By Dato' Dr Amar-Singh HSS
This past year has been an emotional, financial and medical 'roller-coaster-ride' for all of us in Malaysia. 2020 has brought much anguish, despair and grief to many, especially those in poverty, pushed into poverty or have lost their jobs or a family member due to COVID-19. While we have done reasonably well in managing the pandemic, it has exposed many of our limitations.
Never before have we as a nation or health service faced such a prolonged outbreak for which, even now, we can see no immediate end. We recognize our health care professionals are fatigued and the system is not able to cope. This long-drawn-out pandemic has eaten into the emotional reserves of our health care professionals. They need our compassion and support.
We need to reflect on the coming year and ask ourselves where we are going as a nation with COVID-19. We cannot keep looking at and be affected by the day to day numbers of reported cases detected. I would suggest we stop looking at these numbers as they are just a factor of the scale of testing -- how wide and how many tests we do each day. Models suggest we are missing at least 3-4 times as many cases as we detect, perhaps higher. In addition it is important to note that our testing remains very limited and is being restricted. For example we hear in some states of restrictions placed on general practitioners (GPs) on how many tests they can do per day because the system cannot cope with pickups and placements of persons detected as COVID-19 positive.
Hence the public does not get a full picture of the true situation and cannot respond appropriately, allowing for fake news to abound. Whistle-blowers tend to get victimized. The ingrained mentality to always hide unpleasant truths needs to stop. One problem is that we have a major trust deficit.
So where are we going as a nation with COVID-19 in 2021? We have used MCOs as a tool to try and mute the spread of COVID-19, especially in the face of our limited testing response. But this cannot continue as it now harms a significant portion of the population. Vaccines offer us much hope but we will have to see how they will work in the real world context, to control the pandemic from spreading, and allow some return to an active society. Even then we will have to maintain many SOPs for the coming year at least.
For Malaysia to have a hopeful 2021 where COVID-19 is concerned we need the following changes in outlook and behavior.
Transparency is crucial
If we want to move forward then there must be transparency. We must not learn about things first from whispers on social media and cries for help on Twitter or Facebook. We must learn it first from the authorities, no matter how unpalatable the situation. The public must not be given part of the information or part of the truth but the whole truth. Sharing extensive data openly is the only way we can work together as a nation. This is the way we can mobilize everyone and can be united as a nation to fight this scourge.
Stop blame shifting and take responsibility
Stop putting the entire blame on the public for the failure to control the pandemic. It is time to stop fining and arresting the average citizen for SOP violations. The failure of some elected representatives in government to maintain effective SOPs and the lack of penalty for them is a major thorn in the side of the public. In addition, get 'your own house in order' first -- some government departments have not embraced the SOPs, as can be seen from their image postings of recent official meetings and gatherings. It is time to continue supporting health staff and not discourage them with threats of disciplinary action for lapses in SOP. We must also stop the negativity towards our economic migrant workers, they have contributed to the development of our nation and we must support them in this pandemic. Encouraging compliance with leadership-by-example and taking responsibility for failures is what is required.
We need many voices
We need many people with ideas to speak up. We need many divergent views to be aired and discussed. We need an ongoing national dialogue to chart the best way forward. There is no time now to 'lead from front' and ignore the wealth of knowledge and thinking ability available in the community. No one can see the unknown, or predict accurately what is going to happen with COVID-19 in the near future. Hence it is important that we encourage the community to express critical opinions and learn from each other. We must stop this culture of trying to silence individuals who speak or share divergent views on how to tackle the outbreak.
More support is required
The amount of resources and support we have put into dealing with this pandemic is still limited. We need to ramp up our support and initiatives. We urgently need to absorb all the health manpower that is available (before we lose them to our neighbors). No one should be left on a contract job – all medical officers, pharmacists, nurses or other allied health staff on contracts should be offered permanent posts immediately. This should include the thousands of medical/pharmacy graduates waiting to get a job. We must ramp up our testing capacity considerably to enable the end to MCOs. Using extended MCOs as a control measure without wide-scale testing only damages the economy. We need to do at least 100,000 antigen tests per day for community screening and reserve PCR for symptomatic admissions. On-going, significant improvement in health infrastructure is vital. We need to extensively support those who are suffering in this time -- those who have lost their jobs, are struggling financially and have no food security. This has still not been fully resolved by government agencies.
Truth must be spoken and we cannot hide the reality of the COVID-19 situation and impact on the country. Any attempts to do so will only harm the nation. Our hope, as always, is in the people of this nation who will rise to any challenge if they are given the information, opportunity and freedom.
(Dato' Dr Amar-Singh HSS is a Senior Consultant Pediatrician.)