Malaysia to enter Guinness Book of Records for the country with the most contact tracing apps?

We had another spike in cases yesterday to 103 from 10 cases the day before.  This is the week of spikes.  

What is the difference between yesterday’s spike and the 172 cases on 25 May? 

• About 2/3 of the cases on 25 May were in captive compounds whereas yesterday were among people who could move about (of course within the context of CMCO)

• About 1/4 of the cases on 25 May were from workplaces whereas yesterday the workplace clusters accounted for about 3/4 of the cases for the day. 

Cluster	25 May (no of cases)	29 May (no of cases)
Detention centres	112	0
Workplace	44 (a)	77 (b)
Returnee	5	7
Misc	11	19
Total	172 of which 92 % foreigners	103 of which 82 % foreigners

Notes

a) KL construction 2

b) Pedas and cleaning company

 

Although there were more cases on 25 May, I am very sure the MOH staff will have a harder time managing yesterday’s cases as there is more contact tracing work to be done. 

I am actually concerned about the Pedas cluster as it was first reported on 8 May when 786 people were tested and 60 found positive.  So I am willing to bet that it had gone to the next generation given the almost 3 weeks duration. 

What does it all mean for you and me?

• Contrary to what I said yesterday, the % of cases from workplaces will become bigger as more people go back to work.  

• Our contact tracing and isolating the PUI among the foreign workers is still bad (Look at Pedas)

The fact that the majority of the cases in both "spike days" are foreign workers does not really help as they are probably working with Malaysians and you can imagine how the infection will spread if not nipped in the bud.

But I think we are far away from reverting to another round of MCO as the work clusters seemed containable – yes, more will probably get infected but I will be surprised if MOH has not identified and isolated all those connected to the infected.  They may be foreign workers but I am confident the employers have better records to help contact tracing that those who had organized public events in the past.

I have received several articles on contact tracing and sad to say that after reading them, I have to conclude that this is the weakest link in the Malaysian arsenal.  It is bad because I have not seen our ministers or MOH talking about contact tracing – I am sure the political leaders would have made a big announcement if this was something to be proud off.  

I have seen briefings about our testing and our treatment capacity, but I have yet to see any MOH statistics on our contact tracing team or resources.   If we follow New York state contact tracing guidelines for opening, Malaysia will require about 10,000 contact tracers!  I am sure we don't have anywhere near this number

And don’t talk about contact tracing apps.  I am still trying to get my MyTrace to work.  Looking at what is happening to contact tracing apps in Malaysia, I think we are going to enter the Guinness Book of Records as the country with the most contact tracing app. 

• First, the Federal govt has not got its act together with MyTrace, MySejahtera and Gerak Malaysia.  I think it is one app for each component party of the PN government!!  

• Then we have each state trying to do its own. There is PgCare from Penang, SabahTrace, SeLangkah from Selangor,  KLStep for Kuala Lumpur, COVIDTrace and QMUNITY both from Sarawak (why 2?).  I suspect the only reason why Kedah, Perak and Malacca have not come out with their own contact tracing app is due to the political in-fighting over who governs the various states!!!

• Finally, the private sector has its own as well eg LYC Healthcare, Covid19-MY by Scicom, CovCT by Madison Technologies, MyEGuard by MyEG (but deployed in the Philippines).  I stopped searching after this, but I won't be surprised that if I had continued searching, I will find a few more. 

If we fail to enter the Guinness Book of Records for the country with the most contact tracing apps, it is because they are still waiting for Perlis (with only 18 cases all in) to come up with its own contact tracing app!!

FYI, I went to 1Utama mall yesterday and failed to get my mobile to read the QR code at the mall entrance.  So I ended up with manual recording.  Then every outlet in the mall required me to register by scanning the QR code before being allowed to go in.  But from what I could see, most of the visitors are like me resorting to pen and paper.  We are Digital Malaysia relying on pen and paper for contact tracing.  I guess it is better than nothing.  

The other thing I noticed is that the thermometer supplier must have made a killing.  Not only was my temperature taken at the entrance to the mall, but another round of temperature was taken at the entrance of almost every outlet in the mall.  My temperature was even taken when I bought a take-away kebab from one eatery.

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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. 

Many Covid 19 cases one day, then very few the next day - welcome to the New Normal

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We had 10 cases yesterday with the media headlining this as the lowest since Mac 12. Compare this with the 187 cases two days ago or the 172 cases three days ago.  If you accept that Covid 19 will have its black swan events, low daily cases are not something to shout about. 

