Saturday, December 4

Dear KJ, we need a pandemic response reset

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This is an open letter to the new health minister, YB Khairy Jamaluddin.

I am writing this for Merdeka Day and Malaysia Day. These two pivotal events in the history of our nation speak of change – a breath of fresh air, our people coming together for the collective good of the nation and leaving the past behind.

I say this to speak about the need for change in our response to the Covid-19 pandemic. In a recent ‘Covid Resilience Ranking’, Bloomberg rated Malaysia as the worst place to be, out of 53 nations, to reopen the economy in the face of the Delta variant.

You have rightly said that taking the job of the health minister is a “very heavy responsibility”. In this pandemic it is one of the most important roles that an elected representative of the people can hold and execute. As such I wish you foresight, courage and endurance for the task ahead.

Allow me to share with you some perspectives on this pandemic that may be useful to your thinking.

Three Areas to Remove or Repair:

1. Repair the trust deficit.

The public has an enormous trust deficit in the government. This can only be overcome with transparent leadership focused on the people’s needs, not those of the leaders. Transparency builds trust.

2. Reduce the burdens on the people.

We have an enormous number of standard operating policies (SOPs). No one is sure of the full number but they exceed 100 and are probably the highest in the world; which is not an honour. Removing the majority and simplifying the essential to a few science and evidence-based lifestyle changes would empower the community. Routine temperature checks at all premises are of little value, maybe harmful (increasing individual contacts) and should be stopped.

3. Truth-telling needs to return to the government and civil service.

We need to stop the denial of the Covid-19 reality. Everything is not OK and is not getting better soon. True, reality based data sharing of the situation with the rakyat at national level and by state health departments is vital. This will require decentralised decision making and empowering of state-level disaster management teams to act rapidly to deal with local situations and communicate openly with the public.

Three Principles for the Pandemic at its Current Stage (Key Covid-19 messages):

1. You can never prepare enough for Delta.

We need to over prepare and then prepare some more. Whatever we do, Delta will cause enormous pain and damage in the next eight weeks, especially outside the Klang Valley. We expect the case numbers and death toll to rise in the coming weeks. The health services in many states are already overrun and in crisis.

2. Don’t put all your eggs in the vaccine basket.

We need to use every tool we have and not just rely on vaccinations to fix the problem. Use of testing and contact tracing has been extremely weak and underutilised. Moving to RTK-Ag testing of all contacts will dramatically help to contain the pandemic.

3. We are in this together.

This is not a problem just for the government to handle as it affects every single person in Malaysia (including migrant workers). We need a coordinated all-of-society approach. Please work with all the civil society organisations (NGOs), the private health sector, wealthy corporate businesses and the average Malaysian.

Three Realities about Dealing with Covid in the Face of Delta:

It is very likely that all of us will be exposed or infected by Covid-19 at some time. Hence our aim should be to:

1. Reduce the viral load when exposed.

This can be achieved by good mask use (good filtration and fit), adding a face shield and limiting our risks and exposure to others.

2. Reduce severity if infected.

Vaccination is a useful tool and currently our crisis is in six states outside of the Klang Valley that are being overrun due to low vaccination rates (Sabah, Kedah, Perak, Johor, Pulau Pinang and Kelantan). Identifying those infected early and offering them close monitoring (routine finger pulse oximetry) is critical to reduce those brought in dead. We need to actively encourage everyone to maintain their fitness levels and avoid being overweight.

3. Reduce community spread to reduce risk.

The value of contact tracing and testing cannot be overstated. Availability of home testing kits is a useful measure for offices and schools; but we require cheaper RTK-Ag tests. In addition, we need good and widespread genome testing to identify new, dangerous variants of concern.

There is one other area that is so neglected that I have chosen to mention it as an individual item: Ventilation, Ventilation, Ventilation.

We have failed to improve the indoor safety of all buildings – schools, offices, business, food shops, etc. We require measures to increase the existing ventilation rates (air exchange) and eliminate any air-recirculation within the ventilation system of the room or building. This must be put in place urgently and be done without burdening the premise owners.

I have chosen not to offer many details here as some of us have written many documents and suggestions on dealing with the pandemic. Further information for many of the ideas expressed here are available in the ‘Health Emergency Action Plan: Roadmap to Recovery from Covid-19’ we wrote in July 2021 (downloadable link: https://bit.ly/3hTVnHb).

I appeal to you at this time to look outside the Klang valley and offer support to Sabah, Kedah, Perak, Johor, Pulau Pinang and Kelantan as our situation is desperate no matter what the health departments may say. Our support is limited and we need crisis intervention. Please support ALL these states with a surge in vaccine supply and equipment needs.

Listening is a lost ability of governments, and Malaysia is no different. Our government has become hard of hearing the cries of the people. This coupled with a chronic dysfunctional civil service, that always wants to portray that they are doing well, has damaged our health response. Leadership has been limited and this has further impaired decisive action.

All of Malaysia pray for you and want you to succeed so that we can move out of the crisis stage of this pandemic. You are not alone.

Dato’ Dr Amar-Singh HSS

Consultant Paediatrician