Covid-19 in Penang – prepare in advance

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PENANG is in its third consecutive week of declining trend in the number of positive cases as well as deaths since epidemic week 37 (EW37: September 12-18, 2021), continuing through epidemic week 39 (EW39: September 26 October 2, 2021).

Our average daily cases fell 23.5% in EW37, 20.5% in EW38, and an additional 30.95% in EW39. From a record daily case count of 2,474 cases on September 8, Penang’s daily cases fell to 623 on October 6.

Adult vaccination has already reached 96.1% for the first dose and 86.5% for the second dose. The percentage, however, could be much higher than reported as there are essentially no more names to call on MySejahtera. One possible explanation could be that those who took their vaccines in the private market did not update their MySejahtera status. This is a national problem that the Ministry of Health must resolve quickly.

The vaccination of adolescents in Penang is also ending soon. When Penang began immunizing adolescents on September 23, we were the slowest in terms of immunization rates among the states. When we started with just 4,177 doses on that first day, I immediately set a goal of 10,000 doses per day for the state health department. Today, thanks to the efforts of our frontline workers, we have not only achieved our goal of 10,000 doses per day, but we are now among the top five in the country with the fastest vaccination rate among adolescents.

As I mentioned over the past two weeks, one of my goals is to increase our health care capacity. And one of the critical facilities we had to work on was our intensive care beds. From 69 intensive care beds at the end of July, we managed to add 32 additional intensive care beds in three weeks from EW37. Today our intensive care bed capacity stands at 101.

Since September 11, Penang has received an additional RM 19.4 million from the Ministry of Health to support our efforts to fight Covid-19.

Preparing our healthcare system for the future

It goes without saying that as our positive cases and our deaths decline, we must continue to be on our guard to comply with the SOP.

We need to learn from neighboring countries where cases have suddenly increased despite a brief respite and even with a large population vaccinated.

I want to propose five actions to the federal government and the state government to prepare Penang to deal with Covid-19 or any pandemic in the future:

  1. Strengthen our healthcare capacity to perform 3Ts – test, trace and treat – quickly if there is an increase in new cases. This includes facilities, equipment as well as personnel. Instead of locking everyone down with OLS, the healthcare system should be able to quickly identify and isolate patients for treatment.
  2. Increase our intensive care facilities. When the pandemic began in March 2020, Penang had only 26 intensive care beds, six of which were reserved for Covid-19 patients. From July to September 2021, when there was a big spike in Covid-19 cases in Penang, we had 69 intensive care beds. As mentioned above, today we have 101 intensive care beds for Covid-19, or around 5.7 beds per 100,000 population, the national figure is 4.7, Malacca (9.4), Negri Sembilan (7.8), Kedah (5.9), Pahang (4.8), Kelantan (4.7), Perak (4.5), Perlis (4.3), Sabah (5.8), Sarawak ( 5.4), Selangor (3.0), Terengganu (3.0), Johor (2.9).

(Note that the beds above are Covid-19 intensive care beds, the total number of intensive care beds is usually slightly higher.)

Compare with pre-Covid-19 data on the capacity of intensive care beds in other countries: Brunei (13.1), Singapore (11.4), South Korea (10.6), Thailand (10, 4), Japan (7.3), Indonesia (2.7), Philippines (2.2).

(Reference: Phua J, Faruq MO, Kulkarni AP, Redjeki IS, Detleuxay K, Mendsaikhan N, Sann KK, Shrestha BR, Hashmi M, Palo JEM, Haniffa R, Wang C, Hashemian SMR, Konkayev A, Mat Nor MB, Patjanasoontorn B, Nafees KMK, Ling L, Nishimura M, Al Bahrani MJ, Arabi YM, Lim CM, Fang WF, Asian Analysis of Bed Capacity in Critical Care (ABC), the Asian Critical Care Clinical Trials Group researchers. intensive care beds in Asian countries and regions. Crit Care Med 2020; 48: 654-662.)

According to our observation, the total number of deaths fell by 1.57% in EW37, 24.4% in W38, and then stagnated in EW39. This is an indication that we still have a gap in our intensive care bed offering and it should be addressed as soon as possible.

  1. Set up a home care program for Covid-19 patients quarantined at home by mobilizing private doctors to provide medical and health monitoring services either by telemedicine, phone calls or, if necessary, home visits. Patients in home quarantine should not be left unattended, as few have the know-how to deal with medical conditions resulting from illnesses such as Covid-19. Providing consistent home care will also minimize the incidences of death on arrival due to a sudden escalation in a patient’s condition at home. The state health department had recently notified about 100 private practitioners in the state and many of them had expressed interest in being part of the home care / home monitoring program. At this point, we need to quickly resolve the legal, logistical and procedural hurdles in order to activate this network of doctors to be part of our fight against Covid-19.
  2. Improve and modernize local health facilities such as district health office, district hospitals, klinik kesihatan, etc. because the treatment and control of diseases mainly takes place in these establishments rather than in Putrajaya or even in KOMTAR. For example, the modernization of the facilities at Sg Bakap Hospital, Balik Pulau Hospital and Bukit Mertajam Hospital is long overdue.
  3. Set up an infectious disease center in Penang to tap into the health ecosystem and talent pool in Penang to deal with infectious diseases, such as respiratory diseases like Covid-19 or even vector-borne diseases like dengue, which is a long-standing health problem.

A Malaysian health plan for the 21st century

In general, it is also high time that the Ministry of Health formulated a Malaysian health plan that will enable our health system to meet the health challenges and demands of the 21st century. For Penang, such a plan can be adapted to our Penang 2030 vision to fit the local context. We must not lose the opportunity of this crisis to rethink and reform health care in order to be better prepared to respond to the next crisis quickly and effectively.

Last year, at the end of the First Order of Movement Control (MCO1.0), I wrote that there are two conditions to relax movement restrictions, namely low stats and high system: we must have a low number of Covid-19 cases but at the same time achieve a high level of readiness of the health system.

The government needs to understand that reducing the number of cases today is really saving us time to prepare our health care system to deal with possible future waves. – October 6, 2021.

* Steven Sim is MP for Bukit Mertajam.

* This is the opinion of the author or post and does not necessarily represent the views of The Malaysian Insight.


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