Urgent lockdown needed for Sarawak General Hospital 


SARAWAK General Hospital (SGH) needs a lockdown to control the spread of Covid 19 among healthcare workers (HCW).

There have been 51 HCW in SGH diagnosed with Covid-19 as of April 21. 

The first few HCW  to test positive were exposed to the first Covid-19 victim who died in SGH at the end of March.  

During the time of admission, the patient had been admitted for having “pneumonia” despite the classic presentation of high fever and cough. He was admitted to the medical ward and intubated by the anaesthetic team at midnight without personal protective equipment (PPE), as they were told he was “low risk“ for Covid 19. 

When the swab result came back at 6am, the anaesthetic team had already gone for rounds to other wards and ICU to carry on their work. There was a lockdown of the ward, and all personnel involved were triaged. The close contacts were swabbed on day 1 and 13, and all put under quarantine.

All swabs came back negative on Day 1. On Day 13, swabs were taken and the instruction given by the infectious disease team was to allow them back to work with masks on Day 14.  In the afternoon of the same day, the results came back and one quarter of those tested were positive – at least two were doctors. They had already resumed their daily rounds, and had meals in the pantry with their colleagues with no masks on. 

That was when havoc started. They had already exposed the anaesthetic and medical department staff.

The anaesthetic team who had contact with the doctor who tested positive was then triaged to red, green and yellow – depending on their point of contact with the positive doctor. Almost 50 staff had to be contact traced and triaged.  

Had they just waited until the second swab results returned, they could have avoided this cascade.

However, there was a discrepancy in the triaging. On the day of the incident, some were triaged green, but when they showed up to be tested in the centre a few days later, they were tagged red and told to undergo home quarantine immediately. 

There is still a discrepancy in the triaging system in place. No doubt this pandemic has put us in an unprecedented situation, but certain logic has to be in place. 

The current practice for HCW screening is “catch and release”. Those who are not triaged red will be tested and then sent off back to work and advised to keep their mask on at all times.

Here lies the discrepancy in testing. 

There are two main divisions of the Sarawak Health Department. “Perubatan” is in charge of hospitals, and “kesihatan” is in charge of the district health clinics.

The protocol for the kesihatan side is, if a case is suspected positive, they will be tested and put to home quarantine until all swabs come back negative. Contact tracing is done vigorously and contacts are tested. Some health clinics had to be closed temporarily until all staff were tested, because they treated a Covid-19 positive patient.

However, for HCW under “perubatan”, unless they are red coded they are not told to undergo quarantine. They are allowed back to work even before the first swab result is back (usually 36-48 hours). This caused a few asymptomatic HCW who were eventually tested positive, but returned to work before the results were out, causing potential spread of infection to others.

There was no talk of any lockdown or partial lockdown of the hospital. In all other states in Malaysia, there are other hospitals that can be mobilised in case another is shut down. Unfortunately, in this vast and economically rich state, SGH stands as a lone ranger to cover the district of Kuching. The cardiac hospital – Pusat Jantung Hospital Umum Sarawak( PJHUS) – and smaller district hospitals, which cannot cope, are back ups in case SGH is closed. The 300-bed Petrajaya Hospital, which was supposed to be ready a few years ago, stands unfinished. 

In any other location , if there are more than 40 cases, enhanced MCO is required, with barbed wire and soldier controlling the movement within the area. But with 50 cases and rising here, none of the above is carried out.

Many HCW from medical, anaesthesia, peadiatrics, obstectrics , emergency department and orthopedics have now tested positive. Unless some strict, clear and logical protocol is put into place, this will just spiral out of control. 

For one Covid-19 positive doctor, 50 people have to be contact traced and potentially tested.  If that one doctor was put in quarantine at least until test results are back, there will be less of a risk to the patients and other HCWs.  

I hope some measures will be taken urgently to control the spread of Covid-19 because healthcare workers’ lives do matter. – April 29, 2020. 

* A Concerned Citizen reads The Malaysian Insight.

* This is the opinion of the writer or publication and does not necessarily represent the views of The Malaysian Insight.


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Comments


  • Get rid of the State Health Minister and put the DG of MOH in charge instead!

    Posted 5 months ago by Malaysian First · Reply

  • That's why it is better to be over cautious than under cautious. It should be a lesson for the infection control team and infectious disease experts in SGH. AS ALWAYS SAID THERE IS NO URGENCY IN PANDEMIC.... ALWAYS WEAR PPE BEFORE ATTEND TO PATIENTS. Important to take care of HCW.

    Posted 5 months ago by Fellow Sarawakian · Reply

  • Well, yet nurses are asked to return to work if the pcr returns negative until symptoms appear? How is that protecting the other patients? And hcp?

    Posted 5 months ago by Bridget Wong · Reply

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    The current clinical evidence (although not yet represented in the literature), the theoretical bases of LUS in the aerated lung, and LUS findings of similar aspects in other diseases (ARDS and flu virus pneumonia) strongly suggest the potential diagnostic accuracy of LUS, which may be useful in the following situations:

    Triage (pneumonia/nonpneumonia) of symptomatic patients at home as well as in the prehospital phase.
    Diagnostic suspicion and awareness in the emergency department setting.
    Prognostic stratification and monitoring of patients with pneumonia on the basis of the extension of specific patterns and their evolution toward the consolidation phase in the emergency department setting.
    Treatment of intensive care unit patients with regard to ventilation and weaning.
    Monitoring the effect of therapeutic measures (antiviral or others).
    Reducing the number of health care professionals exposed during patient stratification (a single clinician would be necessary to perform an objective medical examination and imaging investigation directly at the patients bed).

    Source: https://onlinelibrary.wiley.com/doi/10.1002/jum.15284

    Posted 5 months ago by Jimmy Lim · Reply

  • To the writer who is definitely from SGH I would like to dedicate this song to you, Don't Cry for me Argentina.

    Posted 5 months ago by Teruna Kelana · Reply

  • As a retired pediatrician and public health specialist with 23 yrs service in the Sarawak Health Dept, I totally empathize with the HCW's complaints in the media - but am saddened by the calls for lockdown of Sarawak General Hospital (SGH).
    I am proud of my colleagues in the hospital and government clinics who continue to provide good standard of care despite the terrible personal vulnerability and sacrifices.
    It is a scary time to be a HCW/doctor.. I wish patients would tell us the exposure and travel history, the severity or duration of illness, so we can adequately protect ourselves.
    Most patients are so desperate to be seen (and not referred to the government clinics) that they just omit to tell the whole truth, which is how some HCW got infected.
    Thanks to the covid unit staff - of the ?50 drs in SGH who got infected over the last 5-6wks , none have died.. early test n diagnosis, close monitoring n treatment and rest is key.
    I am grateful my asthma and pneumonia patients can still go to SGH because private hospitals are reluctant to admit them. I am grateful mums can still deliver safely there, even mums with covid. likewise accident cases etc.
    Even in developed countries health services have been paralysed by HCW becoming exposed n needing quarantine. Who will be left to care for the other sick patients besides covid?
    Recruiting medical students and fresh new graduates into the frontline of this war zone is a desperate last resort in some countries - but creates ethical and moral issues for managers and consultants.
    It is like appointing people who have just learnt to swim to serve as lifeguards..
    I am thankful and confident, in SGH in particular and in Malaysia in general, that in the not so unlikely event that one of us gets infected, my HCW n doctor colleagues will be ready and able to put up a really good fight, and WIN!
    Malaysia can stand tall , not just because our D.G. "rocks" , but also because our Doctors have been well trained for such a time as this!!!

    Posted 5 months ago by Poh Tin Tan · Reply