Community mitigation strategies such as social distancing, quarantining high-risk individuals, and limiting large gatherings are recommended to slow the spread of COVID-19. The document discusses how respiratory droplets from coughs and sneezes can spread the virus and lead to superspreader events. It also notes the importance of risk factors like age, preexisting conditions, and living conditions in determining outcomes. Caution is urged as restrictions are lifted to avoid a potential second wave or peak in cases.

1. Covid-19 risk
mitigation
Prepared by
Tengku Hanidza Tengku Ismail, PhD

2. 9/6/2020 Covid19 risk mitigate/Tengku Hanidza 2

3. Putting mitigation into practice is based on:
• Emphasizing individual responsibility for
taking recommended personal-level actions
• Empowering businesses, schools, and
community organizations to take
recommended actions, particularly in ways
that protect persons at increased risk of
severe illness
• Focusing on settings that provide critical
infrastructure or services to individuals at
increased risk of severe illness
• Minimizing disruptions to daily life to the
extent possible
9/6/2020 Covid19 risk mitigate/Tengku Hanidza 3

4. Community
Mitigation
Community mitigation
activities are actions that
people and communities
can take to slow the spread
of infectious diseases,
including COVID-19.
Community mitigation is
especially important before
a vaccine or drug becomes
widely available.
9/6/2020
Covid19 risk mitigate/Tengku Hanidza
4

5. 9/6/2020 Covid19 risk mitigate/Tengku Hanidza 5

6. •People with risk factors
may be more likely to
need hospitalization or
intensive care if they
have COVID-19, or they
may be more likely to die
of the infection
•Take extra
precautions to avoid
exposure to the virus
that causes COVID-
19
•Reduce your risk
for severe COVID-
19 illness by
managing any
conditions you
have that are risk
factors
•It is important to learn
about risk factors for
severe COVID-19 illness
because it can help you
Why Risk Factors Matter
Pregnancy
Race/Ethnicity
Gender
Underlying
conditions Use of certain
medications
Poverty Overcrowding
Certain
occupations
Age
9/6/2020 Covid19 risk mitigate/Tengku Hanidza 6

7. COVID-19 Transmission in the air
9/6/2020 Covid19 risk mitigate/Tengku Hanidza 7

8. Covid-19 spread in confined spaces: How 1 person infected 94 co-workers
Attack rate is 43.5%
No evidence of linked to other clusters
Extensive contact tracing, testing all contacts, and early
quarantine blocked further transmission and might be
effective for containing rapid outbreaks in crowded work
settings. Floor plan of the 11th floor of building X, site of a coronavirus disease outbreak, Seoul, South Korea, 2020.
Blue coloring indicates the seating places of persons with confirmed cases.
9/6/2020 Covid19 risk mitigate/Tengku Hanidza 8

9. Covid-19 spread in confined spaces: 1 member
spread to others in the choir group
In a study yesterday in Morbidity and Mortality Weekly
Report (MMWR), researchers describe a COVID-19
super-spreading event at a Washington state choir
practice in March, which was attended by a symptomatic
index patient and produced an attack rate of 53.3% to
86.7%.
"The 2.5-hour singing practice provided several
opportunities for droplet and fomite transmission, including
members sitting close to one another, sharing snacks, and
stacking chairs at the end of the practice," the authors,
from Skagit County Public Health, said. "The act of
singing, itself, might have contributed to transmission
through emission of aerosols, which is affected by
loudness of vocalization."
(L. Hamner et al. Morb. Mortal Wkly. Rep. 69, 606–610; 2020).9/6/2020
Covid19 risk mitigate/Tengku Hanidza
9

10. Covid-19 spread in confined spaces: A combination of social
distancing and mouth covering will break the COVID chain.
Here’s why…
9/6/2020 Covid19 risk mitigate/Tengku Hanidza 10

11. (1) A human cough: saliva droplet’s
disease-carrier particles cannot
travel more than 2 m in space at
approximately zero wind speed.
A human cough: mechanisms of airborne saliva droplet’s transport,
breakup, dispersion, and evaporation. This figure shows different cloud
kinematics (elongation and rotation) depending on the wind shearing force;
the gravitational or settling forces; and the evaporation rates.
(2) A human cough: saliva
droplet’s disease-carrier
particles may travel in the air
medium to unexpected
considerable distances
depending on the environmental
conditions.
9/6/2020
Covid19 risk mitigate/Tengku Hanidza
11

12. 9/6/2020
Covid19 risk mitigate/Tengku Hanidza 12

13. Rather than falling to the ground, the microdroplets float in
the air and drift about. The researchers estimate that a
single cough or sneeze can produce 100,000
microdroplets
9/6/2020 Covid19 risk mitigate/Tengku Hanidza 13

