A Belated but required Challenge to Asia Sentinel critique of the DG

Yesterday I was sent an Asia Sentinel’s (AS) article dated 23rd April 2020 headlined “Malaysia’s Health Czar Under Fire.” 

According to the AS article, critics had accused the DG for Health, Datuk Dr. Noor Hisham Abdullah for 

1. mishandling the country’s Covid 19 approach
2. fostering a cult of personality
3. aggrandizing his importance almost rendering him out of control

Wow, these are pretty serious charges.   

 

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Unfortunately, I did not see the article as soon as it was published.  Otherwise, I would have defended him immediately.

The main problem with the AS article is the lack of data-based evidence to back up the various contentions. It was more like a story tale than a science-based article.

But the best defense is hindsight.  Today, 2 months after the article was published many of the scenarios which the various critics had warned of did not materialize.

So the critics would have brought the country into a“Trump-like” Covid world if the critics had been in charge.

Judge for yourselves.  

• I have categorized the key AS arguments into 3 buckets corresponding with the 3 allegations.

• I then listed them in the following table and where appropriate I have laid out my counter-argument side by side.

Of course, I also have some views that are in line with those of the critics but I would like to think that mine is more supported by data. 

1) Mishandling Covid 19

AS allegation	MY Covid 19 Saga
1)  Delays and miscues in testing and tracking.  ·      We have 3,515 tests per million c/w 16,203 per million in Singapore ·      More than 1,000 cases being discovered in Singapore c/w double figures in the whole of Malaysia	Test per million cases is not the correct measure.  It is the positivity rate ie no of positive detected over total tested. ·      In mid-April Malaysia had 5 % positivity c/w WHO standard of min 10%.  ·      In mid-May Singapore positivity rate was still 14 % ie not enough tests given the no of infections So it does not matter that Singapore had discovered more cases… it is because they had more cases.  Malaysia's low positivity rate meant we have an effective detection rate.
2)  Ministry complacency borders on negligence	I am not sure how AS concluded this.  If they are looking at the number of cases, Singapore Ministry would be much more complacent then.
3)  Malaysia first case was in Jan 2020 with visitors from China 2 days after Wuhan lockdown.  ·      Other cases emerged slowly yet MOH made few emergency preparations.  ·      This lack of preparation from Jan till MCO (53 days) resulted in a shortage of PPE, ventilators, beds and testing and tracking equipment which may have cost lives of dozens of people	By 25th Mac, based the govt had already announced the following set aside for Covid 19 ·      3,500 beds ·      300 ICU ·      925 ventilators The only info I don’t have is the PPE but I have not come across reports of medical staff having to use make-shift PPE like in the US. Malaysia medical capacity was not overwhelmed during the whole Covid 19 period AS's contention is not supported by the facts.
4)  Only ordered rapid test kit on April 17 (3 months after 1st case)	At the start of MCO we were testing about 1,000 daily.  ·      By 23rd April we were testing 4,000 daily. ·      By 1st week of May, it was 10,000 daily The Rapid test kit was to speed up the waiting time for results and eventually these kit we allocated to Sabah/Sarawak so that they do not have to send the samples to the labs in Peninsular. I am not sure that the ordering of the Rapid test kit is proof of mishandling.
5)  On 12 Feb, Health Minister, in direct contradiction to WHO, announced that public gatherings in Malaysia would not be banned. ·      DG had a central role in advising the go-ahead for Tabligh event ·      Tabligh was a source of single largest outbreak, etc.  Multiple clusters were linked to Tabligh eg Tafhiz	AS has not been able to support the allegation that DG had any special role in this approval. My view is that no civil servant or Minister would have been able to ban the Tabligh event as ·      There was no history of a virus surge that any govt could justify to the public ·      It was a religious event and we all should remember the issue when the mosque in Shah Alam tried to close its doors (before the Tabligh became a known source of infection)   The reality is that without the Tabligh event, Malaysians would not have taken the Covid 19 seriously. Citing the large impact of Tabligh is with hindsight but the large impact is not proof that DG had a role in not advising for a ban.

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   2) Cult of personality

AS	MY Covid 19 Saga
1) AS cited local journalists writing uncritical valentine to DG and even Lim Kit Seng calling for DG to be named Health Minister	I am not sure why this is the fault of the DG.
2) A private practitioner said that DG was living in an ivory tower and failed to provide front liners and allege lack of PPE had led to 30 healthcare workers testing positive ·      DG on 14 April said PPE can only last for 14 days ·      One social media adopted “Anonymous” for fear of persecution	All the letters and comments did not have any supporting data.  They were general comments. The 14 days stock could have been a supply delay and not due to lack of order. Besides AS never showed that we ran out of PPE.

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   3) Out of control/Power grab

AS	MY Covid 19 Saga
1) DG supposedly criticized for advising MCO	AS and all the critics of the MCO have not shown that we could have controlled the virus without the MCO.
2) On 9 April, DG rejected the call by 16 former presidents of MMA for staged wind-down of MCO ·         MCO extended with greater power to DG without referral to political powers	All the letters and comments calling for the opening was based on “narrative” and not based on data. It was one set of opinions (without data) vs MOH view.  It was very sad that many of the letters by people with a science background did not provide science-based arguments. I have actually provided a data-based argument on why we could have a stage opening as ·      Virus is below our medical capacity ·      Cases are coming down ·      We have EMCO to isolate critical areas The part of MCO extending the DG powers without relating to political power – this was in the statute.  Whether in practice this was followed is open to debate.
3) April 17 AG intervened to revoke power given to DG to issue fines without a trial thus circumventing the judiciary.	I am not sure it was DG who has been talking about the fines. My impression was that it was the Defence Minister
4) Multiple ministers in PN govt humiliated for attempting to rein DG ·         Health Minister sidelined due to his own making ·         Azmin forced to announce that MCO related economic decision went through Health Ministry ·        DG dismissed the Higher Education Ministry to allow 80,000 healthy students confined in hostels to be allowed to return home	I think AS has not made a case that all the Ministers' plans, etc were based on science.  AS seem to have confused economic and other non-health issues with public health issues. No Ministry has argued that MOH public health view was wrong.  Furthermore it was a govt policy to place public health above economic considerations and I don’t think the DG alone could have made this decision
5) PM policy sabotaged by DG ·         After PM announced MCO would be eased, DG disagreed
6) DG sabotage Health Minister order requiring prior testing for all employees for firms opening up delaying the opening for 2 week	I have shown that we don’t have the testing capacity to implement this.  The Defense Minister made similar comments about testing without relating to practicality
7) Former ministers also escaped humiliation as spat with former boss
8) Former ministers fumbled for excuses for DG failure to advise them on Tabligh ban
9) Almost every day DG identifies new previously ignored risk group to just longer lockdown	I am not sure why this statement is in the article.  Are they suggesting that the new cases are not real?  Are they suggesting that MOH could have foreseen the infections among the new clusters. We had the MCO because nobody knew how far the virus would spread

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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.