If it ain’t broke, don’t fix it — Musa Mohd Nordin

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JANUARY 24 — The data shows that the MOH is doing relatively well.

The risk of a Covid-19 death per population n Malaysia is 1 per 50,000.

This compares favorably against the Global average of 1 per 3,676.

It is worse in the UK and US, 1 per 700 and 781 respectively.

Singapore’s Covid-19 death per population is 4 times better at 1 per 200,000.

Put another way there are 5, 20, 272, 1280 and 1429 deaths per million population in Singapore, Malaysia, World, US and UK respectively.

Testing and the consequent positive rate is a critical metric for understanding the pandemic, how it is spreading and whether it is under control or not. With this testing data, we can learn from the countries who are doing well at controlling the pandemic and which countries are just underreporting cases and deaths.

The most recent positive rate in the third quarter of January 2021 (7-day rolling average) for Covid-19 testing is higher in the US and UK at 14.5 per cent and 7.5 per cent respectively, when compared to Malaysia at 5.7 per cent and best in Singapore at less than 0.1 per cent.

According to WHO, a positive rate of more than 5 per cent indicates that the epidemic is not quite under control in the country.

Prior to the onset of the third wave in Malaysia, the positive rate had dropped to less than 1 per cent. This later rose to 9.1 per cent in early January 202, and is now showing an encouraging downward trend. The countries doing best at pandemic control and mitigation have reported positive rates of less than 3 per cent, which is a useful target to aim for.

Testing needs to be twinned with rapid Isolation of cases and prompt Tracing of contacts and their quarantine. This can only be achieved with a Rapid Test Kit – Antigen (RTK-Ag) with a Turn-Around-Time of less than 24 hours, more affordable and can be undertaken at the Point-Of-Care.

The PCR which is presently utilised, is not the best Public Health tool for Covid-19 surveillance purposes. It is best suited for analytical sensitivity and clinical diagnosis within the hospitals.

The FTTI work process between the 2 testing regime looks like:

RTK-Ag: Day 1-Test, Day 1-Results/Isolate, Day 2-Trace/Quarantine: Covid busted.

PCR: Day 1-Test, Day 3-Result, D4-Inform, D5-7 Isolate/Trace: Covid spreads.

The integration of MySejahtera with SeLangkah would be able to power an automated digital apps, leveraging on data science and machine learning, to facilitate contact tracing and to Find hotspots in the country which mandates, pre-emptive, targeted and mass screening as part of the FTTI rapid response to bust the Covid-19 clusters and mitigate the sporadic spread of the coronavirus.

Despite the surging numbers of Covid-19 cases, the MOH infrastructure and services are holding up well and delivering good outcomes when compared to the US, UK and our southern neighbours. Therefore, if it ain’t broke, don’t fix it. It is in this context that the following suggestions are made:

1. The MOH should continue to operate with the 52 dedicated Covid Hospitals.

2. If these are inadequate to meet the current surge in Covid-19 cases, select private and government facilities can be transformed into dedicated Covid Hopsitals.

3. The concept and operations of Hybrid Hospitals should be avoided as much as possible. It compromises the Quality of Care, especially among the Category 4-5 patients, and the Safety of patients, HCW, other hospital staff and visitors, due to the real risk of nosocomial infection from this most transmissible coronaviruses.

4. The lay public is fast becoming very fearful of Covid and Hybrid hospitals and this has led to them shunning away from hospitals despite their need for regular hospital visits and review.

5. If they delay or miss their appointments, the management of Non-Covid illness eg NCD, Cancers, Immunization uptake, will be compromised.

6. The MOH has begun to decongest and create more empty General and ICU beds in Covid Hospitals by discharging Category 1&2 patients to Home Isolation with clear instructions on the use of Health Assessment Tools.

6. MOH can also begin to start decanting Non-Covid patients in Covid Hospitals (occupying General/ICU/Ventilator beds) to Private Hospitals. This exercise will help to create more General, ICU and Ventilator bed in Covid Hospitals.

7. This smart triaging of cases will protect the capacity of our Covid Hospitals and allow the Private Hospitals to play a bigger role in this Private Public Partnership (PPP) in Covid Pandemic Management.

* This is the personal opinion of the writer and does not necessarily represent the views of Malay Mail.

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