This is an open letter to the new Minister of Health, YB Khairy Jamaluddin.
I am writing this for Merdeka Day and Malaysia Day. These two pivotal events in our nation’s history speak of change – a breath of fresh air, our people come together for the collective good of the nation and leave the past behind.
I say this to talk about the need to change our response to the Covid-19 pandemic. In a recent Covid Resilience Ranking, Bloomberg ranked Malaysia as the worst place out of 53 countries to reopen the economy against the Delta variant.
You have rightly said that taking the post of Minister of Health is a “very heavy responsibility”. In this pandemic, this is one of the most important roles that an elected representative of the people can hold and perform. As such, I wish you foresight, courage and endurance for the task ahead.
Allow me to share with you some perspectives on this pandemic that could be useful for your reflection.
Three areas to remove or repair:
1. Fix the trust deficit.
The public has a huge deficit of trust in government. This can only be overcome with transparent leadership focused on the needs of people, not those of leaders. Transparency builds trust.
2. Reduce burdens on people.
We have a huge number of Standard Operating Policies (SOPs). No one is sure of the full number, but they exceed 100 and are probably the highest in the world; which is not an honor. Removing the majority and simplifying the essentials to a few science and evidence-based lifestyle changes would empower the community. Routine temperature checks in all rooms are of little value, possibly harmful (increasing personal contact) and should be stopped.
3. The truth must come back to the government and the public service.
We must stop the denial of the reality of Covid-19. All is not going well and is not improving anytime soon. It is true that sharing reality-based data with the rakyat at the national level and by state health services is vital. This will require decentralized decision-making and the empowerment of state-level disaster management teams to act quickly to address local situations and communicate openly with the public.
Three principles for the pandemic at its current stage (key messages from Covid-19):
1. You can never prepare enough for Delta.
We have to prepare too much and then prepare more. Whatever we do, Delta will cause enormous suffering and damage over the next eight weeks, especially outside of the Klang Valley. We expect the number of cases and the death toll to increase in the coming weeks. The health services of many states are already overwhelmed and in crisis.
2. Don’t put all of your eggs in the vaccine basket.
We need to use all the tools at our disposal and not just rely on vaccinations to solve the problem. The use of testing and contact tracing has been extremely low and underutilized. Passing all contacts to RTK-Ag testing will go a long way in helping to contain the pandemic.
3. We are in the same boat.
This is not a problem to be managed only by the government as it affects every person in Malaysia (including migrant workers). We need a coordinated whole-of-society approach. Please work with all civil society organizations (NGOs), the private health sector, wealthy businesses and the average Malaysian.
Three realities on the management of Covid in the face of Delta:
It is very likely that we are all exposed or infected with Covid-19 at some point. Our goal should therefore be to:
1. Reduce viral load upon exposure.
This can be achieved by proper use of the mask (proper filtration and fit), adding a face shield, and limiting our risks and exposure to others.
2. Reduce the severity in case of infection.
Vaccination is a useful tool and currently our crisis is in six states outside the Klang Valley that are overrun due to low vaccination rates (Sabah, Kedah, Perak, Johor, Pulau Pinang and Kelantan). Early identification of infected people and close monitoring (routine finger pulse oximetry) is essential to reduce the number of deaths. We need to actively encourage everyone to maintain their fitness level and avoid being overweight.
3. Reduce community spread to reduce risk.
The value of contact tracing and testing cannot be overstated. The availability of home test kits is a useful measure for offices and schools; but we need cheaper RTK-Ag tests. In addition, we need high-quality, large-scale genomic testing to identify new dangerous variants of concern.
There is another area that is so neglected that I chose to mention it as an individual item: Ventilation, Ventilation, Ventilation.
We have failed to improve the internal security of all buildings – schools, offices, businesses, grocery stores, etc. We are asking for measures to increase existing ventilation rates (air exchange) and eliminate any air recirculation in the ventilation system of the room or building. This must be put in place as a matter of urgency and be done without burdening the owners of the premises.
I chose not to go into much detail here as some of us have written a lot of documents and suggestions on dealing with the pandemic. Further information on many of the ideas expressed here is available in the “Health Emergency Action Plan: Roadmap for Covid-19 Recovery” that we wrote in July 2021 (downloadable link: https: // bit.ly/3hTVnHb).
I am calling on you at this time to look beyond the Klang Valley and offer your support to Sabah, Kedah, Perak, Johor, Pulau Pinang and Kelantan as our situation is dire, no matter what the health services say. Our support is limited and we need crisis intervention. Please support ALL of these states with increased vaccine supply and equipment requirements.
Listening is a lost ability of governments, and Malaysia is no different. Our government has become difficult to hear the cries of the people. This, coupled with a chronic dysfunction of the civil service, which always wants to show that it is doing well, has damaged our health response. Leadership was limited and this further compromised decisive action.
All of Malaysia is praying for you and wish you success so that we can come out of the crisis phase of this pandemic. You’re not alone.
Dato ‘Dr Amar-Singh HSS