A strong start by the Health Minister, and more is needed

The Malaysian Health Coalition (MHC) welcomes the strong start by Minister Khairy Jamaluddin, and note the recent evaluation criteria that he set for the Ministry of Health (MOH). We hope to see the entire MOH machinery, as well as inter-agency collaborations, be mobilized to achieve these goals.

We urge the following:

1. Clarify the specific policy changes for an endemic COVID

The Minister stated that Malaysia “can expect to move into an endemic COVID-19 phase” by the end of October 2021. The MOH must clearly communicate this new strategy to the public by announcing the specific policy changes to its COVID-19 responses. Controlling virus transmissibility,  routine vaccination programmes, efficient testing, and improving healthcare capacity, are among the areas that require clear policy shifts, so that we can treat COVID-19 as part of daily Malaysian life. We urge some caution in labelling COVID-19 as endemic, unless these parts of our health system are strengthened. Otherwise, we risk a complacent population or a public administration that stops focusing on COVID-19.

2. Involve expertise from outside MOH when making decisions.

We believe that it is the Minister’s right to build a team which he feels comfortable working with. Nevertheless, we recommend the Minister to get appropriate health advisors and implementation partners, especially from among health experts outside the MOH. Therefore, we urge that non-MOH health advisors and implementation partners be systematically embedded within the decision-making and implementation process, rather than be consulted on an ad hoc basis. A good working model is the Greater Klang Valley Task Force. The MHC and our member organisations are ready to assist.

3. Establish phased Key Performance Indexes (KPIs) for 30-60-90 Days

We commend the Minister’s 100 Day KPIs. However, as we are in the middle of a raging pandemic, some urgent measures must be taken earlier than the 100 days. Therefore, we suggest the Minister agrees on a phased set of KPIs to be achieved within 30, 60, and 90 days, together with MOH and non-MOH experts. This phased KPIs must be publicized for accountability, and also to unite all of Malaysia to achieve these KPIs together. These phased KPIs must be merged with the National Recovery Plan, Budget 2022 and Rancangan Malaysia ke-12, where Health must be at the forefront of all policy considerations.

We must now make up for some lost time due to the political instability of the last 18-months. Therefore, we stand behind the new Health Minister as he leads the MOH to turn the COVID-19 tide in Malaysia’s favour. We will fulfill our duties as responsible health professionals and citizens.

Read here (Malaysian Health Coalition (MHC), Sept 9, 2021)

MOH estimates three undetected Covid-19 cases for every reported infection

‘Malaysia likely has four times more Covid-19 cases than are being officially reported due to limited testing, said Greater Klang Valley Special Task Force (GKVSTF) chief Dr Chong Chee Kheong. Dr Chong said he agreed with views that the real case tally could be undercounted as the government’s policy is to focus on testing symptomatic cases rather than all suspected cases. “On whether it is true that for every Covid-19 case we detect, there are three more undetected cases, that is true,” he told a media briefing today. The Ministry of Health (MOH) reported a record high 20,596 new Covid-19 cases yesterday.’

Read here (Code Blue, Aug 6, 2021)

Covid-19 in the classroom: Over 2,000 infected in three months

‘The Health Ministry has reminded educational facilities nationwide to take precautions to prevent Covid-19 infection, after three of the eight new clusters reported today involved learning institutions. Its director-general Dr Noor Hisham Abdullah said 41 such clusters have been reported to date since the beginning of the year, infecting 2,228 people so far.

‘Most of the cases (1,058 cases; 47.5 percent) involved tertiary educational institutions, although they comprised only 15 of the 41 clusters. This was followed by 631 cases (28.3 percent) involving 13 secondary school clusters, and 419 cases (18.8 percent) involving 10 primary school and preschool clusters. Other educational institutions account for three clusters, totalling 120 cases (5.4 percent).’

Read here (Malaysiakini, Mar 25, 2021)

Ground SOPs in science: The Academy of Medicine of Malaysia

‘The Academy of Medicine of Malaysia is troubled by the introduction of the Prevention and Control of Infectious Diseases (Exemption) Order 2021, which states that Cabinet ministers returning from official overseas visits must only quarantine for 3 days instead of the mandatory 10 days for inbound travellers. The Health Minister clarified that only Cabinet ministers who travel in a ‘bubble itinerary’ will undergo 3-day quarantine. Moreover, this move is intended to open up the economy as the policy will eventually be applicable to foreign dignitaries and business travellers.

