MALAYSIA has seen a surge in Covid-19 cases in the past three months after reporting zero local cases only in July because of the lack of proper adherence to standard operating procedure (SOP), said medical experts.

The Health Ministry and medical practitioners are overwhelmed by the number of cases after the massive Sabah outbreak, putting the whole medical ecosystem under duress, they said.

When the system cannot cope with the number of cases, the contact-tracing process is not done thoroughly and this leads to new clusters being formed everywhere across the nation.

Former deputy health minister Dr Lee Boon Chye told The Malaysian Insight when the numbers increase, there is a lack of adherence to the SOP among Malaysians, which makes it hard to curb or even reduce the number of cases.

“If you trace back what has happened, it is the failure to contain the epidemic in Sabah after the elections in September (that caused the spike). The virus spread to the whole state and then to Peninsular Malaysia.

Failure by authorities

“There was (also) failure in dealing with prisons and foreign workers.

“If prisons and detention centres had followed the SOP, they would not be seeing such a high increase in the number of cases,” Lee said.

The Gopeng lawmaker added if the SOP were adhered to, especially by authorities like the Prisons Department and the Immigration Department, the number of cases would have been easily reduced.

“Even if there is an outbreak, it will be controlled. In prison, there is supposed to be a (confined) sort of environment and even when there are activities, they are supervised. Prisons failed to adhere to the SOP,” Lee said.

After reaching zero local cases in July, the number of Covid-19 cases saw a spike in September, which the government said was due to the increase in the number of undocumented migrants entering the country.

The number skyrocketed after the Sabah elections at the end of September and many Malaysians blamed politicians who travelled to and from Sabah.

The Covid-19 infections have steadily increased in the past three months and experts predict it will reach the 100,000 mark in the next few days.

Yesterday alone, 2,062 new infections were reported, bringing the total number of cases to 97,389. The total number of fatalities is 439.

With the number of cases increasing daily, Lee said the healthcare system, as well as medical practitioners, cannot cope with the numbers and are struggling.

“The healthcare system is under a tremendous amount of strain. Government hospitals, the practitioners and staff are overstretched.

“Initially, they could handle the first and second waves, and then there were an endless number of waves, which put the system in peril,” he said.

The PKR lawmaker said when the system is overstretched, there needs to be more people roped in to deal with the pandemic, to do contact tracing, for example. The process is not as efficient as it was earlier (before the third wave).

“We need to have the capacity to do contact tracing efficiently. We have to identify people within 48 hours for those who come into contact with a positive case. That is when the risk of spread can be controlled.

“Now, we are getting new clusters every day. That means some cases happened before and they could not trace the point of origin. They are listed as new clusters,” Dr Lee said.

Low health literacy

Healthcare watchdog Galen Centre CEO Azrul Mohd Khalib said the SOP is not followed thoroughly by all Malaysians as the health literacy levels in the country are low.

“We need to maintain high levels of compliance with SOP, even with the deployment of vaccines in the future. 

“However, the fundamental problem is that our health literacy levels are low, which was highlighted in the recent national health and morbidity survey,” Azrul told The Malaysian Insight.

The report found that one in three Malaysian adults has a low ability to find, understand and use health information and services for decision-making.

Azrul said because of this, even though the government imposes hefty punishments on those who flout the SOP, Malaysians still continue to do it.

“Regardless of whatever restrictions are imposed, or threats of penalties are bandied about by the government, people are less likely to adhere to the SOP when they are among family members, friends and even office colleagues,” he said.

Malaysian Medical Association (MMA) president Dr Subramaniam Muniandy, said there is a steady spike in cases as the government is more vigorous in screening foreign workers.

“What is happening is, we are screening more than before. It is compulsory to screen foreign workers to make sure they are virus free.

“There are a lot of foreign workers scattered all over, it is not like Singapore where they stay in dorms. So, it’s a big task to find and test them,” he said.

Nationwide contact tracing

Moving forward, the experts believe Malaysia needs to put more emphasis on contact tracing and increasing allocations to the Health Ministry, which will help hospitals and medical practitioners cope with the pandemic.

“Our health services performed tremendously well and acted to the (best) of their abilities and capacity, but it is going to be extremely hard to retain low numbers without causing tremendous and long-lasting harm to the economy,” said Azrul.

Lee said Putrajaya should “pump in more resources” to the health sector and take contact tracing nationwide instead of leaving it with the ministry alone.

“The government should focus on increasing the capacity for contact tracing. They should employ more personnel to do that.

“They should also involve other government agencies, civil society groups and the community as the Health Ministry is overworked. It should be the whole nation (participating in) contact tracing,” he said.

To achieve this, Putrajaya needs to spend money on healthcare education which Azrul said is vital to gain an advantage in the war against the virus.

“The government must continue to invest in health messages and communications, which have been consistent and successful in changing behaviours.

“Ensure that people understand, cooperate and more importantly, support the efforts being done. It takes time, but it must be done. There are no short cuts.” – December 23, 2020.