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LETTERS: As we individually emerge from Conditional Movement Control Order (CMCO) hibernation, we have all been reminded to consider how we as citizens will live in this new normal.

Countries which initially thought they had achieved control have very quickly faced a resurgence as people started returning to old routines and a few thoughtless individuals lost sight of their earlier concern towards their fellow citizens.

More important than ever, the standard of public hygiene must be raised higher, encouraged and enforced by the authorities, from the Ministry of Health to the council enforcement officer.

In Malaysia, we have always been proud of our hawker and street food culture.

Some have even posited that a little bit of roadside dirt is what makes our hawker offerings special.

Our love for tasty food is so great that hundreds continued to break the Movement Control Order (MCO) rule for days after it came into force, thereby endangering our country, just to satisfy that urge for nasi lemak or char koay teow.

Covid-19 has and will continue to force us to reevaluate our passion for food and the dangers of poor hygiene.

We can no longer afford to allow vendors and their workers with low health literacy to carelessly handle dishes and utensils which are shared by hundreds in the community.

In the past, poor food practices meant that the worst consumers had to suffer was diarrhoea.

Now, it will only take one infected stall owner or server to spread illness, suffering and death to hundreds, then to thousands, in a matter of days.

The SARS-Cov-2 virus can be found in saliva, tears and faecal matter.

Have you ever wondered what facility is available to the roadside chef and server after they attend to a call of nature before the busy lunch hour in sweltering heat?

The virus can be found on plastic, glass and steel surfaces: the very materials that define all the forks, spoons, chopsticks, cups and plates in Malaysian eateries.

It is not destroyed just by wiping with a wet rag, that time-honoured action which we see repeated in roadside stalls through to coffee shops.

Authorities and organisations must step up to ensure food is served only in spaces with proper water and sanitation.

Sinks, clean water, detergents and soap must be readily available to all food preparers, vendors and servers.

Places without these basic requirements should not be allowed to operate. To turn a blind eye to these now critical requirements is tantamount to aiding and abetting the spread of disease.

If we survive this pandemic, let us not allow the diligence and awareness created during the MCO to be undone by a return to old habits and old ways of doing things.

Covid-19, our unwelcome guest, will be joining us at every “makan-makan”.

by K. Tan.

Read more @ https://www.nst.com.my/opinion/letters/2020/05/595322/need-vigilance-food-stalls-prevent-virus-flare

LETTERS: WITH the current pandemic swirling around us, most Malaysians now wear a face mask when they go out. In fact, it has become a must-have item.

What is worrisome is that millions of these used face masks are being discarded indiscriminately.

I have seen face masks strewn on pavements, in drains and on escalators. Even our beaches are not spared.

Besides being an eyesore, used face masks pose a public health risk.

As they may carry the Covid-19 virus, they should not be randomly discarded as normal waste.

Think about it: should a contaminated face mask be discarded inside a confined space such as an elevator, it will pose a threat to those using it.

Unfortunately, not many consider the face mask a hazardous waste and hence pay little attention after its use.

Face masks used by health frontliners and patients are treated as medical waste (and disposed of accordingly to strict rules). However, the same cannot be said of face masks worn by the general public.

The standard practice upon reaching home is for us to quickly remove our face masks and throw them into the trash bin.

These face masks are not separated but instead dumped into the same bin together with other household trash.

What if one member of the family is asymptomatic? What is the way forward? Here are some suggestions.

1. All Malaysians must exercise care in the disposal of used face masks to protect fellow Malaysians and the environment.

2. The authorities should heighten awareness on the correct way to dispose of used face masks. For instance, folding and then wrapping the face mask into a plastic bag before throwing them away so that it is not exposed to the air.

3. Issue reminders. There should be posters and advertisements to remind the public of the need to dispose of used face masks safely.

4. Recycle. The authorities should inform the public on where to send used face masks for recycling, if this is even possible.

5. Legislate. A law can be enacted to impose heavy penalties on those who do not dispose of used face masks properly.

Special dedicated face mask bins should be placed at public places, for instance train stations, supermarkets, shopping malls, schools and government departments frequented by the public.

All offices, businesses, apartments and condominiums should have these special bins too.

Over time, if this matter is not given the attention it deserves, we can expect a huge quantity of hazardous waste and source of contamination in our midst.

We have convinced most Malaysian to wear face masks when they are in public places. Let’s go one step further by instilling in them the importance of disposing of used face masks in a responsible manner.

by POLA SINGH,

Read more @ https://www.nst.com.my/opinion/letters/2020/05/594780/public-health-risk-discarded-face-masks

WHILE standing in a long queue to enter a supermarket, the man behind me was grumbling because of the physical distancing rule, among the movement control measures to curb Covid-19.

