Dr Alzamani Mohammad Idrose
Consultant Emergency Physician
A Malaysian front liner
By May 2021, Malaysia has a total of more than 440,000 COVID-19 cases with more than 1600 deaths. When COVID-19 first hit Malaysian shores on 25 February 2020, it could not have happened at a worse time. Malaysia just experienced a change of government following a fall of majority of the ruling government when a coalition party withdrew its support.
For two weeks, there was no government and no Minister of Health. Nevertheless, we had an efficient health system in place. Headed by our Director-General of Health, the pandemic was handled professionally and effectively.
A Successful Start
We had things under control. A system of contact tracing, swabbing for diagnosis and isolation was in place. At all emergency departments, all patients returning from China (later from affected countries) were isolated and if symptomatic were deemed ‘patient under investigation’ and admitted. Dedicated COVID-19 hospitals were determined in the whole country.
We started to redesign the system at our emergency departments. One that had separate areas for those with fever or respiratory symptoms. We had a tent set up at the ambulance bay for assessment of patients under investigations (PUIs) as well as swab taking for COVID-19 testing.
Our doctors were retrained to use personal protective equipment (PPE), positive air powered respirators (PAPRs), transport isopods, video-assisted intubation, lung ultrasound and more.
Stringent infection control practice was in place with repeated trainings on donning and doffing of PPEs. Clinics redesigned their workflow to space people out with distanced waiting areas apart from staggered appointment system to avoid overcrowding.
Temperature checks were in place in hospitals and all public places. During this time, we had our first surge of cases from a cluster of mosque congregation. One patient was found to be COVID-19 positive joined the congregation and this turned into a huge cluster of infection. Our Director-General (DG), Tan Sri Datuk Dr Noor Hisham Abdullah gave daily briefings on the latest number of cases without fail.
With the surge of cases, we had a lockdown when cases were only around 300. A large quarantine centre that could house 6,000 patients was set up following this. People were adhering to our call to wear masks and maintain 1 metre distance from others. There was social distancing and the streets were empty.
Malaysians supported front liners strongly. When we had a shortage of PPEs, some fashion designers took to making PPE and donated them to us. The public too rallied to provide us with much needed equipment and even food. Slogans such as ‘kita jaga kita’ meaning ‘we take care of us’ made us believe that we owned this and we could handle this pandemic well as one nation.
It was a success.
By July, we had zero cases. In fact, Malaysia was singled out by the World Health Organization as one of the best countries in the world handling Covid. It was an amazing feat, considering that Malaysia is not an island and has 35 million people. At that point of time, even Singapore was struggling to handle some 3,000 daily cases of COVID-19 especially among its foreign workers. Our DG was indeed a hero and he did a phenomenal job.
The State Election: the success destroyer
Unfortunately, the success did not last.
In September 2020, a political power struggle saw a by-election held in the state of Sabah, east of Malaysia. Politicians flocked the state for a series of campaigning. The Ministry of Health wanted to impose quarantine for those returning from Sabah but politicians being politicians refused to listen. As a result, Covid cases exploded again.
We had to reopen quarantine centres which were already closed and again, repurposed wards to accommodate Covid patients. Separate Intensive Care Units (ICUs) were set up for Covid patients while non-Covid ICUs had to still be made available. Elective surgical cases were postponed and their staff were redeployed to handle Covid wards. From then on, the cases never hit zero until today. It did not help that foreign workers too were hit and became big clusters.
I had a few ‘misses’ myself whereby the patients I handled turned out to be Covid-positive. I had my nasal and oral swabs taken twice and quarantined too. My department too, at one time, almost collapsed as there was a Covid contact who mingled with almost all of us! Luckily, he turned out to be negative while we all still adhered to stringent PPEs in the department. This similar scenario happened to many of our colleagues in the country.
Preventive Emergency Medicine Via Social Media
Photo : Preventive Emergency Medicine : educating the public via social media
Towards the year end, there were movements across states for year-end holiday as well as wedding ceremonies. In Malaysian culture, a lot of weddings are held during school holidays. I could already foresee that we were heading towards trouble.
From the start of the pandemic, I had been using my Facebook account which had about 30,000 followers to influence people to follow the standard operating procedures (SOPs). By definition, I am only a ‘micro influencer’ as a true ‘influencer’ would have at least 100,000 followers. Nevertheless, I did my best to educate people. I wrote that I predicted there would be 5,000 cases by February.
