On the eve of Chinese New Year in 2020, Dr Chong Chee Kheong barely had time to sit down for his reunion dinner with extended family when his phone rang.
On the other end was his counterpart from Singapore’s Ministry of Health (MOH). A Chinese tourist who visited the island city-state had tested positive for the novel coronavirus. Worse, the infected traveller had already crossed the border into Malaysia.
“That’s when I knew the Year of the Rat was not going to be good,” Dr Chong recalled.
At the time, Dr Chong was deputy director-general (public health) at the MOH, with just a year and a half left before retirement in July 2022. He had anticipated a relatively quiet end to his career. Instead, the Covid-19 pandemic would propel him into one of the most critical leadership roles in Malaysia’s public health history.
Dr Chong had spent years at the forefront of disease control and epidemiology. Before becoming deputy director-general, he was director of the National Public Health Laboratory, head of the Vector Borne Disease Sector, and director of the Disease Control Division in the MOH.
A graduate of Universiti Malaya, Dr Chong earned his medical degree (MBBS) in 1986 and a Master’s in Public Health in 1990. He was gazetted as a public health specialist in 2003 and certified as a field epidemiologist in 2006.
The Delta wave came and swept our prevention and control efforts away like a fly in a storm.
By mid-2021, the Delta variant ravaged the nation. Nowhere was the crisis more severe than in the Klang Valley, the country’s economic and population hub. Hospitals overflowed, patients gasped for breath while waiting outside emergency rooms, and mortuaries ran out of space.
“The Delta wave came and swept our prevention and control efforts away like a fly in a storm,” Dr Chong said. “For the first time, we were seeing pictures of patients lining up outside casualty, severely ill patients inside, overcrowded wards, more people dying at home, and bodies piling up at the mortuary. And all this was happening in the Klang Valley.”
Dr Chong was appointed commander of the Greater Klang Valley Special Task Force (GKVSTF), a unit formed on July 8, 2021, to stabilise the region’s failing health care system. As commander of the GKVSTF, Dr Chong found himself at the helm of an operation that included the military—a highly unusual arrangement, given the army’s strict hierarchy.
Yet, urgency demanded unorthodox solutions, and the mild-mannered Dr Chong was placed above military leadership in the chain of command.
As the crisis deepened, the government launched Operation Surge Capacity, a vaccination blitz targeting the hardest-hit areas of Selangor, Kuala Lumpur, and Putrajaya. While inoculation slowed the virus’s spread, it was the GKVSTF’s pivot to mitigation that ultimately turned the tide. Within 10 weeks, the situation stabilised.
In an exclusive interview with CodeBlue last month, Dr Chong explained how the GKVSTF’s strategy worked and how its success showed, in hindsight, that Malaysia should have transitioned from containment to mitigation earlier during the Covid-19 pandemic.
The Dilemma: When To Pivot From Containment To Mitigation
The GKVSTF was formed as an independent unit reporting directly to the prime minister. Unlike the MOH’s Crisis Preparedness and Response Centre (CPRC) or the National Covid-19 Task Force, which were MOH-led and focused on containment, the GKVSTF operated as a multi-agency task force, bringing together the MOH, the Malaysian Armed Forces (MAF), and private sector to shift from containment to mitigation.
The CPRC, the MOH’s central command for outbreaks, managed Covid-19 surveillance, data tracking, and hospital resource coordination. The National Covid-19 Task Force – led by then-Health director-general Dr Noor Hisham Abdullah, a surgeon by training – oversaw national containment policies, including lockdowns, movement restrictions, and public health measures.
Dr Chong led the GKVSTF as commander, with Brigadier General Dr Mohd Arshil Moideen from the MAF overseeing ground operations and MOH’s Dr Mohamed Alwi Abdul Rahman, head of emergency at Selayang Hospital, managing patient care.
