Unfair To Speculate Manipulation Of MOH Covid-19 Figures: Expert

By Ashswita Ravindran | 29 October 2020

Health experts also disagree on whether stable Covid-19 patients should be treated at home to reserve hospitals for moderate to severe cases.

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KUALA LUMPUR, Oct 29 — A public health expert has urged the public to stop questioning official Covid-19 figures, saying it was difficult to get minute, real-time data, amid conflicting information on whether Sabah’s hospital beds are full.

Public health trained pediatrician Dr Tan Poh Tin said that it is tough for the Ministry of Health (MOH), especially Health director-general Dr Noor Hisham Abdullah, to keep track of all the Covid-19 cases in so many places as he is covering the whole of Malaysia.

“These figures are living figures every day in and out and there are 20 over centres in Sabah,” Dr Tan told CodeBlue, referring to the rate of discharge and admission of Covid-19 patients to hospitals, as well as to low-risk quarantine and treatment centres.

“If you are trying to shoot the general, the army is getting demoralised and tired. I think that is really irresponsible.”

On October 22, Sabah’s Covid-19 spokesperson and state housing and local government minister Masidi Manjun told a press conference that 99.5 per cent of the beds in Sabah facilities were filled with Covid-19 patients. When MOH then released their data on hospital and low-risk quarantine and treatment centres, there was a huge discrepancy in the occupancy rate, as compared to the state government’s announcement.

MOH on October 26 said that in Sabah, only 52 per cent of Covid-19 beds are occupied in hospitals, 69 per cent of beds occupied in the intensive care unit (ICU), while only 28 per cent of the low risk quarantine and treatment centres are occupied.

Then, yesterday, Masidi clarified that only half of Sabah’s Covid-19 beds are full. He also said that he had inadvertently taken the cumulative number of Covid-19 cases, and not the active cases, in his October 22 announcement on the mistaken 99.5 per cent bed occupancy rate. However, Masidi did not have the breakdown of bed occupancy rates according to individual hospitals or quarantine centres.

Multiple anecdotal reports have emerged on social media about positive Covid-19 patients in Sabah, the current coronavirus epicentre in Malaysia, being forced to stay at home or facing delayed admission because of insufficient space in hospitals.

Dr Tan said that frontliners on the ground may feel fed up hearing these figures because it may not necessarily reflect the exact picture in their hospital, as some hospitals like Queen Elizabeth Hospital in Kota Kinabalu may be fully occupied while other hospitals may still have space.

“Please don’t get cooked up on these figures, except on the deaths and new cases. As a DG, he cannot go into detail, he will never finish his work.

“The poor chap is working for nine months, no break. I don’t know how he can sleep also,” the public health trained physician said.

“I mean, to me, statistics is wonderful. The figures are moving. Sometimes, you discharge them, they don’t keluar the ward,” she said referring to some patients who will have to wait for hours for their transport to arrive if for example, they are from Tawau but admitted to Queen Elizabeth Hospital in Kota Kinabalu.

“People have to work in the wards to know.”

Dr Tan suggested for those who are trained in data science to volunteer with MOH to key in and analyse hospital statistics so that real-time data can be presented to the public.

Counselling Should Be Provided For Frontliners

A health care worker sitting in an ambulance at a public hospital in Sabah. Picture credit anonymous.

As the frontliners on the ground have been working tirelessly, more often than not, working extra hours to compensate for their colleagues who are quarantined, Dr Tan suggested that there should be a counsellor or a psychologist on the ground to talk to them and help them out if there are any issues.

“I think in every centre, where they are managing these types of cases, I would suggest either a voluntary or a full time psychiatrist to come in and actually chit-chat with some of the ones who are really really down because when people are tired, they get stressed out, and you find that they might make mistakes,” Dr Tan said.

“To help the frontliners there should be a team of volunteers, counsellors or psychiatrists to actually have regular counselling sessions, that’s one way of helping (them).”

Free Malaysia Today recently reported that nurses on the ground in Sabah cry because they are overworked, while doctors working in the ICU resort to sleeping pills because of overwork and stress.

Covid-19 Patients Should Not Be Managed At Home

Kampung Numbak in Sabah. CREDIT: Bassam Khawaja 2019

Dr Tan disagreed with the idea of Covid-19 patients being managed at home, as previously Masidi said that stable Covid-19 patients were allowed to be treated at home upon assessment by the doctor.

