A Clarion Call For Immediate Public Health Surge Capacity — Dr Sanjay Rampal & Dr Lokman Hakim Sulaiman

Ignoring public health and not reinforcing our district health centres may lead to unmitigated transmission with over 100,000 daily Covid-19 cases.

The Omicron wave has arrived in Malaysia. The strain was likely imported from December 2021 onwards, and community transmission was established in January 2022.

Should the government immediately increase our public health capacity and resources at the district level to manage the oncoming wave? 

Some may perceive that public health activities do not justify additional resources for reinforcement, because the Omicron wave will be over quickly. Others may perceive that the burden on downstream factors, such as hospital care, does not justify the cost of increasing our preventive services. 

A wait-and-see public health approach appears to be pervasive and would underestimate the burden. The system will quickly be overwhelmed due to rapid transmission rates of Omicron. This approach appears to be reactionary, and will be less effective against higher rates of transmission. 

Ignoring public health and not reinforcing our district health centres may lead to unmitigated transmission. The daily number of Covid-19 cases may eventually breach 100,000 cases a day under such circumstances.

We have to acknowledge the limitations of our public health care capacity. It would look silly if we do not mitigate the exceptionally rapid transmission, but later overreact to very high daily case numbers.

It is more cost effective to increase public health services and primary care services for the next six months than implement movement and lockdown restrictions that have very high economic, social, and health costs. 

Public health at the district level will continue to play an essential role in mitigating Covid-19 transmission. We need a stronger message from the Ministry of Health to say that public health services are essential to managing this oncoming wave. This message will promote higher morale among our public health workers on the ground.

To sustain morale among the public frontliners, the government needs to back this message up by providing additional resources at the district level for the continuing effective and efficient implementation of public health services, or else the proclamation that public health is important and the best brains should be in public health is just another rhetoric. 

Digitalisation of some public health services through MySejahtera was a good move. However, the Omicron wave may be too big a stress test and too soon for the MySejahtera system to manage by itself. 

We should have learned a bitter lesson during the previous Delta surge in the Klang Valley. A system failure at the district level and loss of primary care functions will lead to the collapse of the entire health care system, with dire consequences that will lead to a humanitarian tragedy. It will be a crime if this tragedy is repeated.

There is an urgent need to strengthen public health and primary health care services at the district level to fight the Omicron wave.

Dr Sanjay Rampal is Professor of Epidemiology and Public Health at the Faculty of Medicine, University of Malaya, and Dr Lokman Hakim Sulaiman is Professor of Public Health at the School of Medicine and Pro Vice Chancellor, International Medical University.

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