Malaysia is not alone in seeing a rise in Covid-19 infections recently. Rapid increases in the number of cases are happening all over the world, partially on account of viral mutations. The D614G mutation is now the dominant variant. While it is not more severe, this mutation has been shown to have a much higher transmission rate.
The virus is not the only thing changing. The US’ Centers for Disease Control and Prevention (CDC) has reported a changing age distribution. Earlier in the pandemic, infection rates were highest among older adults. Since June, however, asymptomatic and pre-symptomatic younger adults are now the biggest contributors to community transmission. It is no different here in Asia-Pacific and in Malaysia; the transmission of the virus is now being increasingly driven by young adults.
Data of Covid-19 cases between August and September in Malaysia shows that just over 50% of positive cases are in people aged between 20 and 39 — younger working adults. Illness and death from Covid-19 are significantly higher among the elderly while younger people generally can carry on with their lives fairly quickly. But it is important for us to remember that these young people do not live in a social vacuum. While they may experience less severe infections, they can easily transmit the virus to more vulnerable people, especially relatives and friends.
The CDC reported that where there is a spike in cases among young adults, there is usually a similar jump in numbers for older adults within two weeks. What this highlights is that the virus is adapting; we must do the same.
Covid-19 demands that we rethink our lives from the perspective of health security
The pandemic shows us that we need to exercise common social responsibility, and so far Malaysians have risen to this challenge commendably. Nationwide registration of the MySejahtera contact-tracing application has reached 60% of the entire Malaysian population, the threshold for an effective contact tracing ecosystem.
A survey by the Ministry of Health (MoH) also shows that during the initial Recovery Movement Control Order (RMCO), 99% of respondents reported active practising of safe distancing measures, with 59% citing that they would only be comfortable to stop safe distancing if there were no more Covid-19 cases reported.
But it is clear that we are now suffering from “pandemic fatigue”. At the end of the day, we are all human and strictly adhering to the standard operating procedures (SOPs) while limiting social contact is exhausting, and that is precisely why community collaboration and support are vital. Enforcement of the SOPs is important, but even more crucial is to tackle the perception that there are biases in implementation. Trust in equal enforcement is a key to success.
Malaysia is now well into the third round of containment of the disease. The difference between this wave of infections and the first wave in March lies in our preparedness to coordinate and respond as an interconnected, cooperative community.
The Ministry of Health has been testing younger people more aggressively; over 1.8 million have been sampled with a positivity rate of only 1%. Meanwhile, the majority of the Malaysian public are also already aware of the 3Ws — wash, wear and warn but we are doing less well on critical avoidance of the 3Cs — crowded places, confined spaces and close conversations, and this is undoubtedly one of the drivers of transmission.
Contact tracing has been successful with the use of mobile apps by Malaysians nationwide. In spite of the virus’ changing nature, it is clear that we know more than we did before and so can be better prepared. The imposition of the Conditional MCO (CMCO) — and its more specific counterpart, the Targeted Enhanced MCO (TEMCO) — while inconvenient, ensure that both our lives and livelihoods are not compromised any more than necessary. What we are doing here is very much in line with current global practices — recognising that a total nationwide lockdown today is harmful to the economy and not necessary.
On the international stage, Malaysia is actively adopting a multi-pronged approach to vaccine procurement through investments and negotiations in international and bilateral agreements and is in an advanced stage of discussions to becoming a signatory to the COVAX facility. But there are still many questions surrounding the development of a safe, effective and lasting vaccine for all. In spite of measures to accelerate development, more time will be needed before a vaccine is available.
Public health strategies such as wearing a mask, maintaining good hygiene, practising physical distancing and self-isolation are things that we will need to continue doing to keep outbreaks manageable. We need to rethink our lifestyles — which begins with each and every one of us thinking about our own health security and that of our loved ones, friends, neighbours and fellow citizens.
Here in Malaysia, culture matters and our culture is one of warm welcome and togetherness. We enjoy celebrating festivities with family and friends, and greeting one another with a firm handshake or a salam. These gestures of respect and friendship need not end. Instead, this is an opportunity to show that the Malaysian culture of communicating respect extends beyond physical contact.
The “Salam Malaysia” of placing our right hand on our chest while greeting is safe but the more common fist-bumps or elbow-touch that we have seen being practised globally is not. At the very least, we can never go wrong with a simple smile and a nod. These are just some ways for us to maintain our bonds, while safeguarding our health. They may be unfamiliar or strange at first, but it is worth remembering that we are also living in strange times.