14. Created by Purdue University in 2014 based on the related SARS virus
A cough can infect up to
ten surrounding people
Saliva droplets from one cough cause an initial plume of germs, which then spread
throughout the plane in the air.
Will COVID-19 fits
into this scenario?
9/6/2020 Covid19 risk mitigate/Tengku Hanidza 14

15. 9/6/2020 Covid19 risk mitigate/Tengku Hanidza 15

16. The rate of particle emission during normal human
speech is positively correlated with the loudness
(amplitude) of vocalization, ranging from
approximately 1 to 50 particles per second (0.06 to
3 particles per cm3) for low to high amplitudes,
regardless of the language spoken (English,
Spanish, Mandarin, or Arabic).
This findings (2019) help to explain the
superspreading events during COVID-19 pandemic:
• A choir practice in a church in Mount Vernon,
Washington
• 80 infections tied to live music venues in Osaka,
Japan
• 65 cases resulting from Zumba classes in South
Korea
9/6/2020
Covid19 risk mitigate/Tengku Hanidza
16

17. 9/6/2020 Covid19 risk mitigate/Tengku Hanidza 17

18. 9/6/2020 Covid19 risk mitigate/Tengku Hanidza 18

19. The decision was made after an observational study was
published in the medical journal The Lancet on Friday,
which described how seriously ill Covid-19 patients who
were treated with hydroxychloroquine and chloroquine
were more likely to die.
Who do you want to believe?
Science vs the President
9/6/2020
Covid19 risk mitigate/Tengku Hanidza
19

20. (26/5)
“Berdasarkan pengalaman dan pandangan pakar-pakar kesihatan mendapati ubat antiradang ini
dapat membantutkan penyakit ini (COVID-19) pada peringkat awal bagi mencegah ia daripada
melarat, namun ada kesan sampingan dari segi denyutan jantung dan mata. Jika pesakit itu
didapati mempunyai denyutan jantung panjang, kami akan menghentikan terus penggunaan ubat
itu bagi mengelakkan jantung berhenti dan sebagainya. Pakar-pakar masih lagi mengkaji bagaimana
untuk mengelakkan kesan sampingan sedia ada dan bagaimana elakkan dos tinggi, dan tunggu literature
review yang akan dikeluarkan oleh WHO pada pertengahan Jun ini (Pengarah KKM).
9/6/2020 Covid19 risk mitigate/Tengku Hanidza 20

21. The science behind COVID-19 testing
9/6/2020
Covid19 risk mitigate/Tengku Hanidza
21

22. False positive, false
confidence
A false positive will lead
someone to believe they have
been infected when in fact
they have not been.
9/6/2020
Covid19 risk mitigate/Tengku Hanidza
22

23. Survey says….. after President Trump publicly asked whether injecting such
products could treat COVID-19
9/6/2020 Covid19 risk mitigate/Tengku Hanidza 23
Washing food with bleach, using household cleaning
or disinfectant products on bare skin, and
intentionally inhaling or ingesting these products
were some of the most commonly reported "high-
risk" practices in a May 4 online survey of 502 U.S.
adults, the Centers for Disease Control and
Prevention (CDC) reported.
39% reported intentionally engaging in at least one
high-risk practice not recommended by the CDC to
prevent coronavirus infection, including using bleach
to clean food or misting the body with a disinfectant
spray.
4% drank or gargled with diluted bleach solutions,
soapy water or disinfectants.

24. 9/6/2020 Covid19 risk mitigate/Tengku Hanidza 24

25. The risk of a spike in infections is clearly present as some countries
scrambled to restart their economies after easing stringent COVID-
19 restrictions, a top health official has warned.
Michael Ryan, executive director of the World Health Organization's
(WHO) emergencies program, expressed his concerns on Monday
over the lifting of certain lockdown conditions that he reckons may
lead to a resurgence of coronavirus cases.
"Shutting your eyes and trying to drive through this blind is about as
silly an equation as I've seen.
"And I'm really concerned that certain countries are setting
themselves up for some seriously blind driving over the next few
months," he added.
His comments came as Germany, France, Spain, Italy, Belgium, the
Netherlands and the UK relaxed restrictions in a bid to revive their
almost stagnant economies.
Ryan praised Germany and South Korea for putting in place robust
measures that would be able to trace and stop virus clusters before
they get out of control.
9/6/2020 Covid19 risk mitigate/Tengku Hanidza 25

26. Europe easing up lockdown mid May
Coronavirus: How lockdown is being lifted across Europe
https://www.bbc.com/news/explainers-52575313
9/6/2020
Covid19 risk mitigate/Tengku Hanidza
26