Then-MOH secretary-general Mohd Shafiq Abdullah provided critical financial and logistical support, while Dr Jemilah Mahmood, special advisor to the prime minister (PM), leveraged her disaster management expertise to mobilise NGOs and private hospitals. It was under Dr Jemilah’s advice that the then-PM instructed the formation of the GKVSTF. Among those involved was Nadiah Wan, then-CEO of TMC Life Sciences and Thomson Hospital Kota Damansara.
This broad coalition allowed GKVSTF to act faster than national efforts. While the National Covid-19 Task Force led by Dr Noor Hisham remained focused on containment and lockdowns, GKVSTF pivoted early to mitigation—expanding hospital capacity, streamlining patient triage, and accelerating vaccinations to stabilise the Klang Valley’s collapsing health care system.
“In all pandemics, the theory is very simple: early detection, containment, mitigation, and recovery,” Dr Chong explained. In practice, transitioning between phases is far more complex.
Malaysia struggled with early detection due to delays in acquiring test kits. Initially, nasal swab samples had to be sent to a limited number of government labs before private labs were engaged at a cost. Only when home test kits were introduced did detection improve.
Containment was the next step—aimed to trace, isolate, and limit outbreaks. “But we know very well that in theory that would never be possible because this was a pandemic, so cases kept growing,” Dr Chong said. “At some point, the health care system gets overwhelmed, and you need to go into mitigation.”
That point came swiftly in the Klang Valley, but the government hesitated. “Mitigation means prioritising what to do, living with the virus. The difficulty in any case is, when do you try to make the transition from containment to mitigation because mitigation seems like surrendering to the virus—like giving up hope,” Dr Chong said.
The goal of containment was to slow the rise in infections, buying time until a vaccine or cure was available. But by mid-2021, Delta had upended that strategy.
One clear sign of an overwhelmed system is when doctors are forced to make difficult triage decisions, including do-not-resuscitate (DNR) orders for certain patients. In the United Kingdom, reports emerged of blanket DNRs being issued at the height of the pandemic, raising ethical concerns about how resources were allocated in overstretched hospitals.
When asked if Malaysia faced similar decisions, Dr Chong acknowledged the dilemma but said he could not speak directly about hospital policies.
“I was in public health, so I wasn’t really in charge of the medical side—hospitals, specialists, and so on. It would not be fair for me to actually tell you what they did or didn’t do.
“But what I can tell you is that, yes, when the ICU (intensive care unit) beds are full, the doctors really have a dilemma on whether to give up on the patient or continue, but at the same time, they have patients waiting at the doorstep, waiting to come in.
“If you have interviewed the medical side—the hospital directors or the specialists—they actually have guidelines on what to do under those circumstances, something which the specialists agreed among themselves. These are the criteria they follow when the situation reaches a stage where they need to make those not-so-good decisions.”
Our dilemma at the national level was when to move from containment to mitigation. I think in that sense, we were a bit slow. We should have moved to mitigation a bit faster.
Malaysia’s Covid-19 vaccination programme began in February 2021, but the initial rollout was slow, with limited supply and logistical challenges. By mid-2021, Klang Valley’s vaccination rate remained low even as cases surged, pushing hospitals to their limits.
In response, Operation Surge Capacity was launched in July 2021 to rapidly increase vaccinations in the Klang Valley, alongside the formation of the GKVSTF. Before the operation, only 57 per cent of the Klang Valley’s 6.1 million adults had received at least one vaccine dose. By August, that number had risen to 97 per cent.
The Covid-19 Immunisation Task Force (CITF) was established on February 3, 2021, led by then-Science, Technology, and Innovation Minister Khairy Jamaluddin as Coordinating Minister to oversee the rollout of the National Covid-19 Immunisation Programme (PICK).
Operating under the Ministry of Science, Technology, and Innovation (MOSTI), the CITF officially concluded on October 31, 2021, by which time 95.5 per cent of Malaysia’s adult population had been fully vaccinated.
