LETTER | Brigadier General Dr Mohd Arshil Moideen, who is the management chief of the Malaysian Armed Forces Health Service Division, stated recently that "In a war, like the war on Covid-19, we need a single standardised strategy line of command that everyone can abide by."
Make no mistake. We are in a war against Covid-19, and we are clearly on the losing side - ICUs full, shortage of staff and oxygen, and a high number of daily deaths.
It is appalling that it has been almost 18 months since the first case of Covid-19 was detected in Malaysia, and we still don’t have a “single standardised strategy line”.
Other nations may experience similar surges due to new variants, however, they are not in the dire condition as seen in videos and photos of overflowing hospitals around Klang Valley circulating in social media. Some nations are even returning to pre-Covid-19 days as seen in the ongoing European football championships. They have a clear strategy. Malaysia doesn’t.
Eighteen months in, and we are still changing our standard operating procedures for food delivery from 8pm to 10pm as if the virus abide by our 8pm curfew.
Malaysia’s plan and hope on “lockdown” to bring down the cases have backfired as can be seen in terms of economics, social protection and mental health as cases are continuing to rise despite being on lockdown for almost the entire year.
Our strategy is not up to date with the latest guidelines and research studies. There are not enough studies that support the idea of “lockdown” bringing cases down without other Public Health Surveillance Measures (PHSM) being implemented. Even the World Health Organization (WHO) guidelines do not recommend “lockdowns”.
Maria Van Kerkhove, an Infectious Disease Epidemiologist and the Covid-19 Technical Lead at WHO, tweeted: “Use of PHSM does not mean ‘lockdown’. It means having policies in place to lower risks every day. Surveillance, testing, supported health workers, training, adequate PPE, O2, face mask, hand hygiene, avoid 3Cs, improved ventilation, vaccination (for those lucky enough to be offered one), etc.”
Abandoning our focus on other proven PHSM and putting all our eggs in the “lockdown” basket have brought us to where we are today.
Another factor that contributes to our current condition is that we are lacking Public Health and Infectious & Epidemiology experts taking the lead in this pandemic. A pandemic should be led by experts from these fields. This is their forte.
Mohd Arshil is also a public health doctor. With this credential and his experience in the army, his perspective needs to be taken with serious consideration if we want to win this war. His view has been hailed by other experts in Malaysia. Even Dr Jemilah Mahmood, the special public health adviser to Prime Minister Muhyiddin Yassin, agreed in a now-deleted tweet, “Spot on and well said, sir.”
A pandemic is more than the disease itself. It involves a balance between a nation’s economy and healthcare, including mental health. With an increase in the suicide rate due to the lockdown, we have not seen an action plan to tackle this problem by the Health Ministry. Mental health should not be ignored.
A dichotomy of choosing between the economy or healthcare is false and misleading. Without healthy people, the economy cannot run. However, without the economy, the government will not be able to provide the supplies (like drugs, oxygen, beds) and staff for the healthcare to run.
Without economy, the public’s mental health has taken a toll due to negative impacts of the lockdown- financial, fear of infection, stigmatisation. This dichotomy has been used by multiple pro-lockdown supporters. Even some medical experts used this statement. However, these medical experts are not public health experts.
Throughout the pandemic, numerous local public health experts such as Dr Lokman Hakim Sulaiman has shared their view on this matter on CodeBlue. However, it seemed to fall on deaf ears.
Managing an individual’s disease is way different from managing a population’s disease. Other factors play a role. Both the economy and healthcare need to function together for us to win this war. Public health is the bridge between these two sectors.
We need all hands on deck to win this war. We have been using the army sparingly as frontliners at roadblocks and in setting up additional health centres. They also have talents and experts with experience and knowledge in both the medical and strategic crisis management fields, like Mohd Arshil.
The Health Ministry is overload, exhausted, and lost. Maybe it’s time to practice the third step of our Basic Life Support (BLS): “Shout for help”. Now it’s not the time for ego. It's time to work together and it seems that the army is ready to help.
It’s been almost two years and yet no proper or realistic exit strategy is seen. The current condition and the future seem bleak. What do we have to lose?
The views expressed here are those of the author/contributor and do not necessarily represent the views of Malaysiakini.
