Government hospitals in the Klang Valley are at breaking point.
The acute care wards for seriously ill Covid-19 cases are packed to capacity and emergency units are overflowing with patients who have difficulty breathing. Intensive care wards are full.
The system is no longer able to provide adequate care to the 20 – 25% of Covid patients who require high quality and timely treatment with oxygen, steroids and anticoagulants to pull through and survive their ordeal.
Furthermore, the exponential rise in brought-in-dead Covid cases, particularly in the Klang Valley, is cause for alarm. According to recent figures from the Crisis Preparedness and Response Centre of the Ministry of Health, Selangor recorded the highest number of brought-in-dead cases this year at 181 (27% of the 670 brought-in-dead cases), followed by Kuala Lumpur (11.6%), out of the total 4,856 coronavirus deaths in 2021.
Covid is a self-limiting disease for about 75% of the patients who contract it. The infected person’s body produces antibodies to neutralise the virus, and within a week the multiplication of the virus is curbed and the patient is on the road to recovery. Nevertheless, about a third of patients will go on to develop debilitating long-term symptoms (ie Long Covid).
However, in about 20 – 25% of the Covid cases, the immune system goes into overdrive (the cytokine storm) and starts damaging the lungs and other organs. This dangerous and potentially deadly phase occurs about seven to 10 days after the person first develops symptoms of infection.
If this immunological over-reaction is recognised early, it can be nipped in the bud with the use of steroids and anticoagulants while supporting the patient with supplemental oxygen. But these interventions have to be initiated in a timely fashion for maximum benefit.
We need to recognise that even if the number of new cases in Kuala Lumpur-Selangor miraculously drops to zero tomorrow, the overstretched hospital services in the Klang Valley will continue to be inundated by about 640 new category 4 Covid cases each day for the next two to three weeks. This is because there is a time lag of about a week to 10 days between first symptoms to the development of breathlessness due to an immunological over-reaction.
The average number of cases diagnosed daily in the KL-Selangor region was 3,029 for the period 24-29 June and 3,477 for 1-5 July. Category 4 Covid cases will require at least five to seven days of inpatient treatment to stabilise. This will push up bed occupancy rates, which already exceed 100% in some government hospitals.
On average, 10% of patients requiring oxygen support (the category 4 cases) will require intensive care within a week of admission. So the hospitals in the Klang Valley will need 64 more ICU beds every day for the next three weeks. If we cannot provide this level of care, Covid morbidity and mortality will rise.
Already, the case fatality rate in the current Covid wave has reached 1.3% – in other words, 13 patients die out of every 1,000 patients diagnosed. Compare this with 2020, when only 3.8 died out of every 1,000 cases. The current variants appear to be more vicious, and if we are unable to provide optimum care, the case fatality rate will rise even more.
Increasing the vaccination rate and tightening physical distancing measures are important public health measures. But these will not solve the problems that our overstretched Klang Valley public hospitals are facing currently.
We understand the Ministry of Health has started to mobilise doctors and nurses from public hospitals in other states to help the public hospitals in the Klang Valley. We think this is timely.
However, we need to urgently mobilise even more resources to forestall the collapse of medical care in the Klang Valley. Among the measures we need to implement are:
- Transfer a portion of the new category 4 Covid cases to hospitals in surrounding states – Perak, Pahang, Negeri Sembilan and Melaka. The category 5 cases are too ill to be transferred safely and need to be handled in the hospitals where they are
- The declaration of a state of emergency specifically empowered the government to temporarily acquire private hospital facilities to handle the Covid crisis. The time to use this provision is NOW. The government has to take over a portion of the ICU beds of the private hospitals in the Klang Valley so that the pressure on government ICUs can be relieved. (A portion only because the private hospitals will need some ICU capacity to deal with the really ill patients that they have. But they will have to reschedule elective cases that require ICU management post-operation.)
- We should be prepared to borrow ventilators from Singapore, China and Australia so that we can quickly expand our ICU capacity
- The monitoring of patients being managed at their homes has to be upgraded so that deterioration to the immunological phase of the illness can be recognised early and appropriate treatment initiated in a timely fashion. The Covid assessment centres at district level should enlist a corp of volunteers (retired doctors, nurses and others who are able) who are each given a set of patients to follow up by phone every day for the first two weeks after Covid diagnosis. If their symptoms indicate possible deterioration, these patients should be admitted for assessment and optimal treatment. A system of reporting should be put in place such that the volunteers give daily feedback on all their wards.
These four measures are all doable, but they need to be initiated from the highest levels of the Ministry of Health and the National Security Council.
The political temperature is going up with the approaching parliamentary session and the end of the emergency. There is a real danger that political intrigues will distract the authorities from the fact that many Malaysians are now struggling for their lives and that our healthcare system in the Klang Valley is at the point of collapse.
Let’s prioritise the safety of our Covid patients and collectively raise our voices to urge the government to immediately implement the above measures to prevent a healthcare disaster.
The People’s Health Coalition comprises Agora Society, Citizens’ Health Initiative, Health Equity Initiative, the Socialist Party of Malaysia and Third World Network