By Dato’ Dr Amar-Singh HSS
Senior Consultant Paediatrician
Now that the coronavirus outbreak (COVID-19) has been declared as a pandemic by the World Health Organisation (WHO), it is time we ramp-up our actions as a nation. As the head of WHO, Dr Tedros Adhanom Ghebreyesus, says he is “deeply concerned by alarming levels of inaction”. He points out that it is possible to limit transmission but “the challenge for many countries, who are now dealing with large clusters or community transmission, is not whether they can do the same – it’s whether they will.” He calls for “urgent and aggressive action” by governments.
So the question that faces us is: Will Malaysia and Malaysians act aggressively enough to deal adequately with the outbreak in our country? It is not an issue of ‘can we’ but ‘will we’.
I would like to highlight important groups that are either at risk of enabling the spreading of the virus (ones we need to deal with urgently) and those that are at risk of getting infected and having a serious illness (ones we need to protect).
Groups that are At Risk of Enabling the Spreading of the Virus
There are three large groups that we need to address immediately to limit the size of the outbreak.
Firstly the religious groups. The recent huge religious occasion in Selangor, where an estimated 10,000 persons met over a few days, and one was found positive, shows us how it is possible to have ‘super-spreader events’. The photographs of the event showed how closely and densely packed individuals were. I am sure the comradeship shown during the event would have enabled easy spread. It is unexpected that organisers allowed this to go on in the current climate. Similar, smaller events happen all over the country every week in temples, mosques, churches, etc. The experience from a number of countries has shown the extensive spread of the coronavirus through religious communities. We must act now to stop these congregations today. All temples, mosques, churches and other religious groups should immediately suspend their routine meeting and services. It goes without saying that weddings should be deferred and funerals kept small. Remember that many religious persons tend to be older, making them at higher risk of serious illness and death.
The second group is our immigrant workers, legal or illegal. Our nation runs on immigrant manpower – from the construction industry to the food outlets and domestic support. Conservative estimates put the immigrant population at 2.7 million; true numbers are possibly double that. Are we supporting these individuals in the face of the coronavirus outbreak? They have helped to build our nation, support our children and feed our stomachs. Are we providing them with adequate health education in their native languages? Some will require testing. Asking them to get a coronavirus test privately is far beyond their means at RM400-700 per test. Does the Ministry of Health (MOH) have the testing capacity? We need the availability of 5-10,000 free tests daily nationwide to combat the outbreak – not just for Malaysian but also for our immigrant workers. If we ignore immigrant workers, we do so at our peril. They can be an undercurrent of extensive coronavirus spread in the nation if left unaddressed.
The third group is our politicians and government office staff. They seem to meet and congregate frequently, especially our politicians. We see this on the media daily. Time has come to institute work from home for all non-essential government office staff. We need to instruct politicians to stop their kenduris, ceramahs, mass meetings, public launching events, etc. Where politicians visit or appear, people tend to gather and meet then and take selfies. I hope all politicians will stop most visits and limit their activities to essential ones. A number of leaders and ministers have become ill in other countries with some fatalities. Remember again that politicians as a whole tend to be older and at risk of serious illness.
There is a fourth group that I am uncertain about, that is, children. I thank God daily that young children, especially those under 10 years, are not severely affected by this outbreak. But are children, young or older, vehicles of spread in the community? We are uncertain but many nations have shut all schools, colleges and universities as they believe that this is a means of transmission to adults. I believe this action is also critical in limiting the spread of the coronavirus.
Groups that are at Risk of Having Serious Illness if Infected
There are three possible groups that are at risk of getting infected and possibly having a serious illness.
The first are those in some form of residential care or confinement. This includes old folk’s homes, residential care facilities for the disabled and prisons. Adults in residential care or confinement are at high risk of spreading the virus in their facility, once one is infected. We need to urgently have strict SOPs for all residential care and prisons. One important measure is to limit visitors to only immediate family members and perhaps even that may be a risk. There are other groups to think of, like those with chronic disease who require frequent daycare visits e.g. those on dialysis.
The second group that worries me is our frontline healthcare workers – the doctors and nurses that work at general practitioner (GP) clinics and MOH primary care clinics (OPDs, antenatal clinics, immunisation clinics). They see large volumes of patients and people daily. Children and adults coughing in a GP’s or OPD doctor/nurse’s face repeatedly are high-risk events for the staff. We cannot afford for the health system to go down because the healthcare professionals become ill. The public must become much more responsible and have strict cough and hand hygiene etiquette. Many of our frontline healthcare workers are not able to supply masks for patients who walk in and have respiratory infections. Who will provide this? If they use up their supply then their exposure will increase. The government needs to make available mask supplies to all government and private outpatient facilities. Remember that the viral load matters (the volume of viral particles that you are exposed to). We need to minimise this for our important frontlines.
The third group at risk are people in the ‘essential’ service industry – that is, pharmacy staff, those working in food outlets, taxi/Grab drivers, counter staff, etc. They too are at risk, like our frontline healthcare workers, from the sheer volume of people that come through their hands every day. Solutions for them are not easy. Plastic face shields may be more practical than face masks for those in counters or fast food outlets. Perhaps time to travel without air-conditioning in taxis/Grab cars. If these ‘essential’ service industry staff get infected, they have the potential to infect many, many more which is why we need to think about how we can protect them.
I plead with our government not to diminish the potential of the coronavirus outbreak by offering reassurances without radical actions; it is a very, very serious problem that could engulf our nation. The best thing that could happen to us is that we take such drastic measures that virus spread is minimal and we can laugh about it with relief in the future.
Anything else is a nightmare to contemplate.
Time is not on our side and the window to make a difference is rapidly closing.