Covid-19 to carry on dominating 2021


Overcrowding of migrant workers, like those living in the small house in this filepic, is a main factor in their high numbers of Covid-19 cases.

Just like 2020 - a global annus horribilis (Latin for “horrible year”) – Covid-19 will dominate 2021.

Hopefully though, it will be more manageable this year.

This new infectious disease has been described as unpredictable, but in reality, it was not.

For more than a decade, political and healthcare leaders have warned of the need to prepare for a pandemic.

Former US president George W. Bush stated in 2005: “A pandemic is a lot like a forest fire.

“If caught early, it might be extinguished with limited damage; if allowed to smoulder undetected, it can grow to an inferno that spreads quickly beyond our ability to control it.”

He was thinking of an influenza-like pandemic.

The World Health Organization (WHO) had been warning for almost two decades of emerging diseases that “appear in a population for the first time, or that may have existed previously, but are rapidly increasing in incidence or geographic range”.

A list of disease priorities needing urgent research and development was published by the agency in 2015.

They were Crimean Congo haemorrhagic fever, Ebola virus disease and Marburg virus disease, Lassa fever, MERS (Middle East respiratory syndrome) and SARS (severe acute respiratory syndrome), Nipah, Rift Valley fever, and Disease X.

Disease X “represents the knowledge that a serious international epidemic could be caused by a pathogen currently unknown to cause human disease”.

Roadmaps were formulated for each one.

When I wrote that “new emergent communicable diseases may appear particularly with the globalization of travel” at the beginning of last year, I had in mind diseases like the Ebola and SARS outbreaks, which had affected few countries.

However, the Covid-19 pandemic took the wind out of my sails.

The moot question is whether Covid-19 was Disease X itself or the precursor of a more deadly form of Disease X to come this year.

Many scientists have warned of more unknown viruses to come with death rates about or greater than Ebola’s 50% (range 25%-90%).

Going forward into 2021, many healthcare areas from last year will still require our attention this coming year.

More Covid-19 cases

The number of Covid-19 cases will continue to increase with at least three to four in 10 Malaysians at risk of severe disease.

The vulnerable are males, those aged above 50 years and those with one or more of these diseases: high blood pressure, diabetes, cardiac disease, chronic renal disease, asthma, obesity and chronic pulmonary disease.

Covid-19 will disproportionately affect the vulnerable and deprived, with the Sabah cases exemplifying the latter.

Migrant workers are our Achilles heel.

They comprised about a quarter of Covid-19 cases at the end of last May.

Yet their testing only increased in November.

As of Dec 27, 205,896 had been screened with a 21% positive rate.

Consider the number of positives if all the estimated two million workers are screened.

Screening became mandatory for all migrant workers on Jan 1.

However, overcrowding, which is one of the root causes of the spread in migrant workers, has not been adequately addressed by the delayed implementation of the Minimum Standards of Housing and Amenities Act (Amended 2019).

The Institute for Health Metrics and Evaluation at the University of Washington in the United States, projects that Malaysia will have an estimated 28,743 daily infections (including those not tested) and 3,547 deaths by Apr 1 (2021), based on the current Covid-19 scenario.

Controlling the pandemic

Individual and shared responsibilities in controlling Covid-19 will remain, but there will be variation with new knowledge in 2021.

The former includes physical-distancing, use of face masks, frequent handwashing, and avoiding crowds, confined spaces and close contacts.

The latter includes testing, contact tracing, isolation/quarantine, treatment, vaccination and appropriate messaging.

More tests, treatments and vaccines will be available in 2021, with more rapid and extensive testing, more effective treatment of positive cases, and hopefully, prevention of spread with vaccination.

Vaccines will not end the pandemic as at least 60-70% of the population have to be vaccinated.

Will this be possible by the end of 2021?

The purchase of the vaccines is the easiest part; what are the preparations for the logistics and delivery of the vaccines, and mass vaccination?

Once vaccination starts, the danger of another surge is real if the public do not continue to comply with their individual responsibilities as mentioned above.

