Call for a royal commission of inquiry into the management of Covid-19

It’s no secret that the Malaysian healthcare system has been on the verge of collapsing a few times during the current Covid-19 pandemic.

The cumulative number of confirmed cases in Malaysia exceeded 2.6 million as of November 24, 2021.

Meanwhile, our global ranking of the cumulative number of confirmed cases fell from 89th position on November 18, 2020 to 20th position on September 27 (2021).

The reported number of Covid-19 deaths in the country exceeded 30,000 on November 21, 2021.

The number of deaths per million inhabitants is the highest in Asean and is about 1.4 times that of the world average.

According to the Statistics Department, there were 44,307 and 65,584 deaths in the second and third quarters of 2021 respectively.

These were respectively 10.1% and 60.5% higher than in the second and third quarters of 2020.

The highest number of deaths – 23,539 – occurred between June and September of this year (2021).

Several factors have contributed to this, including:

  • Insufficient testing and contact tracing
  • Human resources issues involving healthcare professionals
  • Inadequate collaboration with the private and academic sectors, and civil society
  • Less attention paid to non-communicable diseases that exacerbate the severity of Covid-19
  • Inadequate treatment of the squalid living conditions of migrant workers
  • Non-compliance with standard operating procedures by politicians, and
  • Inconsistent risk communication.

The political instability that our country has experienced over the past two years (2020 and 2021) has also played an important role.

Additionally, we have insufficient use of digital technology and insufficient genomic testing, with Malaysia’s genomic sequencing efforts still inferior to Cambodia’s.

The Covid-19 has impacted many aspects of daily life, particularly health and healthcare.

For example, Dewan Rakyat was informed on September 14 (2021) by the Ministry of Health that his backlog of surgeries was estimated at 200,000 cases due to the pandemic.

This will have long term consequences for illness and death, with excessive and premature death as a likely outcome.

Global experiences from previous emergencies indicate that illnesses and indirect deaths are likely to exceed those directly caused by Covid-19 itself when the numbers are finally added up.

Two positive measures that have been successfully undertaken are national vaccine coverage against Covid-19 and the formation of the Special Working Group on the Greater Klang Valley.

These measures brought the disastrous health situation under control within about 10 weeks thanks to aggressive coordinated public health and clinical measures.

While many, including the government, agree that our national health system – which has been struggling with a limited budget for years – needs to be further strengthened, the budget for the Ministry of Health has only been increased by $ 1. , 5% for 2022.

More soon

There were several epidemics and outbreaks during the first two decades of the 21st century that affected many countries.A security guard checks a visitor’s MySejahtera app before allowing them to enter the mall.

Old diseases have returned and new ones have joined them.

The former include plague and polio.

These include Severe Acute Respiratory Syndrome (SARS) in 2003, H1N1 Influenza in 2009, Middle East Respiratory Syndrome (MERS) in 2012-2013, Ebola in 2014, Zika in 2015 and Covid-19 in 2020 at this time. day.

These diseases have spread faster and further with a wider impact.

Epidemics that were previously localized can now go global very quickly.

This has been and is exemplified by Covid-19, which has killed over five million people worldwide to date.

While it is impossible to predict the nature of the disease (s) to come, its source, or when it will begin, the World Health Organization (WHO) has stated that “with a high degree of certainty, that when it will occur, there will be (a) an initial delay in its recognition; (b) a serious impact on travel and commerce; (c) a public reaction which includes anxiety, even panic and confusion, and (d) this will be facilitated and encouraged by the media coverage ”.

Many scientists and doctors have warned of future pandemics.

This was said succinctly in the Richard Dimbleby Annual Lecture Aired on BBC One on December 5, 2021 by Professor Dame Dr Sarah Gilbert.

The professor of vaccinology at the University of Oxford and inventor of the AstraZeneca Covid-19 vaccine said: “This will not be the last time a virus threatens our lives and livelihoods.

“The truth is, the next one could be worse.

“It could be more contagious, or more deadly, or both.

“We can’t allow a situation where we’ve been through everything we’ve been through and then find that the huge economic losses we’ve suffered mean there is still no funding for pandemic preparedness.

“Just as we invest in the military, intelligence and diplomacy to defend against wars, we must invest in people, research, manufacturing and institutions to defend against pandemics. “

Lessons to be learned

One of the factors that may affect the management of future pandemics is human resource issues involving health workers.One of the factors that may affect the management of future pandemics is human resource issues involving health workers.

The main lesson we need to learn from the pandemic is the massive impact of inequalities and structural disadvantages on its course and outcomes.

The flaws in Malaysia’s public health system have been exposed by Covid-19.

Years of underfunding have had and continue to have an impact on the rakyat.

Health and related health care issues such as long Covid, health inequalities, resilience of health workers, mental health, better ventilation in buildings etc. need to be resolved.

Vaccination and “living with Covid-19” cannot be considered the end of this public health chapter in our nation’s history.

As such, there is a strong case for creating a Royal Commission of Inquiry (RCI) to investigate and report on the management of the Covid-19 pandemic to date, as well as to make recommendations. on strategies and solutions to strengthen the health system so that it is better prepared for the next inevitable public health emergency.

The RCI should determine what measures to manage Covid-19 worked and what did not.

The goal is to learn from mistakes and recommend solutions.

Such an RCI should be chaired by a retired senior judge.

Its members should include stakeholders such as civil society and professionals.

To ensure public confidence and avoid politicization, no current or retired politician should be appointed to the RCI.

It cannot be predicted when the current pandemic will become endemic.

Postponing the RCI to a later date, for example when Covid-19 becomes endemic, would deprive the country of the opportunity to put measures in place for the next public health emergency.

To this end, a deadline, for example six to nine months, must be put in place for the RCI to submit its report to the nation and to Parliament.

The next epidemic must see us ready and prepared to face it, well armed with the hard-learned lessons of the lives, blood, sweat and tears we have lost to Covid-19.

Dr Milton Lum is a past president of the Federation of Private Physician Associations and the Malaysian Medical Association. For more information, send an email to [email protected] The opinions expressed do not represent those of the organizations with which the author is associated. The information provided is for educational and communication purposes only and should not be construed as personal medical advice. The information published in this article is not intended to replace, supplant, or augment consultation with a healthcare practitioner regarding the reader’s own medical care. The star declines all responsibility for any loss, material damage or bodily injury suffered directly or indirectly as a result of the reliance on this information.

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