MORE than a year since the Covid-19 pandemic reached our shores, Sungai Buloh Hospital’s infectious diseases consultant Dr Suresh Kumar Chidambaram said there is still a lot to learn about the virus and the most effective ways to treat it.

While it was challenging to treat the disease initially, as there was no text book to refer to, Suresh said Malaysia has come a long way and learned fast, improvised fast and did what needed to be done to keep the pandemic under control.

“Initially, it was challenging because it was a new disease and we didn’t know much about it. By then we already knew what was happening in Italy and the dramatic responses China had to (take) to control the virus. So, we knew bits and pieces and so that helped us prepare.

“In the initial days we used to do video conferencing with the Chinese colleagues, they came over here and we had discussions with the clinicians there. The data sharing was very good. All the latest papers were immediately released and we could get information from there.

“We collected all this information and, within the country, all the treating physicians came together and we would have weekly video conferencing. Together, we came (up) with treatment guidelines,” he said.

While there is now a treatment guideline for how to care for Covid-19 patients, Suresh said they are still certain aspects of the virus they are still learning about and trying to understand better.

“We know who gets severe disease, we are very clear on that. The older you are, you are more likely to get severe disease. If you have other medical conditions like diabetes, you’ll get severe disease.

“We also know that anti-inflammatory treatment is very important. Steroids are very important for this particular disease.  But we still have patients who, despite all these treatments, their lungs continue to get damaged, and that we’re still not sure what to do.

“There’s still a lot more that we need to learn because we still can’t decrease the morbidity of this disease in the older age group,” he said.

Although steroids such as dexamethasone have been effective in treating Covid-19 patients, Suresh said there is still a 20-25% chance of those in higher risk groups catching the virus again as there is still no drug available that can kill off the virus.

“We’re unable to prevent it. One of the reasons is because we don’t have an effective drug that can kill the drug from day one. (We don’t have) an antiviral drug.”

“I don’t have a drug now where I can give the person to make sure he doesn’t get a severe disease. I manage the person when he gets a severe disease. So that is still challenging.

“We can decrease the damage Covid-19 does, especially to someone’s lungs, but I can’t prevent it completely,” he said.

The government designated Sungai Buloh Hospital as the main Covid-19 hospital in March last year. Though the hospital was equipped to treat infectious diseases from its experience in treating HIV, tuberculosis and, most recently Ebola, Suresh said it was not prepared for the scale of the pandemic.

Sungai Buloh hospital, which has 700 beds, had to convert all its halls and its nurses’ hostel into wards at the peak of the pandemic to accommodate up to 2,000 patients.

“We are prepared for outbreaks and we have a ward that is ready as a first response (ward). We didn’t expect the scale to be so big and it was challenging because we are a busy hospital for general medicine and surgery. We are also a trauma centre.

We had to, by stages, close them (the centres) and transfer patients to hospitals in the Klang Valley to empty the beds, in the initial stages.”

Overwhelmed as it was, Suresh said the hospital responded well to being made the main Covid-19 centre.

“The hospital responded very well and it was a one hospital approach. The whole hospital came under the hospital director and we didn’t have multiple departments. All the medical officers moved in and all the specialists chipped in.

“It was nice to see the hospital coming together. We are normally different departments and hardly meet other departments, but the hospital came together,” he said.

Categorising Covid-19

In order to effectively treat Covid-19 patients, Suresh said the hospital needed to come up with a guideline, and this was done by collaborating with their counterparts in China and locally with other doctors who were working with Covid-19 patients.

“Together, we came with treatment guidelines. There was no text book to go too. You have to decide how to classify the disease, mild, moderate or severe. (You have) to decide how to treat (each one). We had to come up with the classification, then we had to come up with treatment,” he said.

Over time, Suresh said the whole world currently has a fairly agreed upon treatment guideline and they all treat quite similarly.

“Of course, in the initial days we didn’t have (a guideline) and it evolved over time.”

The hospital also started collecting data from its own patients, the first 6,368 patients, on whom it had detailed data. That data also helped to determine how to treat them and who is the high-risk group.

The data showed that of the 6,368 patients, 3,162 showed no symptoms and recovered quickly. Of the remaining 3,206 patients, 2,827 developed mild to moderate disease and recovered, but 379 required further treatment.

Of the 379, 143 developed severe disease before recovering while the other 236 patients needed critical care. 155 patients received further treatment from the ICU before being discharged and 81 patients died.

In Malaysia, Covid patients are separated into five categories, ranging from mild to severe symptoms.

“Category 1 is someone with no symptoms and is perfectly normal. Category 2 is mild, (may have) alteration in taste or smell, bit feverish and cough, that’s all. We do a chest x-ray and it’s normal.

“Category 3 is similar (to Category 2), but the chest x-ray will show pneumonia. They don’t need any oxygen and they can walk about. They have no problems.

“Category four is somebody who requires oxygen, meaning the lung is a bit damaged and Category 5 is the one that enters ICU (intensive care unit).”

Suresh said most treatment for Covid-19 patients start at Categories 4 and 5 who make up 15-20% of the caseload, while 85% of them get better without needing any treatment at all.

Not alone in the fight

As healthcare workers, Suresh said they are trained to treat sick people irrespective of infectiousness as that is their ethos. However, that does not alleviate the fear that comes from treating a virus such as Covid-19.

“The ethos as a health care worker helps, you know you’re supposed to do these things, treat sick people irrespective of the infectiousness. As human beings there is fear in the back of the mind, and the way to overcome fear is to train and train.

“That’s what we did, train them again and again. We did simulations and in the initial days there was always someone looking over your shoulder to see if you’re doing it correctly.

“We showed that working in the hospital is quite a safe place,” Suresh said.

The fear of catching the virus, however, was incomparable to unknowingly passing it on to a loved one. 

“One fear is that we will get Covid-19 and fall sick. The second fear, especially for the younger healthcare workers, was that they will unknowingly spread the disease to other people, their older family members. That second fear was quite a disabling fear.”

Although the hospital adhered to strict standard operating procedure in treating patients, it was once again caught off guard at the number of personal protective equipment (PPE) it will need to keep everyone safe.

“We were caught off guard and we had a lot of people sewing PPE, our own staff (even). (there were lots of donations from) nurses, doctors, physiotherapists, and well-wishers. It was a stressful few months, we had a lot of patients but not enough PPEs.”

The various contributions from the public in the form of PPE and food, Suresh said, helped them alleviate the fear that came from treating Covid-19 patients as it showed that they were not alone in the fight.

“… that decreased the fear that we were all going through,” he said.

In November last year, the Covid-19 team at Sungai Buloh Hospital was at the Global Health Awards (GLA) 2020 for its unwavering efforts to fight the pandemic.

The regional Asia-Pacific awards aim to recognise companies in a variety of regional and global markets that have maintained consistently high standards in delivering quality care and pushed the boundaries of delighting their customers at every stage and in every interaction.

As of April 5, Malaysia reported 1,070 new Covid-19 infections in the past 24 hours, the lowest number of daily cases in a week. The country’s total caseload currently stands at 352,029 with 1,295 deaths. – April 6, 2021.