Khoo ML, See KS Kris, Osel Diagnostics, Osel Group
In December 2019, a cluster of pneumonia cases were reported in Wuhan, Hubei Province in China. This cluster was later linked to the identification of a novel coronavirus which caused the coronavirus disease (COVID-19). Since then, COVID-19 has spread to many countries globally. On 11 March 2020, WHO Director General declared COVID-19 as a global pandemic.
In Malaysia, the first COVID-19 cases were detected on 25 January 2020 involving three tourists from China. This has raised national alarm and it requires immediate attention from the Malaysian government and various stakeholders to address the COVID-19 outbreak in the country. Based against this backdrop, this article aims to illustrate the readiness and response to combat COVID-19 from a Malaysian perspective.
Readiness and Response by Malaysia
Various efforts have been undertaken by the government to combat Covid-19 which include:
1.The National Crisis Preparedness and Response Centre (CPRC) was activated on 23 January 2020 to manage the response.
2. Create awareness among health care workers concerning case detection, case management and contact tracing of COVID-19
· Latest guideline version No. 5/2020
· Notification of PUI and COVID-19 case to nearest District Health Office (DHO)
· Referral of case to hospital
3. Reinforce Points of Entry Screening.
4. Health education and advice to general public.
5. Increase and improve laboratory capacity to conduct COVID-19 test.
6. Management of COVID-19 confirmed cases and PUI COVID-19.
7. Activation of Rapid Assessment Teams (RAT) and Rapid Response Teams (RRT) at all levels for case detection and investigation.
8. Uphold Infection Prevention and Control at all levels (PPE).
9. Improving Acute Respiratory Infection Surveillance through SARI and ILI – for detection of sporadic cases.
10. Establishment of a Joint Working Group For COVID-19, Malaysia-Singapore.
11. Increase multi-sectoral close collaboration and coordination, in addition to regional and international partnership.
12. Central Disaster Management Committee-High Level Meeting led by the Deputy Prime Minister.
13. Increasing ASEAN-EOC Network-sharing of information, experience, best practices in handling COVID-19.
14. Special ASEAN-China Foreign Ministers’ Meeting on Coronavirus Disease (COVID-19) on 20 February 2020.
15. Collaboration with WHO from time to time. (Allaudin, 2020)
Case Definition
1. Patient Under Investigation (PUI) of COVID-19
Acute respiratory infection (sudden onset of respiratory infection with at least one of: shortness of breath, cough or sore throat) with or without fever AND travelled to / lived in foreign country within 14 days before the onset of illness ORclose contact in 14 days before illness start with a confirmed case of COVID-19 OR attended an event related with known COVID-19 outbreak.
2. Confirmed Case of COVID-19
A person with laboratory confirmation of infection with the COVID-19.
(Ministry of Health, 2020a)
Clinical Management of Confirmed Covid-19 Case
Clinical Stages Related with COVID-19
Clinical Stage
1. Asymptomatic
2. Symptomatic, No Pneumonia
3. Symptomatic, Pneumonia
4. Symptomatic, Pneumonia, Requiring supplemental oxygen
5. Critically ill
General Care
a. Supportive care and symptomatic treatment, optimal dietary intake, maintain fluid and electrolytes balance, and close monitoring.
b. Monitor vital signs (BP/PR/RR/SpO2) 12 hourly to 8 hourly with additional monitoring during intensive care.
c. Blood investigations, e.g. FBC, CRP, LFT, RP, coagulation, Blood culture, Ferritin, D Dimer, Fibrinogen, Procalcitonin based on clinical signs. ABG if required depending to severity of disease.
d. Supplemental oxygen depending on SpO2.
e. Monitor sugar level when required.
f. For children that requires bronchodilator treatment e.g. Salbutamol; avoid using nebulizer. Instead use MDI with spacer.
g. Ensure good hydration in children by encouraging their usual milk/diets.
Specific Treatment
· No specific treatment for COVID-19 infection is currently approved.
· There are inadequate data on trial agents including chloroquine, hydroxychloroquine, Lopinavir-ritonavir, interferon, ribavirin and others.
· The treatment regime recommended below is likely to change as new evidence arises.
(Source: Ministry of Health, 2020b)
Handling Healthcare Worker (HCW) During Covid-19 Pandemic
Healthcare workers should abide to stringent infection control measures as per recommendations including the use of suitable PPE. Health-care workers who are providing care for confirmed COVID-19 or Patient Under Investigation (PUI) will be monitored daily by the OSH Unit or Safety and Health Committee of the healthcare facility. Healthcare workers monitored must be recorded in a database for contact tracing purpose.