She highlighted that it would be difficult to self-isolate, considering spacing constraints such as the number of bedrooms and bathrooms and multigenerational people living in the house, i.e the old and the young.

“If you are insisting that they have to be home managed, then you must provide the caretakers with personal protective equipment (PPE), and not just provide them with PPE everyday, you must teach them how to dispose.

“Imagine if they throw it down into Sabah’s village on water, (or) they just throw it into the sea, they have no idea what is the danger to the neighbours.”

She also highlighted that patients who are treated at home may not know that they are really getting ill and by the time they call the ambulance, they would have already collapsed and to make things worse, upon reaching the emergency room, which is already crammed, they will have to wait in queue for the ICU beds.

“Put them in low risk centres. You have good qualified staff and you can monitor when they are really sick.

“The monitoring has to be very careful, the people who monitor has to be trained to recognise early symptoms because the patients themselves may not be aware that they are really sick,” Dr Tan added.

“Some people, when they stay at home, they don’t want to go (to the hospital) and the anak will be begging them to come to the hospital, they will refuse. Then, they will collapse on the children.”

Dr Noran Naqiah Hairi — a professor from the department of social and preventive medicine, University Malaya — said that at least for the moment, stable Covid-19 cases should still be placed at low-risk treatment centres.

“From DG’s statement, the occupancy rate at low-risk treatment centres is at 30 per cent. Thus, Covid-19 cases should be admitted to these places,” Dr Noran told CodeBlue.

“Nevertheless, if numbers continue to surge, this will be difficult, taking into account the duration that a patient needs to stay.”

Dr Noor Hisham posted on Twitter earlier today that the bed occupancy rate for 7,242 beds in 27 low-risk Covid-19 quarantine and treatment centres in Sabah reached 41 per cent as of October 27. Bed occupancy rate for 1,264 Covid-19 beds in the state was 59 per cent.

Besides that, Dr Noran also pointed out that it will be difficult to home-manage Covid-19 cases, especially in communities where the understanding of the virus is poor.

However, she stressed that even with the lack of manpower in Sabah, community engagement and communication is vital.

“Coordinating and engaging with local community leaders to ensure that the community fully understands the current situation faced is important. Messages given must be consistent and credible at all times,” the professor from University Malaya said.

“This needs to be done, even with the lack of manpower.”

Isolating Mild Covid-19 Patients At Home Helps To Reserve Hospitals For Severe Cases

Dr Sanjay Rampal, Public health medicine specialist, University of Malaya. Picture by Dr Sanjay Rampal.

On the other hand, Dr Sanjay Rampal, a public health medicine specialist from University Malaya, said that allowing stable patients to be isolated at home gives more health care availability for severe Covid-19 patients.

“Keeping a case in the house will raise questions of transmission, but a mitigative mindset balances the harm with the benefits of greater health care availability (for) those more severe patients,” Dr Sanjay said.

He said that even family members of the house of a positive Covid-19 patient will have to be further quarantined from the larger community.

“Larger communal living quarters does increase the complexity but can be addressed by quarantining all members.”

Dr Sanjay also said that in more dire scenarios, low-risk quarantine centres can then be modified to accept higher-risk patients, reserving hospitals only for those who need intensive care.

“As the number of cases increase, it becomes more likely that more ICU beds will be needed. The current 127 ICU beds will have to be greatly increased to accommodate the larger number of active cases,” Dr Sanjay said.

Previously. a doctor from Queen Elizabeth Hospital told CodeBlue anonymously that the hospital lacks beds to treat critically ill patients. The doctor also shared that patients have to wait up to two days for an ICU bed.

Dr Sanjay also said there are two strategies in prevention and control of Covid-19 during this pandemic: containment and mitigation.

According to the public health specialist, the community mitigation strategy becomes important when containment becomes difficult as during the pandemic, the risk of Covid-19 is globally present and a large proportion of the population remains susceptible to the disease.

The mitigation strategy aims to slow the transmission, or flattening the epidemiological curve, to allow the health care system to optimally manage the Covid-19 cases.

“The mitigative measures may vary from community to community due the uniqueness of different communities. A ‘one size fits all’ solution becomes difficult,” the professor said.

He said that in Sabah, there are many unique problems and issues due to the heterogeneous environment and sociocultural backgrounds hence, more resources may have to be invested at the community level.

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