By Dato' Dr Amar-Singh HSS
Many individuals and groups have voiced suggestions to manage our raging COVID-19 pandemic in Malaysia, however few appear to have been considered. Allow me to summarize five key measures we critically need to take to help put out the COVID-19 raging fire in our nation.
1. Test extensively
Ramping up our PCR tests to 100,000 a day is insufficient. PCRs are labor intensive and results are usually delayed. If it takes 3-5 days to get a result, this limits the value of the testing. We need hundreds of thousands of RTK-Ag tests on the ground. With a 1 hour result time they offer a rapid response and action when positive. Even if they are only 75% sensitive, it significantly mutes the pandemic. Equivocal results can be sent for PCR. We should keep PCRs for patients requiring admission and testing in high risk symptomatic persons (over 60 years with major comorbids).
2. Restore contact tracing
Contact tracing activities have been swamped by the huge numbers and have currently failed. We must learn from other nations. Rapidly employ 10,000+ retrenched non-medical professionals, train and use them to re-establish contact tracing in all states. This will also free health staff to do more vital tasks. We must dramatically improve our hand phone applications to allow for a seamless contact tracing and notification of the public.
3. Support MOH staff
Our MOH staff are long past burnt out. The burden of excessive work, long hours wearing PPE, fears of getting COVID-19 and lack of adequate emotional support have wrought havoc to a health system that was always fragile and inadequate. We must immediately offer permanent jobs to all MOH staff on contract, as well as hire all available doctors, pharmacists and nurses waiting for jobs. Also consider graduating all final year doctors, pharmacists and nurses, using their continued formative assessments and prior examinations results as a proxy indicator of performance.
4. Improve home quarantine
Home quarantine is useful for COVID-19 individuals who are well and healthy. However maintaining home quarantine for large numbers is a challenge. There are numerous reports of those who are supposed to be under home quarantine, either positive or close contact of a confirmed case, traveling outside their home to get food, visit a doctor, etc. In addition there have been numerous individuals lost at what to do at home and waiting for days for MOH personnel to contact them. There must be a mechanism to improve the current home quarantine. We should hire and train retrenched non-medical professionals and use them to monitor and support these individuals. It may be important for MOH to offer hospitalized quarantine for those over 60 years with major comorbids, as they are at high risk for death.
5. Widen pick up services
Individuals who are found COVID-19 positive and require hospitalization should not have to wait. Currently we hear many anecdotal reports of these persons waiting for a few days for admission. We recognize that the MOH ambulance services are overwhelmed. We need to urgently widen the pick-up services. We can train and use private ambulance services, especially for those who are more ill. For those who are mildly ill and require hospitalization, we could work with established transport services (taxis, Grab, etc) to provide a dedicated pick up service with good PPE and protection for the drivers.
When there is a huge fire raging in a large region, using hand-held fire extinguishers will not work. We cannot continue with the same initiatives we have practiced thus far to control the vast local outbreak. Using imaginative, out-of-the box strategies are necessary. No one person or organization has all the solutions/answers. Listening to diverse views is critical.
(Dato' Dr Amar-Singh HSS is Senior Consultant Pediatrician.)