State govts must be transparent to ward off ‘crisis status’

 

From Dr Amar-Singh HSS

About a week ago, I wrote an article to highlight the deteriorating Covid-19 situation in certain states.

This article is to share the realities and crisis that is already upon us.

Situational analysis

The graphic above shows a situational analysis of what is potentially impending for different states. The crisis situation in the Greater Klang Valley (Selangor, Kuala Lumpur, Putrajaya and Negeri Sembilan) will probably settle slowly over the next two to four weeks due to the huge Delta outbreak, massive vaccination ramp-up and enhanced resources poured in by the government and civil society.

However, total numbers in the country and even deaths may not come down as the Delta wave hits other states, especially Sabah, Kedah, Perak, Johor and Penang.

These states are deteriorating rapidly and may become worse than the Klang Valley as they have low vaccination rates (due to low vaccine supply) and some have a weak hospital infrastructure (especially Sabah). All these states have second dose vaccination rates of under 20%.

The table below shows the ICU beds for Covid-19 usage for these five states/territories. It is important as we look at this data to understand the realities:

• The trend of ICU bed usage for July is a steep upward curve.
• Almost all states have exceeded their official ICU bed numbers. The original ICU beds they had are of far better quality than repurposed ICU beds.
• Kedah and Perak have exceeded their total ICU beds (original and repurposed beds) and are in full crisis mode.
• Sabah may “look” better but its Covid-19 hospital admissions have reached the crisis numbers of last year. State hospitals are struggling to cope.
• Remember that these numbers do not count patients who should be in ICU beds (Category 4 and 5) but are being managed in Emergency Departments (casualties) and quarantine centres. Kedah also has a high number of brought-in-dead patients.

Table: ICU beds and Covid-19 usage by selected states, Aug 1, 2021
State
Sabah	116	72	188	99*
Kedah	77	55	132	132 (Exceeded)
Perak	69	42	111	117 (Exceeded)
Johor	120	67	187	131
Penang	20	60	80	67

*Sabah’s total hospital admissions for Covid-19 have reached the crisis numbers of last year
Data Source: MOH, Malaysia

We can never be prepared enough for Delta

We need an all-of-society approach to deal with the crisis as it grows. I would like to make some suggestions for the health departments, state governments, corporate bodies, civil society and the general public. More details can be found here.

1. True, reality-based data sharing by state health departments:

It is vital that the public in each crisis state are aware of the full reality. The time for “Don’t worry, everything is OK” or “We are in control of the situation” or “We have prepared for this crisis” has passed. These statements are of no value.

Delta does not respect or care about attempts to “not alarm” the public. We can never be prepared enough for Delta, and the Klang Valley with all its resources, shows this clearly. State health departments must have daily crisis sharing with the public (media, Facebook, other online outlets). Trust is crucial to fighting the pandemic and this is based on transparency.

2. State-level disaster management teams led by state health directors fully supported by state governments, and with a strong liaison to corporate bodies and civil society (NGOs):

Those of us outside the Klang Valley know that no help is coming for our states. The federal government has limited funds, having invested significant resources to support the Klang Valley. Hence, we must work closely with wealthy business leaders and NGOs to ramp up resources and services. We need strong, decisive leadership and not individuals from the state administration looking to make a financial gain out of the crisis.

3. Don’t put all our eggs in the vaccine basket:

While we advocate for more vaccine supply and ramp up vaccination, we must not put our hopes in that measure alone; we need to use good public health measures as the World Health Organization repeatedly tells us. Lockdowns are not the solution. There must be good mask use, avoiding all unnecessary social interaction, effective contact tracing, using RTK-Ag testing for confirmation, etc.

The continued use of large PPV centres is a risk for Covid-19 transmission. We should fully transition to using maternal and child health clinics, school health teams, GPs, private hospitals and outreach teams.

What can corporate bodies, civil society and the public do to support their states?

1. Purchase and donate equipment to hospitals and quarantine centres:

Corporate bodies, NGOs and the public should liaise directly with individual specialists and medical officers to know the real needs on the ground while protecting their identity. They will better inform you what items they need and where to get them.

• Important items to manage patients include oxygen concentrators, oxygen tanks, oxygen regulators, infusion pumps (to deliver drugs), portable suction machines, portable vital sign monitors, blood pressure monitoring sets, electrocardiograph (ECG) machines, stretchers and canvas beds.
• Support the PPE of health staff which are in high usage, including N95 masks, powered air-purifying respirators (PAPR), isolation gowns, face shields or goggles, gloves, disposable caps and footwear.
• Provide Medical Device Authority-approved RTK-Ag saliva test kits to enable health staff to speed up and increase testing of all contacts in clusters and the community.
• Consider offering reliable emergency transport services because the health department ambulance services will be overrun. This may help reduce brought-in-dead cases.
• Grow ICU capacity by creating new ICUs. This requires the larger corporate bodies to fund and rapidly construct (within two to four weeks) purpose-built ICU facilities (with high dependency unit wards) at major hospitals.

2. Supporting positive individuals and contacts:

Individuals found positive or are contacts of positives will be required to home isolate or be admitted to quarantine facilities. Those in home isolation will require support including:

• Reliable finger pulse oxymeters for monitoring.
• Medical support for monitoring (video calls daily from health professionals).
• Some may require practical support in terms of meals.
• RTK-Ag saliva testing support for those who are contacts (symptomatic or asymptomatic). We should also fund these so that we can enable the public to self-test.
• Purpose-run quarantine facilities for those living in homes or accommodation unsuitable for home isolation (crowded homes, limited space, migrants, etc). This would mean using hostels and hotels to house them (good ventilation and no central air conditioning; private rooms with toilets).

3. Supporting communities hard hit economically by the pandemic:

A significant portion of our public is struggling with daily needs and we need to support them. Although government agencies are doing some of this work, many fall through the cracks and have minimal support. Some ways to do this are:

• Partner with reliable local NGOs and disaster organisations delivering food to the poor, and setting up and maintaining food banks.
• Family-to-family support – adopt poorer families for six to 12 months, and offer a fixed sum of money monthly to aid groceries and utility bills.
• Give away food coupons that can be redeemed at sundry shops/convenience stores.
• Hire individuals who have lost jobs as volunteers to support others.
• Support families traumatised by Covid-19, who have lost loved ones, lost their jobs, etc and are struggling to cope emotionally. This includes children who have become temporary (both parents hospitalised) or permanent orphans.

I appeal to the Sabah, Kedah, Perak, Johor and Penang state governments to be transparent so that extensive and comprehensive emergency action can be taken by all in society to deal with the crisis at hand.

There are mothers and fathers, sisters and brothers who need to be saved in the coming weeks. Please let us not wait until we reach a Klang Valley crisis status. - FMT

Dr Amar-Singh HSS is a consultant paediatrician and an FMT reader.

The views expressed are those of the writer and do not necessarily reflect those of MMKtT.