From Dr Amar-Singh HSS
Many individuals and groups have voiced suggestions to manage our raging Covid-19 pandemic. Allow me to summarise five key measures we critically need to take to help put out the raging Covid-19 fire in our nation.
1. Test extensively:
Ramping up our polymerase chain reaction (PCR) tests to 100,000 a day is insufficient. PCRs are labour intensive and results are usually delayed. If it takes 3-5 days to get a result this limits the value of the testing.
We need hundreds of thousands of RTK-Ag antigen rapid test kits on the ground. With a one-hour result time, they offer a rapid response and action when positive. Even if they are only 75% sensitive, it significantly mutes the pandemic.
Equivocal results can be sent for PCR. We should keep PCRs for patients requiring admission and testing in high-risk symptomatic persons (over 60 years with major comorbids).
2. Restore contact tracing:
Contact tracing activities have been swamped by the huge numbers and have currently failed. We must learn from other nations. Rapidly employ 10,000 retrenched non-medical professionals, train and use them to re-establish contact tracing in all states. This will also free health staff to do more vital tasks.
We must dramatically improve our handphone applications to allow for seamless contact tracing and notification of the public.
3. Support health ministry staff:
Our health ministry (MoH) staff are long past burnout. The burden of excessive work, long hours wearing personal protective equipment (PPE), fear of getting Covid-19 and lack of adequate emotional support have wrought havoc on a health system that was always fragile and inadequate.
We must immediately offer permanent jobs to all MoH staff on contract, as well as hire all available doctors, pharmacists and nurses waiting for jobs. Also consider graduating all final-year doctors, pharmacists and nurses, using their continued formative assessments and prior examination results as a proxy indicator of performance.
4. Improve home quarantine:
Home quarantine is useful for Covid-19 individuals who are well and healthy. However, maintaining home quarantine for large numbers is a challenge. There are numerous reports of those who are supposed to be under home quarantine, either positive or close contacts of a confirmed case, travelling outside their home to get food, visit a doctor, etc.
In addition, there have been numerous individuals lost at what to do at home and waiting for days for MoH personnel to contact them. There must be a mechanism to improve the current home quarantine.
We should hire and train retrenched non-medical professionals and use them to monitor and support these individuals. It may be important for MoH to offer hospitalised quarantine for those over 60 years with major comorbids, as they are at high risk of dying.
5. Widen pick-up services:
Individuals who are found Covid-19 positive and require hospitalisation should not have to wait. Currently, we have many anecdotal reports of such persons waiting for a few days for admission. We recognise that the MoH ambulance services are overwhelmed.
We need to urgently widen the pick-up services. We can train and use private ambulance services, especially for those who are more ill. For those who are mildly ill and require hospitalisation, we could work with established transport services (taxis, Grab, etc) to provide a dedicated pick-up service with good PPE and protection for the drivers.
When there is a huge fire raging in a large region, using hand-held fire extinguishers will not work. We cannot continue with the same initiatives we have practised thus far to control the vast local outbreak.
Using imaginative, out-of-the box strategies are necessary. No one person or organisation has all the solutions or answers. Listening to diverse views is critical.
Dr Amar-Singh HSS is a senior consultant paediatrician.
The views expressed are those of the writer and do not necessarily reflect those of FMT.
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