‘We, the Academy of Medicine of Malaysia, wholeheartedly oppose the Exemption Order as well as any plans to extend the 3-day quarantine rule to other travellers.

‘We wish to remind the government that all standard operating procedures (SOP) must be grounded in science. The quarantine period for inbound travellers is set at 10 days based on research which shows that the risk of transmission is extremely low (~1%) after 10 days with monitoring and testing in place. The incubation period for Covid-19 is on average 5 to 6 days but can be as long as 14 days. Therefore, three days is insufficient to detect symptoms. There must be an evidence-based, public health explanation for the government’s decision to reduce quarantine days.

‘The effectiveness of so-called ‘travel bubbles’ are also still in question as new variants of Covid-19 with increased transmission capability spread rapidly around the world. There is insufficient data on the mutations to develop robust protocols for safe travel. We understand there is urgency to restart the economy for the benefit of Malaysians and businesses that are struggling, but this can only be done by bringing the pandemic under control first. The government must not open up our borders to ‘bubble’ delegations and risk bringing in new variants that could overwhelm our health system.

‘We call on the government to revoke the Exemption Order and—until there is scientific evidence that suggests differently—enforce a 10-day quarantine for all.’

Read here (AMM press release, Feb 10, 2021)

Fighting vaccine hesitancy with information, trust

‘It appears that vaccine hesitancy is due to lack of information and trust. Despite the government's assurances about Covid-19 vaccines, which include repeated television announcements by Special Adviser to the Prime Minister on Public Health Tan Sri Dr Jemilah Mahmood, many people are still hesitant to get inoculated, with some cynically telling their friends and relatives: "It's not that I don't trust the vaccines, but let's wait and see what happens to the people who will get their shots first."

‘Since efforts to build trust in public institutions, such as the Health Ministry, have been made, we need more sound bites, including building a more credible perception of the vaccines' safety and effectiveness. Hence it is good to ensure that politicians from both sides of the divide, officials and prominent figures, are among the first to be vaccinated. Leading by example, the prime minister would be among the first to be immunised when the National Immunisation Plan gets underway by the end of this month.

‘The authorities must boost public awareness of vaccine development and production, as well as their importance during a pandemic, and at the same, debunk myths. They must explain that the vaccines will not make the virus disappear since it is already too wide spread. They should also tell the public that the vaccines could prevent its spread and reduce its severity.’

Read here (New Straits Times, Feb 7, 2021) 

Covid-19: It’s all doom and gloom unless… — Dr Musa Mohd Nordin

‘There is much misunderstanding about the Covid-19 situation in the country. In particular, the high rates in the Klang Valley and the role of the only state task force, the Selangor Task Force on Covid-19 (STFC)...

‘In many ways, if the STFC had not stepped in, did mass testing, rolled out POIS (Prevention of Outbreaks at Ignition Sites), allocated Z millions for FTTIS (find, test, trace, isolate, and support), the situation in Selangor would be far worse, critical even...

‘And other states, industries, agencies, etc, are buying in STFC’s POIS programme and implementing it. This tripartite initiative between government-industry-NGOs pivots on three preventative strategies namely, enhanced public health measures, early detection testing regime and health education. So STFC doesn’t just talk but rolls out programmes, mass testing, POIS, procuring vaccines, etc, to end the pandemic...

‘At the end of the day, we are in it together. If we refuse to learn from each other and operationalise the best public health practices, we are in for a rough ride.

‘I hope the national task force, as petitioned by the 46 top physicians, is rapidly recognised, accepted, and formalised to empower it to immediately re-strategise and transform the mindset, and policy at the top end of the Health Ministry, so that the operations at ground zero will be a truly rapid-response FTTIS which has zero-tolerance for cases, clusters or outbreaks.

‘MCOs are the blunt tools of those who have failed to operationalise the back-to-basics of pandemic management and in my opinion, they should either seek a second opinion from the task force and/or gracefully exit to minimise further harm to the nation and allow the task force to steer the nation out of this Covid-19 conundrum and to protect the lives and livelihood of its rakyat.’

