Serious deficiencies in managing pre-admission Covid cases

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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 5 days ago had become very breathless overnight. She had developed fever and cough about 8 days previously, about a week after she had contact with a friend with active Covid-19 infection.

The private lab that carried out the Covid test for her had taken down all her particulars and had said that they would inform the Ministry of Health (MOH) authorities. However my friend and his wife were not contacted by any MOH personnel up till this morning. They 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.

However 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 in 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 would not entertain his request for admission.

Luckily I still have friends who are working in the government sector and I managed to get her admitted to UMMC where she has been started on supplemental oxygen and steroids – the mainstay for those with Covid Stage 4 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 19 cases in Malaysia. That is why steroids are given – to calm down the over-excited 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.

But something is wrong isn’t it? Why was she not contacted by the MOH authorities in the 5 days after she was diagnosed as PCR positive for Covid-19? Did the private laboratory not submit the information, or did the MOH 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, advise regarding keeping other family members safe and about basic medications they can take and perhaps the utility of pulse oximetry at home?

Yes agreed, the MOH is over-burdened at this point in time – with the management of the ill cases, contact tracing of the clusters and the vaccination programme. I would be the last person to criticize the MOH front-liners. They are doing us a tremendous service, and at significant risk to themselves. But what about getting some GPs and retired health care staff to man the hotline for people like my friend’s wife – calling these patients once a day to check symptoms and give relevant advice following a protocol? Surely this could be done and the necessary data base set up so that a senior MOH person at the District level could keep an eye on the all the cases being managed at home.

I hope the authorities – the MOH and the MKN – will look into this aspect of the management of the pandemic. With the acute beds being filled up, there are going to be delays in getting people admitted to Covid facilities. A safe mechanism should be set up for the monitoring of the Covid positive cases who haven’t yet been moved to the Covid hospitals or hostels. A proper monitoring system would help us ensure that those whose 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, the retired doctors and nurses. We need the MOH and the government to initiate this service quickly.

Dr. Jeyakumar Devaraj
Retired Chest Physician
Parti Sosialis Malaysia

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