Friday 29 Mar 2024
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This article first appeared in Forum, The Edge Malaysia Weekly on March 30, 2020 - April 5, 2020

By the third week of March, the number of Covid-19 deaths in Italy had overtaken that of China. In Malaysia, the number has been rising, with 1,796 confirmed cases as at March 25 and 20 deaths. With the government imposing a Movement Control Order from March 18, we joined the list of countries restricting the movements of their populations to tackle Covid-19. What was to be a two-week restriction has been extended for another two weeks until mid-April.

Lockdowns inevitably have adverse economic impacts, especially for businesses, particularly small ones heavily reliant on continuous turnover. While a lockdown may temporarily reduce new infections, without effective public health interventions, a resurgence of new cases after that is likely. Also, are there other ways to bring the pandemic under control without lockdowns?

 

South Korean lessons?

South Korea is one of a handful of mainly East Asian economies that have dramatically reduced the number of Covid-19 cases and related deaths. On Feb 29, it saw 909 newly confirmed cases.

By March 25, the number of newly confirmed cases had fallen to 100. It has gone from having the second highest rate of infection globally to eighth place, behind China, Italy, the US, Spain, Germany, Iran and France, all with varying rates of testing. For now, South Korea has checked the spread of infections. It has managed to slow the spread of Covid-19 without imposing lockdowns, even in its most infected city, Daegu. How has it responded differently to the crisis?

The key to South Korea’s response has been mass testing. As at March 20, it had carried out the most Covid-19 tests by country — over 300,000, or over 6,000 per million inhabitants. Germany, in second place, had done 167,000 tests by March 15, or 2,000 per million.

Malaysia did just under 21,000 tests as at March 25, or about 640 tests per million inhabitants. Government plans to ramp up its testing ability to 16,500 tests per day by the first week of April should have come much sooner with sufficient funding and political prioritisation.

The infected who show no symptoms (that is, the asymptomatic) or only have mild symptoms are more likely to transmit the virus to others. As undetected cases are more likely to spread infection, mass testing can check the spread of the virus by identifying and breaking the chains of transmission.

The median incubation period between infection and symptoms first appearing is about five days, during which time asymptomatic individuals may unknowingly infect others. Mass testing detects infections early so that individuals can self-isolate and get treatment instead of infecting others.

South Korea had built up its testing capabilities following the Middle East Respiratory Syndrome (MERS) outbreak in 2015. It was thus prepared with test kits and facilities for rapid development, approval and deployment in the event of future outbreaks.

After the first case of Covid-19 on Jan 20, hundreds of test facilities, ranging from drive-through kiosks to hospitals and local clinics, quickly became available across the country.

 

Trace, test and treat

The tests are mainly free for those whom medical professionals suspect need to be tested — for example, if they recently returned from China — and even for secondary contacts of a person known to be infected or those from at-risk groups.

Others who do not belong to these categories but wish to be tested are charged 160,000 Korean won (RM560), but are reimbursed if the result is positive, with any treatment needed paid for by the government.

Another legacy of the MERS outbreak is that the government has the legal authority to collect mobile phone, credit card and other data from those who test positive for contact tracing efforts. China, too, has made use of artificial intelligence and big data to improve contact tracing and manage priority populations.

This has sparked debates over privacy concerns but South Korea’s pro-active testing and contact tracing methods have been praised by the World Health Organization, which is encouraging other countries to apply lessons learnt in South Korea, China and elsewhere in East Asia.

Although South Koreans are banned from entry into more than 80 countries around the world, its authorities have only restricted incoming travellers from China’s Hubei province, where Wuhan is, and Japan, due to bilateral political tensions.

Special procedures require visitors from China and Iran to use smartphone applications to monitor for symptoms such as fever. As Europe has become the new pandemic epicentre, all visitors from the continent are now being tested for Covid-19, with those staying long term having to be quarantined first.

The Korean Centers for Disease Control and Prevention continue to urge people to practise social distancing and personal hygiene. Mass gatherings are discouraged and employers encouraged to allow employees to work remotely. But no lockdown has been imposed and South Korea has not imposed nationwide restrictions on the movement of people within its borders.

 

Learning the right lessons

Apart from South Korea, WHO has also praised China for its Covid-19 response, which has rapidly reduced new cases, besides helping other countries with their efforts. More and more countries are restricting freedom of movement through lockdowns, citing China’s response in Wuhan.

However, Bruce Aylward, who led the WHO fact-finding mission to China, notes, “The majority of the response in China, in 30 provinces, was about case finding, contact tracing and suspension of public gatherings — all common measures used anywhere in the world to manage [infectious] diseases.

“The lockdowns people are referring to … were concentrated in Wuhan and two or three other cities … that got out of control in the beginning. The learning from China ... is all about the speed. The faster you can find the cases, isolate the cases and track their close contacts, the more successful you’re going to be.”

China and South Korea are now primed to detect and respond rapidly, which makes all the difference in preventing a new wave of infections. This is not to say that lockdowns are ineffective; we will soon know whether such measures will succeed in countries like Italy.

The South Korean and Chinese experiences suggest that resources should be concentrated on rapid and early detection, isolation and contact tracing, protecting the most vulnerable and treating the infected, regardless of means, instead of mainly relying on strict lockdown measures.


Nazihah Muhamad Noor has a Master of Public Health and a bachelor of science degree in biomedical science (global health) from Imperial College London. Jomo Kwame Sundaram was an economics professor and senior United Nations official. Both are associated with Khazanah Research Institute. The views expressed here are their personal opinions.

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