We are not the only one with a sudden jump in cases as South Korea yesterday reported its biggest daily increase in 55 days with 79 new infections. South Korean health officials have warned that with the resurgence it is getting harder to track the cases.

I think we are better off than South Korea in that we can trace the source of the jump.  More importantly, the jump has not invalidated the reason for the opening of the economy. 

For those of you who have forgotten, the rationale cited by PM for relaxing the MCO was because we have met the 6 WHO guidelines for opening. I re-checked these WHO guidelines (refer to 5 May posting Boo to those saying we are opening up too early ) as per below to see whether we can still meet it despite the 335 cases from the detainee cluster.  Judge for yourself. 

• transmission under control - it does not mean zero cases but rather that it is manageable.
• healthcare system able to detect, test, isolate and treat every case and trace every contact - I think we have achieved this although I question the speed.
• hotspots risks are minimized e.g. nursing homes - ok we missed the detention centres, but we covered the old folks home 
• schools, workplaces and other essential places have established preventive measures - there are SOP but the concern is compliance
• risk of importing new cases can be managed - we have a mandatory quarantine
• communities are fully educated, engaged and empowered to live under a new normal - I have seen lots of ad on TV and of course we have the daily MOH briefings

We still pass.  

If there is any point that is a grey area, I think it is the last one as we seem to have political and other thought leader making a statement that doesn’t make sense in the light of a new normal:

• Malaysiakini had the PAS information chief saying that the move to deport all detainees who have been tested negative is part of a larger effort to save Malaysians from being exposed to the risk of infection – we are infected by those positives and not those who are not sick!

• The Malay Mail had an article where a number of “economic observers” implied that as long as there are still cases in the country, there is the potential of re-imposition of restrictions and this will have a bearing on consumer confidence – the new normal means living with Covid 19 and we cannot make plans assuming that the virus will go away

Any economic activity must be because we have learned to operate with the virus in the background e.g. wear masks, have surged in cases and occasionally some EMCO. Since the bulk of the economic activities are undertaken by those between 20 to 60 years old, these are not in the high-risk group (in terms of mortality).  I am not an economist, but surely many activities could operate on such a basis. 

Actually, the number of cases/clusters that are work-related is still small.  I estimated that based on the total cases as of 27 May

• 5 % are work-related (construction, factory, mall, office)
• 4 % are from the market

The biggest source is attending religious events. 

Economic activity	No of cases	Reference
Religious events	3560	Tabligh, Church
Education	683	Tahfiz
Construction	88	Setia + 2 KL
Factory	161	Pedas
Retail	48	Cheras mall
Misc office	109	Italy, Case 26
Markets	271
Detainee	282	3 centres
Returnees	462
Bal	1955	EMCO,
Total	7619

Source:  A re-casting of MOH info

 

You may argue that we are still in the early days and we will probably have more cases which are work-related. 

However, the other way to look at it is that employers are probably more careful since they can easily be identified and held accountable whereas for infections from residential areas (especially where there are lots of foreign workers), I am not sure who the authorities are going to hold accountable.  If you take this view then there will be more residential clusters than work clusters.

But the takeaway message is that we should continue to ban public gatherings, especially those where there will be difficulty in recording the attendees.  It is not so much only about preventing the transmission, but also the ability to trace all when an infection is detected.

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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. 

 

A 2.7 times increase in Covid 19 cases in MCO Week 10 - a Black Swan

We ended Week 10 of the MCO with 610 cases for the week, significantly higher than those of the past 5 weeks.  As can be seen from the chart, there is a 2.7 times increase in the number of cases for the week compared to those for the week before.  For those of us who have a curve-fitting model, I can tell you that it screws up the model and makes you want to surrender.  Mathematically you can only account for this with a discontinuity – a black swan event.  

How many other black swans are there? 

• Detention centres -  we have 14 detention centres nationwide and 4 temporary ones in Sabah.  The detainee cases so far have been from 3 centres. Then the Padang Besar Immigration, Customs, Quarantine, Security complex was yesterday reported to be temporarily closed after 6 Thai students who passed through the checkpoint were confirmed Covid 19 positive. 