Read here (Malaysiakini, Jan 30, 2021) 

If it ain’t broke, don’t fix it — Musa Mohd Nordin

‘The data shows that the MOH is doing relatively well. The risk of a Covid-19 death per population n Malaysia is 1 per 50,000. This compares favorably against the Global average of 1 per 3,676.b It is worse in the UK and US, 1 per 700 and 781 respectively...

‘Despite the surging numbers of Covid-19 cases, the MOH infrastructure and services are holding up well and delivering good outcomes when compared to the US, UK and our southern neighbours. Therefore, if it ain’t broke, don’t fix it. It is in this context that the following suggestions are made:

1. The MOH should continue to operate with the 52 dedicated Covid Hospitals.
2. If these are inadequate to meet the current surge in Covid-19 cases, select private and government facilities can be transformed into dedicated Covid Hopsitals.
3. The concept and operations of Hybrid Hospitals should be avoided as much as possible. It compromises the Quality of Care, especially among the Category 4-5 patients, and the Safety of patients, HCW, other hospital staff and visitors, due to the real risk of nosocomial infection from this most transmissible coronaviruses.
4. The lay public is fast becoming very fearful of Covid and Hybrid hospitals and this has led to them shunning away from hospitals despite their need for regular hospital visits and review.
5. If they delay or miss their appointments, the management of Non-Covid illness eg NCD, Cancers, Immunization uptake, will be compromised.
6. The MOH has begun to decongest and create more empty General and ICU beds in Covid Hospitals by discharging Category 1&2 patients to Home Isolation with clear instructions on the use of Health Assessment Tools.’

Read here (Malay Mail, Jan 24, 2021) 

FTTISI:The bedrock of Covid-19 infection control — Dr Musa Mohd Nordin and Dr Mohammad Farhan bin Rusli

‘The key element in the blueprint of action to mitigate this Covid-19 national emergency, must surely be a well executed Find, Test, Trace, Isolate and Support (FTTIS) system recommended by the WHO, which has fallen terribly short in national implementation.

‘The FTTIS system Finds and Tests hotspots of Covid-19 outbreaks. Rapid Isolation of cases and quarantine of close contacts through Tracing is extremely critical. Isolation will only work if the rakyat, especially the B40, receive Support during the MCO period with food security and financial Support.

‘The government through its relevant ministries and agencies must provide this social security net and support to this new policy of home isolation to ensure its success. Otherwise, the rakyat will fail to comply with home isolation, in order to search for and put food on the table and scour for basic home essentials. The government already has in place Low Risk Isolation Centres for households who are unable to effectively isolate at home.

‘Clinical support is also vital for monitoring the health of cases and contacts who are undergoing home isolation in the community.’

Read here (Malay Mail, Jan 15, 2021)

DG: Health system at breaking point, targeted MCO proposed

‘Rather than the “one size fits all” approach of last year’s MCO, Noor Hisham explained that the proposed new strategy involved different rules for different states. Travel restrictions could be imposed on areas with a high number of infections and clusters.

“We are looking at green and yellow states to see how we can protect them, and control cases from rising. This is important. For states that are red zones, more drastic action will be taken. We might implement more targeted (action) in those states by looking at the clusters in the state. We will also tighten border control by barring people from travelling across states and districts based on the latest (case) trends,” he said.

‘Nevertheless, the decision remained the prerogative of the legislators but Noor Hisham said he had faith in the government making the right call. The goal of the upcoming strategy, he added, was to achieve that precious balance between lives and livelihoods.’

Read here (Malaysiakini, Jan 6, 2021)

Use emergency funds for Sabah’s Covid-19 fight as donations will be slower, doctors tell federal govt

‘The federal government should allow emergency funds to be used for resources and equipment to tackle Sabah’s Covid-19 situation, the Malaysian Medical Association said today. MMA president Professor Datuk Dr Subramaniam Muniandy cautioned that waiting for donations for Sabah’s Covid-19 fight would not be time-effective when there is an urgent need for more medical resources in the state.’

Read here (Malay Mail, Oct 18, 2020)

Health DG responds to open letter to PM from ‘MOH specialist’

Dr Noor Hisham Abdullah responds to the open letter of Dr Tachdjian to the prime minister "Covid-19: Wake up, enough talk, take action". ‘Even though it is not directed to me, but as the director-general of Health, I have to understand what this "Health Ministry (MOH) staffer" is trying to relay, regardless of the person's rank, grade, or profession. It occurred to me when it was said that the doctor was an "MOH specialist" it would surely attract everyone's attention to read it...’

