From Dr Amar-Singh HSS

Much of the recent focus in the fight against the Covid-19 pandemic has been in the Klang Valley, including Negeri Sembilan, and rightly so. The outbreak there continues to rage and the multi-sectoral task force set up to deal with the region, the Greater Klang Valley Task Force (GKVTF), is working hard to make a difference.

However, we may not be aware that other states outside the Klang Valley are gradually slipping into a crisis too.

If you track the use of intensive care (ICU) beds by Covid-19 patients in Perak, Kedah and Penang, for example, you can see that there has been a steep rise over the past three to four weeks (see Figure).

Remember that this data does not show the full picture as for every one Covid-19 patient documented in an ICU bed, there are perhaps one to two times more who are Category 4 and Category 5 patients in a non-ICU bed, often in the emergency department.

Much of the rapid change in the situation is due to the Delta variant, which is most likely the predominant strain spreading in the nation at the moment. The Delta variant is highly infectious as it has a very high viral load and infects more persons faster.

Additionally, the fully-vaccinated rates for many states outside the Klang Valley are lower due to limited vaccine supply.

Data for July 25, 2021 shows that completed vaccination rates (two doses) for Perak stood at 14.4% of the total population. For Kedah and Penang it was 11.5% and 14.5%, respectively. With the Delta variant, the two-dose protection is important.

What can we do to prevent a Klang-Valley-like disaster?

We need to act now to prevent the situation in many states from getting worse. We possibly have a narrow three- to four-week window to act. Some summary suggestions are as follows:

1. Advocate for more vaccine supply and ramp up vaccination to the maximum possible. Leave no vaccine vials in storage.

Avoid using large PPVs and instead, organise drive-by vaccinations using the existing vaccination infrastructure – such as maternal and child health clinics, school health teams, GPs and private hospitals.

We must reduce the risk of mega PPVs becoming a location for Covid-19 transmission.

2. Reduce all non-critical social interaction to cut community spread of the virus. Avoid social, travel and religious activities. Avoid the use of vaccination passports at this time for travel, and especially avoid all interstate movement.

3. Use PCR only for hospital admissions and expand dramatically the use of RTK-Antigen testing for all contacts, whether symptomatic or well.

Enable the public to self-test with the availability of reliable, cheap saliva-based RTK-Antigen tests at pharmacies, medical centres, and GP clinics.

The state government should consider subsidising these tests. Anyone who is tested positive via the RTK-Antigen test should be considered a case and be isolated and monitored.

4. Activate a state level multi-sectoral disaster team, not unlike the GKVTF. Get the plans in place, teams activated and resources on standby as quickly as possible, so that when the Delta wave hits, we will be better prepared. This includes increasing the number of hospital beds, oxygen delivery capacity and electrical power supply.

5. The state-level disaster management teams must be empowered to act immediately (decentralised decision-making) and supported by state governments.

Remember that the federal government invested significant resources to support the Klang Valley and may have limited funds for other states.

Hence, state governments must come together with wealthy business leaders to act now for their state.

6. We need to give a clear message that vaccination alone will not stem the Delta wave. Therefore, we need all public health measures and SOPs to be strictly enforced as well – face masks, physical distancing, ventilation, etc).

We also need to encourage the public to be vigilant and maintain their SOPs even after being vaccinated.

7. Finally, transparent data sharing with the public to comprehensively explain the true situation is crucial. We cannot say “everything is under control” when we know it is not. Granular, down to district level, will encourage an all-of-society involvement to reduce the impact of the Delta wave. A concerned public is one that acts.

We have an opportunity to avoid the anguish that the greater Klang Valley residents are going through. If we have good, strong regional leadership stepping up now, we just may avoid the worst of the crisis that is impending.

Dr Amar-Singh HSS is a consultant paediatrician and an FMT reader.

The views expressed are those of the writer and do not necessarily reflect those of FMT.