KUALA LUMPUR, Oct 12 — Sabah’s Covid-19 onslaught threatens to overwhelm the poorest state in the country, as hospitals and frontliners struggle to cope with over 100 coronavirus cases entering the public health care system every day.
Doctors have already dubbed Semporna — the worst-hit district in Sabah with over 600 active Covid-19 cases — as “Little Wuhan”, referring to the central city in China where coronavirus was first reported last December.
According to health authorities, 85 health care workers in Sabah have been infected with Covid-19 in just 10 days since the start of October. An anaesthesiology medical officer in Hospital Duchess of Kent Sandakan (HDOK), who has been working in the Covid-19 intensive care unit (ICU) ward, tested positive for Covid-19 last Saturday.
Across Sabah, medical frontliners described full beds with sick Covid-19 patients, understaffed hospitals, fatigued health care workers labouring 24/7 as their colleagues contract coronavirus, and protective gear stocks running low. Stable coronavirus patients in Semporna and Lahad Datu are decanted to public housing flats, while Kota Kinabalu and Sandakan public hospitals have shuttered specialist clinics.
CodeBlue interviewed four doctors working in public hospitals in Semporna, Lahad Datu, Kota Kinabalu, and Tawau, as well as a government doctor and pharmacist in Sandakan, about their experiences during Sabah’s Covid-19 surge. Social media posts from Sabah frontliners were also collated. CodeBlue is keeping all their identities anonymous, as government doctors are not allowed to speak publicly without permission from top Ministry of Health (MOH) officials.
As of yesterday, Sabah comprised a quarter of all Covid-19 cases reported in Malaysia since the start of the pandemic here last January. Sabah also comprised about 15 per cent of the country’s coronavirus fatalities. Sabah currently has 2,720 active coronavirus cases. Unlike the second Covid-19 wave, which could be linked to a single event — the tabligh gathering in Kuala Lumpur — Malaysia’s third wave marks the true scale of outbreaks like those seen in other countries, with soaring sporadic cases and clusters as Sabah bears the brunt of the virus.
Semporna’s ‘Little Wuhan’
According to MOH, the coronavirus has infected almost 700 individuals in the small town of Semporna, Sabah.
A doctor, who is part of Semporna Hospital’s Covid-19 team, told CodeBlue that the emergency department is busy with an overwhelming number of sick patients.
“Emergency department in Semporna is busy with ill patients coming in, they are resuscitated and then sent to Tawau Hospital. So they are not managed in Hospital Semporna,” the doctor told CodeBlue.
As Semporna started reporting more Covid-19 deaths, especially the heartbreaking death of a one-year-old baby girl, Semporna Hospital started treating ill Covid-19 patients before transporting them to Tawau Hospital. Medications were brought in to Semporna Hospital and doctors were briefed on the management of ill Covid-19 patients, a doctor tweeted.
From a Facebook post by a doctor, ill patients were transported by frontliners through rough roads, even in the middle of the night sometimes, for almost two hours to Tawau Hospital for further treatment.
The Semporna Hospital clinician who spoke to CodeBlue said that even Tawau Hospital is overwhelmed.
“Tawau Hospital is overwhelmed with ill patients from Semporna Hospital — beds are full, intensive care units (ICU) beds are full, patients are ill.”
Anonymous Semporna Hospital doctor
As the small Semporna district hospital struggled to create more space to accommodate patients, things became more difficult when a tent (balloon concept) that was donated to isolate the patients started leaking. The team was left with no choice but to manually pump air into the tent every half an hour, a doctor shared on Facebook.
Stable patients are treated in the Bubul Ria People’s Housing Project (PPR) public housing flat in Semporna. However, even with this facility being set up, it severely lacks manpower. Semporna health authorities are calling for volunteers to help as frontliners in this centre. Volunteers must be of the age above 21, with their own vehicle, and should be able to work from 8am to 5pm, according to their schedule
Besides that, Semporna Hospital doctors were seen on social media posts wearing patients’ hospital uniforms, instead of their usual scrubs, that is worn under the personal protective equipment (PPE) because of the limited number of scrubs.
They not only have a limited number of scrubs, but their PPE stock is running low. Volunteers shared posts on their social media pages urging people to donate to help out with the PPE shortage in Semporna Hospital.
Just to ensure they give their best to their patients, a doctor working in Semporna Hospital shared on Facebook that frontliners work continuously with their PPE, without eating or drinking for 10 hours non-stop.
