JANUARY 7 ― We did great facing the first and second wave of the Covid-19 pandemic. Not only the front-liners deserved pats on their backs but also all Malaysians who sacrificed and worked together to overcome the challenges of this new threat. Yet here we are now, where yesterday the director-general of the Ministry of Health finally admitted that our healthcare system is at a breaking point. It is better to face our inevitable situation with eyes wide open and start getting down to taking strong and even unpalatable actions to prevent it from getting worse. Firstly, let us learn from mistakes we made when facing this third wave.

A. Where did we go wrong?

1. The Sabah state election

Cases in Sabah were already on the rise before the state election. In spite of that, we went ahead and held the election. SOPs were formulated to minimise the risk of infection during the campaign period. Yet both politicians and the general public largely ignored the SOPs; and enforcement was very lax.

On top of that, we did not impose quarantine on those returning to Peninsular Malaysia from Sabah even though we are aware of the huge risk we were taking. As a result, the situation in Sabah became worse and clusters with the ‘Bah’ prefix appeared all over Peninsular Malaysia. It was just a matter of time before community transmission sets in. Initially worst hit were prisons, detention centers and foreign workers’ hostels due to their overcrowding and less than ideal living conditions. Before long it started spreading through the general population.

2. Imposition of the conditional movement control order (CMCO)

As number of cases continued to climb, CMCO was imposed in Kuala Lumpur, Putrajaya, Selangor, Labuan and Sabah in mid-October. Later other states were added.

When clusters appeared, we were not aggressive enough in busting them. Then the CMCO was relaxed prematurely with larger gatherings allowed and borders were opened up.

As the CMCO dragged on, SOP fatigue set in among the public and even healthcare workers. New cases keep on climbing to overwhelm our health system.

B. Moving forward

Even though we are now faced with a dire situation, there is still much we can do to overcome the pandemic. This will include the following:

1. Movement control order (MCO)

Presently, CMCO must be continued in Kuala Lumpur, Putrajaya, Selangor, Sabah and certain districts and sub-districts in other states. It is already too late to impose MCO since community transmission is already widespread in those areas. We also do not have the resources to carry out containment measures such as screenings and contact tracings on a mass scale. Furthermore, a second MCO will probably need to be more prolonged compared to the one we endured in March and April last year, and it will inevitably result in much damage to our already fragile economy.

Schools and other educational institutions should reopen as scheduled. Hopefully the Ministry of Educations has planned how lessons can be carried out in a safer environment acceptable to teachers and parents. There need to be constant engagement with them to build confidence and iron out implementation hiccups. We should not have an “all or none” approach in opening schools. Only schools with outbreaks or in a very high-risk locality need to be closed temporarily.

However in well defined localities (eg. flats, housing estates, and workers’ quarters) where there are high numbers of cases; enhanced movement control order (EMCO) must be imposed early to bust these clusters. The delayed EMCO imposed to contain the Teratai cluster, which is the biggest cluster, and still growing, should be a bitter lesson to us.

Even though there is compulsory screening for all foreign workers, we must not forget that due to their large number and involvement practically in all economic sectors, many of us are in daily contact with them. Hence, targeted mass screening must be carried out for Malaysians in areas with recorded high number of cases.

Borders of states under CMCO must be closed to minimize further spread of the virus to other less affected states. All economic activities should be allowed except probably those related to tourism. Leisure and social activities involving large groups should be banned. Strict enforcement of SOPs must be carried out without fear or favor. 

2. Managing new Covid-19 cases in the field

Healthcare workers in the field are being overwhelmed with the high number of cases. Hence their first priority is to manage newly identified cases and their close contacts. All Covid-19 cases once they are confirmed must be assigned to a healthcare worker. It is the responsibility of the healthcare worker to do a quick initial over-the-phone risk assessment and arrange transportation. All Covid-19 cases must be isolated in either hospitals or low risk isolation centers depending on their risk assessments. There is no necessity to use ambulances to transport cases to low risk isolation centers. Properly modified vans and buses will suffice. These have to been carried out diligently to avoid more incidents of Covid-19 cases being brought in already serious conditions or brought in dead to hospitals.

The healthcare workers are also responsible to identify all close contacts of cases under him/her and advise them accordingly to self-quarantine and arranged for Covid-19 screening.

3. Vaccination

Now that we have admitted that we are at the breaking point, the relevant authorities must consider the fast-track emergency approval of the Covid-19 vaccines. Once we receive our first batch of vaccines end of February, we must be ready to start vaccinating our population immediately. This means we have less than 2 months to plan, train and prepare the logistics. To vaccinate about 28 million people is a herculean task and with the best of effort, we probably can achieve it within a year.

For months we have been bombarded with anti-vaxxers’ material on social media. Yet the Ministry of Health has not started on an aggressive Covid-19 campaign to counter them. This is crucial since vaccination is voluntary and we want to achieve herd immunity. Then there is the immediate need to identify vaccination groups according to priority and registering them.

4. Community participation

Community participation is crucial in this fight against the Covid-19 pandemic. The only way to have a successful community involvement is for the government to be transparent. Being opaque will lead to misinformation being spread. When there is a trust deficit, it can even result in public resistance.

Until yesterday, the government has been sugarcoating about the alarming Covid-19 situation in the last 3 months. This fuelled complacent among the public and many started to ignore the SOPs. Sometimes conflicting messages were given to the public. The DG of Health encouraged the public to stay at home but a minister encouraged domestic tourism.

The Ministry of Health must keep on emphasizing the importance of complying with the SOPs and the authorities must enforce them. The SOPs must be clear, simple to understand and to follow. They should not be changed haphazardly or relaxed until certain measurable objectives have been achieved. The public must be made to understand that they themselves are ultimately responsible to protect themselves and their loved ones from getting infected. Public figures especially politicians are supposedly role models but when they break SOPs with impunity, it becomes harder to expect compliance from the man in the street.

In healthcare, we have a wealth of expertise not just in the Ministry of Health but also in academia and the private sector. There are bound to be differences in opinion between them but all share the same objective in beating this pandemic. We must harness our collective strength and work together.

5. Politics

Politics is Malaysians’ favourite past time but we should all agree that there must not be a snap general election until we have the pandemic under control. If the politicians really want to change the present government, I humbly suggest it be done only through a vote of no confidence when parliament is in session. This will help to reduce the never-ending political tension. If a vote of no confidence succeeds, His Royal Highness YDP Agong will then appoint the Member of Parliament who now commands the confidence of the Dewan Rakyat as the new Prime Minister; without the need to hold a general election. Our politicians need to learn some humility and set aside their self-interests for the sake of our beloved country. Only a stable government with the support of the people can give its full attention in resolving the health and economic challenges Malaysia is facing now.

In conclusion, it is time we put aside any differences we may have. We as Malaysians can surely work together and overcome this pandemic.

https://www.malaymail.com/news/what-you-think/2021/01/07/covid-19-are-we-at-the-breaking-point-raja-jamaluddin/1938110