How does it feel being appointed to the WHO Science Council?

It came as a huge surprise and a huge honour—it's one of the prestigious councils that reports directly to the director general Dr Tedros Adhanom Ghebreyesus. It’s currently made up of a group of nine people, two of whom are Nobel Prize winners including the chair, Professor Harold Varmus. Our first parcel is to look at the role of genomics in surveillance, diagnostics and treatment.

There’s been a huge explosion of genomics—for instance the use of PCR in diagnosing Covid-19—and in better precision medicine for cancer and other genetic diseases. For example, how we can identify risk groups, people who have the BRCA-1 genes for breast cancer, and how to target with better prevention and treatment measures. We're not specifically dealing with Covid-19 or the day-to-day WHO work and deliberations.   

How have you and your team been coping with this latest surge of Covid-19 cases?  

The stress has been enormous. We've had to mobilise our staff and get all kinds of specialists looking after patients, so stories of orthopaedic surgeons caring for Covid patients are true. But don't worry; they are there as part of a bigger team of people including myself and there are guidelines and protocols, so everyone is given their best care.

Last year before the vaccines arrived, the team's greatest fear was getting infected and infecting their children or elderly parents back home. It was a very real fear that the hospital leadership had to really manage, to the extent that we provided temporary accommodation for people to shower and rest before they went home. Some didn’t even want to go home.

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Another challenge was in terms of putting the right SOPs in place, for example, which PPE gowns to use and when. It took a lot of time, discussion and deliberation, and although there were international guidelines, it needed to be adapted and discussed for local settings. It's a lot of work and it will continue to be a lot of work, but we manage.

We have a number of staff who, despite getting their two vaccination doses, were infected with Covid-19. They’re fine and their symptoms are usually mild, but we then have to ensure they don’t infect other patients and team members. So there’s a whole sphere of work beyond our usual duties of caring for patients.

How has Covid-19 affected the nation's more vulnerable, unseen communities?

My observation in this fourth wave is that many more people from the lower socioeconomic classes are getting infected, coming to the hospital very late and then dying, perhaps due to a lack of awareness that the disease can be a silent killer. They seek help a lot later than they should— usually until such time that their oxygen level has dropped. 

Other groups that have been badly affected by the pandemic are the migrant workers, the refugees and prisoners. Many clusters have arisen from workplaces as a result of poor living conditions for these workers. Likewise with prisons. Overcrowding in prisons has seen
22,295 inmates with 21 deaths, and 1,112 staff with one death as of May 2021.

In terms of HIV programmes and access to treatment, disruption has not been that bad because hospitals adapted very quickly to tele-medicine and re-organising appointments. Thankfully, our community partners have really stepped up to ensure that needle syringe programmes and delivery of anti-retroviral treatments continue.

This is certainly reflective of the experience globally, where community organisations have mobilised to ensure that services aren’t disrupted too much. Despite that, projections have shown that Covid-19 will reverse the gains made in the global HIV response in terms of death and new diagnosis. 

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What's at the top of your priority list right now?

To ensure that we reduce the number of deaths and brought-in dead; to ensure better management of Category 3, 4 and 5 Covid-19 patients, and to ensure that non-Covid patients are not being neglected. We need to get better at using technology and digital tools to manage those who are in Categories 1 and 2 at home so that don’t progress to more severe categories. There are treatments that can be given to them once they progress to a more severe stage of disease. The issue is identifying these patients and treating them quickly so they don’t progress further to the point of needing ventilation and ICU care.

Drugs such as corticosteroids and immunomodulators such as tocilizumab and baracitinib have been shown to reduce progression to severe disease and mortality. The trick is to give these drugs at the right time. So monitoring patients carefully and knowing who is more at risk of progressing is very important. These individuals include those above the age of 60, males and patients with diabetes, hypertension and are overweight or obese.

Effective testing and contact tracing are vital so that when we open back up, we don’t go through yet another cycle of lockdowns and not being able to detect people who are infected.

What's the biggest obstacle faced by hospitals in Malaysia right now? 

Unfortunately, 85 per cent of Covid-19 patients coming in to hospitals right now are in Categories 4 and 5, which makes it really difficult to reverse the disease. These are the ones in ICU, and the surge results in a backlog, and so on.

The daily numbers keep going up and that’s because we have a huge pool of people who are infected and right now we’re still finding them. We must improve our data collection and analytics so we can be more precise in our response, knowing exactly where the trouble spots are, and where they are going to be.

The data has to be a lot more granular than it is right now so that, moving forward, blanket lockdowns will be a thing of the past. 

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What role does the non-medical public play in curbing the spread of this virus?

Honestly, if you ask me what has been one of our weaknesses, it has been this very area of mobilising, financing and working with grassroots organisations and leaders to assist with knowledge, education and practical support, beyond just giving out food baskets. Ultimately, we are all going to have to bear with the effects of this pandemic until as many people as possible are vaccinated.  Even then, we can't let our guards down. 

How have you learnt to cope with the stress of the job? 

I’ve always been the type not to sweat the small stuff. I tend not to let the chatter and noise over trivial issues get to me. Trust and delegation are very important as well. I trust my down-liners to do the right thing. So I’m there to supervise, troubleshoot, and to see the really problematic, sick patients, but overall I trust in my colleagues that we’ve trained them well to manage these cases. Sweating the small stuff and not delegating would probably have killed me in this job. 

What does your downtime look like?

I enjoy catching up with family and friends over a meal, something the pandemic has stopped us from doing for awhile now. I do a combination of yoga, Pilates and high intensity exercise about five times a week and I love reading newspapers and magazines particularly, The New York Times and The Atlantic.

My new hobby is gardening. It just happened quite serendipitously that I and a few of my colleagues I’m close to all quite independently developed an interest in gardening, starting with getting indoor plants for the office and home. Maybe it’s the doctor in us, the inherent medical training of making things better, of making people live again that translates to us looking after plants and getting so excited at seeing a new bloom or leaf.

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