Let Us Together Flatten the COVID2019 Epidemic Curve

Let us together flatten the COVID2019 epidemic curve

Dato’ Dr Musa Mohd Nordin
Damansara Specialist Hospital
13 March 2020

The WHO officially declared the outbreak of the novel coronavirus 2019 as a pandemic on 11 March 2020. This is the second in the 21st century after the HiN1 influenza pandemic in 2009.

The Ministry of Health (MOH) Malaysia, marshaled by the past Minister, Dr Dzulkefly Ahmad, was on the ball, immediately after the announcement of the first Wuhan case of COVID2019 on 31st Dec 2019.

It is pertinent to take stock of our current containment and mitigation strategies and benefit from best practices elsewhere, to craft our Malaysian plan of action against the SARS-CoV2 pandemic.

We should first try to understand current and best knowledge of this coronavirus which is bewildering most scientists studying it.

The SARS-COV2 is a very smart coronavirus. It does not overkill it’s host unlike SARS-CoV1 and MERS-CoV. Its Case Fatality Rate (CFR) is 2% when compared against 10% for SARS and 35% for MERS.

It therefore lives another day to further infect more humans. This is reflected in its Ro (Reproduction Nought) of 2-4, an index of how contagious the virus is. Contrast this to the less infectious MERS (Ro less than 1) versus the extremely infectious measles virus with an Ro of 13-18.

The mean time from exposure to the manifestation of symptoms, namely fever, cough and breathing difficulties, is 7 days, with a range of 2-14 days.

However, it is now established that he SARS-CoV2 is able to infect others even prior to manifesting clinical symptoms. Analysis of 124 Wuhan cases with clearly documented contact history illustrated an incubation period of 5 days (ranging from 1-11 days). It also showed that 73% of secondary cases were infected before the onset of symptoms in the index COVID2019 case.

This suggests that a substantial proportion of secondary transmissions was acquired prior to the onset of clinical symptoms and signs in the index case. Experts best  estimates is that 12% of carriers can spread COVID19, 2-4 days before the manifestation of the signs and symptoms.

This existence of asymptomatic transmission of SARS-CoV2 makes total containment very difficult and problematic.

In the light of these disclosures of the transmissibility (and fatality) of the SARS-CoV2 we may need to realign and reconsider some of our strategies of containment and mitigation.

I do not think we need to follow the draconian, lockdown methodology of China and Italy. South Korea has been very successful in reducing confirmed cases of COVID2019 from 900 per day to less than 100 per day and declining further. Probably we could learn from some of the salient features of South Korea’s strategy to “flatten the COVID2019 epidemic curve”

We should continue to screen, through fever checks and rt-PCR testing, detect the positive cases and isolate cases. Self-quarantine should be advised in appropriate clinical settings

We should ensure that there is sufficient, rapid and accurate diagnostic test kits and which is undertaken appropriately to conserve the supply chain. South Korea undertakes 12,000 – 20,000 tests per day. Prior to the lockdown of Italy only 20,000 tests were done. Due to restricted and flawed test kits only 4,000 tests were done in the USA prior to the declaration of global pandemic. The US CDC therefore does not have an idea of the burden of COVIC2019 disease in their community, which makes it very difficult to solicit public support for their ensuing public programs.

To facilitate testing South Korea has organized several Drive-Through SARS-CoV2 tests at public areas. This Drive-Through model has been replicated in KPJ Damansara Specialist Hospital (KPJ-DSH) and Hospital Sungai Buluh. In fact, KPJ-DSH has operated mobile Drive-Through COVID2019 testing at several Government Linked Companies (GLC) premises, as part of testing of persons in close contact with Index Case 26.

 Dr Dzulkefly during his stewardship of the MOH emphasized transparency of their work processes, which seems somewhat alien to the work culture of most government ministries. He pushed for the public release of the findings of the independent investigation of the fire incident in HSA in 2016 despite fierce protests from the top officers in the MOH. Tan Sri Abu Bakar Suleiman, vice chairman of the fire investigation commission and myself, as part of the now defunct Health Advisory Council (HAC), advocated for the prompt and complete release of the fire report.

This transparent work culture permeated through Dr Dzul’s handling of the COVID2019 disease outbreak. Apart from being transparent, he made sure the information was accurate, readily accessible and presented in a reassuring and calming manner.

