This article first appeared in The Edge Malaysia Weekly on October 18, 2021 - October 24, 2021
Lockdowns have been damaging to livelihoods and mental health
AFTER battling with Covid-19 for more than 19 months, Malaysia is set to move to an endemic stage, from a pandemic, although the exact date has yet to be announced. What is certain is that we will have to live with Covid-19 for a longer period of time.
Initially, many Asia-Pacific countries adopted a zero-Covid strategy, following the successful containment of the virus. But then came the highly infectious Delta variant, dashing such hopes and prodding nations such as Australia, New Zealand and Vietnam to ditch their plans.
China is the last major holdout, prompting a warning from S&P Global Ratings that this could worsen the debt situation of the companies in the country, especially when outbreaks continue to lead to broad mobility restrictions and disruptions.
Nevertheless, as Health Minister Khairy Jamaluddin has pointed out, accepting Covid-19 as endemic is not a defeat but a measure to adapt. So was the lifting of the interstate travel ban last week, which allowed the people some degree of freedom, as more than 90% of the Malaysian adult population have fully been vaccinated. Of the total population, two-thirds have been fully vaccinated.
Returning to normalcy, the country now has more tools to safely manage the risks of Covid-19 collectively and as individuals, according to medical doctor and health systems specialist Yap Wei Aun.
“We understand a lot more about the disease and how it spreads and how it doesn’t spread. And vaccines, when in the arms of people, have been a game changer. It is now time for us to reap the benefits of our sacrifices and technological progress — vaccine and rapid diagnostics,” Yap tells The Edge.
While Malaysia progresses to the endemic stage, Datuk Dr Adeeba Kamarulzaman, professor of medicine and infectious diseases at the University of Malaya, notes that the virus will always be present at a low level, with little damage to the population. But the health system will be able to cope with the challenges, she assures.
“We will have to accept a certain number of infections and deaths from the disease. We will continue to have breakthrough infections, but our hope is that the impact will be less severe and more manageable. Initially, we thought Covid-19 was a temporary thing. Most countries were aiming for zero-Covid. But now, it is not possible, regardless of herd immunity,” she tells The Edge.
The zero-Covid-19 strategy, Yap says, has been damaging to both lives — including mental health, suicides, unhealthy lifestyles as well as domestic abuse — and livelihoods. At the same time, it draws the attention of the healthcare system away from other preventable health risks such as cardiovascular risks and cancer.
To coexist with the virus, he says, a large part will involve doing what the people have already been doing, such as mask wearing, physical distancing, and accepting safe and effective vaccines. The difference is that more activities will become permissible as the risks have been reduced.
“All activities have risks, which we have managed even before Covid-19. So, in many ways, we are reverting to a situation where we act as free but responsible citizens. Not everyone will want to do everything that is permissible and that is fine. But for those who want to, that is also fine, provided that basic risk reduction norms are followed to minimise harm to others.”
As part of a safe reopening, Yap says, any increases and decreases in the number of Covid-19 cases are to be expected, and that the same goes for localised outbreaks. “These are not, on their own, an indication that the reopening has failed, but it is about how we manage them so that deaths, severe infections and disruptions are minimised.”
With a high vaccination rate, Adeeba is confident Malaysia will not see a huge spike in coronavirus cases again if the country continues to implement a mixture of safety control, including standard operating procedures (SOPs), and testing.
She stresses that the government must have policies and measures in place for non-pharmaceutical interventions including social distancing, maintaining hygiene and masking. Over time, there should be further relaxations of restrictions while balancing them with the underlying risks.
“Taking into consideration the high vaccination rate, maybe masking should be applied only to indoor places, then people will start to feel some sense of normality. For example, in Germany, masking is needed only when you get into public transport or go indoors or into crowded places.”
All stakeholders — the government, employers, schools, families and individuals — will have their role to play, Yap says.
“The government must have a rapid and efficient, but not overly disruptive, testing and tracing system in place, as well as surveillance capability to detect localised outbreaks early on, so that a large outbreak can be avoided.
“Employers, likewise, will have an important role to ensure that they can confine any potential cases to a small bubble of workers, so that these workers do not infect other workers and jeopardise operations while protecting the surrounding community. Individuals, collectively, also play an important role by reducing activities that have a higher risk of spreading.”
Adeeba urges employers to take care of their workers, especially those who live in dormitories. “Employers should take a step back and look at the role they have played. How did they contribute towards the number of infections or prevent them?
“Look at how they treated migrant workers, many of whom got infected. Can employers do better if they don’t want their factory to be shut down? Are they ensuring 90% or more of their employees have been vaccinated? Have they looked into the ventilation of their factory?” she asks.
