Over the last ten months since the first COVID-19 case arrived in Malaysia, the Ministry of Health has fought around the clock to save lives and support the government in curbing the spread of the virus. It is with MOH's guidance that the country successfully emerged from the movement control order (MCO) having flattened the curve.

The government has been mindful of balancing lives and livelihoods since businesses and public life reopened in June 2020. The national unemployment rate reached a record high of 5.3% in May following the first MCO introduced in March. This number went down to 4.9% the following month as the country transitioned into recovery MCO.

This progress must not be undone with the reintroduction of conditional movement control order (CMCO) in the entire Klang Valley and Sabah.

Despite the government's efforts to minimize economic impact by allowing many businesses to remain open, it is small-and-medium enterprises (SMEs), low-income and vulnerable groups that have yet to recover from the first MCO that will likely be the most affected.

Therefore, the Academy of Medicine of Malaysia (AMM) urges the government to enforce a targeted enhanced MCO (TEMCO) in Kuala Lumpur, Putrajaya and Selangor as opposed to a state-wide CMCO.

As of October 12, 2020, two of the nine districts in Selangor were green zones, while six were yellow zones. Within those six yellow-zoned districts, 26 out of 41 subdistricts do not have an active COVID-19 case.

We recognize that as the economic center of the country, Klang Valley is densely populated, making it difficult to draw boundaries for enforcing a TEMCO, but the government must not jeopardize the livelihoods of Malaysians in Selangor's green zones.

In enforcing any type of MCO, we urge the government to ensure that the guidelines are evidence-based and consistent.

Certain red zones in Sabah have been under TEMCO since September 28. Another TEMCO was enacted in Klang on October 9. That same day, it was announced that weddings would be allowed in these areas on the condition they comply with standard operating procedures (SOPs).

This is counterproductive to the TEMCO's aim of containing the spread of the virus. However, as of the October 12 announcement of state-wide CMCO, weddings are no longer allowed.

It is imperative that the government guidelines under any MCO are consistent with the evidence on best practices to break the chain of transmission.

These guidelines must also be communicated clearly and in details to the public to minimize confusion and ensure maximum compliance.

Finally, future MCOs must not restrict outdoor activities as they are important to maintain both mental and physical health during the pandemic.

A global survey on COVID-19's impact on people's behaviors found that 44% of Malaysians felt their mental wellness declined, while 56% reported having less physical activity during MCO.

The outdoors are relatively low-risk settings for virus spread and studies have found that natural environments are beneficial for one's mental health. Moreover, we must strike a balance between battling COVID-19 and non-communicable diseases, such as diabetes and hypertension, which are also prevalent in our population (refer to our previous statement on June 3).

Team sports can be put on hold, but Malaysians must be given flexibility to maintain their mental and physical health by going outdoors.

Movement control is a necessary step in stopping the third wave. The SOPs must fully account for the economic, mental, and physical well-being of all Malaysians and Malaysian residents to maximize compliance rates and achieve our goal of flattening the curve once more.

(The Academy of Medicine of Malaysia, embracing 11 Colleges and 15 Chapters, is a registered body representing medical specialists in Malaysia)