• Prisons - I don’t have current data, but the past 3 yrs prison population is around 60,000 to 70,000 (Source: World Prison Brief website).  I understand MOH is going to conduct tests there.

• Old folks’ home – this should not be a black swan item as MOH has identified 11,100 residents and staff and taken 9,429 samples as of 25 May with 23 positives. 

Of course, we all know why we have this spike in MCO week 10 – it is due to an oversight of not looking into the risk of infections among the detainees.  Since there is a 1 to 2 weeks incubation period, whatever should have been done to mitigate this risk should have been done just at the start of the CMCO.  

But if you will all recall at that juncture, the “expert” comments were about the risk of a third wave from the relaxation of the MCO and people going back to work.  I surely did not see any “expert” opinion about testing the detainees and others in captive situations.

MOH has assured us that this spike is not due to the Raya holidays (this one will come in 2 weeks' time if any) but rather due to those in the detention centres.  Indirectly MOH message is that this will not lead to a re-introduction of stricter measures i.e. another MCO.

I don’t often accept what MOH said, but this time I agree.  It is not time yet for another panic buying.

I think it is worthwhile reminding ourselves why we went into MCO in the first place – this was due to the confluence of three items:

• The Tabligh cluster where with 16,000 participants who dispersed all over the country, MOH had contact tracing problems.  To its credit, it realized that it could not isolate the attendees and their contacts in time to prevent an exponential growth

• The fear of an infection wave from those coming back from going overseas to Korea, Hong Kong, Italy during the March school holidays.  MOH cited a case where one ministry had 8,000 approved leave. OK, this did not materialize but we couldn’t have known it then.

• We were still scaling up our medical capacity then

I am very sure you will all agree that we don’t have such intersecting situation currently as

• The detainees are mainly in “captivity”.  Even the MAEPS centre that has been turned into a treatment centre for the detainees have be placed under EMCO-like condition

• There is no unknown wave coming.  Ha! There is speculation but I think nobody takes the Raya cluster seriously enough to have another clampdown before any evidence of such a cluster

• Finally, our medical system to treat Covid 19 patients currently has lots of unused capacity. 

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Remember the testing mysteries I had on my previous postings?  I think I have some plausible answers.

25 May. (Refer to Has all the additional Covid 19 testing capacity gone into testing for new cases? NO)  I found that only about 1/3 if the testing capacity was for testing for daily new cases.  So where has all the balance capacity been deployed?  I had offered one possible answer then i.e. for re-testing those under quarantine, but this could not account for all the balance.

Then I saw a MOH Facebook posting on 26 May which said that its maximum test capacity was 27,667 and that the day before it had conducted 15,083 samples (55% equivalent).  It occurred to me that maybe not all the testing capacity has been deployed.  You can imagine this being possible given the targeted testing programme i.e. if most of the members of the targeted groups have been tested, the staff on the ground may not know who else to test resulting in unused capacity.  I hope this is not the case as it would be a waste.

 

15 and 16 May.  (Refer to Hey, Where Did The Malaysian Test Numbers Data Go ? and The Continued "Mystery" Of Malaysia's Missing Testing Data PLUS...An Open Question To Any Epidemiologists Out There... ) I noticed that the cumulative number of tests reported by Worldodometer remained unchanged from 11 to 14 May at 271,721 tests.  Then on 15 May, there was a jump in the cumulative number to 424,306 which was equivalent to an increase of 152,582 tests for the 4 days period.  It was an anomaly then, but I now have the answer. 

According to MOH, the lab data from all sources – MOH, universities, MOSTI, army and the private sector – have been streamlined using a Public Health Lab Info System (SIMKA) causing a jump in the number of tests for 15 May.  It makes you wonder about the accuracy/reliability of the data before this date.  I hoped the authorities did not rely on these data alone to make policy decisions.  Could this be why we had conflicts about allowing the barbers and salons to open? 

 

Moral of the story – data-based analyses don’t lie unless of course there is an error in the analyses.

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Be fearless to get more to Stay Safe, Share this Blog

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. 

 

Covid 19 - Look who is pointing at the foreign workers

On Mon, NST had the headline “Malaysia’s health chief warns against discrimination of migrant workers amid coronavirus outbreak at detention centres”. 

This actually an ironic headline because MOH provides specific information (almost daily currently) on the number of cases from the foreign workers' community whereas it does not do so by race when it comes to Malaysian cases. 

