It will likely take months for the Klang Valley to recover amid the surge in Covid-19 infections, sporadic cases and presence of more contagious variants in the community.
An expert said the government needed to maintain stringent movement restrictions with tightened standard operating procedures — coupled with an aggressive find, test, trace, isolate and support system — and accelerate the vaccination drive to bring the numbers down to a manageable level.
Epidemiologist Professor Datuk Dr Awang Bulgiba Awang Mahmud of Universiti Malaya said the deadly Delta variant could become the dominant variant, triggering a new infection wave.
He said the two-week Enhanced Movement Control Order (EMCO) would not be sufficient unless mitigation steps were taken.
"The high test positivity rate (in this region) indicates widespread community transmission and the number of people under the EMCO is large.
"The problem with the so-called 'total lockdown' last month was that it was not total.
"If it was, the incidence rate may have declined by now, but it is still high despite the reduced testing carried out by the authorities," he told the New Sunday Times.
The Science, Technology and Innovation Ministry's Covid-19 Epidemiological Analysis and Strategies Task Force chairman had on May 30 said Malaysia required at least two to three months of "total lockdown" to contain the virus' spread.
Dr Awang Bulgiba said one of the reasons for the surge in unlinked cases in the community was a Health Ministry's directive issued on Jan 13, which said contact tracing should be carried out on only 10 per cent of contacts if there were more than 50 people exposed to a case.
He said this meant that a person would need to undergo quarantine for only 10 days with no second testing.
"Newer variants with an infectious period greater than 10 days would, therefore, be propagated, if persons who still had the virus, but had not been cleared as negative after the 10 days, were free to move about.
"So community transmission continued to increase silently. It was just a matter of time before there were so many unlinked cases that the rise would be picked up."
He said the high 14-day incidence density for Selangor, which has increased from about 80/100,000 population in April to more than 400/100,000 population this month, indicated that contact tracing and mass testing strategies had not been effective.
This, he said, had contributed to a failure in pandemic management as it appeared that the total lockdown has hardly had any effect on this parameter.
He said there was a need to focus on curbing the outbreak in states or federal territories that reported higher 14-day incidence densities than Selangor this month, namely Negri Sembilan, Labuan and Kuala Lumpur.
"But these places have much smaller populations. This fact is lost on people as we are looking at absolute numbers rather than rates.
"The situation in Negri Sembilan is a cause for concern as parts of it are in the Greater Klang Valley area. Economically, it is closely linked to Selangor."
He said movement restrictions would not be effective in the long term if they are not accompanied by a long-term preventive strategy via vaccination.
Therefore, he said, vaccination was the effort that needed to be stepped up, especially in high-risk areas, to ensure eligible and vulnerable persons were inoculated as quickly as possible.
He reminded the authorities of their previous mistakes, amid calls by certain sectors, including the retail sector, to ease restrictions and allow them to reopen.
He believed the Delta and Beta variants had begun to spread in the country.
"There is no doubt that airborne spread is very real in this pandemic.
"It is likely that the Delta variant will displace other variants as has happened in other parts of the world. This is cause for great concern."
Up to June 30, Malaysia had detected 40 Delta variant cases. Up to yesterday, there are 217 cases of variants of concern (VOC) and variants of interest (VOI), 198 of which are VOC and 19 VOI cases.
He said while the Pfizer-
BioNTech and AstraZeneca vaccines were effective against these variants after two doses, a single dose would not offer people optimal protection.
"I have suggested to the government to reduce the dosing interval for the AstraZeneca vaccine to four instead of 12 weeks.
"Although the government has cut the interval to nine weeks, there are other things that need to be considered.
"For example, the heterologous prime-boost approach and our Voluntary Vaccination Registry to monitor the effectiveness of vaccines."
Epidemiologist and biostatistician Professor Dr Jamalludin Ab Rahman from International Islamic University Malaysia said workplace-linked cases in the Klang Valley were dominating and unlinked cases in the community were increasing, indicating an uncontrolled spread of infection.
This, he said, called for a wider coverage and faster vaccination rollout and liberalisation of testing capability.
"The United Kingdom and Israel, for example, vaccinated 10 to 20 per cent of their population in a month. It took Malaysia three months to achieve that.
"That is not really the government's fault due to a limited vaccine supply. But if we are unable to roll out the vaccination programme to everyone in high-risk states, we will not be able to bring the cases down soon.
"In the UK, test kits are sent to those wanting to get tested free of charge. They had been educated on how to test themselves, report and self-quarantine. This should be emulated in Selangor and the Klang Valley.
"Other factors, like when to seek medical help, are crucial to reduce the number of brought-in-dead cases."