Published on August 9, 2020
1. PREPARED BY: HERNIFITA BINTI ABD GHANI GS 54460 ENVIRONMENTAL RIK ASSESSMENT (ESC 5113)
2. The Beginning of the COVID19 Outbreak in Malaysia ■ December 2019, Chinese public health authorities reported several cases of acute respiratory syndrome in Wuhan, China. ■ The Malaysian health authorities were on high alert and believed that these could culminate into a major health concern in the region ■ Planning and preparedness began. Coordination with public health teams, plans for renovation of hospitals for surge capacity and plans for procurement of reagents. ■ On 23 January 2020, eight Chinese nationals entered Malaysia via Johor Bahru on Malaysia’s Southern border with Singapore. These travellers had been close contacts with a COVID-19 index case detected in Singapore, and all eight were tested for COVID-19. ■ On 25 January 2020, a public announcement was made that three of these individuals had tested positive for COVID-19. In total, Malaysia recorded 22 cases in January 2020, all of which occurred via imported cases ■ On 26 January 2020, the Ministry of Health (hereinafter MOH) first advised Malaysians to avoid crowded places
3. The Beginning of the COVID19 Outbreak in Malaysia “A serious concern for a more massive COVID-19 outbreak in Malaysia was when we received notification on 9 March 2020 from our counterpart in Brunei Darussalam about a positive COVID-19 case detected in their country. The case was epidemiologically linked to an annual mass religious assembly at Seri Petaling Mosque, Kuala Lumpur held between 27 February to 1 March 2020 involving more than 14,500 local and 1,500 international attendees.” -Dr Noor Hisham- Following the substantial number of COVID-19 cases reported domestically following the religious gathering in Sri Petaling, the Government of Malaysia made the decision to implement lockdown via a Movement Control Order (MCO) nationwide, beginning from 18 March 2020.
4. Planning and Preparedness for ‘Surge Capacity’ ■ Initial planning starting in December 2019, diagnostic reagents procurement in January 2020, and a number of renovations to hospital facilities done in February 2020. ■ Optimise diagnostics capacity within both public and private laboratories. Laboratories within the Institute for Medical Research (IMR), the biomedical research arm of the Ministry of Health, ordinarily carries out over 300,000 specialised diagnostic tests per year as well as training for laboratories nationwide and began preparations in January ■ A joint effort occurred between the Ministry of Higher Education (MOHE – in charge of university hospitals) and the Ministry of Science, Technology, and Innovation (MOSTI) to mobilise 10 university labs as well as an additional lab at the Malaysian Genome Institute under MOSTI. ■ Diagnostics capacity for COVID-19 increased from an initial 6 laboratories to 43 laboratories including those in public hospitals, public health laboratories, IMR, university laboratories, laboratories within the Malaysian Armed Forces, the Malaysian Genome Institute, and private laboratories
5. Planning and Preparedness for ‘Surge Capacity’ “ In February we started emptying the hospitals. Surgeons had to do surgeries elsewhere so we could clear ICU beds of post-op patients. Other hospitals took the brunt so that we could focus on COVID-19. We knew that a lot of the mortality in Wuhan was because of the surge (in cases) and the fact that their hospitals couldn’t cope.. I’ll give you an example of this – Sungai Buloh is actually a 900-bedded hospital. We made renovations to make sure it could accommodate over 2000 bedded patients. There was an old hospital next door that we immediately renovated and brought in beds to get it ready. We also learned from China that their ICUs were totally overwhelmed – so we then reviewed our own ICUs. We saw that the daycare centre could become ICU beds, that the operating theatre could include ICU beds. We seem to have come out of this without our hospitals getting overwhelmed.” - Dr Suresh Kumar, infectious diseases clinician, Sungai Buloh Hospital-
