Minutes of Virtual Meeting CMAAO NMAs
25th April, 2020, Saturday
Dr KK Aggarwal, President CMAAO
Dr Yeh Woei Chong, Singapore Chair CMAAO
Dr Rajan Sharma, National President IMA
Dr RV Asokan, Honorary Secretary General IMA
Dr Marthanda Pillai, Member World Medical Council
Dr Ravi Naidu, Past President CMAAO, Malaysia
Dr N Ganabaskaran, President Malaysian Medical Association
Dr Thirunavukarasu Rajoo, Hon. General Secretary, Malaysian Medical Association
Dr Alvin Yee-Shing Chan, Hong Kong
Dr Marie Uzawa Urabe, Japan
Dr M Namazi Ibrahim, Malaysia
Dr Russell D’Souza, UNESCO Chair in Bioethics, Australia
Dr KK Kalra, Former CEO NABH
Dr Sanchita Sharma, Editor IJCP Group
The following points emerged from the discussion today:
- Many Asian countries are coping well and are in a better position than the western countries like the US, UK and European countries.
- Some countries like Malaysia, Singapore are facing some outburst of cases due to foreign workers.
- CMAAO countries are working very hard to contain the spread of Covid-19. The mortality is lower in Asian countries.
- Lockdown seems to be a common phenomenon among the CMAAO countries.
- All countries are in different stages of Covid infection.
- It is still not clear what will be the course of the pandemic in the next 2-3 months.
- The situation is evolving very rapidly.
- The virus is here to stay; it will come back in waves. We must prepare for post-lockdown situation.
- Precautions (personal lockdown) should continue for at least 2 years.
- Pre-operative testing, which also includes Covid-19 in addition to HIV, Hepatitis B & C, will become a norm.
- AII rooms must be introduced in hospitals; if not possible, then rooms must have air purifiers with HEPA filters and exchange rate of 12 per hour.
- Social distancing will be the new norm, even for doctors. Plan for social distancing in offices.
- Airlines will not be fully operational for at least 2 years; may resume travel to lowest risk areas, and monitor it further.
- Malaysia had 88 cases yesterday; total active cases are 1932; 363 (64%) patients have been treated and discharged. At presented total cases reported are 5691.
- The 3rd phase of the MCO has been extended.
- Launched an app “MySejahtera” meaning “My Wellbeing” has been launched; details about your health can be put in the app and there is a symptom checker, which will give results and tell you if you are at risk. We can also check the area we are in (Red, yellow or Green zone) based on our location.
- The government is rolling out a return to work policy. It is planning to roll out RTPCR test for the first 100,000 workers in the next couple of days followed by antibody testing for surveillance of those returning to work.
- The exit strategy for MCO will be rolled out slowly.
- Malaysia has a sizeable migrant worker population, which is an area of concern. There might be clusters.
- There has been an explosion of cases in migrant workers, but we still have a very low death rate. One of the reasons for this is that migrants are mostly under 30 years of age. Our local data shows that if you are under 30, only half (0.5%) will need oxygen; the remaining 99.5% are just lying in bed, we test them, if they are negative then they go home. So, fortunately the disease is very mild in our migrant population.
- Migrant population have been moved out of their dormitories and put in temporary isolation centers. Only about 10% rooms are infected i.e. there are clusters within the dorms (the whole dorm is not affected).
- The lockdown has been extended to the 1st of June.
- The lockdown has started to some effects; there are less and less community cases.
- In future, the pandemic will come back in waves.
- Singapore is facing both 2nd and 3rd waves together. 2nd wave due to people returning back, especially from the UK; the 3rd wave is the migrant population.
- Run your own local tests. We used antibody tests that came from China, which had 90-99% sensitivity and specificity, but our local tests showed that it was only 30%.
- We are more or less keeping the rate of growth of infection under control. The doubling time has improved to 6.5 days from 3.5 days.
- The increase is only linear; there is no exponential increase in the number of cases.
- Because of shortage of PPE kits, we have started manufacturing (good standard) them locally.
- The situation varies from state to state. Every district has been divided into 3 zones - red, yellow and green depending upon the number of Covid-positive cases.
- Antiviral drugs are being tried as treatment; convalescent plasma therapy has been successful in at least one patient.
- Vaccine trials are going on at ICMR level and the National Institute of Virology (NIV), Pune.
- The lockdown is complete; we are slowly trying to release the lockdown for economic and social reasons.
- Pre-operative test for Covid-19 should be routine for all surgeries, even elective procedures. This has medicolegal and safety concerns.
- Decontamination of clinics is a viable option.
- The quality of kits is very important. Kits from China have also failed in India.
- The govt. of India has brought in an ordinance to amend the Epidemic Diseases Act, 1897 incorporating stringent provisions against people who commit violence against doctors, nurses and paramedical workers. Attacks on doctors, paramedic staff have been made non-bailable offences punishable with up to 7 years imprisonment. We hope that the govt. will extend this law even when there is no epidemic and we will have this as a regular law.
- All surgeries
- There are very good reports from Australia.
- Australia is in the midst of stage 3 lockdown. New Zealand is in stage 4 lockdown.
- The lockdown in Australia could be lifted in three weeks, in a gradual manner. Schools will restart.
- We are now improving but it is still not controlled since there are few patients with serious illness.
- We have tried to prepare ICU into a full negative pressure room to reduce the use of PPE.
Hong Kong Update
- The number of confirmed cases has been less than 10 each day. This number has been nil for the last 2 days now.
- We have practiced absolute quarantine for those coming back to Hong Kong; moving them to hotels designated for quarantine. There is no contact between people coming back from overseas and the local people.
- People have been using face masks voluntarily. We have advised them to not touch face even though wearing a mask; this is a loophole for getting the infection.
- We have kept our confirmed cases to 1036, but this is not the time to be complacent. Next month, there is a possibility that the border between Hong Kong and mainland China may reopen. We are on our guard.
- Schools are still closed; university entrance examinations started yesterday. Few students had high fever and left the examination room. This has introduced loopholes in the disease transmission.