“This will not end until we have a vaccine”, he voiced out. He sounded like Bill Gates, who said things will remain this way “until we vaccinate the entire world population”.

Perhaps most of us have the same feeling – we need a vaccine. And that is the hope to bring an end to lockdown. Back in my mind, I was wondering, will a vaccine really make all of us safe?

We have had quite a number of vaccines that prevented many diseases. Otherwise, we would have to continue to face measles, mumps, rubella, diphtheria, and many other deadly infectious diseases. Yet here we are with a dire need of another vaccine against a novel coronavirus.

Hopefully, we shall have one soon. And that will boost our confidence to go back to our old normal. What did we have in that old normal?

According to the Department of Statistics Malaysia, in the year 2018, the top five deadly cause of death are ischaemic heart diseases (15.6 percent), pneumonia (11.8 percent), cerebrovascular diseases (7.8 percent), road accidents (3.7 percent), and chronic lower respiratory diseases (2.6 percent).

A total of 18,267 people in Malaysia died from ischaemic heart disease only in 2018, averaging 50 deaths a day.

According to a recent report from World Health Organisation, more than 60 percent of male and female Malaysians are obese or overweight. The prevalence of diabetes among adults aged 18 years and above crossed 17 percent in 2015. The prevalence of hypertension remains high at around 30 percent, while more than 50 percent of diabetes or hypertension remain undiagnosed.

The numbers of mortality and morbidity paint quite a picture of the total noncommunicable diseases (NCD) in our old normal. Clearly, the scenario is more complicated and fearsome compared to the efforts to overcome Covid-19.

The global scenario is not any better than this. To control those morbidity and mortality levels, we do not require any novel vaccine or drug but personal care for a healthy lifestyle.

Healthy living does not necessarily mean depending on sophisticated health care facilities with a supply of medicines and vaccines.

The biggest chunk of the government health budget is spent to treat sickness of the citizens.

Based on a Malaysian National Health Accounts (MNHA) Health Expenditure report, the total health expenditure in 2014 was RM49.7 billion. In fact, the Government spent RM7.4 billion in 2017 just to treat smoking-related illnesses.

In one hand, we have proven our determination and resilience to control Covid-19. On the other, we have the forever increasing government expenditure for treatment following the steadily increasing morbidity and mortality for NCD that has been part and parcel of our old normal.

It might be good to remind ourselves that more than 70 percent Covid-19 deaths in Malaysia are associated with NCD comorbidities. According to a study published in the Journal of American Medical Association in April 2020, hypertension, obesity, and diabetes were found to be the most common comorbidities among hospitalised Covid-19 patients in New York.

After this unprecedented experience with Covid-19, we might want to revisit our sincerity and effort to address the major health concerns in our old normal. Certainly, we want to end this new normal but should not preserve our old normal either. Better to observe the golden proverb – “prevention is better than cure”.

If we don’t fall sick, we are more productive to have an accomplished life and livelihood. All it needs is our sincerity to adopt a healthy lifestyle by maintaining personal hygiene, physical exercise such as a walk of 30 min; as well as by avoiding excessive junk food, sugar-rich drinks, smoking, being in air-conditioned rooms 24/7, and irregular sleep cycle.

It is also important to avoid over-the-counter medicines such as paracetamol, promethazine, and antacids without a genuine need.

Taking those medicines might give temporary relief, but often our “hyper” dependency on those medicines weaken our immune system and make us sick in the long run.

With a decreasing trend of our immunity, one or another novel drug or vaccine will not guarantee our health. We must prioritize to strengthen our natural immunity while making our dependency on the healthcare facilities as a secondary option.

By Dr. Mohammad Tariqur Rahman.

Read more @ https://www.nst.com.my/opinion/columnists/2020/05/593754/strengthened-immunity-secret-healthy-living

THE world is collectively holding its breath for the Covid-19 vaccine.

It is estimated that 85 to 90 per cent of the population will need to be vaccinated in order for us to break free from the pandemic and for normal life to resume. Progress on the development of a vaccine has been encouraging.

According to the Coalition for Epidemic Preparedness Innovations (CEPI), there are 73 vaccine candidates that are being explored, while 5 have already entered clinical trials.

While it is true that a vaccine cannot come soon enough, it is also vital that Malaysia spends this time preparing for the mass vaccination of the public when a vaccine becomes available.

To do so, Malaysia has to ensure that the vaccine is available, accessible, and does not fall victim to misinformation.

Malaysia has to first ensure that it can secure a sufficient supply of the vaccine. There is a legitimate concern that Covid-19 vaccines may go to the highest bidder unless sufficient global diplomatic and advocacy efforts are made to ensure that the vaccines are equally distributed to all.

