I woke up last week to grim news: 368 deaths in Italy in 24 hours on March 16. “It’s happening, ” I told myself as I felt my stomach knot. “It”, Covid-19, is crushing communities, tearing across the planet with unstoppable force. To face a real pandemic – after hearing of the possibility in public health for years – seems surreal.
There’s no quick fix to stop this. The cat is out of the bag – that cat of containment. The problem is among us, unseen and growing, like a terrorist threat. We have no idea what follows next. Modelling done before for pandemics was based on influenza. There’s no saying whether 20% or 60% of the global population will get infected, say experts. Whatever, it won’t be pretty. We can just hope for fewer infections with a warm summer.
All we can do now is damage control.
First, slow the spread of the virus and reduce the case numbers by social distancing.
Second, get our health care system very, very prepared.
Third, protect people at very high risk, especially the elderly. People with heart and lung diseases, obesity and diabetes are also at higher risk. But don’t assume younger adults are risk-free – one of the Malaysian victims was a 34-year-old man. And a recently released US study showed one-fifth of infected young adults, ages 20 to 44, were hospitalised, including 2% to 4% who needed ICU treatment.
Every step matters. A lot. It determines how many will die. We saw Italy’s cases double in just four days from 10,000 to 20,000 (March 11 to 15). Globally, we’ve seen cases triple in less than a month, to 220,000 (Feb 20 to March 19).
In Italy, a country known for good intensive care, hospitals are at breaking point, intensified by a large elderly population. Doctors are having to decide who lives or dies. A leaked document reportedly stated that patients aged over 80 would be denied intensive care.
To avoid inundating hospitals, countries are locking down to stop new chains of transmission – so as to “flatten” the curve of projected new cases to a flat, wide hill rather than a steep mountain.
On Wednesday, March 18, urged by doctors, the movement control order began in Malaysia. Good. Except some people rushed to their home states, as if on holiday, possibly taking the virus to villages with elderly relatives. Then there was confusion when a ban on interstate travel was withdrawn. Clarity and strong leadership are paramount.
Consider the large number of cases linked to just one gathering, at the Sri Petaling mosque.
“This is exactly what we don’t want to happen, ” says Prof Datuk Dr Adeeba Kamarulzaman, dean of Universiti Malaya’s Faculty of Medicine. She said public health workers had to work even harder, doing the painstaking work of contact tracing, testing and follow up.
She said hospital preparations for an upsurge of Covid-19 infections are already in place, with wards being cleared and elective surgery patients reviewed.
“We’re only at week two at Universiti Malaya Medical Centre and it’s really a lot of work. We’re in this for the long haul.
“I salute my colleagues at Hospital Sungai Buloh who have shouldered the biggest brunt of cases from the beginning.”
The risks are high for healthcare workers.
“There is a lot of anxiety. The fear is real. It’s also the unknowns. How many are we going to deal with? What proportion will be ill? Will patients who are asymptomatic transmit infections?”
Roughly 20% of Covid-19 cases are severe, requiring intensive care and ventilators. Our capacity is limited. Malaysia has a relatively low number of critical care beds at 3.4 per 100,000 population; by comparison, Taiwan, Brunei, Singa-pore, Thailand and Mongolia have 28.5,13.1,11.4,10.4 and 8.8 respectively, a 2020 study in the Critical Care Medicine Journal found.
One severe complication of Covid-19 is acute respiratory distress syndrome. China used relatively sophisticated treatments such as oxygenating blood with Ecmo (extracorporeal machine oxygenation). A lack of such treatments in some countries may raise death rates.
The strategies used here are working so far with four fatalities among 1,183 cases as of noon Saturday (March 21), in part due to reportedly “amazing” work from intensivists and infectious diseases specialists.
But for how long? They work dressed in heavy protective gear specified for handling Ebola patients, leaving their scrubs wet from sweat. To work this way for long periods is tough.
So every time you think about breaking the restricted movement order, think about our stretched medical teams. And the fact that a single case can lead to a few thousand in less than a month.
The medical teams on the frontlines of this war against this virus are our lifesaving defence. Let’s not make their work any harder.
Mangai Balasegaram writes mostly on health, but also delves into anything on being human. She has worked with international public health bodies and has a Masters in public health. Write to her at email@example.com. The views expressed here are entirely the writer’s own.
Did you find this article insightful?
100% readers found this article insightful