This is extremely crucial, because quick access to accurate information is powerful in debunking fake news and fear mongering. It empowers the rakyat to be active partners of the MOH and the government in the fight against the outbreak

Another strategic decision that needs to be carefully considered is the shift from the imposition of physical and legal barriers towards creating healthy social barriers as advocated in the infectious disease philosophy of social distancing.

The cities that practiced social distancing during the Spanish Flu pandemic in 1918 suffered the least impact from the effects of the H1N1 influenza outbreak.

These social distancing strategies ranged from best practice hygiene practices, cough etiquette, avoidance of large crowds, no handshakes, hugs and kisses, replaced with Hola, Namaste and Eyvallah, staying home when unwell, wearing a mask if unwell and still needing to be out, staying put in homes for high risk groups eg pregnant ladies, geriatrics, those with underlying health conditions, work from home, cancelation of all large events eg games, religious congregation, conferences, to more major closures of schools, theatres, mosques and churches.

Manual contact tracing can be very laborious and time consuming and may still not track the vulnerable persons. It is time for the MOH to utilize GPS technology and information for contact tracing.

In South Korea, all travellers entering the country are recruited into the Self Health Check Mobile App which not only tracks the visitors’ symptoms but also his whereabouts. This has caused some embarrassment in certain circumstances eg those who frequented love hotels etc and has raised issues of invasion of privacy and confidentiality.

And I would like to suggest to the MOH to utilize the Artificial Intelligence (AI) expertise of the likes of Dr Dhesi (previously digital health advisor to Dr Dzulkefly) to team with the group in UMMC under Prof Adeeba to get cracking towards AI

AI modeling, tracking and forecasting of COVID2019.

All of these interventions I believe, will help to flatten the COVID2019 epidemic curve, to delay and spread out the progression of the outbreak, reduce the disease morbidities and mortalities and reduce the burden on our healthcare institutions and essential services. This hopefully will buy us some time until anti-viral agents and a vaccine can be produced and its manufactured up-scaled for global treatment and protection

Open Letter to the Mufti of Perlis

12 March 2020

 

Open Letter to the Mufti of Perlis

Manan Razali

 

Assalamu’alaikum Ustaz

I think you know me very well Ustaz. We have known each other well before you became a Mufti. This must be some 15-18 years ago. We have had some very interesting exchanges prior to your talks the following days, during your many visits to KL.

More recently, I have been reading your many statements praising the actions of Muhyiddin Yassin (MY) pulling out Bersatu from PH and partnering with UMNO and PAS to form a new back door government.

Ustaz, you know very well that I am not a politician. I am merely a humble supporter of the Sunnah ways taught to me by knowledgeable teachers including your kind self. I was taught to always prioritise the teaching of the Al-Qur’an and the authentic traditions of the Prophet (PBUH) in all our spirirtual and worldly endeavours.

It is premised on this understanding, that I felt it incumbent to write this piece to balance the political nuances of Ustaz which is utterly confusing the ummah and does not seem to honor the Islamic principles which I have learnt and which you have advocated from the traditions of the Prophet (PBUH).

Let our readers decide which points of views best reflects the teachings of our religion.

To do justice, allow me to first quote your many public pronouncements from your FB, your videos and your interview with Astro Awani on 10 March 2020 at about 2.30 pm. You said:

1 The PH government, allowed sensitive issues related to race and religion to proliferate causing the rakyat to be angry and upset. The PH government was not assertive in controlling the situation. They should have addressed the situation firmly and promptly to allay the hostilities and concerns of the rakyat. It should not have been allowed to drag on and pose a danger to the rakyat and nation

2 Because of the failure of the PH government to handle the situation with tact, it was only appropriate for MY and his team to undertake the “Sheraton Move” to grab power through the back door to overcome this imagined catastrophe by forming an “all-Malay government” which entails kicking out the DAP from office. With the success of this takeover, you are now appealing to the rakyat (namely the Malays) to give MY and his back door government the opportunity to carry out the task of governing.

3 You always reminded us to listen and obey to our leaders, whether we like them or not, until it is proven that they have sinned or are treacherous. And you quoted the hadith;

“To listen and to obey the leaders is mandatory upon a Muslim in all affairs, whether he likes or not, as long as he is not commanded to do evil. When this happens, he must no longer obey nor listen” (al-Bukhari and Muslim)

 

4 On the 17 Feb 2010, you were quoted as having said; “the actions of the rakyats’ representatives to hop parties is a sin in religion because it is treacherous and totally disrespectful of the rakyats’ mandate.

