KUALA LUMPUR, Nov 19 — Hospitals across the Klang Valley have seen gradual increases in admissions of seriously ill Covid-19 patients since interstate travel restrictions were lifted on October 10, with Sungai Buloh Hospital now hitting full capacity.
On Tuesday, Twitter user @Azpapip — identified as Dr Azfar Kamal, a medical officer at Sungai Buloh Hospital — cautioned Malaysians of a potential new wave of coronavirus cases as Categories Four and Five Covid-19 patients begin to overwhelm the Selangor facility designated to solely treat Covid-19.
“Dear Malaysians. Please be aware that we are expecting the next Covid-19 wave in December 2021. There will be a surge of cases for the next two weeks. Covid-19 centre is preparing for the next wave. Our active and ICU wards are full with Category 4 and 5 patients,” Dr Azfar tweeted.
In this regard, he urged Malaysians to adhere to Covid-19 protocols, including respecting mask mandates and observing physical distancing.
In response to CodeBlue’s request for further comments on the post, Dr Azfar said “My pure concern is to give awareness.” The tweet has since been retweeted over 25,800 times.
Sungai Buloh Hospital, along with its National Leprosy Control Centre (NLCC), is the only full Covid-19 hospital left in Klang Valley after Ampang Hospital, Selayang Hospital, and Serdang Hospital were reconverted back into hybrid hospitals.
Ampang Hospital, Klang Valley’s second fully designated Covid-19 hospital, returned to hybrid status on October 15, as new coronavirus cases fell from a high of 24,599 cases on August 26 to 4,343 cases on November 7.
This means that by default, Covid-19 patients in the Klang Valley (Selangor, Kuala Lumpur, and Putrajaya) who require treatment will be directed to Sungai Buloh Hospital by the Klang Valley’s regional bed management unit.
If the utilisation rate is high at Sungai Buloh Hospital, referrals will be directed to other available hospitals in the region such as Kuala Lumpur Hospital, the Cheras Rehabilitation Hospital, or Putrajaya Hospital, according to government doctor Dr Johari (pseudonym), who has knowledge of the matter and spoke to CodeBlue on condition of anonymity due to a gag order on civil servants.
Sungai Buloh Hospital also treats post-Covid patients, defined by the United States’ Centers for Disease Control and Prevention (CDC), as having new, returning, or ongoing health problems four or more weeks after first being infected with the coronavirus.
Sungai Buloh Hospital’s overall bed capacity for non-critical and ICU Covid-19 patients is not known, though it is estimated that the hospital can provide up to 1,700 beds in total, Dr Johari said. The NLCC is said to have a capacity of up to 300 beds.
“All public hospitals in the Klang Valley currently operate on a hybrid model except for Kajang Hospital, Banting Hospital, and Shah Alam Hospital which function solely as non-Covid hospitals. Several university hospitals also have hybrid status where certain wards are designated to treat Covid-19 patients,” Dr Johari said.
A University Malaya Medical Centre (UMMC) doctor confirmed that the university hospital still operates on a hybrid model, while a doctor at the UKM Specialist Children’s Hospital (HPKK) told CodeBlue that the hospital no longer accepts Covid-19 patients.
“All Covid-19 patients requiring oxygen support go to Sungai Buloh,” the HPKK doctor said on the condition of anonymity. He said the move to reconvert HPKK back as a children’s hospital was done four to five weeks ago.
The newly built HPKK, which falls under the purview of the Higher Education Ministry, was temporarily repurposed into a full Covid-19 hospital in June under an emergency ordinance signed by then Prime Minister Muhyiddin Yassin.
When asked if there were any possibilities of HPKK being used to treat Covid-19 again, the doctor said: “No news as of now regarding changing back to Covid-19.”
The situation in Sungai Buloh and in Selangor was confirmed by Selangor state health director Dr Sha’ari Ngadiman in a statement yesterday. Dr Sha’ari attributed the rise in critical Covid-19 cases in Sungai Buloh Hospital to its status as a referral hospital for coronavirus in the Klang Valley.
