Covid-19 in Malaysia now at Code Blue stage

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by Dr Venugopal Balchand

My previous article “100 Malaysians dead in 3 days” was published here on May 15. In the three days since, another 125 Malaysians have died from Covid-19, including a record 45 yesterday.

Code Blue is the medical term to announce a dire in-hospital emergency when the patient has suffered a cardio-respiratory arrest and cannot be moved.

All hospitals have highly trained Code Blue teams who, most importantly, drop everything that they are doing to focus only on resuscitating the collapsed patient.

CPR, or cardio-pulmonary resuscitation, is a term made ubiquitous by the many medical dramas from Hollywood. I must warn you, however, that it is not all that glamorous.

CPR for witnessed cardiac arrests in hospitals, and conducted by trained personnel, have a success rate of close to 40%. Of these, less than 20% are eventually discharged home alive.

Bystander CPR conducted by either trained people or Good Samaritans outside the hospital premises has a success rate of only around 15%.

Less than 10% of these individuals are discharged from hospital even if they reach there alive in the first place.

CPR, without a doubt, offers hope and certainly a decent chance of survival.

DNR is a medical term that is an acronym for “do not resuscitate”. It has no legal standing but is respected by doctors as the patient’s and his/her family’s request to die with dignity.

Medical education is obsessed with saving lives. But the real world teaches you that death is the only constant in life and it deserves empathy, compassion and grace.

I lost my father in 2006 when he was 78. God bless his soul.

Today he would have been 93 and if he had a Code Blue from an illness that had a dismal prognosis and any further treatment was deemed futile, I would unhesitatingly tell his caregivers to DNR.

Of course, only after discussing the matter with my siblings and extended family.

This brings me to what I am trying to say in this letter.

Malaysia’s medical infrastructure is being bombarded daily by a devastating number of Covid-19 cases.

We have reached a stage where, I think, the most relevant numbers are intensive care unit (ICU) beds available, ICU occupancy and ICU mortality.

Currently, we have around 1,100 dedicated Covid-19 ICU beds nationwide, both the public and private sector combined, of which 850 are in the public sector.

Occupancy is at 90% to 100%. And though the overall mortality for Covid-19 cases in Malaysia hovers around 0.4%, a whopping 30-35% of Covid-19 patients on ventilator support in ICUs die. The average length of stay in the ICU is seven to 14 days.

Sobering indeed

We have already reached the stage where our military has set up a field ICU in Penang. While it is extremely commendable on the one hand, it is certainly a stark reminder of the strain on our healthcare system, on the other.

A major hospital in Selangor has already acquired a refrigerated shipping container to store the dead.

These are the harsh realities of the pandemic. The harsh realities of too little too late, and certainly the indubitable consequence of having underestimated this virus.

Agonising images of abject poverty and gory drone videos of mass cremations portray India as hell on earth.

But, objectively, in that hell there are two heavenly consolations:

These are two nuclear options in this war against Covid-19. With these, from the flickering embers of despair and destruction, will rise the clean white smoke of hope, optimism and recovery.

In comparison, Malaysia’s drug manufacturing prowess is a pale shadow of our neighbours, and we only “fill and finish” Sinovac vaccines.

According to a New Straits Times article dated July 14, 2020, the only vaccines actually manufactured in Malaysia are for animals.

So much has been said and written globally about medical infrastructure, oxygen, vaccines, lockdowns, moratoriums, etc, that people forget about the men and women working the hardest in this pandemic.

These nurses, other allied medical support and doctors have names and families. Most importantly, like you and me, they have feelings.

Has the man on the street tried being in full PPE for more than an hour? These heroes don them for a minimum of eight hours at a stretch, sometimes double that.

In the most adverse conditions, they try very hard to snatch victory from the jaws of defeat.

But it is becoming increasingly difficult. Just the sheer volume of patients is overwhelming. Soon they will not be able to cope. They will break down and cry.

There are only so many dead bodies you can see, 45 in a day is way past their acceptable limit.

Ever so often, adversity has only brought the best out of us Malaysians. We can and should help all our frontliners.

And believe me, it is stunningly simple just to do nothing.

Yes, that’s right – do nothing and stay at home. Let the professionals do their work.

With just a little below 5,000 cases a day, Malaysia is gasping.

Soon, even the authorities tell us, it will be 8,000 to 10,000 cases a day. The time for lethargy and pussyfooting is over.

Allow the situation to deteriorate any further and we will be announcing a Code Blue.

In CPR parlance, we need 30 drastic chest compressing decisions and two rescue breaths, immediately, if we are to have even the slightest chance of resuscitating our motherland.

DNR is not an option.

God forbid, if it indeed becomes futile, spare a thought for our ICU doctors and nurses. Somebody has to switch the ventilator off.

One of the most haunting images in medicine is that of a patient who has just died in the ICU.

A green flat line and an awful, eerie high pitched sound on the cardiac monitor with the ventilator still pumping. Two machines begging each other to not give up.

After 35 years as a doctor, I have seen this more times than I would like. But it has, thankfully, not robbed me of my humanity or intelligence.

Every single time, I still get that lump in my throat and my eyes become moist. And through the barrage of emotions, I keep wondering if I could and should have done anything better.

I need to learn. When it comes to human lives, there is no question of repeating a mistake.

God bless Malaysia.

Tiga faktor kes kematian COVID-19 meningkat

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