KUALA LUMPUR, Nov 11 — Public health experts want the government to review their pandemic preparedness plan, share real-time data, and address mental health issues, as part of their mid-and-long term strategy in dealing with Covid-19.
Last October 28, Senior Defence Minister Ismail Sabri Yaakob told a press conference that the government is still drafting mid- and long-term plans in dealing with Covid-19. He also said nine sub committees have been formed to look into these plans covering all aspects including education, economy, and health.
CodeBlue interviewed three public health experts to share their input on what should be included in the government’s mid- and long-term strategy in tackling Covid-19.
Epidemiologist and public health physician Dr Awang Bulgiba suggested that in the next three to six months, as a mid-term plan, the government should share the real-time data on Covid-19 cases and consult experts on it.
“Data needs to be available in real-time and data analysis needs to be fast. Data should not just come from a single agency,” the professor from University Malaya said, while pointing out that technology to use this is already available but not optimally used.
“Data needs to be integrated and it would be wise to consult university experts who have the capability to integrate and analyse data.”
Health Minister Dr Adham Baba, in his November 3 parliamentary reply, said that the Ministry of Health (MOH) will not provide other parties with raw Covid-19 data because of previous “unwanted” incidents.
Dr Adham claimed that this is to avoid contradictory or variable interpretations of data by various agencies which could cause public panic.
The Selangor Task Force (STFC), led by former Health Minister Dzulkefly Ahmad, no longer received granular data on Covid-19 cases by MOH since October, which was when the nation started seeing a surge in Covid-19 cases. This has prevented the state government to map their own risk areas, and conduct necessary testing in those areas.
Engage Behavioural Scientists
Since the beginning of the pandemic, the government has imposed several standard operating procedures (SOPs) for the public to follow to break the transmission of coronavirus, which includes wearing a face mask in public areas, practicing social distance of one metre, regular hand-washing using sanitiser or soap etc. The police issue fines to hundreds of people every day for flouting SOPs, according to Ismail Sabri’s daily reports.
Dr Awang called for the government to engage with behavioural scientists to study how compliance with SOPs can be maintained in the long run, as he said that pandemic and SOP fatigue is setting in among the public.
“We need to understand how to ensure SOP compliance in the long-term. For this, we need the advice of behavioural scientists and we need to use their expertise,” Dr Awang told CodeBlue.
Pay Attention To Non-Covid-19 Patients
Moreover, as a mid-term plan in the next three to six months, Dr Awang said that it is essential for the government to also pay attention to non-Covid-19 patients.
“Concentration of efforts on Covid-19 means that we are likely to see other diseases being neglected,” the professor in epidemiology from University Malaya said.
“This will particularly affect people who reside in areas where the health care facilities have been suboptimal for some time, poverty is high, and borders are porous.”Dr Awang Bulgiba, epidemiologist and public health physician from University Malaya
Currently, Malaysia is facing its third wave of the pandemic especially with the surge in cases in Sabah.In Sabah, certain hospitals have been forced to close their outpatient clinics as an effort to contain the spread of coronavirus.
Sandakan Hospital has closed all its specialist outpatient clinics till November 20, while Queen Elizabeth Hospital in Kota Kinabalu has also closed its clinics until further notice to prevent the spread of Covid-19 infection. This means that health care services to non-Covid-19 patients have come to a temporary halt.
However, in Tawau, the government has set up a field hospital in collaboration with the army to provide health care services to non-Covid-19 patients, while Tawau Hospital can focus on treating Covid-19 patients.
Besides paying attention to non-Covid-19 patients, Dr Awang said that the government should also pay attention to marginalised groups like the homeless and vulnerable, like the poor and elderly, as part of their mid-term Covid-19 plans.
“The elderly really needs to be shielded when community transmission is high,”
Elderly people are the most vulnerable at contracting the coronavirus. The older the age, the weaker their immune system, hence the higher the risk of them getting the infection.
Address Backlogged Covid-19 Samples
As a short to medium term plan in the next six months, former Deputy Health director-general (public health) Dr Lokman Hakim Sulaiman asked the government to address the issue of backlogged Covid-19 samples.
Despite claims by MOH on their diagnostic capacity, Dr Lokman said he received information that the turn-around time (TOT) for sample collection to result in some areas is slow, more than 48 hours.
“Procure more mobile rapid diagnostic tools such as GeneExpert and RTK-Ag. The key performance index (KPI) for TOT should be less than 24 hours in all places,” Dr Lokman stressed.
Health director-general Dr Noor Hisham Abdullah pointed out during his daily press conference on October 30 that MOH now has started to rely on RTK-Ag tests as patients have to wait for four to five days for their RT-PCR test results. The last backlogged samples reported in Sabah was on November 2, with a total of 6,139 samples that have yet to be cleared.
