Is our healthcare facility at breaking point to merit MCO?

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By Dr Musa Mohd Nordin

The only reason to resort to an MCO is to buy time to protect the healthcare facility, to flatten the pandemic curve and allow a breather to our overstretched and exhausted healthcare workers (1).

All of the signatories in the Open Letter to the Prime Minister, and many more who reverted late to the call, will only agree to the MCO as a short circuit to rapidly dampen the spiraling numbers of COVID-19 cases, so as to prevent the healthcare services from being overwhelmed (2).

From the MOH data that is available in the public domain, it suggests to us that our health facilities is not at its breaking point (3).

The Ventilator utilization in our COVID-19 is only 3.4%

The Intensive Care Beds utilization is only 14.0%

It is only the General Bed Utilization which is now breaching 1the 00% capacity.

The third hospital bed census is easily and immediately remediable. In fact, the experts from academia, military and others outside the MOH have suggested this action way back in October 2020. They recommended to the MOH that the Stage 1 and 2 COVID-19 cases, the symptomatic and mild cases, which makes up the bulk of the cases (70-80%) should be isolated at home.

One major COVID hospital in the Klang Valley is presently nearly at full capacity. Category 1 and 2 cases occupy 40-45% and 25% respectively of the bed space in the COVID hospital. Just imagine the number of empty beds that could rapidly be created by emptying 70% of the beds now occupied by the category 1 and 2 cases.

As a matter of fact, most of the developed nations practice home isolation of their asymptomatic and mild COVID-19 cases. It is a well established practice and the WHO has crafted a guideline for the management of patients in home isolation in March 2020 which has since been update in August 2020. (4). 

Only in the past week or so, the MOH has begun to seriously consider this option. The MOH ought to immediately decongest their healthcare facilities of these cases through an efficient bed management process. Besides this, they should also consider decanting all their non-COVID-19 cases to the nearby non-COVID-19 government and private hospitals.

This will allow the COVID-19 hospitals to focus on the care of the sickest patients, stages 3 to 5 and ensure the best outcomes. This will also relieve our health care providers, allow them some much required rest and also reduce the risk of being infected by the large volumes of COVID-19 patients presently in the hospitals.

Even the advisor to the Prime Minister said similarly on BFM “…I don’t agree that the health system is at a breaking point – it is easy to throw these words around. If you look at the situation in the UK, the US and all that, people, the health professionals, the health system, will find ways to cope…” (5)

I think many of the experts in Putrajaya are either not aware or have never witnessed the battle-grounds in the COVID-19 hospitals, the Healthcare Centres or the Low Risk Quarantine Centres. They seem to be unduly rigid with their policies and not pragmatic enough to modify and adjust according to the real world experience on ground zero.

COVID-19 is very much a rapidly evolving disease, and all of us, scientists, infectious disease and public health physicians included are learning to cope with best, contemporary practices and not just sticking rigidly to textbook solutions. The WHO, with its line up of top-notch advisors have similarly erred and changed its position on multiple occasions (6).

In early April 2020, I similarly insisted on the pratice of quaratnine in isolation centres, implying that home isolation was a failure, but I have since changed my position.

Dr Theresa Tam, Chief Public Health Officer of Canada, said, “We have been criticized as public health professionals for changing our advice over time. We have been doing so because the science is evolving (7).

I shudder to think how our MOH would respond to the present situation in the UK, where the mutant coronavirus strain B 1.1.7 is reported to be 50-70% more transmissible and caused 60,000 cases per day with 1,000 deaths as against our daily 2,500 daily cases.

(The views expressed are those of the contributor and do not necessarily reflect the views of Rebuilding Malaysia.)

Sent by email on 10 Jan 2021

Dr Musa Mohd Nordin is a Consultant Paediatrician & Neonatologist

Source:

1.    https://www.scmp.com/week-asia/health-environment/article/3082363/malaysia-says-it-has-flattened-covid-19-curve-what

2.    https://codeblue.galencentre.org/2021/01/07/open-letter-to-pm-10-critical-actions-to-manage-covid-19-health-experts/

3.    https://spm.um.edu.my/knowledge-centre/covid19-epid-live/

4.    https://www.who.int/publications/i/item/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts

5.    https://www.bfm.my/podcast/morning-run/morning-brief/covid-is-back-with-a-vengeance-so-whats-next

6.    https://www.sciencealert.com/who-tries-to-correct-wuhan-coronavirus-risk-level

7.    https://www.cp24.com/news/evolving-science-reason-for-inconsistent-messaging-on-covid-19-tam-1.5156622?cache=yes%3Fot%3DAjaxLayout

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