Non-Covid-19 diseases

The incidence of non-communicable diseases (NCDs) will continue to rise with increasing undiagnosed and uncontrolled numbers as there is no co-ordinated effort to control it.

The Komuniti Sihat Pembina Negara (Kospen) programme, launched in 2014 to tackle this problem by the Health and Rural and Regional Development Ministries, has yet to make an impact.

As NCDs and quality of care were on the backburner last year, the effects will be felt in this year and beyond, with increases in disease complications and pressures on the healthcare delivery system.

Other communicable diseases e.g. dengue, diphtheria and rabies, will also continue to take their toll.

The adoption of technological tools, e.g. online platforms selling and delivering drugs, means that healthcare is being administered by non-healthcare sectors. — BloombergThe adoption of technological tools, e.g. online platforms selling and delivering drugs, means that healthcare is being administered by non-healthcare sectors. — Bloomberg

Public trust and health policies

Public trust in allopathic healthcare continues to wane as evidenced by the purchase of traditional and complementary medicines exceeding that of pharmaceuticals.

Healthcare will be increasingly provided by non-health sectors with technological tools, e.g. online purchases of drugs.

Any budgetary allocation to the Health Ministry will not assure improved patient safety and quality of care unless wastages, inefficiencies and the role of middlemen are reduced markedly.

As long as the ministry formulates health policies without genuine consultation with stakeholders, success will be limited or absent.

The uptake of the PeKa B40 screening and MySalam insurance scheme are unlikely to meet their targets as evidenced by Parliamentary replies.

If the Health Ministry continues with its current approach to Covid-19, its credibility will be increasingly questioned, and then decline, particularly when cases and deaths persist.

Issues such as public displeasure at double standards in the implementation of SOPs (standard operating procedures); the ministry’s refusal to share data with state governments and the public; the ministry’s failure to engage meaningfully with the private sector, universities and civil society; and the lack of transparency, confusing decisions and messages, as well as threats, are bound to come to a boil.

Once the trust deficit reaches a tipping point, the pressure for change will be unstoppable and whoever is in government will have to oblige.

Increasing healthcare expenditure

Healthcare expenditure will continue to rise because of the ageing population, NCDs, infectious diseases like Covid-19, new technologies, increasing patient demands and the unrestrained role of middlemen in healthcare.

There will be increasing out-of-pocket expenditures in both the private and public sectors.

More families will face financial ruin if they or their relatives get catastrophic diseases, e.g. cancer, heart attack or Covid-19, or are made redundant.

Medical inflation will continue to rise unabated.

More general practitioner (GP) clinics, and even private hospitals, will close, primarily because of financial unsustainability.

Medical workforce

Over-production of doctors has yet to be adequately addressed.

However, the public are wiser with decreasing applications to private medical schools, which will lead to mergers, acquisitions and closures of some schools.

Without the involvement of GPs in mass Covid-19 vaccination, there will be delays and limited success, along with an increase in vaccine degradation (affecting their effectiveness, and possibly, safety) in the delivery process.

Medical technologies

New technologies, e.g. smartphones, portable diagnostics, smart drug delivery mechanisms, digital therapeutics, genome sequencing, machine learning and artificial intelligence, will continue to impact on healthcare.

Issues of patients’ confidentiality and security, patient safety, and the successes and failures of the new technologies, will continue to pose problems.

Technology should not be permitted to depersonalise healthcare.

New technologies are just tools. Whether they add or detract from humane healthcare has to do with how and why it is used.

Discrimination and careful evaluation are essential, not technological exuberance.

Take charge of your health

Healthcare is avoided by staying healthy.

A healthy diet, maintaining an appropriate weight, regular exercise, sufficient rest, safe sexual practices, avoiding smoking, moderate alcohol consumption and keeping vaccinations current are necessary.

This requires effort, smart lifestyle choices and the occasional medical check-up.

Covid-19 can be avoided by compliance with one’s individual responsibilities above.

Wishing all readers good health in 2021. 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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