APRIL 8 ― We write to record our praise and appreciation of our dedicated colleagues in the healthcare professions in confronting the current pandemic that has brought deaths and sufferings to many. We salute too the brave members of the police and armed forces and other essential service providers who together form a strong frontline in this fight. They have been marshalled by competent experts, headed by the tireless and commanding director-general of health Datuk Dr Noor Hisham Abdullah. This team of experts know thoroughly the sciences involved and are guided by evidence based thinking. They exude confidence and have succeeded in giving faith to the rakyat.
Since the first case was announced in January, Malaysians have been anxious of the progression of the new virus infection. Every evening we are transfixed in front of our tv sets listening attentively to our D-G of health. And at the end of every presentation in the past week or so we have the feeling that we are moving in the right direction. The D-G and his team exude an air of confidence that we will win this battle.
We now know that the virus is among us in the community. We know that the MCO is the right weapon against it. We need to follow strictly the rules of the MCO. We each need to be disciplined. We need to realise that the rights of the community not to be harmed should not be disrespected by the few who elect to be foolish.
We know also that we need to prevent further invasion through our borders. We have been quick and ready to deal with this and all returnees are swabbed and quarantined. We know this drastic and bothersome action on some will protect many more people in our community. But we know those involved are in the main accepting of this need to sacrifice.
We know too that each of us has a responsibility to keep ourselves and loved ones safe. We also know that we need also to keep the community safe by not behaving irresponsibly. We must declare to our healthcare workers if we have been exposed to the virus through contacts with infected individuals. We may now be more proactive in fighting the spread of the pandemic by getting ourselves and loved ones tested if we feel uncomfortable with our state of health.
The statistics reported to us daily show no more sudden spikes of cases. Figures appear to be stabilising. But how does Malaysia compare with others around the world?
To answer the above question we looked at published figures (as of April 6, 2020) and computed several measures in public health and epidemiology (see table). We have listed several countries in the table, a group from the east and another from the west. We looked at infection rates in the population, death rate in the population and case fatality rates (ie. the rate of deaths in confirmed cases) in these countries.
We can see the different results in the two groups and between the groups. And we note that Malaysian figures stand shoulder to shoulder with the best. Of course, the figures are dynamic and may change as the pandemic progresses.
So what have we and similar countries done right?
The infection rate (or the attack rate) shows how heavy the burden of infection is in the population. It is a reflection of how quick and widespread the virus had spread. Our figures indicated Malaysia reacted well to early warnings of the pandemic. The relatively low figure suggests that we managed to implement effective primary prevention methods in a timely manner. The public was educated early and once the first case appeared we implemented measures to track, test, isolate and treat. It was somewhat unfortunate the Sri Petaling event happened under the radar of the authorities who nevertheless responded promptly.
The population mortality and case fatality rates are also relatively low and are reflections of how efficient Malaysia has dealt with those who have been confirmed by testing. We have done well with testing although our capacity was initially limited. With more tests our case fatality rate may in fact be smaller or will not be rising significantly. The indications are that the principles of secondary prevention in public health have been applied to the maximum by our experts.
It is important to emphasise that although the virulence of the virus is the same worldwide the case fatality rates have differed between countries. Thus there are factors that have come into play to influence outcome. Tops among these are our capacity to treat diagnosed patients in hospitals using systematic evidence based treatment approaches to patients with lung infections. Our infected cases have not been allowed to stay at home as they would be best monitored and treated in the hospital. And of course our specialists are highly trained in all the disciplines that matter ― infectious diseases, respiratory medicine, anaesthesiology and intensive care, cardiology, imaging etc. And our nursing personnel are among the best trained in the world. So are our pharmacists, physiotherapists and radiographers. A serious disease has been handled seriously by us.
We hope the promising trends in our figures are maintained. And each Malaysian has a role to play to achieve this.
Without having to comment on how other better developed countries listed have performed, we can draw lessons from those that have done well. China was the first hit and hit hard and appeared initially to have lost the fight. But their resolve, discipline, high medical and technological expertise, high capacity in human resource and materials and quick utilisation of the military, which is highly competent in logistics, combined with decisive strategic actions have given them the winning edge. Similar lessons can be drawn from South Korea and Japan.
Moving forward, there are valuable lessons already learned and yet to be learned from this pandemic. Malaysia must now reflect deeply on how important it is to strengthen our healthcare sector. Countries that have developed their healthcare systems to be highly efficient based mainly on financial considerations (just in time, just enough) in peacetime may now be seen to flounder in pandemics and natural disasters. The ability to cope can be overwhelmed by a lack of capacity and absence of redundancy. In order to have a highly resilient healthcare system (a much touted mantra in healthcare currently) we need a rethinking on how we develop infrastructure and skilled human resources ie our doctors and other healthcare personnel. Perhaps, although busy with our current duties, it is time to make a heartfelt mental note that we, healthcare leaders, need to take care of our own. We must rewrite our narrative on the state of our manpower needs for a country aspiring to head towards the status of a developed country. We need more doctors and not fewer. And then we must support, train and engage with a touch of parental kindness our junior doctors and other healthcare professionals who will replace us in future fights.
Kudos to all involved in this fight. May you all be blessed.
* This is the personal opinion of the writer or publication and does not necessarily represent the views of Malay Mail.
