Home TA Online Serious deficiencies in managing Covid-positive cases prior to admission

Serious deficiencies in managing Covid-positive cases prior to admission


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I received an emergency call from a friend this morning.

His wife who had tested positive for Covid by nasal swab five days ago had become very breathless overnight. She had developed fever and cough about eight days previously, about a week after she had contact with a friend with an active Covid infection.

The private lab that carried out the Covid test for her had taken down all her details and had said that they would inform the Ministry of Health (MoH) authorities.

But till this morning, MoH personnel had not contacted my friend and his wife.

The couple had tried to manage by making sure she stayed in her room, including for meals, took Vitamin D and C copiously, and monitored her pulse rate and oxygen level with a pulse oximeter three times per day.

But she felt much worse this morning – as though she was drowning, and the pulse oximeter was dipping to 90% on and off (the normal level is 96-100%).

My friend had rented an oxygen concentrator the day before and that helped, but he was really worried this morning. A couple of the private hospitals he called said that their Covid beds were full and they could not entertain his request for admission.

Luckily, I still have friends working in the government sector and I managed to get her admitted to the University of Malaya Medical Centre, where she has been started on supplemental oxygen and steroids – the mainstay for those with stage four Covid symptoms.

“Collateral damage” due to over-reactivity of the immune system is believed to be the main cause of the worsening symptoms in about 15% of clinically diagnosed Covid cases in Malaysia. That is why steroids are given – to calm down the overexcited immune system that sets off the cytokine storm and messes up our clotting system. With proper treatment and a bit of luck, she should pull through.

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But something is wrong, isn’t it? Why was she not contacted by the MoH authorities in the five days after she was diagnosed as PCR-positive for Covid? Did the private laboratory not submit the information, or did the ministry mess up on it?

Even if the MoH cannot immediately admit every single case, shouldn’t they have a system where a health personnel calls up each case who is being managed at home to check symptoms and advise on how to keep other family members safe, what kind of basic medications they can take and the use of the pulse oximetry at home?

Yes, agreed, the MoH is overburdened now with the management of ill cases, contact tracing of clusters and the vaccination programme. I would be the last person to criticize the ministry’s frontline workers. They are doing us a tremendous service, and at significant risk to themselves.

But what about getting some GPs and retired healthcare staff to manage the hotline for people like my friend’s wife? Then they could call these patients once a day to check symptoms and give relevant advice following a protocol. Surely this can be done and a database set up so that a senior MoH person at the district level can keep an eye on the all the cases being managed at home.

I hope the authorities – the MoH and the National Security Council – will look into this aspect of the management of the pandemic. With beds for acute cases being filled up, there will be delays in getting people admitted to Covid facilities.

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A safe mechanism should be set up for the monitoring of Covid-positive cases who have not yet been moved to Covid hospitals or hostels.

A proper monitoring system would help us ensure that those who are deteriorating and those whose home conditions do not allow proper isolation measures are admitted earlier to dedicated Covid facilities.

We have the resources to do this – the doctors in the private sector and retired doctors and nurses. We need the MoH and the government to initiate this service quickly.    

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