The Devil and the Deep Blue Sea - choosing how to control Covid 19 among the foreign workers

MOH has said that the govt will set up an inter-dept group to address the increasing number of cases among the foreign workers.  Considering that we had several about turns by the govt during the course of tackling the virus, I am concerned about whether the various govt depts see the issues. 

So let me give my 2 cents worth based on what has happened in Singapore.

In Singapore, they have identified that the foreign workers at risk are those staying in the dorm, numbering about 300,000 of them.   As of 4 June there are about 34,000 odd cases from these foreign workers.  

 

Chart for the number of daily infected dorm residents in Singapore.  The grey shaded area is the lockdown period. Note that for the current week, there are about 500 cases daily

Singapore strategy for this group appears to be to contain them in the sense that all those in the dorm at not suppose to work and/or move in and out of the dorm -  this was from 21 April to 1 June ie about 6 weeks.

The first thing that stood out is that during this period, these 300,000 could not go to work.  It was Ok in Singapore as the country was on lockdown.

But in Malaysia, most of the sectors in which many of the foreign workers are employed have already started work.  I hope our authorities recognize this constraint. 

Secondly, despite this containment measure, the number of daily infections among the foreign workers (ie those in the dorm) continued "steadily" over the 6 weeks period in Singapore as can be seen from the chart.   This meant one of two things

• They were already infected when the "stay in place" order was effected

• But then considering that they continue to have daily number of infections for more than 2 weeks since the "stay in place" order, it must mean that the virus has been spreading within the community

So while restricting the movements prevented the foreign workers from spreading it to the locals, it did not seem to prevent it from spreading it among themselves. 

Now come to Malaysia. 

The foreign workers stay together.  I am not sure whether we have places where there are exclusively foreign workers, but looking at the news for the various EMCO areas, it looks as if there are also locals staying within the residential areas.

So what are our constraints?

• In the first place, we cannot restrict the movements for all the foreign workers as the economy needs them.  

• Secondly, we don't have enough facilities where we can re-locate the 2 to 4 million workers so that they are separated from the locals accommodation-wise.  

• And l think any talk about providing ample living space is not an immediate thing that can be done. 

So we are stuck with them living close together and being able to move in and out.

We also have to look at how we are going to detect the cases.

a) do we have a testing programme to cover all the foreign workers?  This comes back to our lack of testing capacity.  Assuming we can only do 10,000 tests a day, (ie use up all our effective capacity) it will take 200 to 400 days (assuming 2 to 4 million of them) to complete one cycle.  This is not practical.

b) Do we then react ie whenever there is a case involving foreign workers we then do one of 2 things

• Option 1 - Follow the current protocol ie contact tracing, hospitalize the sick, and quarantine the rest of the contacts. We do this for the locals.  But when it comes to the foreign workers, the sheer numbers would overwhelm any quarantine facilities we have.  

Can you imagine what would happen with a ratio of 1 infection to 30 contacts?  (a number based on our history) 

If we have 40 cases daily, (based on the past 3 weeks average cases among the foreign workers) we will need accommodation for 1,200 contacts.  Over a 14 days quarantine period we will need 16,800 beds.   OK, I am over simplying the numbers to prove my point.  

The point is that we may not have the quarantine capacity if there is a serious outbreak among the foreign workers. Remember we have 2 – 4 million foreign workers which is very different from the 300,000 odd in Singapore. 

 

• Option 2 -  to EMCO the residential areas where the infected stay.  With this, we will still face the continued cases within the EMCO areas like what happened in Singapore but we prevent the spread to the rest of the public.  We don't have to worry about creating special quarantine facilities.  

And this can be applied throughout the country immediately.  

The reality is that any EMCO will affect the locals staying there and other foregine workers working elsewhere.  This mean that other company’s operation (involving the foreign workers) will also be affected. 

It looks as if there are no good choices. There are costs implications, impact on opening the economy, and timing issues. 

It is between the devil and the deep blue sea

I think we will have to continue with our "reactive" testing protocol and secondly, the Option 2 containment idea is better than the current practice of contact tracing and isolating only those with COVID 19. 

Does anyone have a better idea?

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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.