It's not just the elderly or the ill who are vulnerable to Covid-19


  • Wellness
  • Tuesday, 07 Jul 2020

High blood pressure is one of the most common underlying medical conditions in patients who die of Covid-19. — AFP

Anyone can get infected with Covid-19.

The severity of the disease varies from no disease to mild and moderate in about 80% of patients; severe disease in 14% and critical in 5%.

There are reports on the variable prevalence of asymptomatic patients, i.e. those who have no symptoms, but who can infect others without knowing it.

Many Malaysians provide care to family or friends with underlying medical conditions; some on a full-time basis, and others periodically.

Some provide care in organisations that operate care centres or community programmes, while others do so at home for family members.

Carers have to protect themselves and maintain their personal health when providing care for others.

Clinically vulnerable

Certain population groups are at increased risk of severe or critical disease.

Such risk has been categorised by some countries into moderate risk (clinically vulnerable) and high risk (clinically extremely vulnerable).

However, for the purposes of this column, we will not follow this.

Instead, let’s look at who the clinically vulnerable are:

  • Those above 70 years of age
  • Those with underlying medical conditions, e.g. diabetes; high blood pressure (hypertension); chronic kidney, respiratory, liver, nerve or heart disease; cancer; and morbid obesity (a body mass index, BMI, of 40 and above), as well as those who are pregnant.
  • Those with a compromised immune system due to a medical condition or treatment, e.g. severe combined immunodeficiency (SCID), steroid therapy, chemotherapy and radiotherapy.

Many Malaysians have underlying medical conditions that render them clinically vulnerable, like diabetes (18.3% of the population), high blood pressure (30%) and obesity (19.7%).

Of the 121 Covid-19 deaths as of June 28 (2020), around 63% had underlying medical conditions.

The most common conditions were high blood pressure, diabetes and cancer.

Others who are clinically vulnerable include those who have difficulty accessing healthcare, information or transport; carrying out prevention measures, e.g. frequent handwashing and respiratory etiquette; reading; speaking; understanding; or communicating.

Those in geographic or social isolation, e.g. Orang Asli; who have inadequate, crowded or non-existent housing conditions, e.g. some foreign workers and the homeless; and with unstable employment or inflexible working conditions, are also vulnerable to disease.

Covid-19 is a stealthy disease with many faces, i.e. its signs and symptoms are variable. As such, a high index of suspicion is necessary.

It is important to keep updated with current information about the disease and the situation in your local community from trusted sources.

Many Sarawakians live in isolated interior areas that are linked mainly by boat, making them one of the clinically vulnerable groups to Covid-19.Many Sarawakians live in isolated interior areas that are linked mainly by boat, making them one of the clinically vulnerable groups to Covid-19.

Preventing spread

As there is no specific treatment for Covid-19, there has to be strict compliance to non-pharmaceutical or non-drug interventions by carers and the clinically vulnerable.

The following are applicable to both individuals and care or community centres:

> Regular and frequent handwashing

Hands must washed regularly and frequently with soap and water for at least 20-30 seconds.

They should be washed:

  • After blowing the nose, coughing or sneezing
  • After touching surfaces outside the home, including money
  • After visiting a public place
  • After using public transportation
  • Before and after eating
  • After using the toilet
  • After handling garbage or touching pets and animals
  • After changing diapers or helping children use the toilet; when the hands are obviously dirty, and
  • Before, during and after caring for a sick person.
> Using alcohol-based hand sanitiser

Alternatively, a sanitiser containing at least 60% alcohol can be used if the hands are not obviously dirty.

> Avoid touching the eyes, nose or mouth

Touching your eyes, nose or mouth must be strictly avoided as contaminated hands can transfer the virus to these sites, from which it enters the body.

Touch your eyes, nose or mouth only after your hands have been washed with soap and water.

> Good respiratory etiquette

Do adhere to good respiratory etiquette by covering your mouth and nose with a bent elbow or tissue when coughing or sneezing.

The used tissue should be thrown away immediately and your hands washed.

Ensure that the people around you also adhere to good respiratory etiquette.

> Increasing access to hygiene supplies

Access to supplies necessary for hand hygiene and respiratory etiquette, e.g. soap, alcohol-based hand sanitisers, paper towels, tissues and waste containers, should be easy and convenient.

> Avoid sharing personal items

These include cutlery, towels and toothbrushes.

> No reuse of disposable gloves

Disposable gloves should be used for one surface only and thrown away after a single use.

Otherwise, they could spread the virus.

Never touch the eyes, nose or mouth with used gloves.

> Clean frequently-used items

Frequently-used spaces, surfaces and objects, e.g. doorknobs, faucets and shared sleeping spaces, need to be cleaned regularly.

> Physical distancing

Maintain at least 2m from any other persons when outside your home and use a face mask.

Avoid crowded places, which includes gatherings, lifts, queues etc.

And do stay home if you are sick.

> Sharing information

Do share information with family members and fellow carers on what to do if the vulnerable person appears sick, as well as how to care for a disabled person.

All messages have to be:

  • Clear, specific, short and in commonly-used language
  • Accessible, e.g. in infographic form or in Braille
  • In large fonts, and
  • Posted in commonly-used areas in care centres, e.g. entrances, waiting areas and toilets.

The measures that can be taken in care centres and the community include the sharing of:

  • Information about what to do if vulnerable person(s) or staff appear sick
  • Steps on how to care for people living in a crowded place, and
  • Information about how to care for disabled persons and the homeless.
Disposable gloves should be used one time only and thrown away immediately afterwards. — FilepicDisposable gloves should be used one time only and thrown away immediately afterwards. — Filepic

Other measures

The supportive measures that individual carers can consider in addition to the above steps, include:

  • Avoiding public transportation by using volunteer drivers or taxis, preferably the same one all the time.
  • Providing access to food, drinks and supplies, if necessary.
  • Assisting the clinically vulnerable in filling or refilling prescriptions and medical supplies.

It is prudent for organisations that support senior citizens and the clinically vulnerable who have underlying medical conditions or compromised immunity to:

  • Limit their staff’s work to a single facility and limit the locations within the facility in which their staff work.
  • Require all staff to comply with the preventive measures mentioned above.
  • Not allow visitors except under compassionate or special circumstances.
  • Screen all visitors and deny entry if they are symptomatic.
  • Ensure that any staff member who is symptomatic does not come to work.
  • Screen all staff before every shift and deny entry if they are symptomatic.
  • Send all staff home immediately if someone develops symptoms during a shift.
  • Permit entry without screening to those providing emergency services.
  • Avoid organising any outings for residents except for medical appointments.
  • Adhere to the standard operating procedure (SOP) set by the authorities.
  • Refer anyone with symptoms to the nearest healthcare facility.
  • Keep updated on the latest information from trusted sources.

Take care and stay safe.

Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email starhealth@thestar.com.my. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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