Covid-19 National Recovery Plan: Was it planned to fail?

 

The country is now held to ransom by three threshold numbers in the National Recovery Plan (NRP). We keenly watch these numbers every day because that would determine when we can get out of our house and get on with our normal life. Even the gambling numbers have not created so much hype, though some use the NRP numbers to bet.

But are those numbers science-and-data based, as the government claims? Let’s analyse based on primary school arithmetic and science.

As we know now, the government itself is backtracking on these indicators/numbers even before the ink is dry. When daily Covid-19 cases skyrocketed, it is replaced by the severity of cases. 

Daily cases are claimed to be going down, but a few days later cases are increasing. Illogically, the movement from each phase is one way, no matter what the numbers are. 

Belatedly, a new NRP chief has been appointed, and an NRP council formed chaired by the prime minister, begging the question what is it the council can decide that the cabinet cannot.

I will try to make some sense of all this. Additionally, I will estimate the true or actual number of infections, stress the importance of natural immunity from infections compared to vaccine-induced, and the scenario, looking forward.

This opinion is not based on hindsight. On Dec 31 last year, Malaysiakini published my article on 'Five Covid-19 resets', the first of which called upon the executive class of 70 to follow Statistics 101. I talked about statistical sampling and population and ‘what we don’t know, doesn’t hurt’. I guess this too is even too abstract for them.

Natural boosted immunity

Many must be wondering what the true number of cases will be if the whole population of Malaysia is tested. Of course, that is not possible. I have yet to see any answer to this question, but it is an important issue for policy-making.

The government does on average 100,000 tests a day. This is called a sample in statistics. We get about 10 percent infected, or the so-called positivity rate. If that is extrapolated to the population of Malaysia, that would be 3.3 million positive cases per day. 

Don’t be alarmed as the sampling is biased, drawn from known infected clusters. Sampling should ideally be representative of the population. I would estimate here how many are infected in Malaysia each day using the best science so far.

Based on ‘Our World in Data’, the top four leading epidemiology models using US data predict that true infections outnumber confirmed cases in a range of two to six times or an average of four times. 

However, the US daily testing rate is 3.7 times of Malaysia, giving a multiplying factor of 15. Our confirmed cases so far are close to a million. Therefore, the true infection in Malaysia would be approximately 15 million cases thus far. That’s about 75 percent of Malaysia’s adult (above 18) population of 20 million having naturally boosted immunity.

For 13,000 confirmed cases in a day that would amount to about 200,000 true cases. I invite views if there are better ways of estimating the true infection numbers.

That’s the good news, except of course to those who succumbed to the virus. If only vaccination had been timely implemented, that would have further boosted the acquired immunity. 

However, the downside is the government’s on-off lockdowns for the past 17 months which have resulted in the ordinary rakyat living a life akin to “caged animals”. Well, you know what that does even to our existing immune systems. Makes us ponder what our policy prescriptions should have been if based on estimated true cases of infection.

So, why are the cases rising? Answer - the deadly mutant viruses are adapting faster than our immune systems.

Calling for a national testing strategy now is like closing the gate after the horses have bolted. If we can’t even take care of the average 10,000 confirmed cases per day, what do we do with the hundreds of thousands of cases if detected? 

Probably we would be safer not knowing than herded into crowded Covid-19 Assessment Centres (CACs), vaccine administration centres (PPVs), or hospitals. That is why I suggested we focus our efforts and available resources on the 'contain and protect' strategy in my opinion piece ‘Open letter to the PM’ for a duration of three weeks up to July 31.

The government is now conducting a similar ‘operations surge capacity’ for vaccination, a fancy name indeed, for Kuala Lumpur and Selangor, but unfortunately leaving the back door wide open. This is not the ‘contain’ strategy of a curfew, I suggested. At least, we could have seen the cases trending down by now as more are getting protected, compared to the record cases now.

Brinkmanship governance

The prime minister has this uncanny gift of governing by brinkmanship, making his moves on the eve of a pending challenge to his premiership. The emergency ordinance to shut down Parliament, the NRC before the Yang di-Peruan Agong and rulers met, Pemulih stimulus package before the king’s meeting with the speakers, promoting ministers before the Umno supreme council met, and coming down with diarrhoea before a cabinet meeting. 

We should be expecting a major announcement on the eve of July 26, but we hope this time it will truly be a 'Rakyat Survival Plan'.

So, how much science and data could have gone into the NRP? Whose science says that the Covid-19 cases shall neatly and perfectly decline linearly, from about 6,000 to 4,000 to 2,000 and finally 500 and in each two-month period? 

Whose science says that the vaccination rates of 10 percent, 40 percent and 60 percent will cause a proportional decrease in infection exactly every two months? This is an insult to the science of epidemiology.

I believe the thresholds have been carefully chosen to take the pressure off the government and give a false sense of hope to the people. According to the NRP, it seems coincidental that Parliament can only open in October, probably to table Budget 2022, and then seek dissolution of Parliament. That is why Covid-19 cases are expected to decline to 500 cases in November and December, so the general election can be held.

Future scenario

But are these 500 daily cases even based on science? What is it that we know that the world doesn’t? 

The European Union predicts new cases to rise above 620 per 100,000 inhabitants in August 2021, linked to the highly transmissible Delta variant, along with the relaxation of measures. That would mean about 200,000 true cases in Malaysia with about 13,000 confirmed cases, compounded by our slow vaccination process. 

The government should indeed be held accountable for the projected 500 cases at the end of the year.

The reality now is, the virus is becoming endemic. Test numbers are not useful anymore. We have to make every effort to reduce the severity of cases, so that the virus becomes as harmless as the common flu or any other respiratory illness. For comparison, pneumonia at 12.2 percent is the second principal cause of death in 2019.

I wouldn’t propose this in a normal situation. I feel the situation is out of control. Indefinite lock-downs in various forms have destroyed our livelihood, and more importantly, weakened our natural immune system. Vaccination can only do so much.

Please free us from the cage now. We can trust the virus more to acquire natural boosted immunity than the measures put in place in the last 17 months. We saw some light after the first movement control order. We lost it after the Sabah election fiasco.

Use all available resources to bring down the severity of cases by doing another 'Operation Surge Capacity' to boost healthcare facilities. Make vaccines available in every government and private health facility, which should be no more than a few kilometres from every resident. Just forget about the expensive private sector-driven PPVs and the MySejahtera, which is now becoming infamous for all the wrong reasons.

The government has the dreaded emergency ordinances, RM17 billion in Budget 2021 and another RM5 billion from the National Trust Fund, and of course the executive class of 70. Look where we are now in the fight against Covid-19.

Finally a disclaimer. I am not a medical doctor though I carry the designation. But any advice here is based on common sense, which I am sure the ordinary rakyat will readily understand. - Mkini

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RAMAN LETCHUMANAN was director, Environment/Conservation, Ministry of Science, Technology and the Environment (1993-2000), head of Environment/ Haze/Disaster Management, Asean Secretariat, Jakarta (2000-2014), and senior fellow at S Rajaratnam School of International Studies (RSIS), Nanyang Technological University, Singapore (2014-2016). Email: raman.asean@gmail.com.

The views expressed here are those of the author/contributor and do not necessarily represent the views of MMKtT.