With the high risk of exposure, many frontliners themselves were infected with the coronavirus. This led to a shortage of manpower, forcing healthy frontliners to work extra hours, continuously for more than 24 hours, to compensate for the shortage.
“I do know a lot of health care workers are infected. Both hospital side and public health side are very understaffed.”
Anonymous Semporna Hospital doctor
“I don’t have the exact details, but public health in Semporna is very much affected,” the doctor from the Semporna Hospital Covid-19 team told CodeBlue.
In another social media post, volunteers comprising citizens of Semporna were seen helping out frontliners disinfecting the emergency department, transporting oxygen tanks, building partitions to prevent cross-infection among patients, and even disinfecting unused ambulances to be used to treat high risk patients.
Since the lockdown, business in the small town had dropped. A doctor working in Semporna shared a story on Facebook of a citizen who donated a canopy to be used by the hospital to accommodate more patients. The canopy was usually used by the citizen to find his source of income.
Families in Semporna, which is under lockdown, were also seen struggling to get food supply, which is why many volunteers from non-governmental organizations (NGOs) have helped to distribute food to these families.
In another social media post, a patient was seen being transported to the hospital using a wheelbarrow by a family member. According to the post, it is a norm for citizens there.
Sandakan Hospital ICU Doctor Contracts Covid-19
An anaesthesiology medical officer in HDOK Sandakan, who was taking care of the Covid-19 ICU ward for the past few weeks, recently tested positive for Covid-19.
The anaesthesiology doctor took to social media to express how the situation in Sabah is far worse than one can imagine, nothing like peninsular Malaysia, as the state’a public health care system is understaffed, while health care workers are fatigued and burned out. Sandakan currently has 281 active coronavirus cases.
In a letter to CodeBlue, another Sandakan doctor questioned if the anaesthesiology medical officer’s Covid-19 diagnosis would “cripple the medical and anaesthesiology department in HDOK”.
“HDOK is now asking for outside help. Even roping in dental officers to help monitor the stable, asymptomatic patients.”
Anonymous Sandakan doctor
Sandakan Hospital director Dr Francis Paul has decided to close all their specialist clinics comprising — surgical, medical, pediatric, general, eye, otorhinolaryngology, mouth surgery, psychiatric, and paediatric dental outpatient clinics — from today till October 23, The Vibes reported.
Although Sandakan MP Vivan Wong said that HDOK has enough PPE for now, a pharmacist from the Sandakan public hospital told CodeBlue that if Covid-19 cases rise, the hospital may not be able to cope with it.
“Ventilators are still enough at this point, but we are asking for more in anticipation of more ill cases,” Wong told CodeBlue.
Lahad Datu Hospital’s PPE May Run Out In 20 Days
On September 7, there was a major outbreak of the coronavirus infection in the Lahad Datu district police headquarters lockup and Tawau prison, with 50 cases in the Benteng LD cluster then. The cluster — first discovered on September 1 from two undocumented immigrants detained at the Lahad Datu police lockup — has spread rapidly in just over a month, infecting 992 individuals as of yesterday across Lahad Datu, Tawau, Sandakan, and Kinabatangan.
A doctor from Lahad Datu Hospital said that initially, the infection was contained in the prison, so infected people were only selectively admitted to the hospital, while asymptomatic or stable patients were treated and quarantined in the jail itself, but things changed when infections from this cluster spread to the community.
“Following that, (we) noted there were positive cases acquired from the community. More wards were needed to accommodate these patients,” the anonymous medical officer from Lahad Datu Hospital told CodeBlue.
“We are currently trying to shift the stable patients to a new centre in PPR.”
The Seri Sapagaya PPR in Lahad Datu has three blocks, out of which two will be used to treat the Covid-19 patients with mild symptoms while one will be used for all frontliners, including health care workers, armed forces, police, and local government personnel.
According to the medical officer, back in March, during the early stage of the pandemic, Lahad Datu hospital staff used to stitch their own PPE. Now, the current usage of PPE is a minimum of 800 sets every day.
“It is estimated to run out in 20 days,” the anonymous medical officer from Lahad Datu Hospital said.
“Not only staff taking care of Covid-19 patients need to be on full PPE. But also those in Person Under Investigation (PUI) wards, Person Under Surveillance (PUS), Severe Acute Respiratory Illness (SARI) wards or even those in Emergency and Trauma department.”
“We never know who may be asymptomatic Covid-19 positive out there,” the doctor stressed.
