Improve Covid-19 reporting system, say health experts

PETALING JAYA: Health experts have urged the government to improve its system for reporting new Covid-19 cases after health director-general Dr Noor Hisham Abdullah said a spike in cases last week was down to a backlog in case reporting.

The number of daily cases breached the 5,000-mark for three days in a row last week, with Noor Hisham stating that the 16,751 total from Jan 28 to 30 included positive cases detected last year.

Dr Khor Swee Kheng.

While he said system errors and human mistakes were “inevitable” in a multi-year pandemic, Dr Khor Swee Kheng, a health systems and policies specialist, felt that the focus should now be on building a system that allows for errors to be discovered quickly and for corrective and preventive action (Capa) plans to be implemented.

“Capa plans are necessary to ensure that the system self-corrects and self-improves, and Capa plans are present in many industries like oil and gas, aviation and IT,” he told FMT.

“The presence of a Capa system will also strengthen the trust of citizens.”

Malaysian Medical Association (MMA) president Dr Subramaniam Muniandy called for increased manpower to ensure more such cases do not slip through the cracks.

“For so long, we have been saying we need a lot of manpower to get through this. Now everybody is waking up,” he told FMT.

Dr Subramaniam Muniandy.

While he said the country dealt with the pandemic well during the early stages, a spike in cases after the Sabah election and a delay in screening foreign workers meant the virus soon spread to the community.

The health ministry reported 4,214 Covid-19 cases and 10 deaths in the past 24 hours, with the total number of infections now standing at 219,173 and the total death toll currently at 770.

‘Beyond imagination’

Former deputy health minister Dr Lee Boon Chye, meanwhile, said the backlog in cases might have been due to ICT issues and overworked staff at district health offices.

Stating that it was “beyond imagination” that such a backlog existed, Lee added that by law, doctors who order Covid-19 tests have to report positive cases to their local district health office. The office will then forward the data to the health ministry’s Crisis Preparedness and Response Centre (CPRC).

The data received by CPRC until noon is then used to compile the statistics for Noor Hisham’s daily press briefings or media statements on Covid-19 updates.

“Somehow and somewhere along the way, something went wrong,” said Lee.

Dr Lee Boon Chye.

“We are talking about the IT world here, and everything is connected. For me, this is beyond imagination and is something that should not have happened.

“The health ministry should integrate its database with the local labs because that is where the confirmatory tests are done.

“If they are positive, they are forwarded straight away to the CPRC, which can then verify the results and will have up-to-date data everyday by noon.”

Noor Hisham and Selangor menteri besar Amirudin Shari previously said the delays in reporting cases were due to private clinics and hospitals not immediately reporting positive cases, a claim which Lee brushed off.

Stressing that doctors have to report Covid-19 positive cases within 24 hours of receiving the test results, he said the Prevention and Control of Infectious Diseases Act 1988 (Act 342) clearly mandates the compulsory reporting of infectious diseases.

No cover-up

In October, Noor Hisham also attributed a spike in Covid-19 cases reported in Sabah to a backlog in testing, after new infections in the state reached triple digits for more than 10 days in a row.

Touching on reports that patients in Sabah had to wait several days before being admitted to hospital or low-risk treatment centres, Noor Hisham told a press conference on Oct 18 that results “came back a bit late” after it outsourced the processing of samples to the Institute for Medical Research.

Asked to comment about claims on social media that the health ministry was not being honest with the daily Covid-19 numbers, both Lee and Subramaniam dismissed such suggestions.

“It’s not a cover-up,” said Lee. “It’s just delayed information.

“The data cannot be kept up to date. Contact tracing, isolation and quarantine cannot be done in time, so when we fail in this, we cannot control (the pandemic).”

Subramaniam also said he did not think the ministry was “lying or covering up”, stating instead that the backlog may be due to inefficient systems.

“The government has mishandled this,” he said, “and now they have to buck up.”

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