Where does the risk of infection comes from?

Yesterday was an exciting day of conflicting and confusing news. 

• First, there was news that Selayang and Chow Kit market area were EMCO having been sealed off with barb wires.  Then our Defence Minister came out to deny this and said there are under “administrative restrictions”.

• We earlier already had the dispute between the Federal and State govt on who has the right to open up the economy with our MITI Minister talking about resorting to legal means.

• Malaysiakini which had been providing Covid 19 reports by districts re-classified the KL data so that instead of reporting  the number of cases by health district (ie Lembah Pantai, Titiwangsa, Kepong, etc) they are now reporting by a different area classification eg Ibu Kota, Batu, Kg Bharu, etc thereby screwing up any analysis based the earlier district classification.  I suspect that Malaysiakini is merely reporting what MOH provided. 

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Covid 19 won the day since our leaders think that sowing confusion is the correct path and our media continue to provide uninformative reports.

Maybe the DG of MOH is savvier than we thought as he had a few days earlier said that the public will have to take on greater responsibility in order to prevent the spread of the virus. 

The first step in taking personal responsibility is to understand the risk profile.  Unless one is a healthcare worker or those guarding EMCO areas, the risk comes from 3 contagious groups:

• Those who don’t know they are sick ie the asymptomatic cases
• Those who don’t yet that they are going to fall sick ie those at the incubation stage
• Those who don’t care that they are sick ie those who are afraid to seek treatment due to monetary or deportation fears (eg foreign workers) or those who are afraid for some other reasons (remember the few from the Tabligh cluster that the police had to raid)

So as an ordinary rakyat what are key risk mitigation measures each of us can adopt personally?  We all know the drill by now eg stay at home as much as possible, wear masks, avoid areas with known infection for some time, etc

Such precautions can only reduce the chances of you getting infected and is only one side of the coin.  The other side is cutting off the contagious groups from the rest of the community and is very dependent on the authorities as we need them to

• Test, contact trace and isolate so as to keep all 3 contagious groups away from the public

• Enforce EMCO as a shortcut for contact tracing

• Ban all public gathering and have other mandatory social distancing measures to minimize the contagious groups from causing exponential growth

• Make it mandatory to wear masks (not yet in Malaysia) to prevent the contagious group from leaving airborne trails of virus

• Given that foreign workers are more likely to avoid treatment c/w with locals, there should be more testing for foreign workers.  However, I think the requirement to test all foreign workers has not been well thought through yet.  It is not just about our testing capacity.  It also requires continuous testing. The better solution is periodic random testing of foreign workers.  Those who are familiar with Quality Control techniques will tell you that a good random testing plan is far more effective than 100% inspection. 

Yesterday we had 30 cases (0 imported and 21 from EMCO).  The impact of CMCO will only be seen after a week or two and the pessimists will say that with so many people moving all over the place, the number of daily cases would increase.  

Unfortunately, the optimistic view is not that the numbers would be lower, but that we would not have exponential growth as

1. Those who don't care that they are sick will be flushed out by the temperature-taking measures
2. Those at the incubation stage will eventually fall sick and be treated. At that stage, MOH would step in to isolate the contacts and PUI
3. Those who are asymptomatic will infect others and leave a trail of infections that eventually can be tracked and isolated.  Ya even the asymptomatic index case will be caught in the PUI quarantine. 

However, scenario 2 and 3 will lead to an increase in the number of cases. The big unknown is whether all the CMCO measures are enough to avoid exponential growth. Only time will tell.  Considering that many of our CMCO measures are also the ones implemented by many countries to avoid exponential growth, I am more optimistic that we can prevent exponential growth.  

So come Raya, the news is more daily cases and not less.  Since we can see this coming, let us not panic.  After all, the idea is about how to live with the virus without it disrupting the economy too much. 

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PS: This blog is for me to better understand COVID 19 as this will impact my investments. If you are also into equities, follow me at i4value.asia

Disclaimer:  I am not an epidemiologist, healthcare worker, pharmacist or staff in the Ministry of Health, but rather is someone with a strong interest in numerical analysis.  The content is an attempt to understand what is happening in the battle against Covid 19 from a data-based perspective. The opinions expressed here are based on information extracted from readily available public sources but I do not warrant its completeness or accuracy and should not be relied on as such.