There are actually no public/media reports by ethnicity when it comes to Malaysian cases.  Rather and even before the foreign workers became a news piece, MOH reported the incidents by clusters and by districts. 

From the risk mitigation perspective, this is the correct way to inform the public.  We all want to know where to avoid going and what sort of events to avoid.  I don’t see how knowing how many foreign workers are infected is going to help the general public as we come into contact with foreign workers in our daily lives. 

As a simple case in point, many of us have foreign domestic help.  When the MCO ends and they can go out on their off days, are we going to say that they cannot get in touch with their country-person or other foreigners?  Or should we follow Singapore where according to the government, the domestic help should still stay at home on their rest days even after the lockdown is relaxed?

So, if the government is concerned about this discrimination of the foreign workers, MOH should stop this foreign-local reporting and focus on clusters and/or location. 

Now that the number of daily cases has been brought down to a manageable number of daily cases, MOH should see how cluster information can be released earlier.  Cluster classification is of course related to contact tracing work and so how fast new clusters are identified provides a clue on how well we are doing in contact tracing.  Since I don’t have any further data on this on top of what I have covered in my last Sunday posting Have we improved contact tracing, I won’t belabour the point.

When I talk about “manageable” numbers above, my reference is not that we want to manage the number of cases to zero.  Rather as Covid 19 is a long-term problem, I see “manageable” from 2 perspectives

• In the context of clusters, we would want MOH to keep the total number of cases to be within 1 to 2 generations.  I think we are reaching this performance level as per my last Sunday posting.  Of course, we have to accept that given our targeted testing protocol, by the time the index case(s) are detected, the infection would have spread. So, we rely on our contact tracing system to catch them all before they lead to any exponential growth.  In other words, expect cases from such clusters but there is no need to be alarmed.  

• In the context of sporadic or non-community spread (i.e. we don’t know where or who the source of infection), if we keep such cases to 25 – 30 daily cases, based on the MOH model we can avoid an exponential growth. (Refer to my 14 May posting The tricky business of estimating a reliable RO Reproduction Number ).  How are we doing on this front?  As can be seen from the chart below, we are operating below the critical level with an average14 new daily cases for the past 11 days. (Refer to my posting of 8 Are we tracking the right things and 14 May for the number of cases for the earlier periods)

Note:

a) Derived by deducting total cases from those reported for clusters and returnees.

b) For 22 May, there was zero case due to this community/sporadic spread. 

So, on both the cluster and community spread fronts the data suggests the Covid 19 cases are   “manageable”.

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Be fearless to get more to Stay Safe, Share this Blog

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. 

Is the Detainee cluster another Tabligh cluster?

I started my Covid 19 daily analysis sometime in March 2020 in an attempt to understand what was happening in Malaysia vis-à-vis how we are tackling the virus.  

Actually, it began when I watched the MOH briefing on what was happening particularly to the Sri Petaling event. I noticed that the reporters present did not ask pointed questions when I specifically had 2 in mind:

• Is the government testing the people who have come into contact with those who have been infected recently e.g. the Tabligh group? 
• Does the government have a Covid 19 infection model. If yes, what is the model projecting for the number of cases by the end of Mac.

After feeling that no one seemed to care about asking such questions, I figured that I better analyze the situation myself.  

I also shared my analysis with my former upper secondary school mates hoping that those with the medical or pharmaceutical background could provide some insights.  A couple of weeks ago, my son suggested that I should have a blog for these daily comments.  I laughed at the idea then cos I said that the posting would end soon as there would not be anything to cover once we won the Covid 19 battle.  Of course like all children, he did not listen to me and started to transfer those in May into blog postings.

Now I think I am wrong as it looks as Covid 19 would be with us for a much longer time.  I wake up every day to read about new issues and see more uninformative news reports.

We currently have a new cluster from those foreign workers under detention that saw a very significant spike yesterday. 

May            No of new daily cases

21                     34

22                     27

23                     21

24                     33

25                   112

On one hand, we have the NGO saying “I told you so” regarding the risk of infection by having the detainees be kept in a place where social distancing is difficult.  In return, we have MOH saying that those infected or at least the first batch were from those detained pre-MCO.

Since the signs of infection do not manifest immediately, the “I told you so” may not be supported by the data.  Then the mystery is how those detained pre-MCO managed to get infected since they could go out of the centre. One theory by MOH is that they were infected by the staff.  We will have to wait for more statements from MOH before we can get the true story.

