THE Health Ministry must get its house in order on the reporting system of Covid-19 cases.
The Malaysian Medical Association (MMA) notes the warning issued by the Selangor menteri besar that the state Health Department will begin issuing fines to private clinics and private hospitals in the state for late reporting of Covid-19 cases.
We share the same concerns over Selangorians as expressed by the MB, however, we feel it is unfair to target the private clinics and private hospitals when the system is flawed and government healthcare facilities that the private clinics work with are stretched to its limits.
As cases rise, even the laboratories processing tests are stretched.
MMA finds the accusation made in said report deeply troubling.
Apparently one of the reasons for the delay in the reporting of confirmed cases is due to the failure of private practitioners from clinics and hospitals to key in information into the Sistem Informasi Makmal Kesihatan Awam (Simka) system.
For clarity, the ministry’s standard operating procedures (SOPs) dictates that it is the duty of the person that conducts the laboratory processing of the sample to report the result via Simka.
MMA would like to make it clear that all RT-PCR tests are processed in laboratories, unlike RTK antigen tests that may be processed at private facilities themselves.
Therefore, how can one claim that the delay in reporting confirmed cases via Simka is due to the failure of reporting by private practitioners when in reality 100% of RT-PCR processing is done in laboratories?
I think it is only fair for private practitioners to be given an apology. We are all in this together. If the ministry and Selangor Health Department (JKNS) particularly, truly believe in working as a team and in wanting to enhance public-private partnership, MMA implores all parties to stop the blame game.
Under the SOPs and guidelines from Health Ministry (MoH), private clinics must immediately report any patient found positive with Covid-19 to the Pejabat Kesihatan Daerah (PKD). Under Act 342, if the private healthcare facility fails to report the Covid-19 case to the PKD within 24 hours, action can be taken against them.
MMA would like to ask JKNS to provide the following information:
1) Statistics on the number of cases reported by private healthcare facilities each month.
2) The number of cases found unreported by private clinics or private hospitals.
3) What action has JKNS taken against these facilities?
4) When will the notification SOPs be revised and streamlined in order to stop the confusion among private practitioners?
MMA fully supports enforcement on any private healthcare facility that has failed to report confirmed Covid-19 cases within the stipulated time frame in accordance with guidelines and SOPs from MoH, however, it must be supported with evidence.
We also wish to highlight again that even private laboratories are conducting drive through and onsite RT-PCR screening tests when they are not allowed to do so by MoH.
According to MoH, Covid-19 tests by the private sector can only be carried out at a private medical clinic, ambulatory care centre, or a private hospital. Private laboratories are not classified as a healthcare facility however, and it appears that MoH has closed one eye.
It was reported in the media this month that a certain Ms Yong, 49, and her five family members in Petaling Jaya, Selangor were tested at a private laboratory’s drive-through Covid-19 screening service and were all found to be positive.
They had waited at home for three days for a phone call from MoH. Two of the family members were in the high-risk group of complications and had developed more severe symptoms. The call did not come and neither was there an ambulance sent to the home. Her calls to the Sg Buloh Hospital (in Selangor) were also not picked up.
From this scenario, we can see that the PKD who is tasked with providing further instructions for the Covid-19 patient and arranging for an ambulance, was not informed about the Covid-19 case. More importantly, there was no follow up from the private laboratory who should be responsible.
MMA has expressed its concern over this issue in the media but it has been business as usual for these private laboratories conducting Covid-19 screening while MoH continues to be silent. If the Selangor Health Department wishes to go after general practitioners (GPs) and private hospitals that fail to report Covid-19 cases, it should also go after these private laboratories who, according to MoH aren’t even allowed to conduct the Covid-19 screenings in the first place.
Why not simplify and merge the two systems for private healthcare facilities reporting Covid-19 test results?
The two systems for private clinics to report Covid-19 cases further complicates matters. GPs have been immediately reporting Covid-19 positive cases to the PKD via email, phone call and fax as per SOPs and guidelines, however, they were later informed to notify via a new “e-notification” system.
This system was introduced without an update to the MoH guidelines for Covid-19 screening.
To set up an account for the e-notification system, the GPs are required to communicate with the PKDs. But as ordinary citizens are finding difficulty reaching the PKD via phone, the GPs are also finding it near impossible to contact them. We understand, the system is strained. Still, GPs have made the effort to notify every PKD of Covid-19 cases using other means as listed in its guidelines issued earlier.
Then there is the Simka reporting system that requires GPs to report all RTK antigen tests that are being done. All RT-PCR cases are reported using this Simka system by labs approved by MoH to conduct RT-PCR. Private healthcare facilities are only required to notify RT-PCR and RTK antigen positive cases via the e-notification reporting system.
MoH however, in its daily briefing only announces the positive cases picked up by RT-PCR.
Results from RTK Antigen screenings which may have been done by the hundreds of thousands if not millions have never been made public as it is not the confirmatory test.
The gold standard confirmatory test is the RT-PCR test.
The RTK antigen test results take 30mins while the RT-PCR test results typically take 24hours to 48 hours depending on the laboratory.
Middlemen involved in commercialised mass Covid-19 screening
We also urge the authorities to investigate commercialised mass Covid-19 screenings being run and coordinated by middle men or agents. Some of these middle men have no background whatsoever in healthcare. Some labs are also colluding with business entities to conduct onsite and drive through screening. These issues have been highlighted to M0H however they continue to close one eye.
It begs the question, if private laboratories are not allowed to conduct the Covid-19 screenings, how are they reporting Covid-19 cases legitimately? Are results issued in compliance with laboratory regulations?
Now MoH even allows self-uploading via MySejahtera app. Are the Covid-19 swab tests conducted by qualified, trained professionals in full compliance with the SOPs and guidelines from MoH under strict infectious disease prevention and control?
How will the laboratory accept full medico-legal accountability seeing that they are not a healthcare facility?
We urge MoH and relevant authorities to conduct a full audit on private laboratories conducting the Covid-19 tests or the system will run the risk of being compromised.
Speed vital in reporting cases of Covid-19
As speed will be vital in reporting cases of Covid-19, MMA proposes that both the e-notification to the PKD and Simka reporting be integrated into one system to cut down repetitive administrative processes.
If five minutes can be saved on administrative work per patient, an hour can be saved on 12 patients allowing more patients to be seen and tested.
Lastly, the SOPs on reporting Covid-19 cases must be amended as soon as possible. – The Vibes, January 31, 2021
Prof Datuk Dr Subramaniam Muniandy is MMA president