The Special Committee for Ensuring Access to Covid-19 Vaccine Supply (JKJAV) was co-chaired by Khairy and then-Health Minister Adham Baba. Dr Chong, as deputy director general of health, served as a co-ground commander of the CITF alongside Lieutenant General Mohammad Ab Rahman, the deputy chief of the Army.
“Our dilemma at the national level was when to move from containment to mitigation. I think in that sense, we were a bit slow,” Dr Chong admitted. “We should have moved to mitigation a bit faster.”
Still, he acknowledged the decision was difficult. “If we moved too early and more people died, it would be hard to justify,” he said. “But when people were dying in numbers, and the health care system was maxed out, we had no choice (but to shift to mitigation).”
To go straight to a mitigation strategy, you need a highly compliant population. So let me turn the question back to you—do you think Malaysians would be compliant enough?
In a separate Covid-19 anniversary interview with CodeBlue in Singapore, Dr Noor Hisham defended Malaysia’s lockdown strategy, saying that it was guided by science. “Science is science. So MOH advised accordingly, based on the science,” said the former Health DG.
Lockdowns, he explained, were never meant to be permanent but were intended to “buy time” to outlast the virus’s infectivity period. If the virus remained infectious for two weeks, then a two-week lockdown, in theory, could help contain its spread.
Dr Chong observed that a few countries, including Sweden and parts of Japan, avoided full lockdowns and instead relied on community engagement to mitigate the spread of Covid-19. This approach, however, depended on high levels of public compliance—something he believed Malaysia lacked. Movement restrictions in Malaysia were legally enforced with hefty fines of up to RM10,000 for infractions.
In countries without mandatory lockdowns, authorities relied on public cooperation, advising people to stay home and avoid unnecessary activities, with the expectation that they would follow these guidelines. Surprisingly, this strategy worked in some cases.
However, such an approach led to a higher number of deaths among the elderly, suggesting that older populations should have been managed differently during a pandemic compared to younger groups.
“I was surprised the other day. My friend told me he was in Tokyo during the pandemic, so I asked him if there was a lockdown. He said yes, but it was enforced city by city or in sections of the city. Within those sections, people were still moving about—they could go out to buy things, run errands, and do some work.
“So in that sense, they were also using a mitigation strategy. Maybe not entirely, but they were still applying it,” Dr Chong said.
“To go straight to a mitigation strategy, you need a highly compliant population. So let me turn the question back to you—do you think Malaysians would be compliant enough?”
If there’s one thing I’d do differently, it’s transitioning from containment to mitigation faster. We must be brave enough to make that call. When a pandemic threatens to overwhelm the system, we need to act.
The GKVSTF’s mitigation strategy in the Klang Valley did not lower Covid-19 infections, but it prioritised who received care, and how quickly.
“If you don’t need to be in the hospital, why clog up the system? That was the thinking behind the mitigation strategy,” Dr Chong said. “If someone doesn’t need to be hospitalised, why admit them and deprive someone who does.”
At the peak of the Delta wave in epidemic week 27 (July 4-10, 2021), Klang Valley accounted for about 68 per cent of weekly Covid-19 cases and 71 per cent of national deaths.
By epidemic week 37 (September 12-18, 2021), Klang Valley cases dropped to 17 per cent of the national total, with deaths down to 40 per cent. Nationally, however, both cases and deaths had risen.
“By prioritising severe cases, we got the situation under control,” Dr Chong said. “Mild cases stayed at home. That’s how we handled it.”
GKVSTF’s Tactics On Beds And Oxygen
Left: Brigadier General Dr Mohd Arshil Moideen, management chief of the Malaysian Armed Forces Health Service Division, and Dr Mohamed Alwi Abdul Rahman, head of the emergency department at Selayang Hospital—both Joint Commanders of the Greater Klang Valley Task Force—delivering an operational briefing at the MAEPS Covid-19 quarantine centre in Serdang, Selangor, on August 20, 2021. Photo from Angkatan Tentera Malaysia’s Facebook page. Right: A member of the Malaysian Army’s ‘OSCAR’ or ‘Oxygen Carrier’ Team, responsible for replacing oxygen tanks for Covid-19 patients at MAEPS, Serdang. Photo from Tentera Darat Malaysia’s Facebook page.
