WE, the undersigned, view with much apprehension and concern the current status of the Covid-19 outbreak in the country.
Our national metrics paint a very bleak picture of the pandemic management. Despite various iterations of the movement control order and other health interventions, daily reported cases are not decreasing.
The cumulative incidence density (per 100,000 population) and infection rate (active cases per 1,000 population) are not flattening, with the latest national infection rate registered at 0.879 per 1,000 population, meaning eight to nine persons are actively infected for every 10,000 people.
The testing positive rate (rolling seven-day average) is rising, registering 8.9% on January 3, well above the World Health Organisation’s (WHO) 5.0% benchmark of effective pandemic control and containment.
Kindly allow us to propose 10 urgent and critical actions, lest Malaysia slips into Covid-19 intensive care.
1. To ramp up testing with a triaged, mass and frequent regimen, utilising inexpensive rapid testing kits (RTK-Ag) instead of PCR, to help to slow the transmission of Covid-19.
2. Early RTK-Ag diagnosis of cases within 24 hours will enable the rapid isolation of cases and facilitate prompt contact tracing.
3. Automating contact tracing with digital apps will hasten the tracking process, while leveraging data science and machine learning can identify hotspots for targeted screening. Only this find-test-trace-isolate (FTTI) rapid response will bust Covid-19 clusters and mitigate the sporadic spread of the coronavirus.
4. In anticipation of increasing Covid-19 cases and to protect healthcare capacity, we advocate that clinical Stages 1 and 2 cases be isolated at home, with clear guidelines from the Health Ministry. Their well-being can be tracked daily with apps, supported by empowering the local community, and urgent transfers to Covid-19 hospitals organised for cases that deteriorate.
5. We must protect the excellent work of our medical professionals at Covid-19 hospitals by decanting all non-Covid-19 cases to non-Covid-19 government and private hospitals. This will allow them to focus on the sickest cases, and not be distracted by asymptomatic and mild ones, thus ensuring the best outcomes.
6. Support industries, the engine of our economic growth, with creative measures to mitigate the 3Cs. The POIS (Preventing and early detection of outbreaks at ignition sites) initiative is a tripartite government, private sector and non-governmental organisation partnership that emphasises an early-detection testing regime, and enhances public health measures, and health education among industry and migrant workers. This initiative, developed in consultation with the industry and WHO, can be replicated elsewhere as a public health operational tool, truly embracing a whole-of-government and whole-of-society approach.
7. Similar initiatives must be developed for other Covid-19 hotspots, namely prisons and detention centres.
8. Expedite the regulatory processes so that immunisation can begin as soon as the first doses of vaccines arrive at the airport. Debunking Covid-19 and vaccine disinformation will empower our rakyat with informed consent when the vaccines arrive. Apart from prioritising high-risk groups, seriously consider vaccinating migrant workers to protect our industries, and the refugee community, who are silent epicentres of Covid-19 outbreaks. The cost of the vaccines must be capped at RM100 per dose for those getting their shots privately, and by extension, the rapid test kits must be capped at RM100 per test to ensure affordability, and wider coverage and uptake of both vaccines and rapid testing.
9. A Covid-19 task force comprising a cross-sectoral and empowered team of subject-matter experts must be immediately formed to provide evidence-based advice on a harmonised whole-of-government response across ministries and agencies. The task force will help steer the nation out of this pandemic by regularly presenting to the cabinet its recommendations and audits of the health economic impact of key decisions. To ensure the independence of the Covid-19 task force, the Malaysian Medical Association, Academy of Medicine Malaysia, Malaysian Public Health Physicians’ Association and Association of Private Hospitals Malaysia are best positioned to select the members.
10. Do not politicise the pandemic. Instead, secure a bipartisan consensus and approach to flatten the curve, and accelerate efforts to achieve herd immunity as a form of community protection to co-exist with the coronavirus. Holding the 15th general election in the midst of an uncontained pandemic is an unmitigated disaster waiting to happen, as the Sabah election has exemplified.