Read here (Malaysiakini, Oct 12, 2020)

Wake up, enough talk, take action: An open letter to the PM from ‘MOH specialist’

‘Wake up dear Prime Minister Muhyiddin Yassin – you are a self-proclaimed “abah” (father) that wishes to “rotan” (cane) his rakyat for misbehaving and not following standard operating procedure (SOP). You fail to realise that the saddening facts of this Covid-19 wave listed down above are not due to Covid-19, but rather the failure of your administration to prioritise the health of the rakyat above all else...’

Read here (Malaysiakini, Oct 11, 2020) 

Highly contagious Covid-19 variant detected in two clusters

‘Health Ministry director-general Dr Noor Hisham Abdullah has urged greater caution after a highly contagious variant of the virus that causes Covid-19 had been confirmed in two clusters in Malaysia.

‘In a Facebook post just past midnight this morning, the Institute of Medical Research had just identified the virus carrying the D614G mutation in samples collected from three cases from the Sivagangga cluster, and one case in the Bukit Tiram cluster...

“It has been found to be ten times more likely to infect other individuals, and could spread easily if spread by ‘superspreaders’,” Noor Hisham said.

‘He also voiced concern that experimental vaccines currently in development may not be able to tackle the D614G variant of the virus because it is still relatively new.’

Read here (Malaysiakini, August 16, 2020)

MCO and the failure to follow the rule of law

‘We are now told that we can go back to work on Monday by no less than the PM himself.  The National Security Council has issued SOP’s for businesses to open. MITI also appears to be approving the opening of businesses on terms imposed by them.

‘All this in the face of existing PCID-MILA Regulations and the provisions of the PCIDA which expressly confers power only upon the Minister of Health to formulate and enforce regulations relating to activities and movement in infected areas. And so, the confusion and uncertainties continue whilst little is known of what the Ministry of Health has to say about all this.’

Read here (FocusMalaysia, May 3, 2020)

MOH Malaysia lists six criteria for lifting MCO and help develop a ‘soft landing’ exit strategy

The Ministry of Health Malaysia (MOH) has listed six criteria to lift the MCO and help achieve a ‘soft landing’ for the nation amidst the Covid-19 crisis:

1. Strict border control: “If we open our borders then people will start coming in and there’s a big possibility they may have the virus.”
2. Single-digit number of cases: Only when cases start to fall in the single-digit can the government seriously consider lifting the MCO
3. Having a good health system and improving testing standards: Look carefully at e.g. (a) testing capability of labs (b) if we have enough wards and intensive care units. Raise the detection standards from say 48 hours to 24 hours or less.
4. Capability to look after high-risk groups — the handicapped, elderly, and those with co-morbidity illnesses, including patients receiving hospital treatment like chemotherapy
5. (5) Adherence to new social norms: “Putrajaya needs to study this and instil in Malaysians’ minds that following social distancing, washing hands frequently and avoiding crowding around each other is the way to go moving forward.”
6. (6) Community cooperation in infected areas: Identify infected areas and get their communities to work with MOH and the relevant authorities to make sure the virus doesn’t spread again.

Read here (The Malay Mail, April 21, 2020)

The Malaysian Health Coalition (MHC), representing 44 member societies and 16 individuals, calls for four measures to effect a rationalised opening-up

They are (please look at letter for full text}:

1. Decision-making on a phased restart that includes MOH, other relevant ministries or agencies and relevant medical health experts.
2. An exit strategy for the post-MCO period based on the advice of medical health and public health experts with guidelines according to the colour-coded zoning system: green, yellow and red.
3. Large-scale disinfection and sanitisation efforts that follow evidence-based procedures.
4. Work with religious authorities to adapt upcoming religious and cultural traditions to prevent mass gatherings that would further spread Covid-19.

Read here (The Star, April 17, 2020)

MySejahtera app to help Malaysians manage Covid-19 outbreaks

‘MySejahtera is an application developed by the Government of Malaysia to assist in managing the COVID-19 outbreaks in the country. It allows users to perform health self-assessment on themselves and their family members. The users can also monitor their health progress throughout the COVID-19 outbreak. Also, MySejahtera enables the Ministry of Health (MOH) to monitor users’ health condition and take immediate actions in providing the treatments required.’

• For IOS, click through here 
• For Android, here
• For Huawei, here