27. 9/6/2020 Covid19 risk mitigate/Tengku Hanidza 27
25/5
UK easing up lockdown

28. 9/6/2020 Covid19 risk mitigate/Tengku Hanidza 28

29. May 11, 2020, 10:02 PM +08 (Reuters)
SEOUL - South Korean officials scrambled on
Monday to contain a new coronavirus outbreak,
searching for thousands of people who may have
been infected in a cluster of cases linked to
nightclubs and bars in the capital Seoul.
The education ministry put off the reopening of
high schools, which was scheduled to begin on
Wednesday, by one week in light of the new
outbreak.
In less than a week since a 29-year-old man was
confirmed infected on Wednesday -- the first to be found
linked to the infections in Itaewon, a Seoul neighborhood
known for its nightlife -- at least 86 visitors of the
nightclubs there had tested positive as of Monday.
9/6/2020
Covid19 risk mitigate/Tengku Hanidza
29

30. South Korea restarts schools after
coronavirus spread slows (May 20)
9/6/2020
Covid19 risk mitigate/Tengku Hanidza
30

31. What happen when a leader denies COVID-19?
Who do you trust?
Zimbabwean President Cambodian Prime Minister Mexican President
Brazilian President North Korean leader Tanzanian President
Turkmen President Belarusian President California congressman
“The Prime Minister doesn’t wear a mask, so why do you?”
“If this virus is really spreading like some people say that it is,
we don’t have any data on that,”
The sole Asian outlier, a virus-free haven
Coronavirus cases in the Central Asian state
of Turkmenistan is zero.“Corona is the devil and it cannot survive in the body of Jesus,”
“It will burn.”
Released a Facebook video encouraging his
people to go out for dinner.
“No one will die of coronavirus
in our country. I publicly declare this”
“No one will hinder my right
to come and go,”
Held a political rally and gave a speech to several hundred people
at a school blatantly violating his own decree.
9/6/2020
Covid19 risk mitigate/Tengku Hanidza
31

32. • Brazil has the highest rate of
transmission (R0 of 2·81). Large cities
such as São Paulo and Rio de Janeiro
are the main hotspots.
• The biggest threat to Brazil's COVID-19
response is its president, Jair
Bolsonaro.
• He openly flouting and discouraging
physical distancing and lockdown
brought in by state governors and city
mayors.
• The president compared COVID-19 to
a “little cold”, accused the media of
spreading “hysteria”, and encouraged
people to “go back to normality”.
• President Bolsonaro continues to
dismiss the health crisis, saying the
economic impacts will be far worse to
what he's compared to a "little flu."
Data May 17
9/6/2020 32

33. Cases spike in USA as communities reopen
-53
-2
-6
+3
-1
-53
-3
-22
+15
+39
+15
-1
-18
-55
+25
-26
+27
-13
-1
+14
+45
+6
-12
-6
+2
-13
-14
-3
-17
+5
-17
-2
+11
+19
+12
-4
+41
+4
+14
-19
-15
-14
-19
+8
%
• US guidelines call for
14 days decline in new
cases opening
• Some states are
proceeding even
without clearing that
threshold.
• The number of new cases
will rise as a state
performs more testing
9/6/2020
Covid19 risk mitigate/Tengku Hanidza
33

34. WHO warns there could be a second
peak, not a second wave:
During a media briefing, Dr. Mike Ryan,
executive director of WHO’s health
emergencies program, said the world is
“right in the middle of the first wave,
globally." Ryan warned that a second
peak or wave could come during the
normal influenza season, “which will
greatly complicate things for disease
control.”
Americans crowd public places as Covid-19 cases rise in some states:
Crowds packed beaches in Florida, Maryland, Georgia, Virginia and Indiana over the Memorial Day
weekend — many venturing out without masks and others failing to keep their distance even as
officials highlighted the continued importance of both in order to prevent another surge of infections.
9/6/2020 Covid19 risk mitigate/Tengku Hanidza 34

35. Sweden’s Approach to COVID-19: No lockdown, advocate Herd Immunity.
Failure or success?
9/6/2020
Covid19 risk mitigate/Tengku Hanidza
35
Anders Tegnell, the country’s state epidemiologist, told UK-
based daily Financial Times last month that Sweden expects
40% of people in the capital Stockholm to be immune to
COVID-19 by the end of May. In the autumn there will be a
second wave. Sweden will have a high level of immunity and
the number of cases will probably be quite low,” .
Data compiled by the Sweden’s Public Health Agency, as of
May 20, only 7.3% of blood samples collected from people in
Stockholm had antibodies to SARS-CoV-2. At least 70% to
90% of a population needs to be immune to a virus to reach
herd immunity.
Sweden’s COVID-19 mortality rate tops all Nordic countries
and is also among the highest in the world.
Stockholm will not reach this milestone in May.
Earlier this month, Tegnell admitted he is not sure Sweden's
strategy was the right call. "I'm not convinced at all — we are
constantly thinking about this," he told Swedish newspaper
Aftonbladet.

