KUALA LUMPUR, July 14 — A public health expert believes that the find, test, trace, isolate and support (FTTIS) system no longer applies to the Klang Valley, as a surge of Covid-19 cases overwhelms the region’s health care system.
Professor Dr Lokman Hakim Sulaiman, who is also an epidemiologist, also estimates that the actual number of daily new Covid-19 cases in Malaysia could be between 28,000 and 35,000, or four to five times more than official reports.
The Ministry of Health (MOH) yesterday reported a record-high 11,079 new Covid-19 cases nationwide, including 6,861 infections in the Klang Valley: Selangor (5,263 cases), Kuala Lumpur (1,521 cases), and Putrajaya (77 cases).
“Narrative for testing is no longer the standard FTTIS for Klang Valley as we assume the majority of people have been exposed,” Dr Lokman told CodeBlue recently.
He advocated a “real” strict lockdown in Klang Valley and Seremban, saying that all factories should be shut down and nobody should be allowed to enter or leave the Klang Valley, the heart of the national economy with some 8.4 million residents. Malaysia has been under a Full Movement Control Order (FMCO) since June 1, including an Enhanced MCO on nearly the entire state of Selangor since July 3.
“It is very necessary because the temperature is very high already. There are too many infections.”
As Covid-19 ravages the Klang Valley, public health experts called for the redeployment of health care workers from other less affected states to the country’s most developed region.
“There should be an immediate mobilisation of staff from less affected states and districts. Mobilise all final-year students and those waiting for employment,” said Dr Lokman.
“Coordinate volunteers including from other states like what we did during the first Movement Control Order (MCO). We don’t need Covid-19 Assessment Centres (CAC). Turn the CACs into field hospitals for Stage Three Covid-19 patients.”
Recent pictures showed CACs in Selangor over-run with thousands of people lining up on the streets. CACs are meant to designate people who tested positive for Covid-19 into home quarantine, quarantine and treatment centres (PKRCs), or hospitals.
Dr Christopher Lee, an infectious diseases expert who also shared the same thought as Dr Lokman, urged MOH to address the patient load in public health care facilities.
“Currently, the most immediate issue is the lack of hospital and ICU beds. We now really have to maximise all hospital beds in the Klang Valley, including private and teaching hospitals,” Dr Lee told CodeBlue.
“Some MOH hospitals in the Klang Valley have begun to transfer non Covid-19 patients to certain private hospitals under the government fund.”
According to Dr Lee, the number of patients transferred to private hospitals has to be scaled up, besides converting field hospitals to treat Covid-19 patients.
Health Minister Dr Adham Baba yesterday announced that the government has allocated an additional RM100 million for outsourcing of health care services in Klang Valley. That includes adding more beds, oxygen supply, and medical manpower to hospitals struggling with a surge of Covid-19 cases.
With the additional beds, Klang Valley (Selangor and Kuala Lumpur) will now have 4,906 hospital beds, 466 ICU beds, and 591 emergency beds in Selangor designated for Covid-19 patients. That excludes the beds allocated in the university hospitals for the coronavirus patients. A total of 151 beds for Covid-19 patients and 15 ventilators will be sent to the Tengku Ampuan Rahimah hospital in Klang immediately.
“Making new beds is one thing, but another equally important aspect is human resources,” Dr Lee said. “The government may have to redeploy staff from less affected states to the hot states during this crisis period.”
Dr Lokman also mentioned that the military precision approach should be adapted to handle resource management and logistics of health facilities such as hospitals.
“It is proposed that the Military Medical Corps take over the leadership. All hospitals and critical care facilities in the Klang Valley and Seremban, including public, private and university health care facilities, should be placed under one authoritative order.”
“If there is a need, create or invoke emergency ordinance,” he added.
Brigadier General Dr Mohd Arshil Moideen, management chief of the Malaysian Armed Forces Health Service Division, recently mentioned that the absence of integrated action and coordination directives from the top to bottom is the reason why the country could not get out of the third wave of Covid-19
He criticised the delays in the control, diagnosis and isolation of Covid-19 cases in the country and highlighted that Malaysia needs a “single line of command standardised strategy” in the Covid-19 battle.
