Malaysia’s Covid-19 response a good lesson for the West, says international report

KUALA LUMPUR: Malaysia's success in controlling the spread of Covid-19 challenges the idea that medical expertise and a robust health system “is best channeled by legacy powers and historically rich states”, says a report.

Authored independently by Dr Fifa Rahman, who is currently Unitaid executive board member, in collaboration with non-profit organisation the Drugs for Neglected Diseases Initiative (DNDi), the report, posted by Health director-general Datuk Dr Noor Hisham Abdullah on his official website, said compared to the situation in the West, countries in the East such as Malaysia showed innovative and speedy pandemic responses that kept infections and deaths relatively low.

DNDi’s South-East Asia office director Jean-Michel Piedagnel said this illustrated the value of a middle-income country's expertise in a global pandemic response.

"While there is a clear need to invest in more expensive solutions such as new treatments and vaccines, pragmatism and speed in terms of instituting a basic health response is a major factor," he said.

He said middle-income countries had focused on basic available public health tools.

"This is a lesson we all need to remember, ” he said in the report titled The Malaysian Response to Covid-19: Building Preparedness for ‘Surge Capacity’, Testing Efficiency, and Containment.

Dr Noor Hisham, in the report, said early planning and preparedness contributed to the low number of deaths.

"From December 2019 to April this year, in addition to increasing capacity and the number of diagnostic laboratories, we increased the number of hospitals treating Covid-19 patients from 26 hospitals to 40 hospitals, including seven which function as full Covid-19 hospitals.

"We increased the number of screening hospitals from 56 to 120, which is a 53% increment; and we also increased ventilator numbers from 526 units to 1,034 units, which is a 49% increment, ” he said.

The report also said Malaysia hospitalised all individuals diagnosed as Covid-19 positive, whether symptomatic and asymptomatic.

"Learning from other countries, including China, was essential in identifying the dos and don’ts in the Covid-19 response, including in terms of treatment," said the report.

Malaysia’s preparedness began as early as December last year when the authorities heard that an "unknown virus" had precipitated several reported cases of acute respiratory syndrome in Wuhan.

"Planning and preparedness began then, including coordination with public health teams, plans for renovation of hospitals for surge capacity, and plans for procurement of reagents," it said.

The country's previous experience with Middle East Respiratory Syndrome-related coronavirus (MERS) and the 2002 to 2003 Severe Acute Respiratory Syndrome (SARS) epidemic, which included experienced contact tracing teams, was key in enabling a speedy response, it added.

It was almost a month later that the first cases were detected in Malaysia.

Three out of eight Chinese nationals who entered Malaysia via Johor Baru from Singapore on Jan 23 were confirmed Covid-19 positive on Jan 25.

The following day, the Health Ministry advised Malaysians to avoid crowded places when travelling to China.

Dr Noor Hisham said a serious concern for a more massive Covid-19 outbreak emerged when the ministry received notification on March 9 from Brunei about a case detected there that was linked to the annual mass religious assembly at a Seri Petaling mosque in Kuala Lumpur from Feb 27 to March 1.

By mid-March, more than half of Malaysia’s 673 confirmed cases were linked to the event.

Newly-appointed Prime Minister Tan Sri Muhyiddin Yassin on March 10 advised the public to practise social distancing. On March 11, the World Health Organisation (WHO) declared the Covid-19 outbreak a global pandemic.

The following day, the government made the decision to designate Hospital Sungai Buloh as the country’s main Covid-19 hospital.

The government implemented a movement control order (MCO) nationwide beginning March 18.

"Planning and preparedness activities began relatively early in Malaysia, with initial planning starting in December, diagnostic reagents procurement in January, and a number of renovations to hospital facilities done in February," said the report.

Hospital Sungai Buloh infectious diseases clinician Dr Suresh Kumar said the hospital started making space for Covid-19 cases in February. Surgeons had to do their operations elsewhere.

“We started building capacity when we heard how Wuhan was overwhelmed. We knew that a lot of the mortality in Wuhan was because of the surge (in cases) and the fact that their hospitals couldn’t cope," he said.

Hospital Sungai Buloh is actually a 900-bedded hospital, and renovations were made to accommodate over 2,000 bedded patients, he said.

"There was an old hospital next door that we immediately renovated and brought in beds to get it ready.

"We also learned from China that their intensive care units (ICUs) were overwhelmed – so, we then reviewed our own ICUs to see what else we could convert into ICUs, ” he added.

Meanwhile, efforts were taken to optimise diagnostics capacity in both public and private laboratories.

The Institute for Medical Research (IMR), the biomedical research arm of the Health Ministry, began preparations in January.

IMR virology unit head Dr T. Ravindran said it already had the capacity to diagnose and detect SARS, the previous strain, but did not initially know what it was dealing with until Jan 11 when Chinese scientists shared the full genomic sequence of this coronavirus.

"So we had access to that, and based on that we managed to optimise our services by designing and developing our own primers and probes specific for Covid-19.

"The reagents arrived on Jan 21, and we optimised our real time PCR (polymerase chain reaction) by that day itself," he said.

(A reagent is a substance or compound added to cause a chemical reaction or to test if a reaction occurs.)

Dr Ravindran said IMR also provided training to other government facilities and public health laboratories beginning Jan 13.

Meanwhile, Dr Noor Hisham said Malaysia's prompt response to the Covid-19 pandemic was partly due to its experience in containing past infections.

"These outbreaks had made Malaysia more prepared to deal with such situations, including having more thermal scanners that had been placed at all entry points into the country, as well as its actions in isolating Covid-19 cases and placement of suspected cases under quarantine, ” he said.

Malaysia drastically upgraded health facilities and diagnostics capacity in February, including an 86% increment in diagnostics laboratory capacity, 89% increment in critical care bed capacity, and an 49% increase in the number of available ventilators (from 526 to 1,034 units), he said.

The authorities also mobilised 10 university laboratories, as well as an additional ones at the Malaysian Genome Institute, so that diagnostics capacity increased from an initial six laboratories to 43 laboratories at time of writing.

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