MY previous article “100 Malaysians dead in 3 days” was published on May 15. In the three days since, 125 more Malaysians have died from Covid-19, a record 45 on May 17 alone.

Code blue is the medical term to announce a dire in-hospital emergency when the patient has suffered a cardio-respiratory arrest and cannot be moved. All hospitals have highly trained code blue teams, who most importantly, drop everything they are doing to focus only on resuscitating the collapsed patient.

CPR – cardio-pulmonary resuscitation, a term made ubiquitous by the medical dramas on Hollywood screens! I must warn you that it is not all that glamorous though. CPR for witnessed cardiac arrests in hospital conducted by trained personnel, has a success rate of close to 40%. From these only less than 20% are discharged home alive. Bystander CPR conducted by either trained people or good Samaritans, outside the hospital premises, has a success rate of only around 15%. Less than 10% of these individuals are discharged from hospital even if they reach there alive in the first place. CPR, without doubt though, offers hope and certainly a decent chance of survival.

DNR – short for “do not resuscitate”. It has no legal standing but is respected by doctors as the patient’s and his/her family’s request to die with dignity. Medical education is obsessed with saving lives. But the real world teaches you that death is the only constant in Life and it deserves empathy, compassion and grace. I lost my father in 2006 when he was 78. God Bless his soul. Today he would be 93 and if he had a Code Blue from an illness that had a dismal prognosis and any further treatment was deemed futile, I would unhesitatingly tell his caregivers to DNR. Of course after discussing with my siblings and extended family.

The discerning reader will already know where this article is heading.

Malaysia’s medical infrastructure is being bombarded daily by a devastating number of Covid patients. We have reached a stage where, I think, the most relevant numbers are ICU beds available, ICU occupancy and ICU mortality. Currently we have around 1,100 dedicated Covid ICU beds nationwide, both the public and private sector combined. 850 of these are in the public sector. Occupancy is 90-100%. And though the overall mortality for Covid in Malaysia hovers around 0.4%, a whopping 30- 35% of category 5 Covid patients on ventilator support in the ICU die! The average length of stay in the ICU is 7 to 14 days. Sobering indeed. We have already reached the stage where our military has set up a Field ICU in Penang. Extremely commendable on the one hand but certainly a stark reminder of the strain on the system on the other. A major hospital in Selangor has already acquired a refrigerated shipping container to store the dead. Harsh realities of the pandemic. Harsh realities of too little too late. And certainly the indubitable consequence of having underestimated this virus.

Agonising images of abject poverty and gory drone videos of mass cremations portray India as hell on earth. But objectively, in that hell there are two heavenly consolations. 1) India is the largest manufacturer of Covid vaccines in the world. 2) India is the largest manufacturer of generic drugs in the world! Two nuclear options in this war against Covid 19. With these, from the flickering embers of despair and destruction will rise the clean white smoke of hope, optimism and recovery. In comparison, Malaysia’s drug manufacturing prowess is a pale shadow of our neighbour’s. And we only “fill and finish” the Sinovac vaccine. According to a New Straits Times article dated July 14, 2020, the only vaccines actually manufactured in Malaysia are for…animals! Good for you RhimJhim!

So much has been said and written globally about medical infrastructure, oxygen, vaccines, lockdowns, and moratoriums that people forget about the men and women working the hardest in this pandemic. These nurses, allied medical support workers and doctors have names, families. Most importantly, like you and me, they have feelings. Has the man on the street tried being in full PPE for more than an hour? These heroes don them for a minimum of eight hours at a stretch, sometimes double that. In the most adverse conditions, they work hard to snatch victory from the jaws of defeat. But it is becoming increasingly difficult. Just the sheer volume of patients is overwhelming. Soon they will not be able to cope. They will break down and cry. There are only so many dead bodies you can see. Forty-five in a day is way past their limit. 

Ever so often, adversity has brought out the in us Malaysians. We can and should help all our front-liners. And believe me, it is stunningly simple to do. Just do nothing! Yes, that’s right. Do nothing and stay at home. Let the professionals do their work.

With new cases logging in at just below 5,000 each day, Malaysia is gasping. Soon, the authorities tell us, it will be 8,000 to 10,000 cases a day. The time for lethargy and pussyfooting is over. Allow the situation to deteriorate any further and we will be have a code blue in our hands. In medical parlance, this means we need 30 drastic chest compressing decisions and two rescue breaths – immediately if we are to have even the slightest chance of resuscitating our motherland. DNR is not an option. God forbid, if it indeed becomes futile, spare a thought for our ICU doctors and nurses. Somebody has to switch off the ventilator.

One of the most haunting images in medicine is that of a patient who had just died in the ICU. A green flat line and an awful, high-pitched sound on the cardiac monitor and the ventilator still pumping. Two machines begging each other to not give up. After 35 years as a doctor, I have seen this more times than I would like. But it has thankfully not robbed me of my humanity or intelligence. Every single time it happens I still get that lump in my throat and my eyes become moist. And through the barrage of emotions I wonder, could and should anything had been done better? I need to learn. When it comes to human lives there is no question of repeating a mistake.

God bless Malaysia. – May 19, 2021.

Dr Venugopal Balchand reads The Malaysian Insight.