The last two weeks of Covid-19 management in Penang can be characterized as aggressive actions based on data and science through a whole-of-government and whole-of-society approach.
Overall positive cases are in a downward trend – positivity rate is also dropping substantially
We have since witnessed a 23.5% drop in average daily new cases after the first week (labelled “Epidemic Week 37” or EW37 from 12 – 18 September 2021) and a further 20.5% reduction in the following week (EW38: 19 – 25 September 2021).
The good news is, our positivity rate has also been reduced substantially, from almost hitting 20% on 11 September to 10% on 23 September and then 7.6% on 27 September. Positivity rate refers to the ratio of positive cases and number of tests conducted. The World Health Organisation (WHO) recommended a positive rate of 5% as a rule of thumb for adequate testing done.
Faster vaccination for our children
While vaccination of the Penang adult population is expected to fully complete in October 2021 (as of 28 September 2021: 95.6% first dose, 81.1% second dose), we have sped up the rate of adolescent vaccination in order to protect our children from the virus.
When it was launched on 23 September, the daily dose for adolescent vaccination was only 3,500. Upon my request to Jabatan Kesihatan Negeri Pulau Pinang to inoculate at least 10,000 teenagers daily, the number was doubled by 27 September, and two days later on 28 September, we already achieved 10,000 daily doses.
At the state Covid-19 Immunisation Task Force this week, the Chief Minister also gave instructions to the vaccination team complete the first dose for all 130,000 adolescents in Penang within one week.
Deaths per population is still high – but total deaths is also showing a downward trend
With the number of positive cases coming down, the concern in the media has now shifted from the previously 4-digit high number of positive cases to Penang’s high deaths per population.
At this point, Penang is still top on the chart in deaths per 100,000 people.
Two points have to be made here.
Firstly, deaths per population is a ratio rather than an absolute number. What it means is, Penang has more people who died of Covid-19 in every 100,000 people compared to other states. However it does not mean that Penang has more people who died of Covid-19 compared to other states.
To illustrate, Johor (total deaths on 29 September 2021: 3,271) which ranks number two on the deaths per population list after Penang actually has more than double total Covid-19 deaths compared to Penang (1,345). Sabah which ranks number 3 has 2,201 deaths.
Secondly, like our total positive cases, Penang’s total Covid-19 deaths is also showing a downward trend for two consecutive weeks. In the first week (EW 37), Penang saw a decline of 1.57% in total deaths and then a further 24.4% in the week after (EW38).
Ramp-up of Penang healthcare capacity has shown results
One of the key reasons for the reduction of death is the increase in our healthcare capacity.
As I have outlined shortly after my appointment on 11 September 2021, the immediate action plan should be to ramp-up our healthcare facilities from hospital beds to ICUs to medical equipment and personnel.
The reason for this was obvious, 97-98% of our cases in Penang were Category 1 and 2. Hence, our most urgent focus at that time was to ensure the more critical Category 4 and 5 cases have adequate access to medical treatment in order to save lives. That should be our priority.
One oft-received complaints was the lack of Covid-19 beds, especially ICU beds. These are vital facilities as they make a huge difference between life and death.
Hence, just 4 days after a decision was made between Chief Minister Chow Kon Yeow and Health Minister Khairy Jamaluddin, a 100-bed field hospital was erected within 10 days.
Another 132 new Covid-19 beds were subsequently added to various government healthcare facilities including Hospital Pulau Pinang (HPP) and Hospital Bukit Mertajam (HBM).
Furthermore, 300 non-Covid-19 patients in our public hospitals were decanted to private hospitals during EW37 thanks to the cooperation rendered by private healthcare operators in Penang. In the following week, another 136 non-Covid-19 patients were decanted. All these created more space and freed up resources in government hospitals to deal with Covid-19.
Nonetheless, despite the above, what we needed most were more ICU beds. An ICU bed can easily cost between RM500,000 to RM1,000,000, equipment alone. And then, there is also the issue of manpower. A typical ICU bed requires round-the-clock watch from qualified medical professionals. One news report cited at least five nurses are needed for each of the three shifts to cover a 24-hour cycle. This is excluding backup staff and other support staff. (Source: https://www.thevibes.com/articles/news/28284/Not-just-beds-equipment-but-manpower-shortages-worrying-hospitals-battling-Covid-19)
Unfortunately, the number of ICU beds in Penang did not increase at 69 despite the spike in cases and deaths starting from July 2021 until 16 September 2021 when the number of ICU beds was finally increased to 76.
By 26 September we added another 5 to make up 81 ICU beds and now as of 28 September, our total ICU beds stands at 91.
The state health authority informed me that 12-14 more ICU beds will be created in HPP within this two weeks while a modular ICU with 10 beds will be set up in Hospital Kepala Batas in October 2021.
In order to support our operations here, about 250 medical professionals were redeployed by the Ministry of Health from other states to Penang in the past two weeks.
We will see the positive impact of these additional ICU facilities in the coming weeks especially on the number of deaths.
Home care programme should be the way to go for a Covid-19 recovery plan
Having said the above, one death is one too many. Every life is precious.
Last week in Parliament, I raised the need for the Health Ministry to implement a home care programme for Covid-19 patients undergoing home quarantine.
This is to ensure timely medical attention is given to these patients so that their condition will not suddenly escalate and to prevent cases of BID (Brought-in-Dead).
Recognizing that our public healthcare system is already overwhelmed, I proposed to the Minister of Health to employ the “PPV model” where private healthcare professionals such as GPs (General Practitioners) can be roped in, for a fixed fee, to provide primary healthcare to home quarantine patients.
Once given the home surveillance order, a home quarantine patient can be assigned a healthcare professional who will assess and monitor the patient’s condition over the duration of quarantine either through telemedicine platforms, phone calls or if necessary, house visits.
Ensure our healthcare system is ready to respond quickly if there is a future wave
The pandemic is a test to our systems and hence it offers an opportunity for the next phase development of these systems, including healthcare delivery.
I have written at the end of MCO 1.0 last year that we must take the opportunity of the reduced number of Covid-19 cases to strengthen our healthcare system. Our hospitals and other healthcare facilities must be robust enough to promptly respond to any possible future waves.
We must never go through another experience of under-preparedness, which resulted in the loss of precious lives.
In fact, we should only relax movement restrictions when these systems are ready so that in the future, instead of a universal lockdown, we should test, trace, isolate and treat positive cases quickly.
MP for Bukit Mertajam
Penang state-federal coordinator for Covid-19 management
30 Sept 2021