6. Malaysia’s Response in Action Hospitalised all individuals diagnosed as COVID-19 positive, including asymptomatic patients and individuals who have reported close contacts with confirmed COVID-19 cases, or with travel history to high burden areas Increase capacity of automated PCR machine for testing daily nationwide Contact tracing as a method to control infections was evident throughout Malaysia’s COVID-19 response. Keep Malaysians aware of new infection clusters, guidelines, and updates in the Malaysian COVID-19 response In other words, Malaysia’s response was powered by early preparedness, robust contact tracing teams, diagnostics capacity and efficiency, treatment teams that worked on the available knowledge and resources that they had, and strict lockdown measures
7. BASIC PUBLIC HEALTH TOOLS Social Distancing Wearing of face masks Contact Tracing Frequent Hand wash
8. Screening and Diagnosis Walk In Screening Booth For COVID-19 Artificial Intelligence CT Scan for Covid 19 Detection and Monitoring Fluidigm Microfluidics Technology For Large Scale Screening For COVID-19 GENOAMP® Real-Time PCR Tests For Detection Of COVID-19 Chest X-Ray With Artificial Intelligence For Diagnosis Of Covid-19 Face Recognition Temperature Measurement Terminal Serology Test For COVID-19
9. Walk in screening booth in Malaysia - Project 13S cubicles - CoMBat Project 13S cubicles was developed by a group of healthcare professionals from The Malaysian Medical Mythbusters, Awfa Clinic in Kotasas, architects and biomedical engineers from Universiti Teknologi Malaysia (UTM) including the Facebook Community ‘Ini Sains Beb’. The unit has 2 separate cubicles for the attending healthcare worker and the patient, with their own HEPA filtration system. COVID MoBile Test Unit (CoMBat®) was recently developed by a group of doctors and design engineers. 4 The unit was built in a 20 foot contena consisting of 6 patient sampling booths, equipped with a negative pressure system. The third local innovation, Covid19 Screening Booth was proposed by iDeria Sdn.Bhd, a startup company under Universiti Malaysia Perlis. Their concept consists of single booth, double booth and multiple booths concept. Each booth is equipped with UV-C LED light operating, sterilization nozzle to disinfect room and negative pressure system.
10. ■ Improving preparedness to screen passengers especially from affected countries that crossed our International Entry Point ■ Screening the body temperature of all passengers by thermal scanner. ■ Referred passengers who have a temperature of over 37.50C for a medical examination by a Medical Officer. ■ Distributing the Health Alert Card / Home Assessment Tool to all passengers. Distribution of Health Alert Card / Home Assessment Tool to all passengers Strengthening COVID-19 screening at KLIA Entrance
11. Empowering human resources by Mobilization of Officers and Volunteers from others Ministries and Agencies Volunteer from UiTM with control team of Sepang District Health Office MOH received officers and volunteers from other agencies and ministry. These officers assist in screening of flight passengers and also helping the Medical Officer for medical examination. They assisted the District Health Office in the COVID-19 Operation Room and carried out control and prevention activities in the field including in Enhanced Movement Control Order (EMCO) area
12. Issuance and Monitoring of Order for Surveillance and Observation for Contact of COVID-19 Issuance of Order for Surveillance and Observation for Contact of COVID-19 for travelers quarantined at Hotel District Health Office Issuance of Order for Surveillance and Observation for Contact of COVID-19
13. Movement Control Order (MCO) 18 Mac – 4 Mei prohibition of mass movements and gatherings across the country including religious, sports, social and cultural Closure of all public and private higher education institutions (IPTs) and skills training institutes nationwide. those who have just returned from overseas, they would be required to undergo a health check and a 14-day quarantine (or self-quarantine). Sanctions covering all Malaysians travelling abroad activities in mosques including Friday Prayer would be in line with the decision made by the Special Muzakarah Committee Meeting of the National Fatwa Council. Closure of all government and private premises except those involved in essential services Closure of all kindergartens, government and private schools, international schools, tahfiz centres and other primary, secondary and pre- university institutions. all houses of worship and business premises would be closed, except for supermarkets, public markets, grocery stores and convenience stores Restrictions on the entry of all tourists and foreign visitors into the country.
