These issues from Covid-19 remain unanswered

The Star

19 hours ago

Covid-19 was Malaysia's worst public health disaster.
The death rate per capita was the highest in Southeast Asia and the second highest in Asia, next to Hong Kong.
Malaysia's maternal mortality rate (MMR) in 2021 was 68.2 per 100,000 live births
The last time the MMR was at this level was in the mid-1980s.
Decades of health gain were wiped out by Covid-19.
Many governments globally have held public inquiries into their management of the pandemic with reports published on the lessons learnt and how to plan better for the next outbreak, epidemic or pandemic.
Owing to the silence of the government, this is the first of a few articles on Covid-19 issues.
It starts with the healthcare workforce (HCW) which kept the sinking healthcare system afloat.
Personal protection
The initial stages of the pandemic saw widespread personal protective equipment (PPE) shortages, which was worse in Sabah, Sarawak and private clinics.
The HCW had to make their own PPE or utilise PPE supplied by volunteer groups.
The scramble for PPE threw quality and transparency in sourcing PPE out of the equation.
Some PPE suppliers had no experience and delivered PPE that were unsuitable for use.
This meant that HCW at the frontline had to go without PPE, reuse single-use items, use expired PPE or use homemade and donated items.
The writer can recall the heart wrenching efforts in supplying PPE to private general practitioners in the Klang Valley.
The numbers of HCW who felt pressured to work without adequate protection was unknown.
Covid-19 testing
Testing capacity was insufficient at the beginning of the pandemic.
The government drastically overestimated the country's capacity to perform Covid-19 tests at the pace and volumes required.
This initial lack of capacity meant that although testing was prioritised for public healthcare settings, there were not enough tests for all patients who needed them.
This had severe implications for many Malaysians who sought care in private clinics and hospitals.
The initial lack of test kits in public healthcare facilities was so widespread that these facilities had to depend on donations from non-governmental organisations (NGOs) and charities. Due to a worldwide shortage of personal protective equipment, volunteers helped to make these garments for healthcare workers.
Risk assessments
Many HCW were not risk averse to Covid-19.
There were no reports that risk assessments of HCW were implemented or carried out.
This left HCW, particularly doctors and nurses unjustifiably exposed to Covid-19.
They were just expected to carry out working regardless.
The numbers of doctors, nurses and other HCW who died from contracting Covid-19 at the workplace have not been published.
Physical health
Covid-19 posed an immediate threat to the physical health of doctors, nurses and others working at the frontline who were acutely vulnerable to Covid-19 infection, particularly theHCW who had non-communicable diseases.
Many HCW contracted Covid-19 and a significant proportion developed long Covid with its severe and long-term sequelae.
For example, a 2025 study published in the Journal of Occupational and Environmental Medicine reported that out of 976 HCW in Universiti Malaya Medical Centre, Kuala Lumpur, 49.2% developed long Covid.
It was tragic that some doctors and nurses lost their lives while caring for patients whom they did not know.
Their death rates may have been lower and the impact of Covid-19 and death(s) of colleagues mitigated had there been better protection and support by the government.
Mental health
Covid-19 had a considerable impact on the mental health of the medical and nursing professions and their families.
This impact on HCW mental health worsened as the pandemic progressed.
Many in the HCW suffered from anxiety and depression caused or worsened by the pandemic.
The unsatisfactory work conditions contributed to poor mental health outcomes.
The fear of contracting Covid-19 from patients led to poor psychological safety among the HCW.
This was compounded by the fear of spreading the virus to family members especially children and/or parents.
It was no joy going to work knowing that one may not get home at the end of the day/shift.
Overwork and burnout also had significant impact on mental well-being.
This was worsened by staff shortages.
Lacking support
During the pandemic, the HCW needed support more than ever.
However, this was often not forthcoming.
Insufficient publicly-stated governmental support for the HCW impacted on the image of the HCW and led to some doctors and nurses being subjected to unrealistic patients' expectations and, in some instances, even abuse.
The pandemic also impacted on the careers and finances of the HCW.
Medical training was severely disrupted and resulted in delays in career progression.
Some doctors experienced delays in the receipt of their salaries because of inefficiencies.
Some doctors lost income because of long Covid and/or suffered loss of locum work or private practice for public sector doctors.
Professional resilience
The pandemic had some positive effects on the medical and nursing professions who, true to their calling, demonstrated professional resilience that saved the Malaysian healthcare system, particularly the public sector, from collapsing.
The medical and nursing professions' team spirit and satisfaction from being able to contribute in a time of crisis were a marked contrast to the politicians who were displaying their machinations publicly.
The facilitation of hybrid working and remote learning during the pandemic has stimulated changes in healthcare delivery.
Unanswered questions
There are several unanswered questions. They include, among others:
> What can be learnt from the experiences of the HCW with non-communicable diseases during the pandemic?
> How can health inequalities be mitigated in future crises?
> How well did the health system support the HCW who suffered from the short or long-term effects of Covid-19?
> How did the state of the health system going into the pandemic contribute to the impact of Covid-19 on the medical and nursing professions?
> Poor physical and mental health in the medical and nursing professions may be expected in a pandemic. To what extent could this negative impact have been mitigated by the government?
> To what extent were the HCW who suffered from any short- or long-term health effects supported financially by the government, especially those whose lives have been devastated?
> To what extent did the government's lack of support for the medical and nursing professions during the pandemic contribute to negative media and public perceptions of those who risked their lives for those whom they did not know?
> Can hybrid working and remote learning be sustained and maintained, and, if so, what initiatives are needed?
The book The Medical Frontliners' Ballad authored by Ahmad Faisal Ahmad Ramzi, chronicles the raw, unfiltered stories of 15 frontliners in 2020, and also contains many unanswered questions.
Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email [e-mail]. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader's own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.