LETTER | An open letter to Prime Minister Muhyiddin Yassin

LETTER | We the undersigned view with much apprehension and concern the current status of the Covid-19 outbreak in the country.

Our national metrics paint a very bleak picture of Covid-19 pandemic management. Despite movement control orders (MCOs) and other health interventions, the daily reported cases are not decreasing.

The Cumulative Incidence Density (per 100,000 population) and the Infection Rate (active cases per 1,000 population) is not flattening, with the latest national Infection Rate registered at 0.879 per 1,000 population, meaning between eight and nine persons are actively infected for every 10,000 people.

The testing positive rate (rolling seven-day average) is rising, registering 8.9 percent on Jan 3, 2021, well above the World Health Organization's (WHO) 5.0 percent benchmark of effective pandemic control and containment.

Kindly allow us to propose 10 urgent and critical actions lest Malaysia slips into Covid-19 intensive care.

1. To ramp up testing with triaged, mass and frequent testing regimen, utilising inexpensive rapid testing kits (RTK-Ag), instead of PCR, to help to slow the transmission of Covid-19.

2. Early RTK-Ag diagnosis of cases within 24 hours would enable rapid isolation of cases and facilitate prompt contact tracing.

3. Automating contact tracing with digital apps would hasten the tracking process while leveraging data science and machine learning can identify the hotspots in the nation for targeted screening. Only this Find-Test-Trace-Isolate (FTTI) rapid response will bust the Covid-19 clusters and mitigate the sporadic spread of the coronavirus.

4. In anticipation of the increasing Covid-19 cases and to protect the healthcare capacity, we advocate that clinical stage One and Two cases be isolated at home with clear guidelines from the Ministry of Health. Their wellbeing can be tracked daily with digital apps, supported by empowering the local community and urgent transfers to Covid-19 hospitals organised for cases that deteriorate.

5. We must protect the excellent work of our medical professionals in the Covid-19 hospitals by decanting all non-Covid-19 cases to non-Covid-19 government and private hospitals. This will allow them to focus on the sickest cases and not be distracted by asymptomatic and mild Covid cases, thus ensuring the best outcomes.

6. Support industries, the engine of our economic growth, with creative measures to mitigate the 3Cs. The POIS initiative (Preventing and early detection of Outbreaks at Ignition Sites) is a tripartite government, private sector and NGO partnership which emphasises early detection testing regime, enhances public health measures and health education of industry and migrant workers. This POIS initiative developed in consultation with industry and WHO can be replicated elsewhere as a public health operational tool, truly embracing a whole-of-government and whole-of-society approach.

7. Similar initiatives must be developed for the other hotspots of Covid-19 outbreaks, namely the prison and detention centres.

8. Expedite the regulatory processes so that immunisation can begin as soon as the first doses of vaccines arrive at the airport. Debunking Covid-19 and vaccine disinformation would empower our rakyat with informed consent when the Covid-19 vaccines arrive. Apart from prioritising the high-risk groups, seriously consider vaccinating migrant workers to protect our industries and the refugee community who are silent epicentres of Covid-19 outbreaks. The cost of the vaccines must be capped at less than RM100 per dose for those getting their shots privately and, by extension, the rapid test kits must be capped at less than RM100 per test to ensure more affordable and wider coverage and uptake of both vaccines and rapid testing.

9. A Covid-19 Task Force comprising a cross-sectoral and empowered team of subject matter experts must be immediately formed to provide evidence-based advice on a harmonised whole-of-government response across ministries and agencies. The Covid-19 Task Force will help steer the nation out of this pandemic by regularly presenting its recommendations and audit of the health economic impact of key decisions to the cabinet. To ensure independence of the Covid-19 Task Force, the Malaysian Medical Association, Academy of Medicine Malaysia, Malaysian Public Health Physicians’ Association and Association of Private Hospitals Malaysia are best positioned to select the members.

10. Do not politicise the pandemic but instead secure a bipartisan consensus and approach to flatten the pandemic curve, accelerate efforts to achieve herd immunity as a form of community protection to co-exist with the coronavirus. The GE15 in the midst of an uncontained pandemic is an unmitigated disaster waiting to happen as the Sabah state election has exemplified.

This is the back-to-basics public health management of a pandemic which we trust the prime minister will consider urgently and seriously to mitigate the devastating consequences of the pandemic, protect the lives and livelihoods of our rakyat and to reset our economic recovery.