14. Enhanced Movement Control Order (EMCO) and Semi Enhanced Movement Control Order (SEMCO) EMCO SEMCO all residents and visitors within the area are forbidden from exiting their homes during the order; non-residents and visitors outside the area cannot enter into the area subjected to the order; all businesses are shut down; adequate food supplies will be given by the authorities during the 14 day-order to all residents; a medical base will be established within the area; all roads into the area are blocke 4 May 2020, Pudu area in Kuala Lumpur comes under semi enhanced movement control order (SEMCO). Soldiers and polices put up barbed wire fences at road exits. It is understood that besides Jalan Pudu, the affected roads
15. Conditional Movement Control Order (CMCO) 4 Mei - 9 June 2020 most economic sectors and activities are allowed to operate while observing the business standard operation procedures such as social distancing and recording the names and telephone numbers Interstate travel, including Balik Kampung tradition for the AidilFitri are not allowed Religious activities and all congregational or assembly activities in houses of worship are not allowed Outdoor sports activities which do not involve body contact, in small groups without an audience and involving not more than 10 persons are allowed on the condition that social distancing is practised sports activities involving large gatherings, body contact and other risks of infection are not allowed, including all indoor and stadium sports events. social, community and cultural events which involve large gatherings as well as all types of official events and assemblies are not permitted
16. Infected Cases of Covid-19 in ASEAN End of March Malaysia had the highest confirmed cases in the region with triple digit cases recorded for every single day. However, by mid of April, Malaysia reported 85 new cases which a significant plunge after few weeks of high infections. Out of 5.072 Covid19 cases reported before, more than 50% have been cured. Despite being enforced and forced to remain isolation, the pandemic has brought Malaysians closer together.
17. Recovery Movement Control Order in Malaysia (21 June – 31 August 2020) Universities would be allowed to fully re- open on October Gradual re-opening of schools using one of three rotation models International students will be allowed to enter Malaysia pending Covid-19 testing Resumption of religious lectures, dhuha prayers and religious classes in mosque and surau compliance with SOP Travel restriction have been eased to allow interstate travel Malaysia and Singapore are working together on cross-border tarvel The Malaysia Police monitoring compliance through the RMCO special monitoring task force Non-contact sports are allowed Number of guests and participants yo be based on the size of the event space
18. New Cases Reported of Covid-19 in Malaysia The Ministry announced the discovery of three more infection clusters involving a foreign shipping crew and two Malaysians who returned to the country from overseas recently
19. economic loss and stress People / firms Facing insolvency Travel and tourism and associated sectors to be among the most affected industries Malaysia’s Biggest tourist numbers are coming from ChinaExpected economic loss of RM 63 billion people have lost their jobs Firms, both large corporates and small medium enterprises (SMEs), are affected
20. Reopening Malaysia’s Economic in a New Normal ■ small medium enterprises (SMEs) are likely to be severely affected with less resouces to absorb the shock. In Malaysia, SMEs constitute 98.5% of total firms ■ After 47 days of the Movement Control Order (MCO), most businesses were allowed to resume operations on May 4. ■ The policy objective is to ensure firms return to their pre-crisis production and employment levels as rapidly and safely as possible ■ Ensuring support for firms in the electrical and electronics industry, retail, and tourism sectors that are exposed to demand and supply shocks.
21. The Standard Operating Procedures The main key elements in the SOP must be complied by owner of premises are : - 1. Disinfection and cleaning process must be carried out 3 times a day during the operation 2. Provide and display notice to the customer regarding the specified premise policy (examples: mask use, hand sanitizer etc.) 3. Limited customer access to the premises 4. Limited numbers of customer inside the premise at one time depending on the size of the premises 5. Name, phone number and customer body temperature recorded daily 6. Provided hand sanitizer at the entrance as mandatory to use before entering the premises 7. Using electronic payment was encouraged 8. Increase awareness of the cleanliness of premises and employees
22. Monitoring of Compliance with Standard Operating Procedures (SOPs) Economic Reopening and SOP (Recovery Phase) Started 4 May until 9 June 2020, the Government has announced the reopening of several economic sectors with condition of compliance with the SOP. The implementation of this SOP is continued with the Standard Operating Procedure (Recovery Phase) started from 10 June - 31 August 2020. Monitoring of Pasar Tani compliance Monitoring of mosque compliance
23. Closure of Premises for non-complianceSOP Compliance Monitoring at Mini Mart
24. New Norms
