Managing the coronavirus outbreak is a marathon, not a sprint

Malaysia’s response to the 2019 novel coronavirus (2019-nCoV) outbreak has been excellent so far, but it is an open-ended marathon, not a short-term sprint.

No one can guess when the peak will arrive or how quickly it will burn out.

Given this uncertainty of outbreak duration and intensity, it’s crucial that the Health Ministry (MOH) plans for an open-ended marathon response. This will address three important concerns.

One, health professionals will suffer increasing physical and emotional fatigue from 24/7 high-speed and high-pressure operations with little margin for error.

Two, the emotions of the rakyat will be increasingly strained by fear and panic, worsened by distrust and social media rumours.

Three, the healthcare system must continue delivering routine care for illnesses and conditions that are always around us, like childbirths, diabetes and cancer surgeries; it cannot be on permanent “outbreak footing”.

Therefore, I propose three specific strategies for an open-ended marathon response to this outbreak.

Mobilising healthcare professionals

Firstly, we must utilise all available human capital for health in the entirety of Malaysia.

This can be done in three steps: all-of-MOH, all-of-Government and all-of-society.

MOH must rotate their professionals from other units into front-line units such as the Crisis Preparedness Response Centre (CPRC) and airport screening posts.

There are 270,000 employees in the MOH, and we must spread the responsibilities.

Although unfortunate, this outbreak provides real-life training for all our health professionals; we should not waste this opportunity.

Following that, MOH must collaborate with health professionals from the universities and Armed Forces.

Academic-physicians, academics and Masters or PhD scholars in public health, epidemiology or related subjects are crucial resources.

Soldier-doctors and military medicine experts can rotate in and out of policy-setting or front-line roles, taking care not to militarise our outbreak responses.

Media professionals from the Home Affairs or Communications and Multimedia ministries should augment the risk communications strategies of MOH.

Academics will learn from real life and soldier-doctors will learn from civilian responses, strengthening future outbreak responses.

In parallel to mobilising the entirety of MOH and Government resources, we must involve all of society.

Private sector healthcare providers like private general practitioners (GPs) and hospitals must be included in the national effort where possible.

Civil societies, political parties, and even village Rukun Tetangga, must play a part.

Spare manufacturing capacities of glove, mask and personal protective equipment factories must be activated to create a strategic stockpile for Malaysia, with export as a future possibility.

Managing communications

Secondly, all risk communications must build long-term consistency into their thinking and execution.

An initially frequent communications strategy may be desirable to “flood the zone” with correct, reliable and positive information.

However, an excitable response in the beginning may feed into population panic, increase the chances of mistakes, and cause dissonance if communication frequency gradually becomes slower and less intense.

We must also consider that the rakyat may experience cognitive or emotional fatigue with a bombardment of messages.

Therefore, in practical terms, this means that the frequency, length and tone of the risk communications must be sustainable.

It’s a fine balance, and very difficult to get right. However, we can be thoughtful about the various ways this outbreak can develop, and build as much flexibility and sustainability as possible in our risk communications.

A sustainable tempo will increase the effectiveness of the messages, reduce the strain on the MOH’s media team, and perhaps even reduce population panic.

Balancing care

Thirdly, while we should be concerned and vigilant about this outbreak, MOH must deliver reassuring signals of confidence that we will overcome this outbreak together.

The presence of senior leaders during routine non-outbreak events like World Cancer Day, Parliament sessions and Sihat Bersama 2030 discussions, indicate that business-as-usual must continue.

Doctors and nurses delivering routine care can reassure their patients that the system continues as usual, only with the added complication of the outbreak.

Healthcare professionals must be calm and sensible in their social media posts and daily clinical conduct, as our overall tone can either frighten or reassure the public.

This is another tricky balance. The outbreak is important, but it’s not more important than life-saving heart surgery or caring for sick babies.

All politicians and citizens in Malaysia must stop political opportunism and unnecessary criticism without offering help or ideas; if you’re not part of the solution, you may be part of the problem.

This outbreak is an open-ended marathon and can’t be fixed in a short sprint.

Therefore, we must spread our workload, mobilise all of Malaysia’s abundant resources, train future generations of outbreak responders, and each play our part to deliver outbreak and non-outbreak care.

Dr Khor Swee Kheng has postgraduate degrees in internal medicine and public health, and has worked in five health sectors across three continents. He is currently reading Public Policy at the University of Oxford. The views expressed here are entirely his own.

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