This open letter is endorsed by the following individuals in alphabetical order:

1. Dr Abu Bakar Suleiman (former director-general of health).

2. Prof Dr Abdul Rashid Abdul Rahman (secretary-general, Federation of Islamic Medical Associations).

3. Prof Dr Adeeba Kamarulzaman (professor of Medicine, Universiti Malaya).

4. Prof Dr Ahmad Hata Rasit (deputy vice-chancellor and consultant orthopaedic surgeon, Universiti Malaysia Sarawak).

5. Dr Ahmad Munawar Helmi bin Salim (immediate past chairperson, Islamic Medical Association Response & Relief Team).

6. Dr Azhar Abdul Aziz (consultant emergency physician).

7. Dr Amar-Singh HSS (consultant paediatrician).

8. Prof Dr Azizi Haji Omar (past president Malaysian Paediatric Association).

9. Dr Christopher Lee (former deputy director-general of health (research & technical support).

10. Dr Dhesi Baha Raja (consultant public health physician & chief medical & innovation officer of Ainqa Health).

11. Dr Gunasegaran PT Rajan (past president, Obstetrical & Gynaecological Society of Malaysia).

12. Dr Hung Liang Choo (president, Malaysian Paediatric Association).

13. Dr Jahizah Hassan (president, College of Anaesthesiologists).

14. Dr Jeffrey Abu Hassan (immediate past president, Islamic Medical Association Malaysia).

15. Dr Johari Bux (past president, Obstetrical and Gynaecological Society of Malaysia).

16. Emeritus Prof Jomo Kwame Sundaram (former United Nations assistant secretary-general).

17. Dr Khor Swee Kheng (independent consultant, health systems and policies, consultant in health policies, and Malaysian Health Coalition).

18. Dr Kuljit (president, Association of Private Hospitals Malaysia).

19. Dr Lim Teck Onn (former director, clinical research centre MOH).

20. Prof Dr Lokman Hakim Sulaiman (pro-vice-chancellor (research) International

Medical University and former deputy director-general of health).

21. Dr Mary Suma Cardosa (past president, Malaysian Medical Association).

22. Dr Milton Lum (past president, MMA and Federation of Private Medical Practitioners Association Malaysia).

23. Asst Prof Dr Mohammad Farhan Rusli (consultant public health physician, International Islamic Universiti Malaysia).

24. Prof Dr Mohamed Hatta Shaharom (president, Malaysian Society of Psychospiritual Therapy).

25. Dr Mohammad Iqbal Sarwar (consultant paediatrician, KPJ Damansara Specialist Hospital).

26. Dr Mohamed Namazie Ibrahim (past president, Malaysian Medical Association).

27. Dr Muhamad Yusri Musa (president, Islamic Medical Association Malaysia).

28. Dr Musa Mohd Nordin (chairperson, advisory council, Federation of Islamic Medical Associations).

29 Dr Narimah Awin (former director of Family Health Development).

30. Prof Dr Norlisah Mohd Ramli (president, College of Radiology of Malaysia).

31. Associate Prof Dr Pang Yong Kek (respiratory consultant, Universiti Malaya Medical Centre).

32. Prof Dr Roslina Abdul Manap (scribe, Academy of Medicine of Malaysia).

33. Prof Dr Rosmawati Mohamed (master, Academy of Medicine of Malaysia).

34. Dr Sevellaraja Supermaniam (past president, Asia Pacific Association of Gynaecological Endoscopy and OGSM).

35. Shariah Asiah (president, Malaysian Nursing Association).

36. Dr Sivamohan Namasivayam (board member, Association of Private Hospitals Malaysia).

37. Dr Steven Chow (president, Federation of Private Medical Practitioners Association Malaysia).

38. Prof Dr Subramaniam Muniandy (president, Malaysian Medical Association).

39. Dr Tang Boon Nee (past president, Obstetrical and Gynaecological Society Malaysia).

40. Dr Teoh Siang Chin (past president, Malaysian Medical Association, former Melaka state health director).

41. Prof Dr Wan Ariffin Abdullah (past president, Malaysian Paediatric Association).

42. Dr Yap Wei Aun (consultant public health physician).

43. Dr Yolanda Augustin (oncologist and healthcare activist, St George’s University of London).

44. Dr Zainal Ariffin Omar (president, Malaysian Public Health Physicians’Association).

45 Dr Zainudin Md Zin (chairperson Lung Foundation of Malaysia, past president of College of Physicians Malaysia).

46. Dr Zulkifli Ismail (secretary-general, Asia Pacific Pediatric Association).