Klang Valley Hospitals In Quandary As ‘Incidental’ Covid Admissions Rise

The high number of daily admissions – “with” or “due to” Covid-19 – is putting pressure on the Klang Valley’s public health care system that is operating at 80% to 85% of its workforce, as many health care workers get infected and enter quarantine.

KUALA LUMPUR, March 14 – Hospitals all over the Klang Valley have reported an increase in Covid admissions since February, but nearly half were admitted for other medical reasons, say health care workers.

“Incidental” patients – who happen to test positive for Covid-19 while seeking care for reasons unrelated to the virus – are complicating the link between severe illness, hospitalisations, and deaths, putting overworked health care workers in a dilemma.

Many are opting to admit patients for observation as a precautionary step as Covid-19 could worsen pre-existing medical conditions. Ministry of Health (MOH) data also show Covid deaths and brought-in-dead (BID) cases are at a four-month high, prompting medical staff to be extraordinarily careful in assessing patients that may be at high risk.

While Omicron may be less severe than Delta, some patients can still potentially deteriorate within 24 to 48 hours.

“We are seeing a lot of patients coming to the hospital for other reasons who just happen to have asymptomatic Covid-19 when we screen them. That’s where a lot of the Category One and Two admissions are coming from,” said government doctor Dr Malek (pseudonym), who spoke to CodeBlue on condition of anonymity due to a gag order on civil servants.

The MOH does not yet provide information on incidental admissions, although national data on hospitalisation does include information about severity of illness and non-Covid beds.

According to March 12 data, about 61 per cent, or 294 of confirmed 483 Covid-19 cases admitted to hospitals across the Klang Valley (Selangor, Kuala Lumpur, Putrajaya), were asymptomatic (Category One) and mild (Category Two).

Still, regardless of the severity, the high number of daily Covid admissions is weighing on the region’s health system as many hospital employees are themselves sick or isolating after contracting the virus. Omicron is believed to be even more contagious than Delta.

According to the CovidNow site, 633 Covid-19 hospital admissions in the Klang Valley, including those suspected of being infected with the coronavirus, were recorded on March 12, the highest in over six months since August 26 with 700 admissions.

“Many hospitals are short on staff. I’d say many are operating with a workforce of about 80 to 85 per cent because we constantly have people who are infected, who get sick, or have to be quarantined – and that also adds pressure on those who do show up,” said Dr Malek.

A University Malaya Medical Centre (UMMC) doctor told CodeBlue that the hospital has seen a surge in Covid patients over the last two weeks, while also facing staff shortages.

“Yes. Definitely this time around (a lot of medical staff are infected with Covid),” the UMMC doctor said on condition of anonymity.

“We are taking in most patients, so some do end up being stranded in the emergency department. We are focused on all patients, anyone that walks in through the door.”

CodeBlue was unable to get a comment from UMMC’s hospital director.

Higher Covid Admissions Among Pregnant Mothers, Children

Daily MOH hospitals’ paediatric Covid-19 bed utilisation for children aged under 12 years from January 1, 2022 to February 28, 2022. Graphic from the Ministry of Health.

High Covid deaths among pregnant mothers in Malaysia has also resulted in increased Covid admissions involving pregnant women, as obstetricians and gynaecologists become more vigilant about coronavirus infection during pregnancy.

Dr Malek, who has knowledge of the matter, said while some pregnant Covid patients can deteriorate rapidly from Category 2B (moderate) symptoms to Category Four, many are stable and have no complications, which raises the question if admissions are necessary.

Klang Valley hospitals have also seen an increase in Covid admissions involving children, which Dr Malek attributed partly to the cold and flu season, with children also going back to school.

Health Minister Khairy Jamaluddin pointed out recently that the utilisation of Covid paediatric beds in MOH hospitals by under-12 children increased by over 250 per cent from about 100 beds occupied on February 2 to more than 350 beds on February 24.

Khairy said a total of 123,019 Covid-19 infections were reported in children aged below 12 this year as of March 7.

Dr Malek said high Covid admissions among children present a unique challenge for many hospitals as not all medical workers are trained in paediatric care. On this front, he questioned why UKM’s Specialist Children’s Hospital (HPKK) continues to be a non-Covid hospital.

HPKK, which falls under the purview of the Higher Education Ministry, was temporarily repurposed into a full Covid-19 hospital in June last year under an emergency ordinance signed by then Prime Minister Muhyiddin Yassin.

It was reconverted back as a children’s hospital four months later in October. All Covid patients are referred to Sungai Buloh Hospital.

A doctor, who recently left UKM Specialist Children’s Hospital (HPKK), told CodeBlue that the hospital no longer accepts Covid-19 patients and that efforts are underway to transfer UKM’s Canselor Tuanku Muhriz Hospital (HCTM) paediatric patients to HPKK.

CodeBlue attempted to reach out to HPKK’s director for comment.

More Covid Hospitals The Way Forward?

Sungai Buloh Hospital. Picture from Facebook @Hospital Sungai Buloh Selangor.

While the rise in Covid cases among children seems to suggest that having a children’s Covid hospital would help ease some of the burden on Klang Valley hospitals that lack paediatric training, the strategy may not work to address high Covid admissions in adults.

Given that a high percentage of Covid hospitalisations is now incidental, having facilities dedicated solely to treating patients with just Covid appears to be obsolete.

During the Delta wave last year, Klang Valley had four full Covid-19 hospitals: Sungai Buloh Hospital, Ampang Hospital, Selayang Hospital, and Serdang Hospital.

Sungai Buloh Hospital, which remains as Klang Valley’s main Covid facility, is reportedly underutilised for critical Covid care and treatment.

A doctor, who left Sungai Buloh Hospital in December, told CodeBlue that Sungai Buloh Hospital has been transitioning back to a hybrid hospital in phases as the country moves to endemicity.

Sungai Buloh Hospital is estimated to have a capacity of up to 1,700 beds for non-critical and ICU Covid-19 patients, with its National Leprosy Control Centre (NLCC) having an additional 300 beds.

During the Delta surge in July and August last year, hundreds of severely ill Covid patients were referred to Sungai Buloh Hospital each day, as patients at low-risk quarantine centres and those under home surveillance quickly deteriorated.

Sungai Buloh Hospital declined to comment without MOH’s authorisation.

Meanwhile, the Integrated Quarantine and Treatment Centre (PKRC) at Malaysia Agro Exposition Park Serdang (MAEPS), which reopened last month, is now operating at just one per cent, or 100 beds of its maximum capacity of 10,000 beds.

The reopening of the centre was intended to provide a “buffer” for MOH hospitals that are continuing to run non-Covid surgeries as well. MAEPS is designated for Covid-19 patients who are low risk and those that need step-down care.

However, if the centre’s bed occupancy rate remains in the low hundreds, Dr Malek expects the PKRC at MAEPS to shut down again because of cost, similar to the government’s recent decision to close down all Covid-19 mega vaccination centres (PPV) due to high rent.

“What we need now is for all health care facilities to understand that Covid is here to stay, so they need to have the ability to manage Covid at their own facilities,” Dr Malek said.

Several MOH officials contacted by CodeBlue, including Health Minister Khairy Jamaluddin’s office, Health director-general Dr Noor Hisham Abdullah, Health deputy director-general (medical) Dr Asmayani Khalib, and Selangor state health director Dr Sha’ari Ngadiman, did not immediately respond to requests for comment.

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