With such a spike in the number of daily cases, the question is whether we are seeing another Tabligh cluster.  The chart below compared the growth in the number of cases within the first 5 days of both clusters.  You can draw your own conclusion about the pace of change.

Note:  The Tabligh event was in the early days of our virus experience so the daily number of cases due to the cluster was not reported daily. I had to triangulate it from several news sources and as such the daily figures may not be precise although the cumulative figures are more accurate.

There are of course fundamental differences between the Detainee cluster and the Tabligh one

• The Tabligh cluster resulted from the people attending the event in Sri Petaling.  They all disperse after the event and there was difficulty in contact tracing them.  On the other hand, the detainees are all confined to their respective detention centre making it easy to test all of them quickly.

• While only about 16,000 attended the Sri Petaling event, eventually MOH screened 41,200 people resulting in a ratio of 1 : 2.6 for the index population to final cluster screened size  Although the event was held at the end of Feb, there were even 8 new cases from this cluster on 25 May.  On the other hand, we would expect the final number of people in the Detainee cluster to be screened to be slightly higher than the original population size

As of yesterday, there are 4,742 people including staff from the 3 detention centres who have been tested with 227 positive cases to-date as can be seen from the table below.

Detention centre	Total tested	No positives	Positivity rate (d)	No waiting results
Bukit Jalil	1536 (a)	126	19.7 %	896
Semenyih	1,757 (b)	66  (c)	8.1 %	938
Sepang	1,449	36	6.3	873
Total	4,742	228 (e)	9.9%	2,704

Notes

a) 1,422 detainees, 114 staff

b) 1,630 detainees, 127 staff

c) 1 admin staff tested positive yesterday

d) No of positives divided by No tested (ie positives + negatives)

e) There is a discrepancy between the details provided ie 228 cases in total with the 227 total cases cited by MOH

MOH has warned that this is not the end of the number of infections among this cluster as there are 2,704 cases pending the test results. 

I estimated that the number of potential cases could vary from 267 to 291 cases depending on the assumptions made on the positivity rates (the former is based on the overall positivity rate while the latter is based on the rates of the individual centre). 

So expect high numbers for the next few days.  The unknown is whether there will be more detainees but this a question for the immigration dept rather than MOH.

I am not a public health staff nor am I associated with any NGO.  My concern is the risk to the community at large.  I don’t think the general public is going to visit the detention centre and hence there is no risk from this manner of transmission.  This is what MOH said as well.  Of course, the sick will be hospitalized and thus use the Malaysian medical resources but this is another story.

The only risk I see is those Malaysians whose work will require them to be in these detention centres.  They may then get infected (Index case DC) and then be a source of infection to the other Malaysians.

But as I have said in my 6 May posting,(Where does risk of infection comes from) the risk comes from 3 contagious groups:

a)      Those who don’t know they are sick ie the asymptomatic cases

b)      Those who don’t yet that they are going to fall sick ie those at the incubation stage

c)      Those who don’t care that they are sick i.e. afraid to seek treatment 

I think we can rule out the transmission due to (c) from any Index Case DC.  What about from sources of transmission from (a) and (b) then?

MOH is already testing all staff in the detention centres and I think they should also test and have other measures for all visitors to the detention centres.  If this is done, we will be able to catch the asymptomatic and those at the incubation stage. 

If we have bad luck, maybe some of the Index DC cases may pass the virus to their contacts before they are tested positive meaning there will be some spread but then our contact tracing protocol should kick in to control the spread.

Conclusion

1) The Detention cluster is going to be more limited in terms of index population to the final cluster size compared to the Tabligh cluster.  OK if you are a pessimist you can argue that there will be more foreign workers to be detained in the coming weeks and they could be potential new cases.  However,  it has been reported that the MAEPS in Serdang will be turned into a quarantine and treatment centre of the undocumented migrants so this could isolate those infected from new detainees. 

2) If I was to guess, I would say that the final Detainee cluster would be about 500 to 600 cases. Definitely not another Tabligh

3) It may be simplistic, but the main risk of spreading is some Malaysians being caught up as part of the Detention centre cluster.  If I want to be facetious, if you want to avoid risk you should avoid contact with any immigration staff or MOH staff assigned to the detention centres for the next couple of weeks.

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Be fearless to get more to Stay Safe, Share this Blog

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.