Malaysia needs to work with other low- and middle-income countries to ensure that firm rules are being set around the intellectual property rights, pricing, supply, and manufacturing of the vaccine that promotes international collaboration rather than nationalistic competition.

These efforts will also be important to ensure that the vaccine will be affordable enough for the Malaysian government to secure a sufficient supply for all 32 million of us.

In the longer term, Malaysia will also have to consider mobilising its local drug manufacturing capabilities through public-private partnerships to produce affordable vaccines.

It is important that the intellectual property rules for Covid-19 vaccines facilitate, rather than prevent this.

Malaysia also needs to lay the groundwork to ensure the public’s ability to access the vaccine. There are two aspects to accessibility that we have to prepare for.

The first is logistics. Public healthcare officials need to learn from the challenges involved with conducting screening tests and the distribution of masks to the public in order to develop a strategy for the mass vaccination of the population.

Partnerships with the private healthcare sector, especially primary care clinics and pharmacies, will be vital to ensure a comprehensive coverage of the entire Malaysian population.

Community-based and mobile healthcare providers should also be engaged to reach people who are unable to easily leave their homes. If there aren’t enough doses immediately available for the entire population, then a plan needs to be developed to identify and prioritize those most in need.

The second aspect to accessibility is the affordability. The vaccine must be free to the public. The cost of vaccinating the entire population must be considered by the Malaysian government as a prerequisite investment to restart the economy and to protect public health.

A public-private partnership also needs to be worked out where the vaccine can be provided to the public for free, with only minimal costs of administration and logistics to be borne by the government.

It is important that the vaccine is free and that the cost of getting vaccinated as close to zero as possible. Any cost associated with the vaccine creates a barrier among those who are most vulnerable.

Any profiteering of the vaccine will not only be morally wrong but will also create a point of misinformation to be used by anti-vaccination groups.

Lastly, we need to ensure that the vaccine and our vaccination efforts do not fall victim to misinformation. There is no assurance that the public will unanimously accept a Covid-19 vaccine when one is available.

There will likely be concerns about its origins, safety and side effects especially among those with children, as well as the halal status of the vaccine and its components.

There may also be concerns about whether the vaccine was rushed through safety regulations and checks due to the global pressure for it.

The government, healthcare organizations, and all healthcare professionals will need to actively address these concerns and dispel any misinformation that may give rise to anti-vaccine sentiments.

The valiant efforts of our healthcare workers and the sacrifice of the public have bought us time to work on these issues. But, we cannot wait. Having a vaccine will not be enough. Only the successful vaccination of the population will allow us to emerge victorious.

By Dr Mark Cheong.

Read more @ https://www.nst.com.my/opinion/columnists/2020/05/593756/covid-19-successful-vaccination-key-victory

LETTERS: The recent Covid-19 pandemic has undoubtedly changed the face of our healthcare system. Normally, a patient with non-communicable diseases (NCD) such as diabetes, high cholesterol and high blood pressure (BP) or hypertension would have regular follow-up and be given appropriate appointments at a nearby health facility for monitoring.

However, due to recent development, many patients’ appointment have been postponed.

The aim of the postponement, or to allow just brief visits to top-up medication, is aimed at limiting the exposure of high-risk patients to Covid-19 at healthcare facilities.

There is so far no evidence of hypertension and its association with increased risk of contracting Covid-19.

However, having the disease, especially if not controlled, poses a threat. This has been proven true due to increased heart toxicity.

Hence, controlling the blood pressure is essential. One of the many challenges would be having access to routine healthcare treatment that one needs, especially during the Movement Control Order (MCO).

Taking control of your blood pressure (BP) at home is not difficult. It just needs a little discipline and some knowledge of the condition.

Normal blood pressure is around 120/70mmHg, and to be diagnosed with hypertension, blood pressure needs to be 140/90mmHg or higher on repeated measurements at least on two separate occasions.

The target BP for someone diagnosed with hypertension is generally below 140/90mmHg. Blood pressure monitoring can be done at home. Electronic blood pressure machines are affordable and relatively easy to use and store.

When measuring the blood pressure, be sure that the measurement is taken in a quiet room and the person is seated for at least one minute. The back should be supported (sitting on a chair with a back) and arms should be on the table.

It is also important that none of the following activities– smoking, taking caffeine, eating or exercising– are done 30 minutes before taking blood pressure.

Legs should be uncrossed and there should be no talking during measurement. The timing should ideally be around the same time each day, once in the morning before taking medication and breakfast, and once at night before meals.

