Beefing up contact tracing is crucial

The reality is that effective contact tracing, even with the use of apps, has broken down due to the sheer volume of cases


THE Malaysian Medical Association (MMA) has recommended that the Ministry of Health (MoH) revert to its earlier policy of tracing and testing all close contacts possibly exposed to Covid-19, and not only those with symptoms as generally currently practiced.

MMA president Prof Datuk Dr Subramaniam Muniandy said the government should also test the community to monitor community transmissions.

“If they are lacking in resources, private general practitioners (GPs) should be roped in for this.

“There has been a slight improvement with daily cases dropping to below 4,000 of late. However, we should allow time for the Movement Control Order (MCO) to work,” he told The Malaysian Reserve (TMR).

With the country continuing to report four-digit new Covid-19 cases daily, Dr Subramaniam said the infectivity rate or r-naught (RO) should be reduced to MoH’s targeted range of 0.6 before deciding on lifting the MCO.

Globally, contact tracing is being used to limit the spread of all kinds of diseases, not just Covid-19.

Galen Centre for Health and Social Policy CEO Azrul Mohd Khalib said contact tracing is one of the most valuable tools that countries should deploy and use effectively to contain outbreaks.

“But it must be adequately supported and manned. In other countries, additional contact tracers are recruited from the public through volunteers, students, furloughed employees and retirees.

“Apps are supposed to complement, but mySejahtera seems to be not fully utilised for this function and at the moment is more akin to the Foursquare app, rather than an effective tool for contact tracing,” he told TMR.

Contact tracing is part of the wider strategy of find, test, trace, isolate and support approach recommended by the World Health Organisation.

It is intended to find and test hotspots of outbreaks, rapidly isolate confirmed positive cases and quarantine close contacts identified through tracing.

Azrul explained that this strategy only works when people can receive adequate food and financial support.

“Initially, when the cases and clusters were smaller in number, the contact tracing teams were able to cope.

“But now, with the number of daily cases consistently at four digits and active clusters numbering in the hundreds, I suspect that it is beyond their capacity to reasonably and effectively trace all close contacts, isolate and quarantine them. It is practically impossible to break the chain of transmission.”

He said the reality is that effective contact tracing, even with the use of apps, has broken down due to the sheer volume of cases.

“People do not know when they get infected with Covid-19 or delay getting tested. Test results, because of the dependence on polymerase chain reaction testing, are slow to be obtained.

“People are unable to provide all relevant contacts and not all contacts can be reached. The same situation is happening all around the world. Malaysia is not exempted from these challenges.”

Azrul stressed that the benchmark for a successful Covid-19 contact tracing operation is to trace and quarantine 80% of close contacts within three days of a confirmed positive case.

“Very few countries have been able to meet that standard,” he said.

With the rising infection levels, Malaysian Association of Public Health Physicians president Datuk Dr Zainal Ariffin Omar said there is not much improvement on contact tracing.

As contact tracing is among the main challenges faced by MoH frontliners, he suggested for the government to fully use digital apps and mobilise other non-health agencies’ personnel.

“With the nation already battling the Covid-19 pandemic and record-high unemployment, NGOs can play a significant role in contact tracing,” he concluded.

Read our previous report here

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