This is the back-to-basics public health management of a pandemic that we trust YAB Tan Sri will consider urgently and seriously to mitigate the devastating consequences of the virus crisis, protect the lives and livelihoods of our rakyat, and reset our economic recovery. – The Vibes, January 8, 2021
This open letter is endorsed by the following individuals, in alphabetical order:
1. Tan Sri Dr Abu Bakar Suleiman (Former health director-general)
2. Prof Dr Abdul Rashid Abdul Rahman (secretary-general, Federation of Islamic Medical Associations)
3. Prof Datuk Dr Adeeba Kamarulzaman (professor of Medicine, Universiti Malaya)
4. Prof Dr Ahmad Hata Rasit (deputy vice-chancellor and consultant orthopaedic surgeon, Universiti Malaysia Sarawak)
5. Dr Ahmad Munawar Helmi bin Salim (immediate past chairman, Islamic Medical Association Response & Relief Team)
6. Dr Azhar Abdul Aziz (consultant emergency physician)
7. Datuk Dr Amar-Singh HSS (consultant paediatrician)
8. Prof Datuk Dr Azizi Haji Omar (past president, Malaysian Paediatric Association)
9. Datuk Dr Christopher Lee (former health deputy director-general (research & technical support)
10. Dr Dhesi Baha Raja (consultant public health physician, chief medical & innovation officer of Ainqa Health)
11. Dr Gunasegaran P.T. Rajan (past president, Obstetrical & Gynaecological Society of Malaysia)
12. Dr Hung Liang Choo (president, Malaysian Paediatric Association)
13. Datuk Dr Jahizah Hassan (president, College of Anaesthesiologists)
14. Dr Jeffrey Abu Hassan (immediate past president, Islamic Medical Association Malaysia)
15. Dr Johari Bux (past president, Obstetrical and Gynaecological Society of Malaysia)
16. Emeritus Prof Jomo Kwame Sundaram (former United Nations assistant secretary-general)
17. Dr Khor Swee Kheng (independent consultant, Health Systems and Policies, consultant in health policies, Malaysian Health Coalition)
18. Datuk Dr Kuljit (president, Association of Private Hospitals Malaysia)
19. Dr Lim Teck Onn (former director, Clinical Research Centre, Health Ministry)
20. Prof Datuk Dr Lokman Hakim Sulaiman (pro-vice chancellor (research), International Medical University, and former health deputy director-general (public health))
21. Dr Mary Suma Cardosa (past president, Malaysian Medical Association)
22. Dr Milton Lum (past president, Malaysian Medical Association, and Federation of Private Medical Practitioners Association Malaysia)
23. Assoc Prof Dr Mohammad Farhan Rusli (consultant public health physician, International Islamic Universiti Malaysia)
24. Datuk Prof Dr Mohamed Hatta Shaharom (president, Malaysian Society of Psychospiritual Therapy)
25. Dr Mohammad Iqbal Sarwar (consultant paediatrician, KPJ Damansara Specialist Hospital)
26. Dr Mohamed Namazie Ibrahim (past president, Malaysian Medical Association)
27. Dr Muhamad Yusri Musa (president, Islamic Medical Association Malaysia)
28. Datuk Dr Musa Mohd Nordin (chairman, Advisory Council, Federation of Islamic Medical Associations)
29. Datuk Dr Narimah Awin (former director, Family Health Development)
30. Prof Dr Norlisah Mohd Ramli (president, College of Radiology of Malaysia)
31. Assoc Prof Dr Pang Yong Kek (respiratory consultant, University Malaya Medical Centre)
32. Prof Dr Roslina Abdul Manap (scribe, Academy of Medicine of Malaysia)
33. Prof Dr Rosmawati Mohamed (master, Academy of Medicine of Malaysia)
34. Dr Sevellaraja Supermaniam (past president, Asia-Pacific Association of Gynaecological Endoscopy and OGSM)
35. Shariah Asiah (president, Malaysian Nursing Association)
36. Datuk Dr Sivamohan Namasivayam (board member, Association of Private Hospitals Malaysia)
37. Dr Steven Chow (president, Federation of Private Medical Practitioners Association Malaysia)
38. Prof Datuk Dr Subramaniam Muniandy (president, Malaysian Medical Association)
39. Dr Tang Boon Nee (past president, Obstetrical and Gynaecological Society Malaysia)
40. Dr Teoh Siang Chin (past president, Malaysian Medical Association, and former Melaka health director)
41. Prof Dr Wan Ariffin Abdullah (past president, Malaysian Paediatric Association)
42. Dr Yap Wei Aun (consultant public health physician)
43. Dr Yolanda Augustin (oncologist and healthcare activist, St George’s University of London)
44. Datuk Dr Zainal Ariffin Omar (president, Malaysian Public Health Physicians’ Association)
45. Datuk Dr Zainudin Md Zin (chairman, Lung Foundation of Malaysia, and past president of the College of Physicians Malaysia)
46. Datuk Dr Zulkifli Ismail (secretary-general, Asia-Pacific Paediatric Association)