Two readings should be taken each time, one minute apart. The readings should be stored in a log or in the machine’s own memory for the physician review.

Ideally, this should be done accurately especially one week before your appointment.

At home the target levels are a bit lower than in the clinic. Normally, the target at home would be below 135/85mmHg.

Blood pressure may also be monitored from time to time to monitor the BP control, perhaps once ot twice a week.

If the BP level is higher than the predetermined target, this means the blood pressure control is not optimal and this increases the risk of heart attack or stroke.

What is most worrying is when the blood pressure is 180/90mmHg or higher. This is termed uncontrolled severe hypertension. If there are symptoms such as chest pain, difficulty in breathing or altered consciousness, help from a healthcare provider should be sought immediately.

If these symptoms are absent and reading is at this level, a repeat measurement should be done in 5 minutes.

If the reading is the same or higher, head to a healthcare facility immediately.

If there are chest pain, difficulty in breathing or altered consciousness, medical help should be sought immediately, regardless of the BP.

There are many methods to control BP. The most important method is adhering to follow-up and medication, and leading a healthy lifestyle.

Self-monitoring your blood pressure will motivate one to keep the BP in control and also assist doctors in deciding on treatment.

What is important is having a good quality of life and it may be achieved by taking good control of one’s health.

by DR. ANEESA ABDUL RASHID AND DR. NAVIN KUMAR DEVARAJ.

Read more @ https://www.nst.com.my/opinion/letters/2020/05/593570/control-blood-pressure-home

A HEALTH crisis of epic proportion, the Covid-19 pandemic has caused 191 countries to close down all their primary and secondary schools and led to an uneven shift to online learning, according to McKinsey & Company’s ‘School-system Priorities in the Age of Coronavirus’ report.

In Malaysia, the lack of Internet connectivity and ICT infrastructure in remote locations are the main causes of the uneven shift to online learning among urban and rural students, said Sarawak Teachers’ Union (STU) vice-president Adam Prakash Abdullah.

Even before the movement control order (MCO) was in place, there was already a vast gap between the rural and urban schools in terms of student and parent background, teacher qualification and infrastructure, he said, lamenting how aid packages rolled out during the MCO have bypassed dilapidated schools in remote areas.

While the absence of a risk management analysis in the past meant that problems that could paralyse the school system were not anticipated, this pandemic presents an opportunity for us to troubleshoot and start reform efforts to improve the system, he said.

“The Education Ministry and all relevant parties should come up with an inclusive post-Covid-19 action plan that can be effectively implemented even in rural schools.

“Such a plan must include lesson preparations through various modes including print, audio, video and web, so that we will not be blindsided should another crisis occur.

Meanwhile, immediate remedial actions should be in place to revise lessons carried out during the MCO.”Universiti Malaya (UM) Faculty of Education dean Prof Dr Rohaida Mohd Saat said poor Internet connectivity and access to devices hindered the learning process for poor students.

Some households still can’t afford devices for their children despite the government providing tax relief and loans for computing and electronic devices.

“Sharing limited devices will affect a child’s online lesson.

The government could introduce new initiatives such as reducing import taxes on computing devices and capping their prices.

Get companies to sponsor devices for needy families and provide funding for research institutes to develop affordable devices, ” she said, adding that UM has sponsored Internet packages to over 2,000 students.

Prof Rohaida said the education sector – particularly primary and secondary schools – can learn from the pandemic by identifying what needs urgent attention.

Strategic planning, she said, must be immediately carried out to address pressing matters faced by students and teachers so that everyone is prepared to face another crisis if it happens.

“Set up comprehensive standard operating procedures (SOP) and set up an education crisis management body, ” she said.

Addressing the digital divide should be the top priority as it is a first step towards improving the education system post Covid-19, said Universiti Sains Malaysia (USM) acting deputy vice-chancellor (academic and international) Prof Datuk Dr Ahmad Farhan Mohd Sadullah.

“With or without the pandemic, the entire nation should have access to telco networks to at least enjoy sufficient Internet accessibility for learning.

It’s not wise to dream of 5G connection in urban areas when the majority of rural areas have ‘0G’.

Every school and village must be able to have at least a focus area for Internet connection.

”Online learning can happen inclusively when telco networks are available throughout the country, he said, adding that teaching plans for audiences with low bandwidth should be considered.

“For example, USM academic staff were asked to plan lessons for a low bandwidth audience before classes went fully online on April 6.

We achieved a student participation rate of between 85% and 95%, for both synchronous and asynchronous modes in the past four weeks, ” he shared.

By LEE CHONGHU.

Read more @ https://www.thestar.com.my/news/education/2020/05/10/post-mco-strategy-a-mus