The trajectory of COVID-19 scenario in Malaysia: facing the unprecedented

Abstract

Background: Like other affected countries around the globe, Malaysia is shocked by the Coronavirus disease 2019, which is also known as COVID-19.

Aims: This commentary article discusses the COVID-19 scenario in Malaysia, particularly in relation to the sudden increase in the number of new cases related to an international mass gathering.

Findings: Projection through modelling helps the relevant authorities to act quickly and effectively, including enforcement of physical and social distancing. Modelling also assists in understanding the link between the biological processes that underpin transmission events and the population-level dynamics of the disease.

Conclusion: There is no one-size-fits-all approach in managing disease outbreak. The fight against COVID-19 very much depends on their attitude during the 14-day Movement Control Order (MCO) which has been extended recently.

Keywords:

• COVID-19
• Malaysia
• risk modelling
• unprecedented

Introduction

Coronavirus disease 2019 (COVID-19) is caused by SARS-CoV2, a novel coronavirus which was first reported in December 2019 in Wuhan, China and has since spread extensively globally¹. On 25 January, officials in Malaysia announced the epicentre of the outbreak was a positively tested 37-year-old Chinese female tourist from Wuhan, who have travelled from Singapore to Malaysia. The number of positive cases drastically spiked following a 4-day international mass gathering related to an international Islamic missionary movement cluster. There were also participants from China and South Korea, the two countries with high rates of SARS-CoV2 infections. The rapid transmission was predicted to be caused by exported cases from other countries, causing a robust increase in the cumulative cases in Malaysia within weeks with nearly two-thirds are linked to the event.

Risks prediction modelling

The use of models in epidemiological predictions are proven useful for comparing the effects of different control strategies. Epidemiological predictions require knowledge of both the risk of infection and crucially, the risk of transmitting infection if infected². Predictions about future infectious disease risks can be done quantitatively based on several possible situations, (1) risk for an exotic or novel infection will appear in a given host population, given an infectious disease is present; (2) prediction is needed to assess the speed of the transmission, how many people or animals will be affected and how long will it persist for?; (3) the impact of pandemic interventions (treatment, vaccination or enforcement of quarantine, movement restriction order or social and physical distancing) to contain an epidemic; (4) the utility of alternative data sources (e.g. internet searches) to augment traditional surveillance³, and (v) the correct handling of test sensitivity and specificity in serological data, propagating this uncertainty into the real-time modelling^4,5.

Mathematical models have been used in public health widely as they act as a research tool in surveillance of the diseases, to predict disease progress and outcome as well as identify the potential causes of transmission. It can be used to link the biological process of transmission and the emergent dynamics of infection at the population level.⁴. In forecasting disease transmission using mathematical modelling, data related to (1) trends from the epidemic time series obtained from disease activity patterns of social contacts; (2) data from social media; (3) optimal interventions in combating the epidemic such as placement of treatment centres and allocation of vaccine; and (4) data pertaining to environment (such as weather) (5) data on disruptions to activity patterns and mobility due to extraneous processes (such as conflicts and natural disasters) are needed^5,6. However, some limitations have been identified to the mathematical models, such as, they can lead to negative perceptions of models as unrealistic, unhelpful, or confusing, which means they are sometimes disregarded over other, more traditional methods.

Modellers, public health planners, and policy decision makers may have different perspectives and goals. Modellers may be mainly interested in answers to mathematical questions and better understanding of the mechanisms of disease transmission from a scientific standpoint, while public health planners would need detailed estimates for specific scenarios in order to answer policy questions. Policy decision makers are usually influenced by political considerations and need sound scientific information to factor into their decisions. In general, collaboration between public health planners, policy makers and modellers are paramount so that modelling activities will be directed towards addressing the right questions to support complex decision making in the crucial and timely response to emerging infectious diseases⁵.

How to defeat COVID-19?: heed lessons from affected countries and past epidemics

The past learning experiences from dealing with SARS in the past have helped many Asian countries in dealing with COVID-19. When authorities in Wuhan announced on Dec. 31 about a newly cluster of viral pneumonia detected in the Chinese city, with 27 cases linked to a seafood market, the disease was said to be preventable and controllable, with ‘no obvious signs of human-to-human transmission’^6,7. Unlike China, South Korea, Hong Kong and Taiwan swung a rapid response into action based on what they have learned from the past epidemics. The bad experience from SARS turned out to be a blessing for these countries.

China learned some lessons from SARS but failed to grasp the danger of covering up an outbreak. Being the second-highest caseload of the Middle East respiratory syndrome coronavirus, or MERS CoV in 2015, South Korea learned plenty in dealing with COVID-19. Its success is rooted in a previous failure of limited availability of test kits was seen as having aggravated the 2015 MERS outbreak. Both countries struggled with big outbreaks of the coronavirus but appear to have brought them under control, partly related to the stringent and sometimes unprecedented measures within their borders.

What to expect in Malaysia?

Malaysia has enforced the 2-weeks Movement Control Order (MCO) on March 18. After 2 days of MCO in place, 900 cases of positive COVID-19 reported with more than 6000 cases on home surveillance. More than half of the positive cases were from the Islamic missionary movement cluster.

The mitigation measure needs to be sustained and the 2 weeks mitigation plan is merely adequate. According to Professor Cowling, a professor of infectious disease epidemiology from University of Hong Kong, the peak is probably 4–8 weeks away and if it is slowed down by the mitigation measures it can extend to probably 12 weeks. The measures need to keep going or otherwise another surge will occur once the measures stop.

According to a local epidemiologist expert, Professor Datuk Dr Awang Bulgiba, the 14-day MCO may be inadequate due to the likelihood of few more waves related to mass gatherings⁸. Even if the 14-day MCO is successful in showing a decline in new cases, the MCO needs to be extended to another four more weeks in order to observe a very small and manageable number of cases. Based on the China experience in dealing with the new virus, they waited for 14 days following zero new cases to consider the emerging of the new asymptomatic clusters before declaring it was over and no new cases appeared.

Conclusion

COVID-19 pandemic is an unprecedented global war. Mankind is facing the same enemy with the first battlefield is the healthcare workers. Despite the various approaches in dealing with COVID-19, what matters the most is the best method to contain the disease through effective response, preventive measures and community awareness which are crucially important at this moment. Projecting what to be expected helps to break the chain of transmission. Modelling enables us to understand the link between the biological processes that underpin transmission events and the population-level dynamics of the disease. A well parameterised mathematical model allows us to test the feasibility and effectiveness of multiple intervention approaches, without having to apply them in the real world first. Claiming the disease is plateauing after few days of enforcement of MCO is a premature decision. The successfulness of the MCO is very much depending on the awareness and attitude of Malaysians.

Manuscript update: commentary on current events

9 June 2020

Malaysia’s recent success in suppressing the spread of COVID-19 has been recognised by the World Health Organization (WHO) and was strongly related to the fast and active action by the Ministry of Health (MOH); implementation of the various phases of MCO; collaboration with various organizations, including non-governmental organizations, to host fundraising and also provide personal protective equipment to those on the frontlines; and the media’s role in actively spreading the hashtags #stayhome and #kitajagakita, which means that we look after each other.

Transparency

Declaration of funding

This commentary was not funded.

Declaration of financial/other relationships

The authors and peer reviewers of this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

The author thanks the reviewers of this editorial for their valuable feedback.