Dr Sha’ari said hospitals across the state’s most industrialised region have been diverting sick Covid-19 patients to Sungai Buloh Hospital’s ICU so that ICUs in other health facilities can treat non-Covid cases. Sungai Buloh Hospital’s 54-bed ICU recorded a 96 per cent bed occupancy rate yesterday.
He also pointed out that Selangor’s Covid-19 infectivity rate, or R-naught, stood at 1.05, indicating a growing epidemic. “In the last two weeks, the number of daily new cases in Selangor ranges between 1,300 and 1,500 cases, of which 1.5 to 2 per cent were in Categories Three, Four, and Five,” Dr Sha’ari said.
The focus on Sungai Buloh Hospital for Covid-19 treatment implies that other public hospitals in the Klang Valley continue to have beds available, including at ICUs, to treat Covid-19 patients who require medical attention.
This is consistent with CovidNow data which indicate that Klang Valley’s hospital bed utilisation rate is at 66.4 per cent, about 5.2 percentage points below the national rate. Although it hasn’t reached critical levels beyond 70 per cent, the figure represents an increase from a week ago.
Hospital admissions in the Klang Valley saw a weekly rise of 14 per cent on November 17, while new infections in the past seven days have increased by 28 per cent.
ICU utilisation in the Klang Valley is among the highest nationwide at 78.8 per cent as cases rise and new clusters are detected in the region. Critically ill Covid-19 patients typically take much longer to recover at about 15 days compared to an average of seven to 10 days in patients with mild-to-moderate symptoms.
While the overall situation remains under control currently, health care workers are becoming increasingly concerned about a sudden surge, which they believe “can happen anytime” as more restrictions are lifted and people become increasingly complacent.
Lack of manpower is also a cause for concern as the decline in Covid-19 cases in the past two months allowed medical staff such as nurses and medical assistants — who were brought in from other states to cope with Klang Valley’s Covid-19 surge in July — to be sent back to their original place of work.
In hospitals and Covid-19 Integrated Quarantine and Treatment Centres (PKRC) across the Klang Valley like MAEPS, many are operating at a lower capacity compared to when health facilities were overwhelmed by Covid-19 cases four months ago.
At MAEPS, the number of halls used to monitor and treat Covid-19 patients has been reduced from 10 halls to about three to four halls to cut costs. Many medical staff who were stationed at MAEPS have since returned to their respective facilities.
“We’ve been asked to reduce our manpower, shrink our capacity to save cost (following the drop in case numbers in the past two months), which is fine. We understand where they (authorities) are coming from; they are not clinicians.
“When there are 500 to 1,000 beds available but only 100 beds are used, questions will be asked on why money is being wasted. But when there is a surge, this becomes a problem.
“When we try to prime our hospitals without the need for PKRCs like MAEPS, it is impossible because there’s no place to quarantine patients. You can’t be putting everyone in hospitals. So, this is the challenge. It’s a chicken and egg issue. If you do it, it is wrong. If you don’t do it, it is also not right,” Dr Johari said.
In the event of a Covid-19 surge, Dr Johari said Klang Valley hospitals have contingency plans, which involve the planning of staff movement and utilisation of resources.
“Every hospital has been asked to prepare their contingency plan and movement of staff within their respective capabilities and resources. So, they have to make use of what they have. In terms of manpower, we know we will never get the ideal number of staff that we want.
“We can’t be holding back movement of those who have requested for a transfer, those intending to further their studies, or those who have to be posted somewhere else…so, the hospital’s contingency plan has to evolve according to its capacity.
“So, if Hospital A, for example, has to accept 1,000 Covid-19 patients, then the hospital has to manage it accordingly based on the number of staff it has,” Dr Johari said.
At the regional Klang Valley level, this would mean that Ampang Hospital, Serdang Hospital, and Selayang Hospital will likely be reconverted into full Covid-19 hospitals, and more halls at MAEPS will be reopened for low-risk Covid patients to quarantine as was done previously.