Royal Commission On Covid-19 Management — Dr Milton Lum

Covid-19 was Malaysia’s worst public health disaster, with the health care system coming to the verge of collapse on occasions.

The cumulative number of confirmed cases in Malaysia exceeded 2.6 million on November 24, 2021, and its global ranking in the cumulative number of confirmed cases rose from 89th position on November 18, 2020, to 20th position on September 27, 2021. 

The reported Covid-19 deaths in Malaysia exceeded 30,000 on November 21, 2021. The deaths per million population is the highest in ASEAN, about 1.4 times that of the world. 

According to the Statistics Department, there were 44,307 and 65,584 deaths in the second and third quarters of 2021 respectively. These were 10.1 per cent and 60.5 per cent more than the second and third quarters of 2020 respectively.

A confluence of several fatal errors were the ingredients for the perfect storm which Malaysia experienced from June to September 2021, with 23,539 deaths during this period.

The errors included insufficient testing and contact tracing, insensitivity to human resource issues involving health care professionals, inadequate interface with the private sector, universities, and NGOs, notwithstanding the government’s espousal of the whole-of-society approach, no concerted attempt to address comorbidities, inadequate addressing of the squalid living conditions of migrant workers, some inconsistent and confusing SOPs, non-compliance with SOPs by politicians, and asynchronous and even contradictory risk communication. At the heart of these errors were political instability and poor leadership.

We can also add to these errors the insufficient use of digital technology and insufficient testing with Malaysia’s genomic sequencing, which is lower than Cambodia’s.

Covid-19 impacted many aspects of daily life, particularly general health and health care. For instance, the Dewan Rakyat was informed on September 14, 2021 by the Ministry of Health (MOH) that its backlog of surgeries was estimated to be as high as 200,000, which has long-term consequences for morbidity and mortality rates, with excess and premature deaths the likely outcome. 

Global experiences from previous emergencies indicate that indirect morbidity and mortality rates would probably exceed that of Covid-19 itself when the numbers are finally added up.

The two positive measures were the vaccination coverage and the formation of the Greater Klang Valley Special Task Force, which brought the dire situation under some sort of control in about 10 weeks, with aggressive coordinated public health and clinical measures.

There was political rhetoric about efforts to strengthen the national health care system, which has been underfunded and overworked for years. However, this was reflected in a paltry 1.5 per cent increase in the MOH’s budget for 2022.

More Deadly Diseases To Come

There have been several epidemics and outbreaks in the first two decades of the 21st century which affected many countries.

Previous diseases returned, and new ones sprung up. The former include plague and poliomyelitis, and the latter include SARS in 2003, H1NI influenza in 2009, Middle East Respiratory syndrome (MERS) in 2012-2013, Ebola in 2014, Zika in 2015, and Covid-19 in 2020.

These diseases have spread faster and further with wider impact. Outbreaks which were previously localised can become global very rapidly. This was, and still is being exemplified with Covid-19, which has killed more than five million globally.

Although it is impossible to predict the nature of any diseases to come, their sources, or when they will start, the World Health Organization (WHO) has stated that “with a high degree of certainty, that when it comes, there will be (a) an initial delay in recognising it, (b) a serious impact on travel and trade, (c) a public reaction that includes anxiety, or even panic and confusion, and (d) this will be aided and abetted by media coverage”.

Many scientists and doctors have warned of future pandemics. This was stated succinctly in the Richard Dimbleby lecture on December 5, 2021 by Sarah Gilbert, Professor of Vaccinology at Oxford University and inventor of the AstraZeneca Covid-19 vaccine: “This will not be the last time a virus threatens our lives and our livelihoods. The truth is, the next one could be worse. It could be more contagious, or more lethal, or both. We cannot allow a situation where we have gone through all we have gone through, and then find that the enormous economic losses we have sustained mean that there is still no funding for pandemic preparedness…Just as we invest in armed forces and intelligence and diplomacy to defend against wars, we must invest in people, research, manufacturing and institutions to defend against pandemics.”

Royal Commission Of Inquiry 

The primary lesson from the Covid-19 pandemic was the massive impact of inequality, and the structural disadvantages on its course and outcome. 

The chasms in Malaysia’s public health care system were laid bare by Covid-19. The years of underfunding exacted, and is still exacting, a heavy price from the rakyat. 

The nation’s roadmap cannot end with vaccination and “living with Covid-19”. The impact of Covid-19 on related health and health care issues like long Covid, health inequity, health care workforce resilience, mental health, and better ventilation in building designs, have to be addressed.

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

The RCI would have to determine which Covid-19 management measures worked, and which did not. The objective is to learn from the errors made and to recommend solutions.

Such an RCI should be chaired by a senior retired judge. Its membership needs to include stakeholders like civil society personalities and professionals. To ensure public trust and to obviate politicisation, no current or retired politicians should be appointed to the RCI.

The RCI is not only an urgent imperative, but is also critical for planning for the next outbreak or epidemic. 

When the pandemic will become endemic cannot be predicted. To postpone the RCI to a later date, e.g., when Covid-19 becomes endemic would deprive the country the opportunity to put in place measures for the next public health emergency.

Towards this end, a time frame, e.g. six to nine months, must be put in place for the RCI in order to submit its report to Parliament.

Is there willingness to face unpalatable truths? Will the mindset change to being proactive, rather than reactive?

It would be prudent to move ahead of the SARS-CoV-2 virus and prepare for the next public health emergency. 

Will decision makers remember that health is the key to life and livelihood?

Is there a political will for the appointment of a RCI into Covid-19 management? 

Dr Milton Lum is a Past President of the Federation of Private Medical Associations, Malaysia and the Malaysian Medical Association. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.

Dr Lum’s article is part of an exclusive series of guest essays by experts in the health care sector for CodeBlue on their reviews of Malaysia’s 2021 Covid-19 response and their outlook for 2022.  

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