Co-existing with the virus
It is time for us to accept that Covid-19 is here to stay, at least for a while longer. We need to educate ourselves and ensure that we understand the changed risk that our daily social activities create, and how best we can adapt our behaviours accordingly. The spillover of positive cases all across Malaysia from Sabah is a key example in highlighting our interconnectedness. No one is safe until everyone is safe.
The pandemic has also disrupted the way capital is optimised. The Ministry of Finance’s Hasanah Special Grant (HSG) will be transformative in proving how cross-collaboration between the public and private sectors can increase efficiency in mobilising resources. The initiative, which is part of the Economic Stimulus 2020, aims to empower vulnerable communities. At the time of writing, it has provided funding for 73 projects, worth more than RM13 million. HSG has proven the value of inclusive collaboration, as well as the opportunities generated, when government agencies and the private sector work together as equal partners.
Similarly, the establishment of the Malaysian Coordination and Action Hub (MATCH), a platform that uses data analytics to streamline humanitarian assistance delivery, is proving its value. Covid-19 has taught us that we need to work together with everyone engaged — the government, the private sector, non-governmental organisations (NGOs), civil society and, most importantly, the rakyat — so that we can ensure that all layers of society are well protected.
This includes not only front-liners and high-risk groups but also more marginalised populations, including migrants and refugees who call Malaysia their home for now. Through MATCH, health volunteers from several NGOs have been deployed to Sabah to work with the Malaysian Red Crescent Society’s Sabah chapter, providing local logistics support, with Air Asia and Malaysia Airlines providing passenger and cargo support, Pos Malaysia supporting transport of kits and other goods daily while Yayasan Hasanah and the Global Disaster Response Network provide much needed financial resources and other donations.
Recent events have shown that our interconnectedness means that there is no value in pointing fingers, but rather, that we must remain collectively vigilant, observe the lessons learnt and adapt accordingly. As we saw in Singapore, the second wave was largely driven by an outbreak among migrant workers living in crowded dormitories. These dormitories are home to more than 300,000 migrant workers and account for nearly 95% of Singapore’s 57,000 infections. The nation has since learnt from this experience, and is improving the living conditions of migrant workers so as to prevent the spread of infection.
Malaysia does not need to experience a similar predicament to take in the same lesson: If we want the economy to continue progressing, we must protect everyone serving that economy. It is estimated that Malaysia houses over three million migrant workers.
In April, 79 infections were reported in buildings housing migrant workers in Kuala Lumpur. In May, another cluster was identified at a construction site and, most recently, a cluster was linked to a mall in Selangor. From an index case involving a migrant security guard, mass testing at the mall revealed more than 100 cases, of which 87 were security guards. These workers are known to collectively reside in overcrowded and cramped houses. Ensuring that they are not left behind in the communication loop and social protection is critical. This also means that messaging must be tailored appropriately. The same can be said for the 178,000 refugees registered in Malaysia.
But as we look outwards to the migrant workers and refugees coming into Malaysia, we must also consider the needs of the often-overlooked people among us, including the Orang Asal and those living with disabilities. They are often isolated geographically or disconnected from mainstream media. Their immune systems may also be built differently as a result of their lifestyles. All these point to the need to engage with the community via trusted leaders and networks. In crisis response, collaboration, such as that espoused by MATCH, can play an important role.
This pandemic has laid bare some of the long-standing economic and social inequalities we face. It has made us uncertain about the future and caused a great deal of stress and worry. A return to how things were before seems ever more unlikely — and so there is a need for a societal transformation. But for this to happen, we need to recognise two important realities.
First, we need the collective courage to embrace the current disruption and see it as an opportunity to change, and second, we must then be willing to live and work differently. The pandemic is, at least in part, a result of our damaging and self-serving interactions with nature. Changing how we interact with the planet will lessen the likelihood of our exposure to future threats — but, at the same time, we need to live in a way that is better suited to the challenges that lie ahead.
Exponential population growth, climate change, loss of biodiversity and climate-induced epidemics and pandemics are only some of these challenges — and they are already real and present dangers to our well-being. We are already asking far more of the planet than it can sustainably provide. Covid-19, in a very clear and direct way, has given us both a warning and an opportunity to reset our engagement with the planet so that we ensure its health and, by extension, our own.
The road to recovery from this virus may be long and winding, but it is navigable. It is up to us to unite in the face of this invisible war in order to defeat this common enemy that is only 0.5 micron in size.
Tan Sri Dr Jemilah Mahmood is the prime minister’s special adviser on public health