The Malaysian Insight

THE density of people in a venue and quality of air ventilation should be major considerations as the government streamlines standard operating procedure (SOP) for Covid-19, health experts said.

A former top health official and a public health specialist said simplified SOP can be applied as Malaysia moves towards Covid-19 endemicity, but stricter SOP should still remain for rural areas and states with low vaccination rates.

Former deputy director-general of health Lokman Hakim Sulaiman also said detection of symptomatic cases quickly is important in the endemic phase.

He said major factors the government must consider in streamlining SOP under the current scenario is the capacity of a place and the level of ventilation.

As opposed to indoor areas, open spaces are considered safer, even if there are crowds of people, provided there is social distancing and masking.

“On beaches, the risk is very low even without wearing a mask.

“In the United Kingdom, there is no distancing in an open stadium with full capacity without face masks being worn.”

However, proof of full vaccination is compulsory and random inspections should be done to ensure people comply with the vaccination requirement.

For indoor environments such as cinemas, he said, the ventilation rate should be proportionate to the density of people occupying the space.

Other streamlined SOP should include restrictions on the sick going to work, school and public places, Lokman added.

Early last month, the Health Ministry said it was working on a simplified SOP, indicating that SOP will be further relaxed as the number of vaccinated individuals increases.

Malaysia yesterday (October 11) achieved full vaccination of 90% of its adult population. By total population, 65.2% have received full vaccination coverage.

Also effective yesterday is the resumption of inter-state travel and removal of the MyTravelPass requirement for Malaysians to travel abroad. However, international tourists are still not allowed entry.

Lokman said it is all right to streamline and loosen some SOP as vaccination has lowered the risk of infection and death from Covid-19.

“We have also started immunising children between the ages of 12 and 17.

“Even without vaccination, children have a lower risk of getting infected. And if they are infected, the risk of dying is very low,” he said, referring to the case fatality rate among children below the age of 11, which is 0.02% in Kuala Lumpur and 0% for teenagers.

“In urban areas where Covid-19 transmission is most intense, I believe many of the children have been exposed to the infection and have acquired some degree of natural immunity,” he added.

Lokman said children in rural areas and unvaccinated adults across the country are at greater risk of infection.

Universiti Kebangsaan Malaysia health economics, hospital and health management professor Sharifa Ezat Wan Puteh is also concerned for states that have low vaccine coverage such as Kelantan and Sabah.

Both states have a total population vaccination rate of slightly more than 48%.

“Since many are unvaccinated, they may end up in severe categories. This has an impact on the adolescents and children there too. There should be more outreach programmes or even private contractors in these states,” she said.

Otherwise, Sharifa agrees that the SOP in other areas could be relaxed except for the most important rules such as frequent hand-washing, wearing face masks and a minimum one-metre physical distance.

Since Covid-19 screening is now made cheaper with Antigen rapid test kits (RTK-Ag) and self-test kits, she urged the public to screen themselves regularly.

Dr Sharifa said it is good of the government to simplify the current SOP to reduce confusion.

“Currently, there are so many SOP across different venues or states. They can be simplified depending on the state’s vaccination rate.

“States with high vaccine rates may be grouped as one, while those with low vaccine rates are grouped separately,” she suggested.

Lokman added that the government’s focus should be on detecting the symptomatic infections that require hospitalisation.

“While an asymptomatic person can theoretically transmit the infection, the risk is very low with a high vaccination rate. Thus, routine screening of asymptomatic patients may not be cost-effective anymore.”

Symptomatic infections must be caught and isolated quickly, as they could otherwise lead to a prolonged and massive outbreak, thereby raising the possibility of a new variant emerging.

Focusing on symptomatic infections is important once the country enters an endemic state, added Lokman, as outbreaks may occur sporadically. – October 12, 2021.