One key priority of the GKVSTF was ensuring there were enough hospital beds available at all times. Ideally, they aimed to maintain a 10-to-14-day buffer, but as cases surged, they had to make constant adjustments.
Each day, they projected bed availability based on case trends. If 500 beds were available but cases continued rising, those beds could be filled within five days. The team had to recalibrate, first aiming for a two-week buffer, then scaling it down to 10 days, then seven, then five, depending on the severity of the surge.
“If all beds ran out, we had to consider shifting patients to hospitals outside the Klang Valley—to Ipoh, to Penang,” Dr Chong said. “But realistically, those places were full too. That wasn’t really an option, but we had to think about it.”
The process was a daily balancing act. Officials had to track ICU and Covid-19 ward capacity and adjust accordingly. “If we could keep a 10-to-14-day supply of beds based on current case rates, we were in a stable position,” Dr Chong said. “That was the strategy.”
Left: Large oxygen cylinders stand between patient beds at the MAEPS Integrated Covid-19 Quarantine and Low-Risk Treatment Centre (PKRC) 2.0 in Serdang, Selangor, on August 20, 2021. Photo from Angkatan Tentera Malaysia’s Facebook page. Right: Members of the Malaysian Army’s ‘Body Management Team’ (BMT), which handled the transfer of Covid-19 victims from wards to morgue storage. Team members were stationed at seven hospitals in the Klang Valley. Photo from Tentera Darat Malaysia’s Facebook page.
Beyond beds, oxygen supply was another challenge. Unlike hospitals, which had piped oxygen linked to beds, Covid-19 Quarantine and Treatment Centres (PKRCs) relied on tanks. Each patient needed three to four tanks per day, which amounted to thousands daily.
To manage this, 1,000 army personnel were deployed to transport oxygen tanks containing liquid oxygen—moving them from storage, often 200 to 300 metres away, and replacing them multiple times a day.
“I worked with a general who was very efficient,” Dr Chong said. “He managed to get permission to work directly under my command, which isn’t easy because the army follows its own hierarchy. But Brigadier General Dr Mohd Arshil Moideen got things done.”
The scale of the operation was immense. “Imagine moving a single oxygen tank across a huge facility,” Dr Chong said. “Now imagine doing that three or four times a day for each patient. And there were thousands of patients. The manpower needed was enormous.”
Keeping Tabs On Patients At Home: Robocalls And MySejahtera
With hospitals overwhelmed, many mild Covid-19 patients were asked to recover at home. But that raised a critical issue—how do you monitor thousands of people remotely?
“With a few hundred cases, you can call patients individually. But when cases hit 5,000 a day, that wasn’t feasible,” Dr Chong said. The solution was automated robocalls, a system developed pro bono by telecommunications service provider TIME dotCom Berhad.
“All home patients got robocalls. The system was relentless—it would keep calling until they answered,” Dr Chong said. “If they ignored the first call, it would ring again. And again. All day, until they picked up.”
Once connected, patients responded by pressing 1, 2, or 3 on their phones to indicate their condition. This data was fed into the monitoring system, helping officials track those who needed urgent care.
The MySejahtera app also played a key role. “We built MySejahtera so home patients could report symptoms daily. The system would flag those needing urgent care,” he said.
‘Zero’ Covid Messaging
Left: Health director-general Dr Noor Hisham Abdullah holds a press conference on Covid-19. Photo posted by Majlis Keselamatan Negara’s Facebook page on February 28, 2021. Right: Zero locally transmitted Covid-19 cases were reported in Malaysia on July 8, 2020. Photo from Kementerian Kesihatan Malaysia’s Facebook page.
