YAB Tan Sri, we, the undersigned, view with much apprehension and concern the current status of the Covid-19 outbreak in the country.
Our national metrics paint a very bleak picture of the management of the pandemic. Despite movement control orders and other health interventions, the daily reported cases are not decreasing.
The cumulative incidence density (per 100,000 population) and the infection rate (active cases per 1,000 population) are not flattening, with the latest national infection rate registered at 0.879 per 1,000 population, meaning eight to nine persons are actively infected for every 10,000 people.
The testing positive rate (rolling seven-day average) is rising, registering 8.9% on Jan 3, well above the World Health Organization’s (WHO) 5% benchmark of effective pandemic control and containment.
Kindly allow us to propose 10 urgent and critical actions lest Malaysia slips into Covid-19 intensive care:
- To ramp up testing with triaged, mass and frequent testing regimen, utilising inexpensive rapid testing kits (RTK-Ag), instead of PCR, to help slow the transmission of Covid-19.
- Early RTK-Ag diagnosis of cases within 24 hours will enable rapid isolation of cases and facilitate prompt contact tracing.
- Automating contact tracing with digital apps will hasten the tracking process, while leveraging on data science and machine learning can identify the hotspots in the nation for targeted screening. Only this find-test-trace-isolate rapid response will bust the Covid-19 clusters and mitigate the sporadic spread of the virus.
- In anticipation of the increasing Covid-19 cases and to protect the healthcare capacity, we advocate that clinical stage 1 and 2 cases be isolated at home with clear guidelines from the health ministry. Their well-being can be tracked daily with digital apps supported by empowering the local community, and urgent transfers to Covid-19 hospitals organised for cases that deteriorate.
- We must protect the excellent work of our medical professionals in the Covid-19 hospitals by decanting all non-Covid cases to non-Covid government and private hospitals. This will allow them to focus on the most severe cases and not be distracted by asymptomatic and mild cases, thus ensuring the best outcomes.
- The POIS initiative (Preventing and early detection of Outbreaks at Ignition Sites) is a tripartite government, private sector and NGO partnership which emphasises early detection testing regime, enhances public health measures and health education of industry and migrant workers. This POIS initiative developed in consultation with industry and WHO can be replicated elsewhere as a public health operational tool, truly embracing a whole-of-government and whole-of-society approach.
- Similar initiatives must be developed for the other hotspots of Covid-19 outbreaks, namely the prison and detention centres.
- Expedite the regulatory processes so that immunisation can begin as soon as the first doses of vaccines arrive at the airport. Debunking Covid-19 and vaccine disinformation will empower our rakyat with informed consent when the vaccines arrive. Apart from prioritising the high-risk groups, seriously consider vaccinating migrant workers to protect our industries and the refugee community who are silent epicentres of Covid-19 outbreaks. The cost of the vaccines must be capped at less than RM100 per dose for those getting their shots privately and by extension, the rapid test kits must be capped at less than RM100 per test to ensure more affordable and wider coverage as well as uptake of both vaccines and rapid testing.
- A Covid-19 task force comprising a cross-sectoral and empowered team of subject matter experts must be immediately formed to provide evidence-based advice on a harmonised whole-of-government response across ministries and agencies. The task force will help steer the nation out of this pandemic by regularly presenting its recommendations and audit of the health economic impact of key decisions to the Cabinet. To ensure independence of the task force, the Malaysian Medical Association, Academy of Medicine Malaysia, Malaysian Public Health Physicians’ Association and Association of Private Hospitals Malaysia are best positioned to select the members.
- Do not politicise the pandemic but instead secure a bipartisan consensus and approach to flatten the pandemic curve, accelerate efforts to achieve herd immunity as a form of community protection to coexist with the virus. GE15 in the midst of an uncontained pandemic is an unmitigated disaster waiting to happen as the Sabah election has exemplified.
This is the back-to-basics public health management of a pandemic which we trust YAB Tan Sri will consider urgently and seriously to mitigate the devastating consequences of the pandemic, protect the lives and livelihoods of our rakyat and to reset our economic recovery.
