The Special Report in The Edge Malaysia on 26th June 2021 with the title “Testing is sampling-No more no less” about testing in Covid 19 dealt into great details about limitations of testing as an indicator of pandemic control.
It is true that mass testing alone without appropriate follow up measures will not control the pandemic. It is also true that percentage positivity may not correlate with the severity of the pandemic as the tests could have been performed in high risk populations, which naturally give a higher than average positivity.
It is also true that mortality figures is a better reflection of pandemic compared to just the number of confirmed cases.
The number of death per million population in Malaysia is still lower than India, despite the fact that Malaysia classifies every death with COVID-19 positive test as COVID-19 death, irrespective of the presence of underlying disease. This naturally gives a higher and more accurate data on COVID-19 deaths, compared to what is the practice in India.
However analysis of data without understanding of the underlying dynamics of the pandemics and how the SARS-Cov2 virus spread is like “fighting a battle on paper” (quote a Chinese proverb).
First of all, the COVID-19 death statistic in Malaysia is actually worrying, even when we were to compare with India. Situation in India is well over the peak and on rapid decline whereas in Malaysia, the daily deaths from COVID-19 is still hoovering at about 80-100 cases (Refer to chart), despite almost 6 months of lockdowns and Declaration of Emergency since January 2021. Hopefully we are just about over the peak!
The case fatality rate in Malaysia has also increased from about 0.4% earlier in the pandemic to 0.7% now. With the increasing number of BID (brought-in-deaths) due to COVID-19, this is a reflection of worsening community transmission. The higher than usual case fatality is an indicator that more positive cases in the community which are not reported and not in the official statistics. The unreported cases will drive further outbreaks!
Does high positivity rate correlates with higher community transmission? It may not. However assessment of the severity of infection among population can been done by regular random testing or antibody surveillance. Does MOH have the results the these surveys? The results of these surveys if available, should be make public!
The test positivity of about 7% is a reflection of inadequate contact tracing and testing. If each and every closed contact of an index case is identified and tested, the test positivity should be lower. I have repeatedly reiterated that if we are able to identify, test and isolate every close contact within 48 hours, each and every outbreak can be controlled. Failure to do so will allow the virus to transmit to 3rd, 4th and more generations and every cluster will snow ball. The fact that 80% of the existing new cases are sporadic in nature is an indication that the contact tracing mechanism has virtually collapsed.
Going forward, vaccination is key to pandemic control. However, until everyone is vaccinated, the unvaccinated population will still need to be protected from ongoing pandemic contributed by existing community transmission among vaccinated and unvaccinated populations as well as imported cases, when the border reopens. The standard measures of mitigation of pandemic is still applicable, ie Contact tracing, Mass testing at locality with outbreaks and clear and consistent SOP. These measure must be put in place for another 1-2 years.
Lastly, If we can employ additional 18,000 teachers under Minister of Education, why can’t we employ similar number for public health and pandemic control as soon as possible?
Dr Lee Boon Chye
Member of Parliament (Gopeng)
Health spokesperson Parti Keadilan Rakyat