My response to your viewpoints has no political innuendos. My only intent is to seek the truth, an authentic religious perspective of these happenings. I always picture in my mind, how the prophet (PBUH) and his companions would have acted when faced with a similar political crisis.

Our religion has always exhorted us to be just because that is closest to taqwa which is our passport to  heaven. If we act otherwise, we are doomed.

Permit me to share two pertinent passages from the Quran which you and our scholars have always quoted in this aspect:

O you who have believed, be persistently standing firm for Allah, witnesses in justice, and do not let the hatred of a people prevent you from being just. Be just; that is nearer to righteousness. And fear Allah, indeed, Allah is Acquainted with what you do. (5:8)

O you who have believed, be persistently standing firm in justice, witnesses for Allah, even if it be against yourselves or parents and relatives. Whether one is rich or poor, Allah is more worthy of both. So follow not [personal] inclination, lest you not be just. And if you distort [your testimony] or refuse [to give it], then indeed Allah is ever, with what you do. (4:135)

A paramount issue besetting the nation’s politics today is the trail of treachery and broken promises by MY and his back door government. They were together in the PH coalition to face GE-14, defeated the kleptocratic UMNO-BN government and were trusted with the rakyats’ mandate to start a new beginning, Malaysia Baru.

In our religious vocabulary, this act of treachery and broken promise is described as despotic (zalim) which is the anti-thesis of justice (adil). Despotics leaders are cursed by Allah (SWT) in this world and the hereafter.

MY was not only treacherous to PH but also to the rakyat who chose PH, and booted out UMNO-BN which virtually bankrupted our national coffers during its 61 year rule.

My question is, whether the treasonous actions of MY is exempted from the basic Islamic principles which I alluded to earlier?

I would welcome your wisdom of any verses from the Quran or the history of the prophet (PBUH) whereby he (PBUH) or his companions deliberately broke any contracts they made with the non-Muslims or the People of the Book.

I have no doubt in my mind that the treacherous conduct of the (unbelievers) Mushrikin  would be far worse than those of our non-Muslim citizens (if any) in Malaysia. Despite that, the prophet was just to them.

The enemies of Islam (Mushrikin) during the prophet’s (PBUH) time despised Islam even though he delivered the message of Islam in the best possible manner.

There is a world of difference between the Mushirikin during the time of the prophet (PBUH) and the non-Muslims in Malaysia. The latter were neither hostile nor obstruct the Muslims from practicing their religion.

The few non-Muslims who are ill mannered towards the Malays is due to their lack of understanding of Islam consequent upon our (Muslim Malays) failure to disseminate the message of Islam with tact and wisdom.

Let us be upfront about our failures. We are more obsessed with our Malay race than our religion. And it is not far fetched for me to equate our actions like the Jews (Yahudi) who lived many years in Madinah before the coming of the prophet (PBUH).

The Jews never saw the need to invite the Arabs, worshippers of idols (Mushrikin) to instead worship Allah, because they felt it was their exclusive right to Allah. To the Jews, the Arabs had no “class” and in the sight of Allah, they are doomed to the hellfire. Only the Jews had the exclusive right to heaven.

The Malay mindset is much similar to the Jews. Our psyche is like; “Don’t bother with these unbelievers, they don’t believe in Allah, so their rightful abode is the hellfire. We Malay-Muslims good, bad or ugly will eventually enter the heavens. But, whatever, the (non-Muslims) must respect us. Malaysia is our land. These guys are aliens (pendatang). We give them an inch now they demand a mile.”

There were a few drastic actions of the prophet (PBUH) against his enemies, but unlike the allegations of the Western Orientalists, they were all fully justified in response to the treasonous actions of his enemies. These incidents were namely:

  1. The killing of Ka’ab bin Ashraff, a Jewish traitor from Madinah who came to Makkah to instigate the Qurasyh pagans to attack the Muslims in avenging their earlier defeat in the Battle of Badr. This led to the Battle of Uhud not too long after that.
  1. The beheading of all the men from the Jewish tribe of Bani Qurayza and the enslavement of their women and children, for plotting to kill the Prophet (PBUH) who was the head of the state of Madinah and for violating and betraying the state’s constitution which they had pledged loyalty to earlier.
  1. The attack on the Jewish tribe of Bani Nadhir and then exiling them from Madinah for their covert support to the large confederation of enemies of the new state during the battle of Al-Ahzaab.
  1. The violation of the treaty of Hudaibiyyah by the Arab pagans of Quraysh which resulted in the Prophet leading 10,000 Muslim soldiers to march to Makkah and liberate the city from the pagans.

