Covid-19: Ministry must not repeat mistakes
Published on: Sunday, February 16, 2020
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IT’S a fact that no country in the world, however rich, can afford to screen and treat influenza. This is because influenza occurs throughout the year and the sheer volume of cases involved would invariably place a huge burden on the economy.

With the outbreak of the new coronavirus (Covid-19) in Wuhan, China, we hope that if and when it becomes an epidemic in our country, the Health Ministry would be able to handle the situation correctly.

The influenza A virus is similar to the coronavirus in every aspect except that the latter is deadlier.

Looking back at the recent influenza A outbreak here, these were the mistakes made by the Health Ministry in handling it, and it’s time to put things right.

1. All influenza A cases must be reported to the Health Ministry once it’s diagnosed under the infectious disease protocol. This means if your general practitioner (GP) or specialist diagnoses you with influenza A, he or she has to submit online or fax your details immediately to the Health Ministry.

There was an unusual spike in influenza A cases in November last year, but the panic button was only pressed in January. The alarm was only sounded by the Health Ministry when GP clinics, private hospitals, and pharmacies ran out of antiviral drugs and test kits.

Logically, there must have been an epidemic prior to this to cause such an acute shortage. Were doctors failing to report these cases (which is an offence) or did officials at the ministry just decide to wait and hope for the best? It seems statistics gathered from the notifications were not acted upon immediately.

2. There has not been much research on influenza and its treatment at the primary care (GP) level, meaning that most research is done after a patient is warded in hospital after a few days or a week. Government primary care centres do almost zero screening for and treatment of influenza before the first 48 hours of presentation of the symptoms, understandably due to cost.

Only GPs and physicians in private hospitals diagnose this disease early. But the protocol for primary care treatment of influenza is issued by government hospitals. How then can GPs and private specialists follow the treatment protocol from those who only see influenza cases at a much later stage (when patients are already gravely ill)?

3. The general instruction for treating a patient with antivirals within the first 48 hours of onset of symptoms smells of the “cut and paste” policy of the West. It’s a known fact that in some Western countries, patients can languish for days before they are seen by their GPs. As we have experienced in the past for drug recalls, research and treatment, policies from the West must not be followed blindly. 

This situation has resulted in ridiculous statements such as “take paracetamol, drink lots of fluid and rest at home”. The Health Ministry’s spokesperson who was quoted saying this has not undergone the agony of very high fever (>39ºC), severe pounding headache, insomnia, relentless dry cough, vomiting for up to one week and more that are the symptoms of influenza A.

If correctly diagnosed and treated early, he or she would suffer for only one or two days.

In the treatment of influenza, antivirals are not a gimmick by pharmaceutical companies to make money. Doctors who use antiviral medications know that these drugs can cut short the misery and complications of the disease drastically.

4. GPs and private hospital specialists in Malaysia who diagnose and treat 99pc of influenza cases early should work in tandem with government specialists and come up with a realistic treatment protocol at the primary care level. 

Malaysia can be at the forefront of this research because we are one of the few countries in the world where a doctor is accessible for a reasonable fee even after one hour of the onset of fever. 

The middle class and above and the insured could probably afford treatment in private facilities for influenza but our aim is to reduce transmission and complications.

5. The most disappointing aspect was the distribution of vaccines and antiviral drugs that were imported as emergency consignments by the government and marketed by private pharmaceutical companies and marketing agents. These vital medications were supplied to private hospitals first while GPs had to wait for up to two weeks to get ours. (We still haven’t received our vaccines, by the way.)

Hospitals that order a large volume of vaccines get a 40pc discount on their purchase while GPs who can only order a small amount have to pay the full price. This is highly unfair.

Also, antivirals that are imported under the emergency consignment from India are sold to GPs here at double the retail price in the exporting country. As tablets don’t weigh much, one can only deduce that poor handling of these imports led to this shameful fiasco.

Pharmaceutical companies and distributors are only interested in large volume sales and profit. There are 7,000 GPs in Malaysia who can reach out to the masses in every corner of the country, but they are a forgotten lot – again in the name of profit.

The bigger fight is yet to come. This new coronavirus has been headline news worldwide for a reason. Primary care will be at the forefront again and we are ready for the battle with a little help from the Health Ministry. We (GPs) will not abandon our ship because the Hippocratic Oath is deeply embedded in our soul. We will be the first to face this new coronavirus, risking our lives and our clinic being closed down, but so be it!

Disgrunted GP

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