25. With unprecedented distruption to the daily activities of millions of peoples in Malaysia, the pandemic has also reinforced the importance of communications in eliciting appropriate public response in order to successfully implement public health intervention to combat the outbreak Although the level of public knowedge, perception and communication behaviour surrounding Covid19 was high, majority of Malaysians reported receiving a lot of questionable informations Knowledge, Perception and communication of Covid19
26. The sheer amount of information and misinformation communicated by various parties challenges efforts to use science communication and implement necessary behaviour-reliant public health intervention such as social distancing and MCO. 95% of Malaysian respondents agree the information they received strongly influences their behaviour suggests opportunity for effective public health actions through effective communication Highlighting the dangers of unmitigated spread of potentially harmful false information
27. The speed of science in developing necessary tools for containment, will only be successful with strong communication strategies that both advance prudent consistent massages while curtailing any other massages that distract or confuse public attention, energy and resources. Dr Mohd Hanafiah and Chang Da Wan, 2020 School of Biological Science, University Science Malaysia National Higher Education Research Institute , University Science Malaysia
28. Perceptions of Malaysian respondents on their government’s reaction to the covid19 outbreak in 2020 Government’s Reactions Share of population Not acted at all 0% Not acted sufficiently 22% Not acted appropriately 69% Has overreacted of the outbreak 9%
29. Perception towards COVID-19 Pandemic and Psychological Impact among Malaysian Adults ■ Asma Perveen et. all, May 2020, Volume 24, Pages 10408-10417 ■ Results revealed that toward perception 98% responded on knowledge related to COVID-19. Knowledge on behaviour towards precautions Percentage (%) washing hands regularly 92.6 using sanitizer regularly 90.4 wearing face mask as precaution 87.3 social distance 97 covering mouth during sneezing and coughing 86.6
30. Information Sources Percentages (%) social media 94 Ministry of Health Malaysia updates 61.7 local television channe 75.4 The mostly obtained information sources reported : The results showed that there was significant score on precaution behaviour and perception towards COVID-19 infection. During this phase of Pandemic people are struggling to maintain their psychological well-being with movement control order. Study emphasized that adult population in Malaysia is perceiving the precautions positively and have prevalence of psychological issues. Implication of this study are significant for mental health practitioners to deal effectively with the up-coming challenges related to COVID-19 pandemic.
31. THE OUTRAGE IN MALAYSIA
32. THE OUTRAGE IN MALAYSIA Social media lit up with anger and disbelief at the posts, with one asking “how will dressing up and putting on make-up at home (prevent) COVID-19? The suggestions were merely aimed at “maintaining positive relationships among family members during the period they are working from home.” resulting sparks anger among Malaysian "Locked up in Malaysia's Lockdown", produced by the Qatar- based station's 101 East news programme, focused on the plight of thousands of undocumented migrants detained during raids in areas under tight Covid-19 lockdowns. Senior Minister (Security Cluster) Datuk Seri Ismail Sabri Yaakob called on Al Jazeera to apologise to Malaysians, saying allegations of racism and discrimination against undocumented migrants were untrue.
33. The Way Forward in Research and Development ■ Participating in clinical trial on the treatment of tocilizumab for severe COVID-19 cases ■ Playing a leading role in insisting clinical trials are conducted in geographically diverse regions, with ethnically diverse participants, and in resource-poor settings. ■ Improvements of domestic diagnostics and vaccine development. Investments to get ‘local players to develop reagents to prevent shortages in the future due to overreliance on other countries. (developing vaccine expertise for future pandemics) Eg : o special booths to do nasopharyngeal swabs (that would protect frontliners doing the swabbing) o robots in COVID-19 wards to deliver food to patients in isolation rooms as well as for sanitisation of rooms o discussions on collaboration with local and international researchers on clinical trials including for vaccines
34. In summary, the situation of Covid19 in Malaysia finds: Malaysia’s preparedness and planning began in December 2019, when they first heard from Chinese authorities that there were cases of acute respiratory illness; Previous experience with MERS and the 2002-2003 severe acute respiratory syndrome (SARS) epidemic, including experienced contact tracing teams, was key in enabling a speedy response; Malaysia drastically upgraded health facilities and diagnostics capacity in February 2020, including an 86% increment in diagnostics laboratory capacity, 89% increment in critical care bed capacity, and an 49% increase in the number of available ventilators (from 526 to 1034 units); Malaysia hospitalised all individuals diagnosed as COVID- 19 positive, whether symptomatic and asymptomatic; There is a clear need to invest in more expensive solutions such as new treatments and vaccines, pragmatism and speed in terms of instituting a basic health response Middle Income Countries including Malaysia focused on basic Public Health Tools
35. THANK YOU & stay safe