This letter is endorsed by 46 experts in their respective fields.
They are Dr Abu Bakar Suleiman (former health director-general), Dr Abdul Rashid Rahman (Federation of Islamic Medical Associations secretary-general), Dr Adeeba Kamarulzaman (Universiti Malaya professor of medicine), Dr Ahmad Hata Rasit (Universiti Malaysia Sarawak deputy vice-chancellor and consultant orthopaedic surgeon), Dr Ahmad Munawar Helmi Salim (former Islamic Medical Association Response & Relief Team chairman), Dr Azhar Abdul Aziz (consultant emergency physician), Dr Amar-Singh HSS (consultant paediatrician), Dr Azizi Omar (former Malaysian Paediatric Association president), Dr Christopher Lee (former health deputy director-general, research & technical support), Dr Dhesi Baha Raja (Ainqa Health chief medical & innovation officer & consultant public health physician).
Dr Gunasegaran PT Rajan (past president, Obstetrical & Gynaecological Society of Malaysia), Dr Hung Liang Choo (president, Malaysian Paediatric Association), Dr Jahizah Hassan (president, College of Anaesthesiologists), Dr Jeffrey Abu Hassan (immediate past president, Islamic Medical Association Malaysia), Dr Johari Bux (past president, Obstetrical and Gynaecological Society of Malaysia), Jomo Kwame Sundaram (former UN assistant secretary-general), Dr Khor Swee Kheng (independent consultant health systems and policies and Malaysian Health Coalition), Dr Kuljit (president, Association of Private Hospitals Malaysia, Dr Lim Teck Onn (former director of clinical research centre MoH), Dr Lokman Hakim Sulaiman (pro-vice chancellor (research) International Medical University and former health deputy director-general (public health).
Dr Mary Suma Cardosa (former Malaysian Medical Association (MMA) president), Dr Milton Lum (former MMA and Federation of Private Medical Practitioners Association Malaysia president), Dr Mohammad Farhan Rusli (International Islamic University Malaysia, consultant public health physician), Dr Mohamed Hatta Shaharom (Malaysian Society of Psychospiritual Therapy president), Dr Mohammad Iqbal Sarwar (KPJ Damansara Specialist Hospital consultant paediatrician), Dr Mohamed Namazie Ibrahim (former MMA president), Dr Muhamad Yusri Musa (president, Islamic Medical Association Malaysia), Dr Musa Mohd Nordin (Federation of Islamic Medical Associations chairman, advisory council), Dr Narimah Awin (former family health development director), Dr Norlisah Mohd Ramli (College of Radiology of Malaysia president).
Dr Pang Yong Kek (Universiti Malaya Medical Centre respiratory consultant), Dr Roslina Abdul Manap (Academy of Medicine of Malaysia scribe), Dr Rosmawati Mohamed (Academy of Medicine of Malaysia master), Dr Sevellaraja Supermaniam (former Asia-Pacific Association of Gynaecological Endoscopy and OGSM president), Shariah Asiah (Malaysian Nursing Association president), Dr Sivamohan Namasivayam (Association of Private Hospitals Malaysia board member), Dr Steven Chow (Federation of Private Medical Practitioners Association Malaysia president), Dr Subramaniam Muniandy (MMA president), Dr Tang Boon Nee (former Obstetrical and Gynaecological Society Malaysia president), Dr Teoh Siang Chin (former MMA president, former Melaka state health director), Dr Wan Ariffin Abdullah (former Malaysian Paediatric Association president), Dr Yap Wei Aun (consultant public health physician), Dr Yolanda Augustin (St George’s University of London oncologist and healthcare activist), Dr Zainal Ariffin Omar (Malaysian Public Health Physicians’ Association president), Dr Zainudin Md Zin (Lung Foundation of Malaysia chairman, former College of Physicians Malaysia president), Dr Zulkifli Ismail (Asia Pacific Paediatric Association secretary-general).
This letter was published in FreeMalaysiaToday: https://www.freemalaysiatoday.com/category/opinion/letters/2021/01/07/10-steps-to-prevent-covid-19-pandemic-slipping-into-icu/