On Ustaz’s allegations that the PH government failed to address he rakyats’ grievances on issues of race and religion, I would politely ask; “Who was the Minister of Home Affairs during this 22 month period? Is not the nation’s peace ad harmony under his jurisdiction? Why was he not held accountable for the failures to address the rakyat’s concerns”

When the AG released the 12 Indians for their alleged involvement in the terror organization LTTE, I read his answer to the Minister of Home Affairs statement. I was waiting for the Minister’s rebuttal to the AG’s report which unfortunately never appeared. This lack of transparency from the Minister with respect to upholding the rule of law is very disappointing.

With regards to the hadith about obeying our leaders, might I ask Ustaz, which bit of the PH governance was entrenched in evil (maksiat) which we must not obey. It might have escaped my attention

There is no benefit to me to suck up to the non-Muslims especially the very few who misbehave towards us. Whether I like them or not is irrelevant. As Muslims, on the path of the prophet (PBUH), our endeavor is to search and to establish the truth.

Fighting has been enjoined upon you while it is hateful to you. But perhaps you hate a thing and it is good for you; and perhaps you love a thing and it is bad for you. And Allah Knows, while you know not. (2:216)

It is simply not fair for me to hate the non-Muslims just because of the fault of a few among them who who have misbehaved towards us on account of their lack of understanding of Islam. And especially if the Minister of KDN who was tasked to preserve the national harmony did not carry out his job responsibly.

And the Minister of KDN has the audacity to blame them and use this as an excuse to overthrow the government of which he was part of. Did he not promise to save this nation from the thieves in UMNO which he lambasted during GE14. And now he jumps into bed with them and invites them to be part of his back door government. This is totally insane, let alone Islamic!

None of the UMNO ministers have apologised for supporting Najib, the global kleptocrat. If they are truly sincere and have repented, they ought to publicly say sorry to the rakyat.

Ustaz, you are more knowledgeable in this aspect, and you ought to counsel them to apologise to the nation. If they are unrepentant, how can you or the Malays ever trust them to govern and save us? I am very perplexed by your irrational course of action. This is not what I was mentored by you and our other scholars.

And it does not make sense to me to accept PAS, because they were complicit in supporting Najib and UMNOs’ evil doings. They have abused religion to further their political ambitions. Their president seems infallible issuing various nonsensical decrees, and none his party dare to correct him. Suffice for me to summarise as such or it will take another article to enumerate their misdeeds. These are the very people who are doing a disservice to Islam and portrays a wrong image of our religion

If I may reiterate, exactly which Islamic principle Ustaz used to rationalize your support of MY’s treacherous actions.

What values are we preaching and upholding in these difficult times. Does the end justify the means?

If your judgment is permissible (harus) in order to preserve a bigger good, then my preceding questions remains to be answered. The Minister of KDN himself failed in his duties to preserve good relations and cohesiveness between the different races and religions of our nation

He should be brought to task, instead his efforts to overthrow the PH government elected by the people with his bunch of thieves and traitors was lauded by you and received your utmost respect. Is this a strategy taught by the prophet (PBUH) of which I am not aware of, or is it beyond the reach of my limited Islamic knowledge?

It’s no use crying over spilt milk. There is not much more I can do now. Notwithstanding, as a Muslim it is important for me on behalf of many of my confused brethren to establish the truth in this religious imbroglio.

Was the treacherous acts of MY permissible according to our religious teachings. Based on my grasp of the religious texts, I have rationalized that MY’s acts are indefensible. I would truly appreciate Ustaz’s sharing of your understanding of the  religious text, jurisprudence of priorities or politics (fiqh awaliyat, fiqh siyasah) which endeared Ustaz to MY’s “Sheraton Move”  to  oust the PH government.

This is extremely crucial because Ustaz is seen as a defender of authentic Islamic values. However,  your recent actions have bewildered both Muslim and non-Muslims, who now see you more as a racist defending Malay rights rather than a Muslim defending the universal norms of justice, equity and fairplay.

Indeed, Allah orders justice and good conduct and giving to relatives and forbids immorality and bad conduct and oppression. He admonishes you that perhaps you will be reminded. (16:90)