Malaysia’s Youngest Hospital CEO On Fighting Coronavirus On The Front Lines
Gen.T honouree Nadiah Wan, CEO of Thomson Hospital, on overcoming drug shortages, dwindling supplies and a global bidding war for basic equipment
“We’re worried because if the Covid-19 virus continues to spread uncontrolled in a population, even the best healthcare systems—like Italy’s—will completely collapse. If we don’t break this chain of infection now and flatten the curve, then this is something that could really happen in Malaysia.”
Globally, the number of confirmed infections passed 1 million on April 2, with the virus now impacting at least 180 countries and territories and leading to more than 53,000 deaths. Malaysia’s numbers have grown exponentially since its first case of Covid-19 in late January, now reaching 3,333 cases—the highest number in Southeast Asia—and 53 deaths.
In response, Malaysian authorities enacted a nationwide movement control order, effectively banning all visitors, barring residents from travelling overseas and closing all places of worship, schools and business premises, except for those providing essential services, until April 14.
The movement control order has come at a critical juncture, says Wan. “Within Wuhan, the mortality rate for Covid-19 was more than 10 percent, whereas outside of Wuhan it was actually closer to 2 to 3 percent,” she says. “The difference isn't because it's a different virus, the difference is because of the collapse of the healthcare system. And that’s what we’re worried about in Malaysia.”
Thomson Hospital currently runs a drive-through testing system for Covid-19, screening and referring patients to government hospitals for treatment. Like many hospitals, they've taken a number of precautions to stem the spread of the virus. "Firstly, we set up a task force between the doctors and the hospital management to make quick decisions to pass policy, so that we only have one body that's making decisions. We also started doing Covid-19 screening tests as early as February, and now we're doing payment transactions online so that we can reduce that contact risk too."
The country hasn’t yet reached its predicted peak of Covid-19 cases, but frontline healthcare workers are already facing mass shortages of essential equipment. In March, dwindling supplies forced Thomson Hospital to use polystyrene boxes, provided by local supermarket Tesco, to transport Covid-19 test swabs to labs, while the closure of stores meant the hospital couldn’t access supplies like tape, which is used to enforce social distancing measures. “It's been increasingly difficult to get the basic stuff that we never gave a thought to,” says Wan.
Tq u @tescomalaysia for going above and beyond to source and deliver 100 polystyrene boxes to @thomsonhospitalkd which we use to transport COVID-19 swabs to labs. During MCO it’s gotten harder to get even basics to run a hospital but Tesco came to save the day ?? #kitajagakita— Nadiah Wan (@lapetitemaligne) March 22, 2020
A Global Bidding War
Malaysia is in a precarious situation as it must “compete with other countries for supplies,” says Wan. The chronic global shortage of personal protective equipment (PPE), which is essential for frontline healthcare workers, is just one of many examples. “We are competing with countries like the US, who are paying US$7 for a mask, and of course in Malaysia, that’s very expensive. And because the oil price has been really affecting our currency, that in turn has really affected the ability of Malaysian hospitals and healthcare providers to have access to PPE.”
Malaysian hospitals are also facing a potential shortage in drug supplies, says Wan. When US president Donald Trump announced that hydroxychloroquine, a malaria medication, was a potential treatment for Covid-19, there was significant spike in the price of the drug and a constriction of supply, affecting the patients who are currently being treated using hydroxychloroquine and “leaving us scrambling to secure a supply of that drug,” says Wan.
“What's happening across the world can just sweep towards us in Malaysia in a split second. For things like masks and isolation gowns, we are now looking at real-time bidding for supplies across the world on an hourly basis, where the rates are continuously changing.”
Frontline healthcare workers across the country have been going to extreme lengths to make up for a lack of PPE. “They’re coming up with all sorts of innovative ways, using garbage bags and whatever they can to protect themselves from infection,” says Wan.
Protecting healthcare workers is paramount. Not easy to train and replace even a single nurse or doctor. Their risks of infection are 3-5x higher than normal and they can spread it to vulnerable patients if not properly protected. Sadly race for PPE is being won by richer nations https://t.co/eKhgK2b60l— Nadiah Wan (@lapetitemaligne) March 22, 2020
Stay at home
With healthcare workers being up to three to five times more susceptible to infection, Wan fears that there may be dire consequences for both frontliners and society as whole if Malaysians don’t follow the movement control order. “Staying at home will help us break the cycle of transmission. When you look at the second, third, fourth, fifth generation of infection, you are actually saving tens of thousands of people from potentially being infected. So it's not about you, it's about saving the people around you—especially the most vulnerable,” she says.
Malaysian authorities have stated that they may take more severe measures to ensure the movement control order is adhered to, and have already made over 1,000 arrests. Wan hopes that the restriction on movement will help Malaysia manage the peak of Covid-19, but warns that if people don’t start abiding by the rules, “the virus may become a chain reaction that becomes uncontrollable. In which case, you’ll have to be very, very worried.”
Follow Nadiah Wan on Twitter to keep up with developments on the front lines.