KUALA LUMPUR - Malaysia's awkward balancing act between "lives and livelihoods" has finally led to a crisis in the healthcare system, as Covid-19 cases hit new highs repeatedly this month.
But the government is refusing to impose a full-scale movement control order (MCO) similar to that which successfully brought daily cases down to single digits a year ago, banking on achieving herd immunity by the end of the year instead of risking economic collapse.
Two weeks ago, it opted for a soft-touch version of the MCO, expecting that the same restrictions in place from January to March would again bring cases below four-digits daily.
But infections and deaths since what has been dubbed "MCO3.0" came in force have repeatedly breached previous peaks, with critical care wards bursting beyond capacity.
The past week has seen a record 362 deaths, nearly the same as the first 11 months of last year, while intensive care unit (ICU) utilisation surged past 90 per cent or more - hitting 113 per cent in the Klang Valley - despite the authorities preparing more beds for worst-hit patients.
The government has responded with a slight tightening of protocols - which some have mockingly dubbed MCO 3.01 - that take effect on Tuesday (May 25), including mandating work-from-home for 80 per cent of the civil service and 40 per cent of the private sector, cutting public transport capacity by half and limiting most retailers to 12 hours of business.
But health experts believe existing restrictions will only be effective with strict enforcement - which is currently lacking going by the evidence of breaches that have gone viral - and, even then, will require a long period to significantly reduce infections.
"The government didn't show determination in reducing private-sector workers from interacting. Most work clusters are from there but only 40 per cent have to work from home," infection biologist Lim Chee Han told The Straits Times.
Mr Lim, who is from Third World Network, an international research and advocacy organisation, also said that reducing the business hours of retailers would be counterproductive as it would lead to a concentration of patrons, while public transport utilisation was already well below 50 per cent hence limiting capacity would have little impact.
Prime Minister Muhyiddin Yassin justified the "softer touch" approach on Sunday.
"Of course, returning to MCO1.0 will be the best (to stop the virus). But the losses were huge, the economy nearly collapsed. The daily cost was RM2.4 billion (S$770 million)," he said in an interview broadcast on national television. "Millions received government aid. If we want to do it again, the RM340 billion we spent won't be sufficient, we may need half a trillion."
The Prime Minister made clear his administration was relying on the national vaccination programme to ensure "the tunnel is not too long".
"I have been assured that we will receive the supply earlier and we may achieve herd immunity before the end of the year. So it will be parallel with our plans for economic recovery and managing Covid," he added.
Analysts by and large agree that current measures have avoided choking the economy with gross domestic product (GDP) growing quarter-on-quarter so far this year. Barclays' regional economist Brian Tan told ST that "with workplaces still allowed to remain open, the cut from the tightened MCO may yet avoid going too deep".
Kenanga Investment head of economic research Wan Suhaimie Saidie said: "We should lock down but given the lack of fiscal room, or at least the government's unwillingness to deepen the deficit that is expected to breach 6 per cent of GDP again this year, it would be catastrophic for low-income groups."
Although fingers have been pointed at numerous rules being broken - especially during the recent Hari Raya Aidilfitri celebrations - analysts have also suggested that the introduction of more virulent strains of the coronavirus are keeping infections high despite stricter regulations in place.
Variants originating from South Africa and India were detected in early March and the current surge in infections began in April, a month which also saw the proportion of severe cases (requiring supplemental oxygen) peak at more than 35 per cent.
"The best strategy to counter the new variants is vaccination," said Malaysian Medical Gazette chief Khoo Yoong Khean, who said a delayed second dose strategy, as that adopted by Singapore, should be employed to "vaccinate as many as they can, as fast as they can".
Speeding up immunisation - which the government has admitted is behind schedule, although the average number of doses being administered has quadrupled in the past week - and ramping up testing would form part of what health experts, including independent policy specialist Khor Swee Kheng, say should be a "long-term pandemic management strategy to avert MCO 4.0 and 5.0".
Another 6,509 Covid-19 patients were recorded on Monday, bringing the total to 518,600 and a new high of 61 deaths brought the number of fatalities to 2,309.