One of my postings entitled ‘A Letter from a Front Liner’ went viral garnering more than 6000 shares. I also attached an advisory video. Although people largely wore masks, many failed to distance themselves at eating places, in hostels, family and friends home visits and weddings.
My prediction turned out to be correct. The number surged to almost 5,000 by end of January. Subsequent post on our hardship amidst the pandemic was shared by the Director-General and that too went viral with more than 13,000 shares.
Nowadays, we see ourselves not just front liners handling the ‘product’ of the pandemic by managing patients in and out of the hospital. We also took to practising ‘preventive Emergency Medicine’ by running our own version of a social media campaign for the public to adhere to the SOP. We became ‘word crafters’ to come up with something profound to have a thinking society and hopefully one in winning this battle yet again.
The Second ‘Lockdown’
Photo : Our ambulance team conducts ‘mass screening’ to triage and categorize Covid patients
The government then issued the second ‘lockdown’ starting 13 January 2020 and this lasted for 7 weeks. The government also declared a ‘state of emergency’ which would allow new laws to be introduced without having to be debated by the parliament. The fines for flouting SOPs were increased dramatically. Unfortunately, the parliament sitting was cancelled and the system of check and balance was halted. Whether the decision was right or wrong, that was the price to pay.
Nevertheless, this lockdown was not as rigid as the first one. People could still jog in pairs and cycle outside. Businesses were still open. The Ministry of Health does not have the absolute power as regards to the lockdown decision and social rules. Often, politicians meddle and only some of its recommendations were followed.
There was a tussle between health and economic effect. Lockdown was bad as businesses were affected badly but then, lives could be lost if the pandemic was not controlled. The cases came down somewhat but still hovering above 1,000 a day.
We also had to battle it out with those who claimed that the pandemic was a ‘hoax’. Some was bold enough to even say that ‘the pandemic is the biggest hoax in the history of mankind!’
There were a lot of misleading videos circulating on social media and some originated from Europe claiming fallacies in Covid testing and that the Covid was nothing more than a harmless flu.
People started to have distrust on the ministry’s advisories and even accused that the data of cases were manipulated. Of course, this was not true.
In March, vaccines arrived and front liners were vaccinated. There were attempts by some politicians to ‘jump the queue’ and this became an issue too on social media. There was an uproar by the public who insisted that front liners should get the vaccines first.
By April, most front liners either received the first dose or completed vaccination. When vaccinations started, our department also handled patients with adverse events following immunization (AEFI).
The country is currently moving on to phase 2 to vaccinate the elderly and subsequently, in phase 3, the rest of Malaysians will get the vaccines. Still, we also had to battle with ‘antivaxxers’ who were bent on confusing and telling stories that scared people away from registering for the vaccine.
We observed that these antivaxxers used this scare tactic to market their ‘alternative’ products. Again, some of us took to battling this notion out via social media so that our people would not be fooled.
The Third ‘Lockdown’: hard battle ahead
In April, we saw cases surging all around the world and hell broke loose in India following recent celebrations and political campaigns. It was a sad state as there were serious shortages of hospital beds and even oxygen. Back home, cases exploded again and now we are hovering around close to 5,000 cases. This is seriously bad for us too.
We are also having a big festive season coming up mid-May. Thankfully, the government has imposed another round of lockdown. The truth is, with the new strain running amok in India, this indicates a long battle ahead. It is as if we are dealing with a new ‘Wuhan’.
I had been writing and sending series of Facebook and Twitter reminder messages for the public to be serious with the SOPs. Each message was crafted with reason so that the public will follow the SOP with conviction and sensibly.
The truth is, this battle against the virus is not won by us the health workers. It is won by the people themselves by adhering to strict SOPs and embracing vaccination wholeheartedly.
Only then, can we return to a free life like the old normal. We had a temporary win early in the battle. We hope the people can be one with us all the way to the end till we win this for real.
A Battle of the Hearts and Minds
Photos: Some of our team members at the Emergency Department
I believe in Malaysians.
I believe, with clear and rational thinking, we can win this battle together. I believe that the key to winning this battle is winning the hearts and minds of Malaysians in doing the right thing – strict, ‘gapless’ SOP adherence and full vaccination or at least 80%.
These cannot be achieved until we win their hearts and minds. Thus, apart from the battle of patients’ care at clinics and hospitals, we must win the battle to educate their hearts and minds that we can do this together like we once did.
I believe we can. I cannot afford not to.