As of 31 May 2021, Malaysia has recorded 2,796 COVID-19 deaths. 293 out of the total (approximately 10%) are patients who were BID.
These deaths reflect possible systemic failures and must be taken seriously.
We urge the following:
1. Research the possible issues leading to BID
The government must conduct relevant research to determine the exact reasons and causes for the high number of COVID-19 patients BID.
Genomic testing will help us understand if there are more virulent variants in Malaysia.
Granular data from this research should be made public for awareness and analysis. Systemic barriers like lack of physical access to healthcare facilities or lack of education on COVID-19 symptoms should be identified and addressed, especially in Sabah which makes up 29% of all BID cases.
If issues of distrust in science, health professionals or the government are identified, then long-term solutions should be implemented.
The media must provide easy-to-understand information for the rakyat to take COVID-19 seriously, especially those undergoing home quarantine.
2. Strict assessment and better monitoring of home quarantine patients
In theory, all patients diagnosed with COVID-19 are directed to COVID-19 Assessment Centers (CACs), where doctors decide if they can undergo home quarantine or must be admitted to a hospital or low-risk quarantine center.
The delay between diagnosis and quarantine decisions should be reduced. Decisions on home quarantines must strictly adhere to MOH guidelines on COVID-19 management without exceptions or double standards.
Home quarantine patients and their caretakers should be properly educated on the self-monitoring of symptoms, and to report red flag symptoms immediately.
There must be a robust system for district health offices to promptly check on patients who report red flag symptoms, to evaluate whether hospital admissions are necessary.
Private sector GPs should be included in monitoring of home quarantine patients, providing home visits if necessary.
3. Increase testing capacity
As many COVID-19 patients do not have symptoms and can rapidly deteriorate, it is possible that many COVID-19 patients BID did not realize they were positive for COVID-19 until it is too late.
Increasing testing capacity (whether targeted or mass) will accurately identify more of those who are positive with COVID-19.
Rapid antigen tests can be used for rapid assessments, while the PCR test can be used for those requiring admission. This will allow us to correctly triage and optimally manage all COVID-19 cases.
The share of positive rates for COVID-19 tests in Malaysia have consistently been above 5%, which means that the country is under-testing. Therefore, increasing testing will increase the chances of detecting all COVID-19 patients, not just symptomatic patients.
The increasing numbers of COVID-19 patients BID may reflect underlying systemic failures.
We urge the government to implement short-term recommendations to reduce the number of COVID-19 patients BID, while delivering long-term strategies to increase access, trust and health literacy among all Malaysians.