Kota Kinabalu Hospital Allegedly Rejecting Non-Covid Patients Without Life-Threatening Disease
KKM Watch, a group of anonymous government doctors, wrote to CodeBlue that Queen Elizabeth Hospital in the Sabah state capital of Kota Kinabalu was treating 400 Covid-19 patients as of last Saturday.
The group alleged that all non-coronavirus patients who do not have life-threatening illnesses are being turned away from Sabah’s tertiary referral hospital to channel all resources to Covid-19. Routine laboratory tests have also been allegedly cut down to enable more testing for Covid-19.
“Health care workers are tired and stretched thin. Resources, such as PPE and other vital equipment, are running low.”
“Staff are being called to cover other departments as many of them are being quarantined. The many months of hard work since the first MCO (Movement Control Order) has been taken for granted and thrown away!” KKM Watch said.
KKM Watch called for a centralised coordinated PPE distribution system to replace the current one, which they claimed was slow and opaque.
A physician from Queen Elizabeth Hospital told CodeBlue that the hospital is operating with eight wards specifically for Covid-19 patients.
“We are opening about two new Covid-19 wards each week,” the physician said. “PPEs are so far sufficient for stable Covid-19 patient management, but we might be running out of N95s with headloop (from hearsay).”
Health care workers treating suspected or confirmed Covid-19 patients are recommended to use the N95 mask.
Queen Elizabeth Hospital has shut down all its specialist clinics from October 5 until further notice, with exemptions for cancer patients and those requiring continuous monitoring from doctors.
Health director-general Dr Noor Hisham Abdullah said Saturday that two nurses working in the ICU in Queen Elizabeth Hospital have tested positive with Covid-19. Since then, 40 out of the 66 nurses from the ICU team were tested and now being quarantined.
With more than half of the manpower gone, the ICU was forced to reduce the number of patients from eight to six. Nurses, known as the heart of health care, are the ones who give the patients their medication, record their vital signs, care for patients’ needs, assist doctors in procedures etc.
MOH has allocated a total of 66 critical beds for Covid-19 patients in the whole state of Sabah. Health Minister Dr Adham Baba said in a statement yesterday that Sabah has 180 ventilators with a usage rate of 38 per cent and MOH is currently in the process of sending 14 more ventilators to Sabah. By adding Kota Marudu Hospital to the list of Covid-19 hospitals in Sabah, MOH has managed to provide 958 beds across seven Covid-19 hospitals to treat Covid-19 patients. According to Dr Adham, the current usage of these beds as of October 11 is 66 per cent.
Tawau Hospital Lacks Doctors
A Tawau Hospital specialist told CodeBlue that the public hospital does not have enough doctors, even though on October 4, MOH sent two medical officers from the peninsula to Tawau to help with the Covid-19 outbreak, plus another five yesterday.
Dr Noor Hisham posted on October 10 that MOH has mobilised 475 members from various categories and service schemes to Tawau, Lahad Datu, Semporna, and Kota Kinabalu, as he called for additional volunteers to combat the Covid-19 outbreak.
The Tawau Hospital doctor was not able to disclose the ratio of doctors to patients as civil servants are not allowed to speak to the media without prior approval from their higher-ups.
Sabah’s former state health and people’s well-being minister Frankie Poon said that he is very much aware of the shortage of both medical officers and nurses in Sabah. Besides that, medical officers who worked during the pandemic were not guaranteed a permanent position in the public sector after their two-year compulsory service.
“Many felt used and to be discarded upon the expiry of the two years if the pandemic of Covid-19 is resolved,” Poon told CodeBlue.
As Tawau Hospital sees more and more Covid-19 patients coming in every day, to give more space for those needing intensive care, the government has decided to add 100 beds in the Malaysian Armed Forces Field (ATM) Hospital in Tawau.
This hospital will be activated to treat non-Covid patients needing obstetrics and gynecology, pediatrics, and general surgery services, Bernama reported Dr Noor Hisham as saying.
Frontliners Build Isolation Rooms Outside Beluran Hospital
In a small district hospital in Beluran, Sabah, frontliners and volunteers were seen on Twitter building isolation rooms outside the facility for suspected Covid-19 patients.
Instead of outsourcing the project, hospital staff themselves were building and painting the partitions to reduce expenses.
Beluran Hospital usually refers their patients to Sandakan Hospital, but in light of the overwhelming number of Covid-19 cases there, they are trying their best to be as prepared as possible to handle the cases.
The volunteers, on their social media pages, are calling for donations for materials to build the isolation rooms.