Risk Assessment and Handling Healthcare Worker (HCW) with Potential Exposure to Patients with Covid-19 in a Healthcare Setting
It is crucial that the HCW should not attend a healthcare setting if there is a risk that they could spread COVID-19. HCW involved in providing care to patient with confirmed COVID-19 should:
· not be having uncontrolled medical comorbidities / immunocompromised state
· not be pregnant
Asymptomatic HCW with Household Member Who are Being Investigated as PUI for COVID-19
For asymptomatic HCW who has a household member being investigated as PUI for COVID-19, the HCW should notify supervisor immediately and be omitted from work until first PCR result of the PUI is obtained. If the PCR result is negative, the HCW can return to work immediately.
Management of HCW Exposed to Confirmed COVID-19 patients
Exposure Risk Assessment
Category of Risk Exposure
1. Management of HCW with High-risk Exposures
1.1. Symptomatic
Omit from work for at least 7 days with MC, home surveillance order and home evaluation device. Permitted to return to work once:
· at least 72 hours have passed since recovery described as resolution of fever and recovery in respiratory symptoms (e.g., cough, shortness of breath), AND
· negative PCR for at least two consecutive nasopharyngeal (NP) and oropharyngeal (OP) swab samples taken 48 hours apart
1.2. Asymptomatic
Omit from work for at least 1 week with home surveillance order and home evaluation device. Allow return to work once:
· Negative PCR for at least two consecutive NP and OP swab samples taken 48 hours apart. Based on the data obtained on consecutive period of the disease it is suggested to initiate the swab from day 3 after exposure.
2. Management of HCW with Medium and Low-risk Exposures
2.1 Symptomatic
Omit from work with MC for 3 days, home surveillance order and home evaluation device until:
· Negative PCR for at least two consecutive NP and OP swab samples taken 48 hours apart, AND
· Resolution of fever and recovery in respiratory symptoms (e.g., cough, shortness of breath)
2.2 Asymptomatic
Omit from work with home surveillance order until:
· Negative PCR for at least two consecutive NP and OP swab samples taken 48 hours apart. Based on the data available on consecutive period of the disease it is suggested to initiate the swab from day 3 after exposure.
3. Management of HCW with No Identifiable Risk
HCW in the no identifiable risk category do not need testing, monitoring or constraint from work.
Resume to Work and Limitations
HCW will be permitted to return to work, however the following guidelines should be followed:
i. HCW must strictly wear a surgical mask at all times while in the healthcare facility until all symptoms are entirely resolved or until 14 days after illness onset, whichever is longer.
ii. HCW should follow hand hygiene, respiratory hygiene, and cough etiquette.
iii. HCW shall be limited from partaking in the care of immunocompromised patients until 14 days after the last exposure or from illness onset.
iv. Stringent daily monitoring of temperature and respiratory symptoms by OSH Officer.
v. If HCW develop new onset of symptoms (even mild) or deteriorating of symptoms and consistent with COVID-19, they must immediately stop patient care and inform their supervisor or OSH officer before leaving work. (Ministry of Health, 2020c)
Concluding Remarks
On the whole, Malaysia has responded in quite a timely manner with respect to preparedness to combat COVID-19 by gauging at the reduction of COVID-19 cases from three digits to two digits following the implementation of three Movement Control Orders (MCO). Despite the reduction in cases, the Malaysian government and all Malaysians will have to continue to reinforce their preparedness, response capacity and health system competency to battle against COVID-19. Apart from that, further efforts are required to continuously enhance multi-sectoral collaborations and coordination as well as boost regional, international and global partnerships. Such global partnerships are advocated as they are good efforts towards achieving United Nations’ Sustainable Development Goal (SDG) No. 17, which is to foster global partnership among stakeholders. To this end, Malaysia and all nations affected by COVID-19 should aspire to flatten the curve together in unity and solidarity towards achieving SDG No. 3 which is global well-being and good healthcare for all.
REFERENCES
Allaudin, F.S. Ministry of Health. (2020, March 27). Covid-19: The Pandemic of the Century [PowerPoint presentation].
Ministry of Health. (2020a, March 25) Guidelines Covid-19 management in Malaysia No. 5/2020: Case Definition (Annex 1). Retrieved from http://www.moh.gov.my/moh/resources/Penerbitan/Garis%20Panduan/COVID19/Annex_1_case_definition_COVID_22032020.pdf
Ministry of Health. (2020b, March 25) Clinical Guidelines Covid-19 management in Malaysia No. 5/2020: Clinical management of confirmed case (Annex 2e). Retrieved from http://www.moh.gov.my/moh/resources/Penerbitan/Garis%20Panduan/COVID19/Annex_2e_Clinical_Management_22032020.pdf
Ministry of Health. (2020c, March 25) Guidelines Covid-19 management in Malaysia No. 5/2020: Management of healthcare worker during Covid-19 pandemic (Annex 21). Retrieved from http://www.moh.gov.my/moh/resources/Penerbitan/Garis%20Panduan/COVID19/Annex_21_Protocol_for_Health_Care_Workers_08042020.pdf
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