Dr Chong described the “zero Covid” messaging in the early days of the pandemic as a communication strategy, with daily case updates forming part of containment efforts.
“There were a few occasions when cases hit zero. Before Delta, I remember holding up a sign that said ‘zero.’ After Delta, no more. It was just part of our communication strategy. We reported cases exactly as we registered them,” Dr Chong said.
“In the first few months of Covid, everyone was eager to follow updates. But over time, people grew fatigued. So when we reported zero cases, for the first time in, say, six months, people did feel happy. Of course, we knew cases would rise again the next day, but at the time, it was about keeping the public engaged.”
While infectious disease specialists understood that “zero” didn’t mean the virus was eliminated, the public and politicians took the messaging at face value.
In his recent interview with CodeBlue, Dr Noor Hisham admitted that some politicians assumed “zero” cases meant the crisis was over, leading them to push ahead with the Sabah state election on September 26, 2020, despite warnings from health officials.
The state election drew a surge of politicians and party workers from the peninsula and Sarawak into Sabah. Within 10 days, Covid-19 spread from Sabah to every state.
The Next Pandemic: Can We Endure Another Two-Year Battle?
Dr Chong’s biggest concern is whether Malaysia—like most countries—is prepared for a prolonged health crisis lasting one to two years.
While a short-term emergency of three to six months is manageable, an extended crisis, especially one with surges like Delta, will strain not just the health care system but also the economy and education sector, Dr Chong said.
“People always talk about preparedness before a pandemic. What if we face a massive outbreak? We had H1N1 where we mobilised teams to respond. At the time, it felt severe, but in hindsight, it wasn’t as bad. The same with MERS—we had to do a lot, but it wasn’t too bad. These experiences have helped strengthen our preparedness over the last decade. Health care workers are always training for ‘Disease X,’ the next pandemic.
How do you maintain a surge capacity for two years?
“But Covid was different. It lasted for two years. Is it fair to expect the surge capacity to be maintained over two years? That is probably the bigger question. How do you maintain a surge capacity for two years? If the surge capacity is for six months, I think we should have no problem.
“But to maintain a surge capacity for one year, and we still have another year to go, and in between there’s a Delta wave? This is something I think not many countries are prepared for,” Dr Chong said.
“Do we have the endurance to go on for one year, two years? Don’t forget that it’s not only the medical side. It’s also the economy side. Can the economy of the country endure two years of stifling? The same goes for education. Can students afford another year of school closures? These are questions that affect everyone.”
We Can Do Better: Protect Seniors And Act Faster
Dr Chong welcomed the government’s recent move to provide free flu vaccines for the elderly, calling it a smart investment in public health.
“When Covid hit, we saw in places like Italy that it was the elderly, especially those in nursing homes, who suffered the most.
“Protecting them must be part of any pandemic strategy,” he said, noting that while childhood vaccinations have been prioritised, the elderly are often overlooked. “At least now, with flu shots, the elderly will have some level of cross-protection if another pandemic hits.”
Dr Chong added that Malaysia must also be willing to shift strategies when needed. “If there’s one thing I’d do differently, it’s transitioning from containment to mitigation faster. We must be brave enough to make that call.
“When a pandemic threatens to overwhelm the system, we need to act.”
CodeBlue interviewed Dr Chong Chee Kheong on February 22, 2025, in Kuala Lumpur. Dr Chong served as Director of the National Public Health Lab, Disease Control Division, and Deputy DG of Health (Public Health) before retiring in July 2022. He is now a Contributing Scholar at Johns Hopkins Center for Health Security and Senior Health Advisor for ASEAN’s Mitigation of Biological Threats (MBT) programme.
This article is part of a special CodeBlue series marking the fifth anniversary of the World Health Organization declaring Covid-19 as a global pandemic on March 11, 2020.
