However, Luqman Hakkim Abd Razak, a Covid-19 frontline medical assistant (MA) working in the field for over a year now, disputes this view.

His job scope as a medical assistant is wide. Aside from raising awareness and educating the public on the pandemic and safety protocols, he is in charge of the long and tedious process of  contact tracing and screening of walk-in Patients Under Investigation (PUI) at a government clinic in Klang.

When the patients arrive at the clinic, Hakkim told FMT, the MA would do a physical examination before interviewing them on their contact information, their symptoms (if any) and how long they have had them.

“We also ask them the last point of contact with their suspected positive index case, how they met them, how long their meeting was, whether or not they were wearing masks and how far away they were.”

The MA would then ask for details of the index case they were in contact with, including the date of their first swab test, and when they were found positive.

Then, patients are tagged based on where they are in the “infection layer”, or how close they were to the index positive case. They would be put in categories labelled A,B,C,D or E.

An “A” patient is positive and must go to the hospital or quarantine centre, while a “B” patient is a close contact to “A” and must get swabbed and go under a mandatory home surveillance order.

Whereas, a “C” patient is a contact to “B” and would need to self-quarantine until “B” tests negative. Meanwhile, “D” individuals are further down the infection layer, and would generally not need to go into quarantine. “E” patients are people unrelated to any A,B,C or D person.

“From those tags, we can decide if they need to get swabbed for Covid-19,” he said.

If patients are at risk, especially if they are from the “B”category, Hakkim would assist the doctor to prepare a letter requesting them to get swabbed at the nearest clinic or screening centre the next day.

“Once a ‘B’ person is found positive, we need to look for the ‘C’ person. Then the whole process repeats over and over,” he said.

He said the entire process could be fast or slow, and might take days, depending on the patients’ cooperation. Some of the patients may take hours in trying to remember their contacts.

“Some are dishonest and would even manipulate information or give wrong phone numbers – this happens all the time,” he said.

However, he said, tracing every close contact is a must to curb the spread. He does all he can to trace them.

At the end of every day, the medical officer (MO) at the clinic will report the case details to the district health office, either by phone, email or through an online system.

When a patient tests positive

Once a patient is found positive, Hakkim will call for the location to send an ambulance. The pick-up rounds will generally run from noon to 7pm daily.

There are about eight ambulance vans making these rounds daily in Klang alone, he said. Each clinic uses one or two.

“If there are a lot of cases that day, we will be forced to ask for vans from the land office, schools or from the district health office.”

He said the medical assistant in charge during these pick-ups must examine the patients first to see if they are stable and fit enough to be transported to the quarantine centres.

If the oxygen level has dropped, a patient would need to be referred to the nearest hospital. For patients in Klang, this would be the Tengku Ampuan Rahimah Hospital, he said.

After assessing their condition, Hakkim said, the patients would be taken to a transit point, where they would wait for buses to take them to their assigned quarantine centres or hospitals.

In the Klang Valley, patients would typically go to the Sungai Buloh Hospital, the Malaysia Agro Exposition Park Serdang (MAEPS) quarantine centre or the National Leprosy Control Centre.

“In Klang, the transit point is near the Klinik Kesihatan Bandar Botanic. The buses to the quarantine centres run from 7pm until midnight every day,” he said.

High-risk patients would be transported to the centres in ambulances that would also double as an escort to clear the traffic for the buses.

Hakkim’s work ends when the positive patient gets transported safely to the quarantine centre.

Big challenge

The close contact tracing process has always been a big challenge for Hakkim.

He recalled instances where patients would refuse to follow him to the quarantine centres or hospitals after he arrives to pick them up at their homes.

He said tracing foreign workers from the numerous factory and workplace clusters in Klang is also a difficult task because of the language barrier. “Many times, we were forced to trace their supervisors to contact them.”

He said even though they are exhausted, medical frontliners are keeping their spirits up to fight the pandemic. However, as a medical assistant, he said, he could not help but feel frustrated at criticisms about the contract tracing process.

Many improvements have been made to the system from the year before, he argued.

“Before this, the system was haphazard, the facilities and quarantine centres were inadequate and transport was also lacking. But now, thank God, it is much better.”