INTERACTIVE: More Covid-19 patients are being brought in dead – why this happens and what needs to be done

SEREMBAN, 25 Mei - Burial of a Covid-19 patient. 
-BERNAMA photo (2021) All rights reserved.

PETALING JAYA: The number of people in Malaysia infected with Covid-19 but who were only taken to hospital after dying of the disease is going up at an alarming rate.

In May alone, we saw 123 deaths that the Health Ministry categorises as “brought in dead” (BID). The figure represents 47% of the 261 BID cases recorded in the country this year.

Health experts said a detailed study needs to be done to find out why this happening, adding that the trend could be due to two possible factors.

The first is that some people infected with Covid-19 did not take their initial symptoms seriously, only to face a rapid deterioration in their medical condition and as a result died before they could be taken to hospital.

The second possible reason could be the widespread presence of more virulent variants of the SARS-CoV-2 coronavirus which causes Covid-19.

In any case, the experts said that the worrying trend underscores the importance of people closely monitoring themselves for any possible symptom and sticking to the standard operating procedure (SOP) such as social distancing and wearing masks when out, in order to better protect themselves.

As at the end of May, Malaysia has recorded 2,796 Covid-19 deaths since the pandemic reached our shores last year, of which 293 or 10% were classified as BID.

The majority of BID cases occurred in Sabah (29%), followed by Selangor (27.6%) and Kuala Lumpur (10.9%).

While Sabah had more BID cases last year, this year saw Selangor recording the most number of such cases.

In terms of age, most of the BID cases involved patients aged between 60 and 69 (24.2%), followed by those between 50 and 59 (20.5%) and the 70-79 age group (16%). The 30-39 age group made up 8.5% of the overall BID cases in the country.

The youngest Covid-19 patient who was brought in dead, in Tawau Hospital on Nov 28,2020, was a four-year-old in Sabah.

Most BID cases had a medical history of hypertension and diabetes. However, 31.7% or 93 of the cases did not have any record of medical illness.

The Health Ministry said on May 28 that the rising number of BID cases involved three possible scenarios, with the first scenario comprising patients who did not undergo Covid-19 screening despite developing symptoms such as fever and cough.

The second scenario involved confirmed Covid-19 patients who were found dead at home before they could be sent to a quarantine centre or hospital.

"Scenario three involves patients who experience the loss of sense of taste and fatigue but did not take these symptoms seriously. The patient only rested at home and after a few days, was found dead," the ministry said in a tweet.

Universiti Malaya epidemiologist Prof Datuk Dr Awang Bulgiba Awang Mahmud said the rise in Covid-19 patients who are brought in dead to hospitals may be due to several factors, including newer Covid-19 variants which are more virulent, resulting in a more rapid deterioration in the patient’s condition.

Prof Datuk Dr Awang Bulgiba Awang MahmudProf Datuk Dr Awang Bulgiba Awang Mahmud

Another possible reason that the infected person failed to seek proper medical attention quickly enough is that they brushed off their initial symptoms as a common cold or minor cough.

"Other factors may be due medical facilities being far away and not readily accessible, like in remote areas of Sabah and Sarawak," he added.

In order to ensure infected persons receive the medical attention they need, Dr Awang Bulgiba stressed that a data analysis should be done to determine the type of patients who are likely to deteriorate.

"Factors that can predict disease progression may be modifiable but the correct analysis needs to be carried out to find out what those factors are," he said.

Dr Awang Bulgiba also proposed that an epidemiological analysis be combined with genomic surveillance to prevent the spread of new undetected variants that will be a threat to the community.

“Hardly 0.08% of virus samples are being sent for genome sequencing, ” he said, describing the figure as “dismal.”

The medical condition of home-quarantined patients should be monitored more closely through the possible use of mobile applications that would allow the process to be done remotely.

Dr Awang Bulgiba urged the government to ramp up vaccination efforts to between 300,000 to 500,000 doses per day.

"With half a million doses per day, the country can achieve herd immunity in just 100 days or within six months if we vaccinate at a rate of 300,000 doses per day.

“However, the current rate is far below this number, so this is worrying," he added.

Commenting on the increasing number of BID cases, Universiti Putra Malaysia medical epidemiologist Assoc Prof Dr Malina Osman said a study involving animals in India has shown that the new coronavirus variant in that country is associated with more severe clinical manifestations.

"We are still studying the clinical data, but I believe the new strains of the virus may play a role in the deterioration of the symptoms," she said, adding that there is the possibility of multi-strains infections but should be proven by more research and clinical data.

Dr Malina said that among the risk factors of developing severe Covid-19 and deaths are undiagnosed chronic diseases or medical illnesses that can lead to an immunocompromised patient (having an impaired immune system).

Universiti Putra Malaysia medical epidemiologist Assoc Prof Dr Malina Osman Universiti Putra Malaysia medical epidemiologist Assoc Prof Dr Malina Osman

"Some of the factors include the person's compliance to put an effort to get and have the prescribed treatment, effort by the caretakers to help monitor the symptoms as well as the general attitude and practice towards SOP compliance," she said.

She advised those who are infected to closely follow medical advice and to get help from others such as family members, neighbours or friends to keep tabs on them in case their condition worsens.

Malaysian Medical Association (MMA) president Datuk Dr Subramaniam Muniandy reiterated that delays in seeking medical attention, failure to recognise severe symptoms of Covid-19, and newer variants may have contributed to the rise in BID cases.

"Issues of getting quick access to healthcare especially in the remote interiors in Sabah and Sarawak may also be a factor," he said.

Dr Subramaniam said proper assessments and monitoring are key to reducing BID cases, with those infected needing to be properly educated on the various Covid-19 categories to know if their symptoms are worsening from mild or moderate to severe.

"The CAC (Covid-19 assessment centre) would need to ensure more thorough assessments and the district health office would need to ensure all patients on home monitoring are checked on regularly.

"The Health Ministry must also be clear on when a patient should seek care at a hospital's emergency department," he said, adding that the patient's family or caregiver will need to be on alert to call in for medical attention if symptoms worsen.

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