Datuk Prof Dr Awg Bulgiba Awg Mahmud

The COVID-19 outbreak is causing a lot of concern among the medical community and the public. A steep rise in the number of locally transmitted cases is leading to a lot of outcry and lots of actions have been suggested to combat the outbreak. Lots of analysis have been done by experts and non-experts, and healthcare staff are reporting a great strain on resources. 

The Ministry of Health is issuing daily updates on the situation and there have been pronouncements of actions to be taken by various parties including businesses whose staff have been infected. Despite this, there is widespread feeling that the outbreak does not seem to be under control. There is also a lot of confusion on where the management of the outbreak is heading i.e. whether we are still trying to contain the outbreak or whether we are now in the mitigation phase. 

The way I see it, this confusion results from two main deficiencies – lack of clear Outbreak Management Strategies and lack of clear Crisis Communication. The Ministry of Health guidelines dwell a lot on managing individual persons suspected of being infected but does not have a clear overall strategy in managing this outbreak. A clear overall outbreak management strategy needs to answer the following questions:

1. What stage of the outbreak is Malaysia in now?

2. How is each stage determined?

3. What is the capacity of our infrastructure to cope with the current stage?

4. What are the strategies for each stage of the outbreak?

5. What is the goal of the strategies at each stage?

6. What is the trigger for announcing a change of stage?

7. Does each stage need to have different grades?

8. How do we decide how long we should continue strategies for each stage?

9. How do we emphasize individual responsibility for implementing recommended personal-level actions?

10. How do we empower businesses, schools, and community organizations to implement recommended actions, particularly in ways that protect persons at increased risk of severe illness?

11. How can we optimize critical infrastructure or services for individuals who are at increased risk of severe illness?

12. How can we optimize scarce testing and treatment facilities which are scattered across several ministries?

13. When do we start doing triage for severely ill patients to separate those who can be saved and those who cannot?

14. How do we minimize disruptions to daily life?

There is no indication from the health authorities that these questions are being answered and if they are, there is no clear communication to the public, businesses and organizations.

The current outbreak cannot be managed by the Ministry of Health alone. All parts of the government machinery with the help of public health experts, the private sector and NGOs need to work together to tackle this outbreak. It is our health at stake and it is our collective responsibility to take care of that health.

(Datuk Prof Dr Awg Bulgiba Awg Mahmud is a Public Health Medicine Specialist and Professor of Epidemiology at the Dept of Social and Preventive Medicine, University of Malaya.)