A YEAR on after the first Covid-19 case in Malaysia was confirmed, it is clear that the government is struggling for a comprehensive solution to control the pandemic.
For one whole year, mitigation measures to reduce active infection were mainly mandatory quarantine and admission to Covid-19 designated hospitals if tested positive. These measures are costly and not effective when there is significant community transmission.
At the outset, we stated that the Health Ministry could not fight this war alone. On many occasions, we urged the ministry to mobilise private general practitioners (GPs) in this war.
A year ago, FPMPAM (Federation of Private Medical Practitioners’ Associations Malaysia) submitted to the Health Ministry a detailed proposal for a private-public partnership programme to be implemented nationwide using GPs and primary care doctors.
GPs, the unacknowledged frontliners, must be engaged and involved in a nationwide, meaningful and comprehensive private-public partnership to help stem the tide of infections.
At that time, hydroxychloroquine was the main treatment for Covid-19. Today, other medications have emerged as possible treatment modalities.
The proposed programme called for “early diagnosis and early treatment of prima facie cases of Covid-19 at the GP/primary care level” i.e. at the community level where the main pool of infectious cases lurks.
It is aimed at reducing the size of this pool to below critical mass whereby it will no longer be a public health danger, and supplementing the existing public health measures of testing and quarantine.
The proposal highlighted that the 7,000 or more GPs, who are located throughout the country, are a valuable resource that should be actively mobilised, equipped with personal protective equipment, medications and the mandate to treat patients in the community. The Health Ministry should provide GPs with whatever currently recommended therapeutic options for Category 1 (asymptomatic) and 2 (symptomatic, no pneumonia) patients.
In the event where mass testing is not feasible, the proposal called for GPs to treat patients with prima facie evidence of the disease (presumptive diagnosis) based on accepted clinical criteria.
This was the other battleground on Ground Zero that should have been opened up using the GP’s enormous strategic capability.
Each GP treating up to 20 patients daily would be able to provide treatment for thousands of early cases of Covid-19. In a short time, they would have the capacity to reach millions of patients in a community-based setting.
Where costs are concerned, it is clear that treatment of a presumptive case in the community setting is more cost effective compared to the hospital setting.
Together with an efficiently executed vaccination programme, this strategy will hopefully break the chain of transmission.
The Health Ministry also needs to review its public media strategy to encourage people to come forward voluntarily. Being infected with Covid-19 is not an offence, hence it should not carry any social or moral stigma.
The current measures with threat of compulsory lockdowns, quarantine, isolation from loved ones, and barbed wire with armed personnel in areas under enhanced movement control order cast a negative image of the disease and its sufferers.
Such measures drive patients and those who may have asymptomatic disease to go into hiding, which then makes accurate reporting and contact tracing even more difficult.
DR STEVEN K. W. CHOW
Federation of Private Medical Practitioners’ Associations Malaysia
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