By Dr Raymond Alfred
When social distancing was first emphasised in mid-March as a way to “flatten the curve” and limit the spread of COVID-19, it WASN’T a way to eliminate the virus completely, as people may have believed.
What social distancing actually does is slow down virus transmission to a level that is manageable for OUR hospital workers and enables them to have enough hospital beds, masks and equipment to properly treat COVID-19 patients.
While the virus will eventually slowdown in areas that are adhering to social distancing and other safety precautions, there will be some places where it will still be circulating, so it NEVER really leaves. The Movement Control Order (MCO) is aimed at preventing such a strong peak of the virus.
COVID-19 spreads two to three times quicker than the flu. If everybody gets sick all at once, it will potentially break our health care system, to the point where, even when you get a heart attack or are seeking treatment for cancer, you won’t be able to get the health care.
During the MCO, we can get our health care system (manpower, nurse, doctor and equipment) to be ready and further support and able to provide treatment to at least 100 or more patients at any one time.
Once the capacity of the health care system is established, then the authorities can slowly re-open the essential businesses phase by phase. However, at this moment our government should be able to declare the capacity of our health care system - how many patients we can treat at any one time. Reopening of businesses can be done gradually, but consistent monitoring and reassessment should be carried out for these resumptions.
What impact will happen?
We need to do this in a smart way so that we can go safely back to the normal system of our life. Unfortunately, the virus will likely continue to persist until a vaccine is ready, in about 12 to 18 months at the earliest. So, this mechanism of ‘reopening business gradually and reassessing the impact’ will become a compulsory programme for the government, to control the situation and to ensure they are making the right decision.
Assessment, monitoring and management tools
A Spatial Observation Centre will become a tool to assist in the monitoring and reassessment of the situation. This can be done through a two-step approach.
First, spatial statistical methods can be used to calculate exposure, susceptibility, transmission, and health-care resource scarcity risk at a detailed level across a large geographic area to calculate population demand.
Second, location-allocation analysis could be used to model the most suitable locations within a predefined travel distance. The result of this work is a decision-making tool for government leaders to ensure that those individuals or groups most in need have priority access to the care they will require during this crisis. The Spatial Observation Centre will help in identifying the optimal locations for testing, treatment and commodity (food/fund/resources) distribution.
Through the establishment of the Spatial Observation Centre in each district, mitigation strategies can be developed, and budget can be allocated by the government. NGOs or the private sector can provide support if detailed needs can be identified in each district. This will not only benefit during this crisis timeframe but will provide long-time benefits for our future generations.
Will the precautions change over time?
The precautions really haven’t changed. When COVID-19 was first detected, we had to be vigilant about washing your hands regularly; trying to keep a distance of at least two metres (one metre is not enough) from others; covering our faces with masks especially in crowded areas. Do not think that by wearing a mask, you are protecting yourself. It is not for that. The main reason is to avoid your respiratory droplets from getting to the environment and potentially getting other people sick. Someone with COVID-19 may look totally healthy but detection may be delayed and the carriers are very difficult to detect. They can easily spread the virus undetected. Wearing a mask map help the authorities to stop or delay the virus spread.
Large gatherings of more than 20 to 30 people will not be happening in the near future, simply because we need to do it slowly (reopen, reassess and strengthen the health care system). For example, by reopening business, construction work, manufacturing and other relevant work with proper restriction, we need to see what will happen two to three weeks later. We need to see how each step may affect our health care system. The situation will get out of control if the health care system cannot support the consequences arising due to the reopening of business.
The reopening of business can be done gradually as the capacity of our health care system can be improved over time. Once we are confident that our health care system (at hospitals, clinics and private clinics) is able to cope with the maximum consequences, we can then move to the next step.
Strengthening our health care system
There are three instances where the virus can spread very fast – at indoor gatherings (conferences, supermarkets, schools and parks); in working space (office environment and outdoor working area involving more than 20 people) and the public transportation system (bus stops, flights, etc.).
It is very possible that we have to continue strengthening our health care system with budget allocated by the government, through investment in the efforts to continue to identify which medicines are efficient and how the medicines work. Working closely with experts outside the country like in China, Singapore, Taiwan and Indonesia is a must.
As information about the coronavirus pandemic rapidly changes, people must be committed to providing the most recent update of data or information. Some of the information may have changed after publication. Therefore, such transparent update needs to reach the people or public without any delay. Each district may need its own command centre so that information can be gathered in detail. The district office can become the command centre and the public can refer to their local centre to get the latest update or information related to COVID-19 mitigation measures (short-term and long-term).
However, by implementation of the above mechanism, the main challenge for us to ensure that our reopening, reassessment and strengthening of our health care system is working or successful is the presence of undetectable patients.
Over time, the behaviour of patients may change, especially those who have no identification card. They may hesitate to go to the hospital. We worry that if the government takes no action on this, the situation will worsen because by the time these patients are detected or come to the hospital, they may have a disease that has progressed and maybe difficult to treat.
Reaching out in screening programme
An outreach programme should be established to ensure that the targeted group (of foreign workers without identification cards) can get access to the screening programme. This can become one of the monitoring programmes during the reopening process in the next 12 to 24 months.
The government may not able to decide without support from the private sector and academic institutions.
The last requirement to enable us to face this crisis in the future is to retrain or tune ourselves (whether you are working for the government, private sector or academic institution) to be able to create a platform where data can be compiled and solutions can be decided as a team, based on the available data.
The government can no longer decide without input data from the private sector and academic institutions, especially to promote the formulation of relevant policies. In the era of big data, data no longer comes mainly from the government but is gathered from more diverse enterprises. As a result, a department or division to serve as a platform for data acquisition and the integration of heterogeneous data, which requires governments, businesses and academic institutions to jointly promote the formulation of relevant policies, is very essential.
Reopening, Reassessing, Strengthening and Establish Big Data will be our New Normal Life in the next 18 to 24 months. Allocation for this mechanism especially to cater to the assessment, strengthening of the health care system and ensuring big data is established, should be given priority.
Dr Raymond Alfred is the Chief Executive Officer of Allyssa Research Group.
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