In addition, Dr Lee also said that the private hospitals can also assist by sending their staff including nurses and doctors to serve temporarily at the government hospitals.
“During this national crisis, everyone will need to chip in equally.”
The Klang Valley is the country’s current Covid-19 epicentre, as health care workers say that the health care system in the most developed region has already collapsed, amid shortages of beds, staff, ventilators, oxygen supply, and medication.
Accelerate Vaccination Programme For The Elderly
According to Dr Lee, vaccination will be a major aspect of Covid-19 control measures in the country. As of July 4, about 2.3 million senior citizens, or two-thirds, of the population aged 60 and above have received at least their first vaccine dose.
“We are hitting approximately 300,000 shots per day, which is great. But we need to focus more on the hotspots where transmission is rife like Selangor, Kuala Lumpur, and Negeri Sembilan.
“In these areas, we need to simplify the vaccination registration process. For example, anyone who is above 50 years old or those with recognised comorbidities should be vaccinated on the spot.
“This will help to reduce severe cases and death among the most vulnerable group of people. This will in turn help to relieve the high pressure for hospital beds and reduce mortalities as well.”
Dr Lokman, who concurred with Dr Lee, also highlighted the significance of protecting the most vulnerable people, especially the elderly people.
“We should vaccinate all those who are above 50 years old. This group of people should be able to get vaccines by just walking into any health care centres and clinics, anytime.”Dr Lokman Hakim Sulaiman, public health expert and epidemiologist
Dr Lokman also emphasised the need to educate the public on the severity of the Covid-19 disease in order to take care of elderly people at home. He also said that the community should be empowered to take care of elderly who stay alone in their neighbourhood.
At the same time, senior consultant paediatrician Dr Amar-Singh HSS agreed that accelerating vaccination will slowly ease the Covid-19 epidemic.
“We should use up all our vaccines. Don’t keep any supply at all,” Dr Amar told CodeBlue.
Dr Amar also pointed out that the rapid spike in Covid-19 cases in Klang Valley, Negeri Sembilan and Labuan would have been caused by the Delta variant. So he said that the administration of the first dose of vaccine alone will not be effective in combating cases in the current scenario.
“We should speed up the vaccination process for the first dose. We must also vaccinate everybody with a second dose as soon as possible, within the acceptable time frame, due to spread which is likely caused by the Delta variant.”
“The only good vaccine in my mind is the one in a person’s arm and not in the store. Do let us use up the vaccines,” Dr Amar added.
Efficient Contact Tracing Measures
Dr Amar also noted that besides mass testing measures in workplaces and rapid tracing of close contacts are still key to halt silent transmission in the community.
“When someone presents to hospitals with Covid-19, we are actually not doing contact tracing anymore very much. If we cannot trace the close contact of this patient, we cannot break the cycle.
“We have to push for RTK-Antigen testing for the contacts. Even though the test has only about 70 per cent sensitivity, it is still good enough to pick some positive individuals and tell them to practice self-isolation because the quarantine centres are full,” he said.
Dr Amar said that most Malaysians are responsible and conscious not to affect their friends and family. Thus, people should be informed quickly if they are one of the close contacts of an infected person.
“By informing them, at least 50 per cent of them will go and do the test in clinics or other places. Even if we don’t do contact tracing, at least informing them will be good enough.
“Whatever we do today, we won’t change things for two to three weeks. That is because we have a lag between infections and people presenting with severe Covid and admitted to hospitals.”
Dr Lokman mentioned that early case detection is still a crucial measure to be implemented at this time. He noted that the RTK Antigen should be made available free of charge in all public and private health health clinics.
He also noted that Stage One and Stage Two Covid-19 patients should be monitored at home by providing them a simple monitoring chart, preferably with a pulse oximeter to monitor blood oxygen levels.