Is there another reason for the mandatory masks?

I am puzzled by the announcement that the use of face masks in crowded public place areas would be mandatory from 1st Aug 2020.

Don’t get me wrong.  If you have been following my blog, you will realize that I have been advocating for masks to be mandatory.

According to our Defense Minister, the use of face mask will be mandatory in crowded public areas and public transport with the usual fine or prosecution for non-compliance.

He said that the govt made the ruling following the increase in Covid-19 cases for the past 3 days and the lack of SOP compliance.

• 50% of those on home quarantine do not comply

• SOPs in public transport such as LRT, KTM were not complied with eg no social distancing and no face masks

He added that the govt avoided making it compulsory before because it was worried that the low-income group will face financial burden in buying the masks.  He suggested that according to WHO, people can make their own face mask.

Firstly, I am waiting to see how the govt will define crowded public areas.  Unless they make it compulsory for all places, I can imagine our enforcement officials having a field day.

But my main concern is the logic for the decision.

• Firstly quoting non-compliance among those returning (for not following self-quarantine SOP) does not make sense.  After all, it will be mandatory quarantine at designated centres so I don’t see wearing face masks as being relevant

• The second thing is that he quotes the rise in the number of cases

The chart below shows the number of cases for the past 15 days excluding the imported cases

We can see certain spikes.  And there are more cases among the locals c/w foreigners. 

If there was any concern about the increasing number of cases, it should be about the locals. 

Where is the source for the increase in the number of cases for the past 15 days?

I actually went through each of the MOH press releases for these 15 days to try to see whether these cases are due to people getting infected when in crowded public places. (Refer to the Appendix) 

Foreigners

The majority of the cases among the foreigners (in the local transmissions) are from one of the following: 

• Those in detention centres

• Those tested positive as part of the pre-departure screening

• Those from known clusters

Maybe there could be one or two whose source of the infection cannot be identified.

Locals

When it comes to the locals (Malaysians), again I found the following 

• the majority belong to some clusters ie they were tested positive following the contact tracing of some index case. 

• Quite a number were detected as part of the “standard” screening eg before surgery, workplace screening

Again I could not find any spike that is clearly attributable to people being in crowded places.  

The logic for making masks mandatory is that there is a spike in sporadic cases among the general public - MOH news announcement does not seem to suggest this. 

Like all things in Malaysia, I think the mystery (ie the real reason for the mask) will be known with time.

BTW if you look at the chart of daily cases, it would be legitimate to ask whether we are seeing an increase. 

A lot of the cases/clusters seem to be in Sarawak.  

There are currently about 161 active cases in the country (ie those still under treatment). Of these

• 60 odd are imported

• 58 are in Sarawak - with 47 in Kuching

• 19 in Johore

• 20 in Selangor/KL (the KL figures are only for those for the past 14 days)

So if there is any person who should be worried, it would be those in Kuching district.  The rest of the country still seems OK.

I would not worry about the imported in the coming future as they will be quarantined in special centres. 

But if I was in Johore I would also be worried.  Not so much the actual number of cases in Johore itself, but the increasing number of cases in Singapore.

The chart below seems to suggest the start of the second wave in Singapore.   It shows the daily number of cases, as well as the 7-days moving average (denoted as 7MA in the chart)

I don't want to be the alarmist but this was the pattern I saw in Australia a week before they declared a second wave and lockdown Melbourne.

So is there a real reason to be worried about Singapore?

If you breakdown the cases in Singapore into imported, community (ie those not in the dorms) and dorms (foreigners staying in dormitories) you can see that the majority of the cases over the past 4 weeks are still from the dorms.

The growth and/or the potential 2nd wave is still from the dorms.

It is still a mystery to me why Singapore has not been able to bring the number of cases in the dorms down given that the dorms sound like an EMCO area.  Maybe they should talk to our DG of MOH!

Should there be any real concern?

• The average number of daily cases among the locals in Singapore (in Singapore lingo the community cases) over the past 2 weeks is 9 cases

• For Malaysia, the average over the same period is 5

Maybe the plans to allow the cross border traffic through the causeway is OK.   

Appendix

 

Jul	No of local transmission			Causes of transmission
	L	F	Total
24	13	3	16	1F old folks cluster, 2F new cluster, 4L cluster due to contact with imported, 1 old folk cluster, 8L existing Sentosa cluster
23	4	2	6	2F detainees, 3L clusters in Kuching
22	7	1	8	1F pre-departure screen, 5L clusters, 2L screening
21	10	1	11	1F detainee, 7L clusters, 2L screening, 1L self-test
20	13	2	15	1F screening, 1F + 12L old folks home, 1L screen
19	8	3	11	3F different clusters, 1L old folks, 1L close contact, 1L self-test, 5L screen
18	4	1	5	1F pre-departure screen, 3L cluster, 1L screen
17	6	2	8	1F cluster, 1F pre-departure screen, 3L cluster, 3 screen
16	0	2	2	1F detention, 1F screen
15	3	1	4	1F sick, 1L contact, 2L screen
14	0	0	0
13	1	0	1	1L Novograd cluster
12	3	8	11	8F detainees, 1L contact, 2L sick
11	2	2	4	2F detainee, 1L sick, 1L screen
10	3	2	5	2F detainee, 3L screen

 Source:  MOH press releases

Note

1) Screening could be from SARI, flu-like screening, pre-surgical, workplace

2) L = locals

    F = foreigners

 

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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.