Thread by @mohdhelmi

CMCO - of CLUSTERS, MITIGATION, CONTAINMENT and OBSERVATION

There's a loss of context when we treat cases numbers like a scoreboard. For numbers to be comparable, it must be standardized by rate, say per 10k population. Even this doesn't paint the whole picture.

- a thread ...

CLUSTERS - popular and have fancy name, carry different community transmission risk based on context. One that happens in a detention centre (is unfortunate still) carry less risk than one that happens within a community.

In Klang Valley we have 44 active clusters at d moment.

Mostly cluster-in-community it seems....sigh...

But clusters are limited to certain districts only.

But we can be relieved (at least ) that most of these clusters doesn't see any significant growth after its initial discovery. Below is a video of growth rate over time (bit technical)

SPORADIC - these are riskier when we consider community transmission. Its a random discovery of cases in a given community. Could be a tip of an iceberg. An important parameter when considering lockdown. How does our cluster vs non cluster look like in Klang valley ?

Not so good la..4984 active sporadic cases. Means for each of those case we need to Contact Trace, Test & isolate (in detail, but timely). Do we have enough resource to do that against the time ? The last reported National Rt is 1.2.Each of the 4984 can infect another 1.2 person.

Can the current CMCO stop sporadic case growth? Over the last few days of CMCO, sporadic cases count keeps growing in proportion.

And then there's the question...where are the sporadic cases? How to identify community risk if we don't have a place marker?

We now face the reality check of our end-goal for this CMCO.

Are we looking for CONTAINMENT (bring cases number close to none) or MITIGATION (co-exist with the virus at more sensible number, while managing the risk) ?

If it's CONTAINMENT - have to lockdown stricter, but more targeted. Need to hire more contact tracer to manage sporadic cases. Its a race against time to outrace virus progression.

If we slow, the number will go up, n by current logic, means another CMCO period.

If it's MITIGATION (we live with the fact that we try to co-exist) we need a more sensible "alert threshold". Need a prevalence survey to know what is the baseline threshold in community. Maybe its 1% in Klang Valley ? - so x sensible to lockdown at arbitrary number of 40.

MITIGATION also requires a sensible, predictable step-up step-down approach to lockdown (Enclosed pic for example). Require a widely accessible testing facility. And welfare to support ppl under quarantine. Otherwise we can still breach the "baseline threshold"

Hard for this CMCO to produce MCO-like result for containment (i.e. single/double digit prior to 27 sept). Not with the latest cases numbers, the high sporadic proportion, and the limited Contact Tracer we have on d ground. We cant outrace the transmission fast enough.

This is not a call to throw the towel for CONTAINMENT and CONTROL. But a reality check on our goal and strategy.

Different goal has different parameter and hence different strategy.

What is the goal of this CMCO? And what additional strategies are put in place to achieve it?

Disclaimer: This is my personal academic deliberation of public health. May/may not represent any organization I am affiliated with. Will appreciate a data-guided exchange, and intellectual discourse. Pls no haters or attack on credentials or personality. I'm bad in tit-for-tat.

a predictable guide vs an ad-hoc SOP will probably benefit everyone.

Didn't realize this gonna create a lot of tractions 😅.

Can I humbly invite everyone interested to hear of a Malaysian work in Digital Epidemiology, featured in Harvard-Global Health DASH Forum this coming Thursday.

Links below for registration :

https://twitter.com/DASHglobalAI/status/1320784100245049344