is straight forward about what is required to lift the MCO – six conditions to be fulfilled of which three have already been satisfied. The Academy of Medicine Malaysia concurs with him...

‘Detailed guidelines for a return to the workplace are necessary as well as the readiness of both employers and employees to abide by them. If, for instance, it is a crowded workplace, social distancing of a minimum one metre will be impossible to achieve unless, say only half the workforce or less, goes to work. As many people as possible still need to work from home...

‘Premature lifting of the lockdown can be disastrous. Let us spend some thought and effort into deciding what the new norm is, set clear unambiguous guidelines by professionals with no political doublespeak, announce them, and wait for feedback before implementation.’

Read here (FocusMalaysia, April 28, 2020)

Many US states are far short of Covid-19 testing levels needed for safe reopening, new analysis shows

‘More than half of US states will have to significantly step up their Covid-19 testing to even consider starting to relax stay-at-home orders after May 1, according to a new analysis by Harvard researchers and STAT.

‘The analysis shows that as the US tries to move beyond its months-long coronavirus testing debacle — faulty tests, shortages of tests, and guidelines that excluded many people who should have been tested to mitigate the outbreak — it is at risk of fumbling the next challenge: testing enough people to determine which cities and states can safely reopen and stay open. Doing so will require the ability to catch reappearances of the coronavirus before it again spreads uncontrollably.’

Read here (STAT News, April 27, 2020)

Italy's PM outlines lockdown easing measures

Speaking on television on Sunday, Prime Minister Giuseppe Conte outlined how the country would begin "Phase Two" of lifting its coronavirus lockdown. The measures include:

1. People will be allowed to move around their own regions - but not between different regions
2. Funerals are set to resume, but with a maximum of 15 people attending, and ideally to be carried out outdoors
3. Individual athletes can resume training, and people can do sports not only in the vicinity of their homes but in wider areas
4. Bars and restaurants will reopen for takeaway service from 4 May - not just delivery as now - but food must be consumed at home or in an office
5. Hairdressers, beauty salons, bars and restaurants are expected to reopen for dine-in service from 1 June
6. More retail shops not already opened under the earliest easing measures will reopen on 18 May along with museums and libraries
7. Sports teams will also be able to hold group training from 18 May
8. There was no announcement on the possibility of Italy's premier football league Serie A resuming, even behind closed doors.

Read here (BBC, April 27, 2020)

Is it too early to expand our ‘social bubbles’?

‘Drastically limiting people's contact with others seems to be helping many countries stem the spread of the coronavirus. But as economies slump and people become fatigued with rules, governments are weighing up how to ease lockdowns without risking a second wave of infections.

‘One option being touted is to allow people to slightly expand the "social bubbles" - meaning they'd be able to see a select few friends and family.’

Read here (BBC, April 27, 2020)

Malaysia not ready to lift MCO, says medical expert

‘Malaysia is not ready to lift the movement control order (MCO), implemented to contain the spread of Covid-19, in the near future due to many issues that still need to be addressed, said senior consultant paediatrician Datuk Dr Amar Singh HSS.

‘According to the former head of the paediatric department at the Raja Permaisuri Bainun Hospital in Ipoh, Perak, out of the six criteria listed by the World Health Organisation (WHO) with regard to lifting the movement order, Malaysia was still lacking in four aspects—testing and screening, health system capacity, contact tracing and, most importantly, community’s mindset.

‘(The six criteria listed by WHO are transmission is under control; health systems are able to detect, test, isolate and treat every case and trace every contact; hot spot risks are minimised in vulnerable places, such as nursing homes; schools, workplaces and other essential places have established preventive measures; the risk of importing new cases can be managed; and communities are fully educated, engaged and empowered to live under a new normal.)’

Read here (The Malay Mail, April 26, 2020)

WHO/Europe publishes considerations for gradual easing of COVID-19 measures

‘WHO guidance includes 6 criteria for moving to ease lockdown restrictions. Countries must ensure that:

1. Evidence shows COVID-19 transmission is controlled;
2. Public health and health system capacities are in place to identify, isolate, test, trace contacts and quarantine them;
3. Outbreak risks are minimised in high-vulnerability settings, particularly in homes for older people, mental health facilities and crowded places of residence;
4. Workplace preventive measures are established, including physical distancing, handwashing facilities and respiratory etiquette;
5. Importation risks can be managed; and
6. Communities have a voice and are aware, engaged and participating in the transition.

‘Due to the complex nature of the COVID-19 situation, countries are at different stages. Some are beginning to ease restrictions while others are choosing to continue strict lockdown measures.’

The WHO also called for adaptability and a staggered approach.

Read here (WHO/Europe, April 24, 2020)

Work smart, travel alone, eat out fast: South Korea's prescription for coronavirus recovery

‘South Korea outlined guidelines on Friday for a two-year return to a post-coronavirus normality including flexible working, bookings on public transport and quick restaurant meals in a country that has been a role model in containing COVID-19.

“Some experts predict COVID-19 will stay for as long as two years, and we have to accept the reality that we can’t go back to pre-COVID-19 life during that time,” Vice Health Minister Kim Gang-lip told a briefing.

‘The guidelines detail a code of conduct in areas including workplaces, transport, restaurants, shopping and sporting fixtures, starting with general rules such as washing hands, maintaining distance and regular temperature checks and disinfection.’

Read here (Reuters, April 24, 2020)

Lift MCO on areas without new Covid-19 cases over 28 days: Ex-MOH official

‘The MCO can be lifted in white areas without testing, while maintaining strict border control, such as prohibiting entry to people from red or yellow zones, and preventing residents of white areas from visiting red or yellow zones. Covid-19 testing in white areas is unnecessary, Dr Lokman said, as the assumption is that the virus transmission has been broken. “In any scenario, you have got to make certain assumptions, i.e. the likelihood of transmission is active. When you test a person negative, you have to make the assumption that the likelihood that he is positive is very, very, very low, otherwise you will end up with testing all the time, which is ridiculous,” Dr Lokman told CodeBlue in an interview.’

Read here (Code Blue, April 24, 2020)

Lockdown, vaccine, herd immunity. Can there be a winning exit strategy?

‘Lockdowns buy precious time but are not a strategy. The immediate fire is extinguished but the population remains vulnerable as large numbers lack any immunity to Covid-19 – akin to a forest-full of combustible material. It will only take a spark. Exit strategies for Covid-19 must consider this longer perspective, but the following charts explain why there will be no easy solutions and many ethical dilemmas lie ahead.’

NOTE: Dr Yap Wei Aun is a health systems specialist and adviser to the former Malaysian Minister of Health

Read here (South China Morning Post, April 24, 2020)

Learning how to dance - Part 2: The basic dance steps everybody can follow. Tomas Pueyo

‘Any country can follow a series of measures that are very cheap and can dramatically reduce the epidemic: mandate wearing home-made masks, apply physical distancing and hygiene everywhere, and educate the public.

‘It’s time to dive deep into all these possible measures, to understand them really well and decide which ones we should follow. We can split them into 4 blocks:

• Cheap measures that might be enough to suppress the coronavirus, such as masks, physical distancing, testing, contact tracing, quarantines, isolations, and others
• Somewhat expensive measures that might be necessary in some cases, such as travel bans and limits on social gatherings
• Expensive measures that might not always be necessary during the dance, such as blanket school and business closures
• Medical capacity

Read here (Medium, April 23, 2020)