Alternative Views: The unrealistic maths in the recovery plan

This article first appeared in Forum, The Edge Malaysia Weekly, on July 5, 2021 - July 11, 2021.
Alternative Views: The unrealistic maths in the recovery plan
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My son, who is based in Sabah, was diagnosed with Covid-19 last month. In our daily conversations, never once did he say he was showing any symptoms. He only knew he had contracted the virus when a colleague tested positive and testing was done for the rest of the staff.

He spent four nights in a centre and after some tests, he and his colleagues were asked to complete their quarantine at home. His workplace was shut down during the period and placed under strict supervision.

The case of my son and his colleagues is similar to that of many today. They are mostly asymptomatic and form part of the statistics that determine the number of active cases in the country.

Fortunately, asymptomatic cases require almost no hospitalisation other than constant monitoring.

I must profess that I am not a public health expert, but to put it in a nutshell, such cases do not increase the load on the public health system’s hospitalisation facilities and intensive care unit (ICU) capacity, which has been the bedrock of the argument for a strict lockdown.

Under the recovery plan, the government has set 4,000 cases as the target that the daily infection rate has to drop to before the current strict lockdown measures can be relaxed. The other quantitative criterion for opening up the economy is that 10% of the population must be fully vaccinated.

Why the figure of 4,000 was decided on, and not, say, 3,000 or 5,000, has not been delved into.

According to some officials in Putrajaya, the number was chosen as it supposedly reflected the threshold of new infections per day that the public health system can handle without coming under too much pressure of collapsing.

Under the four-phase recovery plan, the number of daily cases has to hit 500, and 60% of the population have to have received two doses of the vaccine, before economic activity can resume to pre-Covid-19 levels. The government expects this to happen in November/December this year.

This target is a distant dream now.

In the immediate term, the threshold is for 4,000 active cases per day before we move to phase 2, when more sectors of the economy can operate. The target was for us to reach this phase by early July. But now, that also is only an aspirational timeline because the number of new cases is closer to 7,000.

In fact, Selangor and some of the more populated states have been in some kind of lockdown mode since February this year. People’s movements have been restricted and only the manufacturing sector was operating as usual. Since June 1, only essential services have been allowed to operate, with most factories and construction sites shut. From July 3, most of the districts in Selangor and many parts of Kuala Lumpur will be put under an Enhanced Movement Control Order, or EMCO.

But the irony is, even as we impose stricter lockdown measures, the number of active cases has not been coming down.

The rising number of infections coincides with the outbreak of the Delta variant and the increasing number of tests being carried out. The more tests that are carried out, the higher the number of cases that will be uncovered. And the Delta variant is more infectious than previous mutations of the virus.

But what is interesting is that the number of patients in the ICUs has not increased in proportion to the rise in cases. Statistics show that despite the number of cases rising since June 26, the number of patients in the ICUs has largely remained steady.

This is probably because many of the new cases are mild or asymptomatic. Also, at the time of writing, more than 5.9 million Malaysians had received at least one dose of the vaccine, which helps prevent serious cases.

Hence, this raises the question of whether the number of active cases should continue to be one of the primary parameters to determine the level of economic activity.

Why not use the number of patients that require hospitalisation and ICU care instead?

As long as the number of patients requiring hospitalisation and ICU care show a declining trend, some segments of the economy should be allowed to start operating as usual.

Also, why are people who have been vaccinated not allowed to go about their daily lives? Shouldn’t they be permitted to go to restaurants or travel between the states if they are fully vaccinated?

Based on studies, even a single dose gives some level of protection. So far, more than 5.9 million people have received at least a single dose and 2.3 million are fully vaccinated, and are fairly protected against the virus.

They should be allowed to go about their lives without restrictions. After all, the whole reason for being vaccinated is that people will be protected against serious harm from the virus. If they are still confined to their homes, what is the point of getting fully vaccinated?

There are examples in other countries where people with a single or double dose are allowed to get on with their lives.

For instance, in Hong Kong, where vaccine hesitancy is high, restaurants are allowed to open as long as all the employees are fully vaccinated. There are no restrictions on the number of customers they can accommodate as long as the patrons have also received at least one jab.

In Ontario, Canada, the three-step programme on opening the economy is based on trends in the public health system and vaccination rates for adults over a 21-day cycle. If 60% of the adult population have received at least one dose and there is improvement in the public sector health system, there is some lifting of outdoor activities. The third and final step is when up to 80% of the adult population have received at least one dose, and 25% are fully vaccinated.

Meanwhile, in Singapore, an editorial in the state-owned Straits Times by two ministers talked about viewing Covid-19 as an endemic disease rather than as a pandemic. According to them, Singaporeans should learn to accept the reality that Covid-19 is here to stay and they should learn to live with it and treat it like any common flu or viral fever.

In Malaysia, the vaccination rate has been ramped up aggressively. A substantial number of the adult population have received at least one dose and are fairly protected. Why not open up the economy to them?

The lockdown has severely affected the livelihoods of many. Unhappiness on the ground is growing as people run out of financial reserves to keep their lives going. The moratorium on loans only gives them respite from meeting monthly commitments. It does not give them money to meet their monthly expenses.

While health director-general Tan Sri Dr Noor Hisham Abdullah keeps advocating strict lockdowns to prevent the public health system from collapsing, who is keeping tabs on the state of the economy to ensure it does not crash?

The situation on the ground is really dire as businesses are not allowed to operate. It is affecting the pockets of the very poor, which is dangerous. If phase two of the recovery plan can begin only after daily infections dip to the 4,000 target, many businesses are going to fold.

While saving lives is important, saving the economy is equally important. The opening of the economy based on the number of daily infections is a questionable indicator. The maths of it does not make sense as there are many moving parts contributing to the infection rate.

A more realistic benchmark should be the number of serious hospitalisation cases due to Covid-19 and the vaccination rate.

M Shanmugam is contributing editor at The Edge

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