Lockdowns Should Only Be Implemented On Affected Communities
For dengue cases, Dr Lokman said MOH maps hotspot areas right down to the community level, and not just districts or sub-districts. Hence, he said, the same method should be used to map Covid-19 hotspot areas.
“Utilise spot mapping of cases for control strategy and risk communication to the public,” the professor in public health said.
“We did that in dengue by identifying hotspots right to the community level, not just district and sub-district. By doing that, the community can be empowered.”
Dr Lokman also said that a more refined implementation unit should be defined to identify Covid-19 outbreaks, as the government currently uses a district or sub-district (mukim) as an implementation unit, which he thinks is too big.
“Since the impact of Movement Control Orders (MCO) is huge on the economy, this harsh measure should be confined to (the) actual problematic area,” Dr Lokman said.
“For example, Petaling is huge, consisting of Subang, Shah Alam, Petaling Jaya etc, and within these zones, (there are) many community areas, by section etc. Covid-19 tends to cluster according to community, and the mapping (as) above will help to identify the specific community involved.”Dr Lokman Hakim Sulaiman, former Health deputy director-general (public health)
He suggested that for major cities and urban areas, zoning according to residential areas, like sections or taman, would be more practical as an implementation unit and implementation of MCO.
“Thus MCO should be enforced only to those communities, thus not affecting economic activities in the rest of the sub-district,” the former Health deputy director-general (public health) said.
Government Should Revise Pandemic Preparedness As One-Year Plan
For the next one year, Dr Awang told the government to involve all relevant agencies to revise the country’s pandemic preparedness plan, which should not only include health preparations, but border controls, education, economy, and finance, as well as science and innovation.
“This needs to be stepped up as efforts appear to be piecemeal at the moment,” the professor in epidemiology said.
“Covid-19 will not be the last pandemic to hit the world and we need to be ready for the next one.”Dr Awang Bulgiba, epidemiologist and public health physician from University Malaya
Dr Lokman also stressed that the government should review their preparedness strategy as a long-term plan. Among his suggestions include overlooking the production of personal protective equipment and stockpiling. He also called for an enhancement in the data analytic capacities.
“Electronic data entry and notification should be the norm of the near future. Every frontliner should be using a tablet by now, not a paper record anymore (I heard this is happening but should be a policy and to all),” Dr Lokman said.
“Speed of quality data is the essence in outbreak investigation.”
As part of the pandemic preparedness strategy, Dr Lokman asked for more funds to be put into research and development in understanding future threats as all major threats seem to come mainly from zoonotic infections.
“Integrative research in the areas of wild-life ecosystem, land use, climatic change and health requires strong support for funding.”
Vaccines And Drugs
Dr Awang suggested for the government to also start working on developing drugs and start planning for home-grown vaccines, stressing that the Covid-19 pandemic will not be the last pandemic we will face.
“Despite being a mega-biodiverse country, Malaysia does not have much capability to produce its own indigenously-developed medicines. It also lacks the capability to produce human vaccines on its own,” Dr Awang told CodeBlue.
Dr Lokman also highlighted that the government should be serious on implementing the vaccine development programme in this country.
“It may not be a lucrative industry but certainly a strategic and of national security importance.”
Tackle Covid-19 Impact On Young People’s Mental Health
A public health specialist from University Malaya, Dr Nik Daliana, suggested that as a long-term strategy for Covid-19, the government should tackle the impact of the disease on the mental health of young people.
With the implementation of lockdowns, closure of schools and universities, social distancing, and quarantine to contain the Covid-19 infection, it has caused young people to experience a prolonged state of physical isolation from their community networks, peers, teachers, and extended family.
“These disease containment measures are thus likely to result in increased loneliness in adolescents and youth, whose usual social interactions are now restricted.”Dr Nik Daliana, public health specialist from University Malaya
“One of the main policies that need to be included in the long-term plans is to prioritise the psychosocial well-being of young people.”
As a long-term plan, more investment should be put in to promote early mental health screening, whereby training should be provided for teachers, family, and community members to identify mental health problems, like anxiety and depression, among young people and to connect them with appropriate support through digital technology or telephone.
“Continuous health promotion activities for young people via various media platforms, for example managing stress using stress mindfulness. This includes increasing young people’s awareness of online tools, for example mobile apps for mental health and well-being,” the associate professor from University Malaya said.
Even when schools reopen after the Conditional Movement Control Order, which is scheduled to end on December 6, Dr Nik said the government should channel more resources to schools for mental health screening.
At the same time, in the next six months to one year, a community-based one-stop centre should be set up in universities that have a multidisciplinary team, such as a public health specialist, psychiatrist, psychologist, counsellors, adolescent health experts, and peer support groups.
From March 25 till late August, it was reported that three government psychosocial hotlines received a total of 11,791 calls for assistance for issues related to emotional support and counselling for stress, anxiety, and loss of hope. World Of Buzz also reported that a suicide hotline, Befrienders had a 38 per cent of increase in the number of calls during MCO this year.