When it comes to simplifying the SOPs, striking a balance between safety and convenience may not be an easy task. Yap believes the focus should be on evidence-based public health principles — such as addressing the causes of transmission, including confined spaces with poor ventilation, and minimising crowded spaces and close-contact settings — while taking into consideration personal and household risk factors such as vaccination status, age and comorbidities.
“This means there will necessarily be a change from SOPs — designed for easy enforceability — towards guidance and principles to empower families and employers to reduce the risk of Covid-19.”
Yap adds that the government has a role, through social protection policies and economic policies, to boost and restore the livelihoods of those most affected by the lockdowns and Covid-19.
On the path to normalcy, clear communication between the government and the public is important to restore confidence, observes Adeeba. In addition, the availability of transparent data will certainly help people make their own assessment.
“Instead of taking the ‘big daddy’ approach, the people need to decide the risks, for example, of eating in a restaurant, based on the infection level in your community. We can’t afford to close and shut. If community transmission is a bit higher, you may or may not go out for the next couple of weeks.”
Despite the relaxations, Adeeba says the country needs to stay vigilant with a proper system in place, with continued testing, tracing and isolation, so that the situation will not get out of control again.
“The Ministry of Health is working on a testing strategy. We have to ensure that testing is widely available. By and large, if you develop symptoms after vaccination, you should undergo quarantine. Be self-aware and prevent the disease,” she urges, noting that effective contact tracing would be through automation and digitalisation.
From an economic point of view, Dr Yeah Kim Leng, professor of economics at Sunway University, says it would be very expensive to implement a zero-Covid strategy.
“If we implement a zero-Covid strategy, the economic trade-off will be huge and the chances of success will be very dependent on the authorities’ capabilities and cooperation from the citizens. It is a whole [of] society approach. When there is an outbreak, then there will be a complete shutdown of economic activities and zero movements,” he adds.
For the transition to the endemic stage — the justification being that almost the entire adult population is already fully vaccinated — the healthcare cost is anticipated to be lower, in view of the reduced number of Category 4 and Category 5 Covid-19 patients.
Yeah says, “The onus is on individuals to build their own so-called Covid bubble. It allows for gradual normalisation of socioeconomic activities. People still have to continue observing the SOPs because of the risk of contracting the virus. Those who have to engage in greater social economic activities will have to take higher risks.
“Covid-19 remains a threat, but it does not deter people from going about their normal lives. They have to take extra precautions, but it is less threatening now with a much lower mortality rate.”
Overall, he says, the transition to the endemic stage will reduce the social cost of lockdowns and restrictions on mobility.
That said, Malaysia still needs to build up its healthcare capacity to address whatever shortcomings it has experienced, says Yeah, who cautions that the progress to normalcy will take longer than expected and could be prolonged with the emergence of new variants.
“We have to see the effectiveness of the vaccine and the need for booster shots,” he adds.
As consumers and businesses are still hesitant about spending and investing, given the lingering threat of another resurgence, Yeah highlights that the government has to take necessary measures to boost their confidence and assure them that it is prepared to face the challenges that may occur.
To help businesses recover faster, he says, there is a need to further consider restrictions on operating capacity. “This will help create jobs to reduce the unemployment rate and increase the people’s income. Right now, the unemployment rate is still at 4.8%, and we need to bring it down to below 4%. That is the short-term critical measure to restore livelihoods.”
Yeah believes the upcoming Budget 2022 will be an expansionary one to provide adequate support to the low-income group and small and medium enterprises.
He says, “Hard-hit households may need more support from the government, especially those who have lost their jobs. After the end of the subsidy programme and loan moratorium, there could be further financial distress among the households, so the government can make contingency plans to provide some relief to them.
“For the small businesses that have been negatively affected by Covid-19, a further relaxation is very important, so that domestic consumption can be spurred, leading to higher business volume.
“If [small businesses] still cannot recover at the end of the loan moratorium, then the government has to provide debt restructuring support to avoid bankruptcies. The government has to engage with the banks to create a win-win solution for both the banks and borrowers. This can be done by setting up a fund to provide short-term assistance, with cooperation from the banks.
“For those who remain vulnerable to Covid-19, especially those who cannot find jobs when the economy recovers, the government has to increase cash handouts. Consumer fear of spending may result in a slower recovery in the economy, so there is a need for an extension of the relief and support.”
Last Wednesday, Prime Minister Datuk Seri Ismail Sabri Yaakob announced that the banking sector would set up a Financial Management and Resilience Programme (Urus) to help the B50 (bottom 50% income group).
Under the 12th Malaysia Plan, the country’s economy is expected to grow between 4.5% and 5.5% over the next five years, but Yeah believes it will be a tall order if no structural reforms are undertaken.
He says, “In the longer term, you need to upskill workers and attract more investments to raise productivity and competitiveness. We need to continue to raise investor confidence, so that we can have sustained investments for the expansion of the economy, failing which, it will lead to fewer jobs and constraints in production capacity expansion.”
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