The year 2021 was annus horribilis (Latin for a year of disaster or misfortune) for Malaysia with the Covid-19 pandemic dominating the year and floods providing the unfortunate finale in December.
There were more than 30,000 recorded Covid-19 deaths and 2.7 million cases as of last Friday (Dec 31, 2021).
There were times when the healthcare system was on the verge of collapse, particularly from last June to September (2021), with more than 23,000 deaths occurring then.
Lives were lost in the floods, with thousands made homeless.
The pandemic and the floods exposed numerous examples of irresponsibility and incompetence, which were underpinned by arrogance and lack of insight.
The public’s humanitarian response in both events put many in authority to shame.
If there is no sea change from the establishment, there will be more of the same in 2022.
Unpredictable virus
The SARS-CoV-2 Omicron viral variant is a reminder that the world is still not out of the woods when it comes to Covid-19.
The question about the Omicron variant is not whether it will spread in Malaysia, but when and what will be its scale and impact on our healthcare system.
Its surge in South Africa, the United Kingdom, Europe and the United States will soon affect the rest of the world.
Clinical data on the Omicron variant is still emerging.
Its numerous genetic mutations enable it to spread more rapidly than the Delta variant and to escape some of the protective effect of current vaccines.
The rate of spread of the SARS-CoV-2 virus has increased with the new variants, i.e. the Omicron variant spreads faster than the Delta variant, which was faster than the Alpha, Beta and wild variants.
A vaccine booster is necessary to restore antibody levels that are waning with time.
Even then, the protective effect against the Omicron variant is less than against the Delta and wild variants.
Emerging data indicates that children are also affected, with increased hospitalisation rates among them.
This is of particular importance as vaccines for the five- to 11-year-old age group are only expected to arrive in Malaysia in the middle of the year (2022).
Other SARS-CoV-2 viral variants are likely to arise in 2022 with their impact(s) on healthcare yet to be discovered.
Will Omicron and other bizarre variants overwhelm the Malaysian healthcare system this year (2022)?
Only time will tell. The only thing predictable about the coronavirus is its unpredictability.
Our weak points
The Omicron variant is looking for the unvaccinated.
These people are at increased risk of Covid-19, compared to the fully-vaccinated.
However, the vulnerability of Malaysians remains, with three to four in every 10 persons at risk of developing severe Covid-19, i.e. those who are male, aged above 60 years and/or have high blood pressure, diabetes, heart disease, chronic kidney disease, asthma, obesity and chronic lung disease.
Although the vulnerable and deprived will be disproportionately affected, it is disturbing that there has been no concerted attempt to address these risk factors.
Long Covid will have an impact on healthcare delivery also, the scale of which is currently unpredictable.
Migrant workers remain an Achilles heel of ours.
Most have received two Covid-19 vaccine doses.
However, overcrowding, which is one of the root causes of viral spread, has not been adequately addressed, despite the Minimum Standards of Housing and Amenities Act (Amended 2019).
A total of 17,457 out of 37,662 (47.15%) Peninsular employers were found to be non-complaint with the law during inspections carried out between last Jan 11 and Nov 30 (2021).
Stick to the basics
Individual and shared responsibilities in controlling Covid-19 remain, but there will be variations as new knowledge emerges this year (2022).
Individual responsibilities include physical distancing, face-masking, frequent handwashing, and avoiding crowds, confined spaces and close contacts.
Shared responsibilities include testing, contact-tracing, isolation/quarantine, treatment, vaccination and appropriate risk communication.
There will be more rapid and extensive testing, more effective treatments and vaccines, and hopefully, prevention of spread with vaccination.
However, vaccines will not end the pandemic.
It is, in fact, probable that regular vaccination will be necessary.
The scale of Covid-19 case surges or waves will increase if the public do not comply with their individual responsibilities and vaccination appointments.
Pandemic fatigue will be aggravated by poorly-considered measures, like the deferred amendments to the Prevention of Infectious Diseases Act.
The incidence of non-communicable diseases (NCDs) will also continue to rise with increasing undiagnosed and uncontrolled numbers as there is no coordinated effort to control them, which will impact on Covid-19 incidence.
Other communicable diseases, e.g. dengue, diphtheria and rabies, will continue to take their toll.
In addition, the backlogged surgeries and treatments for NCDs will lead to premature and excess illness and death.
Grim outlook
The Health Ministry’s budgetary allocations cannot assure improved patient safety and quality care unless wastage, inefficiencies and the role of middlemen are reduced markedly.
As long as health policies are formulated without genuine consultation with stakeholders, success will be limited or absent.
Public trust is likely to continue to wane for various reasons, including poor risk communication; non-compliance to Covid-19 standard operating procedures by certain groups; failure of the authorities to engage meaningfully with the private sector, universities and civil society; misuse and abuse of social media; lack of transparency; and poorly considered measures.
This will be so particularly if and when Covid-19 cases and deaths persist.
Healthcare expenditure will also continue to rise due to our ageing population, NCDs, Covid-19, other infectious diseases, new technologies, increasing patient demands and unrestrained middlemen in healthcare.
Increasing out-of-pocket expenditures in the private and public sectors will lead to more families facing financial ruin if they or their relatives get catastrophic diseases, e.g. cancer, heart attack or Covid-19, or are made redundant because of their illness.
Medical inflation will continue to rise unabated.
More general practitioner (GP) clinics, and even private hospitals, will close because of financial unsustainability and physician burnout.
Medical unemployment and disgruntlement will continue with the issue of contract doctors in the public sector yet to be adequately addressed.
The best and brightest will seek employment abroad, making Malaysia one of the few countries that train doctors at public ex- pense for the benefit of other countries.
There will be mergers, acquisitions and closures of some private medical schools.
The minimal involvement of GPs in the management of Covid-19 and NCDs in public sector patients will impact negatively on population health and the risk of Covid-19 and other infections.
At a tipping point, the pressure for change will be unstoppable and the government of the day will have to oblige.
More tools
Healthcare will be increasingly provided by non-health sectors through technological tools, e.g. online purchases of pharmaceuticals and medical devices.
New technologies, e.g. portable diagnostics, smart drug delivery mechanisms, genome-sequencing, machine-learning, artificial intelligence, etc, will impact more on healthcare.
Issues of patient confidentiality and security, patient safety, and the successes and failures of the new technologies, will be problematic.
New technologies are just tools.
Whether it adds to or detracts from humane healthcare has to do with how and why it is used.
Discrimination and careful evaluation are essential, and not merely technological exuberance.
Stay healthy
The need for 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 risks can be minimised by compliance with one’s individual responsibilities and vaccination.
Wishing all readers good health in 2022. 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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