36. Feeding the hungry during COVID pandemic: Poor nations vs. rich nations
Food security: Will we be better prepared for the next epidemic?
9/6/2020 Covid19 risk mitigate/Tengku Hanidza 36

37. COVID-19
Vs. FAITH
9/6/2020
Covid19 risk mitigate/Tengku Hanidza
37

38. 9/6/2020 Covid19 risk mitigate/Tengku Hanidza 38

39. 9/6/2020 Covid19 risk mitigate/Tengku Hanidza 39

40. COVID-19 CLUSTERS
(Source: MOH, update 1/6/20)
9/6/2020 Covid19 risk mitigate/Tengku Hanidza 40

41. 9/6/2020 Covid19 risk mitigate/Tengku Hanidza 41

42. 9/6/2020 42

43. May 12 – June 9, 2020
MCO 5 (Conditional MCO) regulations
replaced MCO 4 regulations
9/6/2020
Covid19 risk mitigate/Tengku Hanidza
43

44. 9/6/2020 Covid19 risk mitigate/Tengku Hanidza 44

45. 9/6/2020
Covid19 risk mitigate/Tengku Hanidza
45

46. 9/6/2020
Covid19 risk mitigate/Tengku Hanidza
46

47. How are we doing with our fear level?
9/6/2020
Covid19 risk mitigate/Tengku Hanidza
47

48. Normal life (?) resuming in Malaysia
9/6/2020 Covid19 risk mitigate/Tengku Hanidza 48

49. Facts vs. Myth: Body Disinfection?
(Source: WHO)
9/6/2020
Covid19 risk mitigate/Tengku Hanidza
49

50. Financial Implication of testing non citizens to protect
citizens: Risk (costs) vs. benefits (stop COVID spread)
5.95% infection
Expected 60 people positive
Cost 31,204 x rm 300= Rm 9,361,200
Cost of treatment 750 x rm ? = rm ?
9/6/2020 Covid19 risk mitigate/Tengku Hanidza 50

51. 9/6/2020 Covid19 risk mitigate/Tengku Hanidza 51

52. Back–to-school: Post COVID Looking East
Korea: Depending on the school district, schools
will start on different days and students will
alternate between attending classes and online
instructions at home.Class times and lunch hours
are also being staggered. No extracurricular
activities will be allowed.
Students attend half-days or
every other day wearing masks
and sitting farther apart.
9/6/2020 Covid19 risk mitigate/Tengku Hanidza 52

53. Challenges on social distancing:
Classroom capacity: up to 17 per classroom
Teaching capability
Teaching periods
Canteen setting
9/6/2020
Covid19 risk mitigate/Tengku Hanidza
53

54. 9/6/2020 Covid19 risk mitigate/Tengku Hanidza 54

55. The New
Normal?
Personal bubble in the park
Drive-in movie
comeback
Dentist in PPE
Dining with dummies
Sun tan box
Lunch Japanese style
Tete-a tete 2 m part
Drive-through graduation
Cutouts fans
Driver in veil9/6/2020
Covid19 risk mitigate/Tengku Hanidza
55

56. 9/6/2020 Covid19 risk mitigate/Tengku Hanidza 56
Travelling Post Covid
Travel should still be limited to
circumstances in which it's absolutely
necessary.
People who are immunocompromised
or at high risk of developing severe
illnesses, it should be avoided as much
as possible.

57. Informed Citizen:
Continuous Community education
9/6/2020 Covid19 risk mitigate/Tengku Hanidza 57

58. 9/6/2020 Covid19 risk mitigate/Tengku Hanidza 58

59. 9/6/2020 Covid19 risk mitigate/Tengku Hanidza 59
Perintah Kawalan Pergerakan Diperketatkan (PKPD)
Secara pentadbiran yang dilaksanakan di dua kawasan
perumahan di Bukit Changgang, Kuala Langat sejak 2 Jun
dijadualkan berakhir 16 Jun ini. Pelaksanaan PKPD
secara pentadbiran di kawasan itu turut membabitkan
seramai 9,000 penduduk.

60. End of MCO5
June 9, 2020
9/6/2020 Covid19 risk mitigate/Tengku Hanidza 60