FACED with growing case numbers and the post-Raya infections yet to emerge, the government is showing signs of a welcome change in tone on the management of the Covid-19 crisis.
The data of 17,045 new Covid-19 cases yesterday is an important and sad milestone. They give us a clear idea of a new scenario we will be facing in coming weeks, which members of Parliament would have to address in their meeting that begins today. There are three elements of caution in interpreting the daily data.
The first, daily cases are highly volatile and so it is better to look at weekly averages to smooth out the daily spikes. Nonetheless, the Health Ministry (MOH) and other experts have indicated clearly that cases will rise significantly in coming days and weeks, especially following the Raya holiday last week.
Second, as is now well known, data on new cases are sensitive to the number of tests and so indicators such as the percentage of positive cases, or positivity rate, and the R-0 or infectivity rate must be used to interpret the data over time. These show the spread of the disease is far from under control.
Third, we need to look at the impact and severity of the virus and the best indicator of that is the data on deaths. This can be affected by different lags in the pre-Delta and Delta phase, cumulating the deaths and creating extra fatalities in the short term.
Even though the recent data on new cases has been alarming, Health Director-General (DG) Tan Sri Dr Noor Hisham Abdullah has been quick to point out that 98% of cases are Category One (no symptoms) and Category Two (mild symptoms). This severity indicator is essential to put the number of cases and the best management, and treatment options into context.
It is important to note that the vaccination rate, although a key indicator for the National Recovery Plan (NRP), may not be helpful in predicting future cases. Data from the United Kingdom shows that even with close to 70% of the population partially vaccinated and 55% fully vaccinated, the number of cases has risen from a seven day average of 1,800 per day in May to around 46,000 today.
In Israel, which also has a high vaccination rate around 60%, the seven day average at the end of May was 15 cases but is now around 1,700 per day. Israel’s Health Ministry produced a study on the effectiveness of the Pfizer vaccine against the Delta Variant, which shows the efficacy or protection from being infected is only about 39%, even though there is a high rate of 91% protection from serious symptoms.
Protection from transmitting the virus from vaccinated people to others has fallen to 16% for those vaccinated in January, which means they have lost protection from transmission to others and now have a 84% chance of passing it to someone, according to the study.
Based on international experience, we can expect an increase of new cases in the next few weeks and as the vaccination rate rises, the number of cases may also be stubbornly high. This is why a change in signals from the government is helpful and reassuring in understanding how policies may evolve in the coming weeks.
First, there is a sensible signal from Finance Minister Tengku Zafrul Abdul Aziz that, subject to approval from experts, the number of daily new cases may no longer be used as a primary guide to the NRP and may be replaced by severity indicators and deaths.
Second, the signal from MOH that a wider range of therapeutic medicines are already being used is also a sensible move. These include the anti-rheumatic treatment Dexamethasone, which is also used for asthma and respiratory illnesses, and Baricitinib, a drug used to treat rheumatoid arthritis. These are being used “off-label”, which means the medicines are used to treat Covid-19 even though they have not been approved for the purpose.
It shows an openness by MOH to try whatever drug that is effective and can help overcome the hesitancy towards other possible treatments such as Ivermectin, a medicine the DG has said he used himself “off-label” for treatment of dengue.
Respected peer-reviewed meta-analysis has shown that this medicine can be effective and the MOH is conducting trials in Malaysia on its potential use. These changes in policy tone are in line with our recommendations on how the economy can be reopened responsibly by combining multiple policy approaches, including complimentary treatments, such as Ivermectin, Dexamethasone and Baricitinib, to quickly revert the trend and severity of cases and retake control of the management of the virus.
Reducing the number of cases and deaths this way is not possible with vaccines alone because the effect will take weeks or months, as shown by MOH projections. Only when the process is on a clear downward path for all indicators, especially severe cases and deaths, can we be sure that the alternative management and early treatment is working, and that a responsible reopening of the economy is possible.
This is why even non-medical experts must follow and understand the data and the evolution of the virus, and must learn from the experiences of other countries so we can make the correct policy choices.
According to our analysis, future prospects for the economy depend crucially on the ending of lockdowns. This depends on the projected path of the virus, which in turn depends on the policy used to manage the crisis.
By looking at the economic impact of different policy paths, we can see that the changes in policies signalled by recent announcements are important discussion points between the government and Parliament.
Economic recovery can follow quickly with a new scenario for managing the health challenges.
Dr Paolo Casadio is an economist at HELP University and Dr Geoffrey Williams is an economist at Malaysia University of Science and Technology, both based in Kuala Lumpur. Comments: letters@thesundaily.com
