Unprecedented: Sarawak’s way of tackling Covid-19

Covid-19 One Stop Centre (file photo).

By Ling Hui

LIKE the rest of the world, Sarawak faces an unprecedented situation — an unstoppable, deadly and ever mutating virus. The spike in cases triggered the need to organise and effectively manage the limited medical resources including manpower, equipment, logistics and even space from both federal and Sarawak governments.

In Kuching, to better handle available resources and serve the people, the unique Sarawak Covid-19 One-Stop Centre (COSC) — a command centre to coordinate the practical aspects and daily hands-on management of the Covid-19 situation in Kuching—was formed.

Sarawak Disaster Management Committee (SDMC), which was established to deal with all unforeseen disastrous circumstances and natural catastrophes in the State continues to oversee the overall Covid-19 situations in Sarawak while the pandemic in other states or regions such as Sabah is handled by the respective Health Departments. Sarawak is the only region where the pandemic is handled by a local unit, SDMC.

Following the setting up of COSC, the executive arm of SDMC in fighting Covid-19, various strategies to curb and handle Covid-19 related emergencies have been successfully launched.

Covid-19 One-Stop Centre

Established on May 3, 2021, COSC is strategically located at the compound of Kuching South City Council (MBKS) Community Hall due to its spacious premises.

Under the leadership of the centre’s commander-in-chief Dr Cheong Yaw Liang who wears two hats—one as a doctor and the second as an administrator— the COSC which was first launched as a pilot project has, to this day, remained the sole full-scale one-stop centre in the whole of Malaysia, coordinating no lesser than 15 agencies from federal and State governments to manage the local Covid-19 situation.

Since its establishment, ministers from around the country have paid visits to the COSC to see how it operates so that similar plans can be implemented in their own states or regions. Other districts in Sarawak, too, wished to set up their own one-stop centres, but to no avail, mostly due to geographical and manpower limitations.

Tents for drive-thru Covid-19 swab testing at COSC.

Then and now

The original COSC encompassed six components namely screening and polymerase chain reaction (PCR) swabbing, Covid-19 Assessment Centre (CAC), investigation and contact tracing, enforcement, helpdesk or hotlines, and transportation.

Since Aug 28, the CAC was separated from COSC and relocated to Stadium Perpaduan in Petra Jaya in view of the recent in Delta variant cases. The move was also aimed at reducing the number of people visiting MBKS Community Hall daily, and to provide a larger space to accommodate those only going for assessments.

With CAC moved out of COSC, the remaining five components were retained at COSC headquarters in Padungan. Currently running with 350 staff, COSC provides services such as swab tests, sample-taking, issuance of quarantine orders and release orders, and food aid distribution to those tested positive.

Under the COSC umbrella, four more satellite centres for testing were set up at Stadium Sarawak, SJK (C) Chung Hua in Batu Kawa, the Kota Sentosa basketball court, and Braang Bayur Health Clinic, to cater for residents from different areas.

The CAC on the other hand, continues to serve as the location where specialists and physicians determine whether Covid-19 patients need to be admitted to quarantine facilities or may be isolated at home, based on health conditions and infection severity.

A quiet afternoon at COSC, Padungan as the crowd size has reduced following relocation of the CAC to Stadium Perpaduan.

Moving into post-vaccination era

As Sarawak transitions into the endemic phase, one might start questioning whether the Sarawak government will one day stop providing Covid-19 testing and assessment services to the public.

The answer is no. While the State government through SDMC is working on stressing the importance of regular self-testing, Dr Cheong said health facilities for Covid-19 in Sarawak including swabbing and assessment centres will be there as long as they are needed by the people.

The services at the COSC will remain relevant even if Covid-19 becomes endemic, because those who develop symptoms will still need to verify whether or not they are positive with the virus. Some others may need documentation after testing negative in order to travel.

Of course, in the near future, citizens could always opt for self-testing when self-test kits are widely available and affordable for all walks of life.

“For the people to start ‘living with Covid-19’ is not only a slogan, but an intention to move the entire society forward where economy can slowly resume and the region starts rebuilding back to before.

COSC’s commander-in-chief Dr Cheong Yaw Liang

You may feel fine but you are not

With regards to isolation, Dr Cheong said the public must be educated well enough before the State can move towards home quarantines for Covid-19 patients in Categories 1 and 2 with no or mild symptoms. The people themselves need to know how to monitor their blood oxygen levels and vital signs at home, and when to seek medical help.

This is to avoid brought-in-dead (BID) cases due to ‘happy’ hypoxia whereby the patient feels fine but has less than normal oxygen saturation in the bloodstream. This phenomenon, also known as silent hypoxemia, is a silent killer among asymptomatic patients.

For now, he emphasised, the doctors especially ID specialists should be the only ones to make the decision whether a person can or cannot be quarantined at home. Non-medical personnel including the general public should not diagnose themselves without professional consultation.

Total opening by November?

“Currently, (health facilities) in our Kuching Division is still able to cope with that (walk-in testing and assessment), so all positive cases must be seen at CAC.

“We have yet to move into virtual CAC because, as a doctor for so many years myself, I think personal touch is very important, instead of seeing a patient through the screen,” he told DayakDaily.

Amid its future plan to set up a virtual CAC, SDMC has set up seven PKCAC (Quarantine Centres under CAC) especially catering for those who do not have a conducive home environment for self-quarantine.

Dr Cheong expressed hope that the general public will be ready to move forward in about two months’ time by November, as Covid-19 will not be going away anytime soon and every person has to learn to live with the virus.

“We have not reached that stage yet, but this is what I foresee. One day, there will come a time when Covid-19 becomes as common as the common flu. By then, we just live with it.”

Frequently Asked Questions (FAQs)

Ever since the establishment of the COSC, the authorities have been receiving many questions from the public on various matters. If you too have any doubts, feel free to browse through the compilation of FAQs below for answers:

  1. What are the operating hours and hotline numbers for the COSC and CAC?

Currently, the operating hours are from 8am to 5pm every day including weekends and public holidays, for all available centres providing walk-in swab test services to cater for the needs of the public.

The facilities involved are the COSC at Padungan, CAC at Stadium Sarawak and four additional testing centres at Stadium Sarawak, SJK (C) Chung Hua in Batu Kawa, the Kota Sentosa basketball court, and Braang Bayur Health Clinic.

Hotline numbers for the COSC during operating hours are 082-597 539 and 082-597 790. For the CAC, they are 082-312 749 and 082-313 961. The authorities are now looking into adding 24-hour hotlines to cater for those in need of medical advice outside operating hours.

  1. Will I need to pay for a swab test?

Close contacts and patients with influenza-like-illness (ILI) who are required by the authorities to get tested will not need to pay. Charges of RM150 will be imposed per swab, only for self-initiated tests.

  1. How long does it take to process my swab test?

Results are normally available within 48-72 hours after the swab. The result will be sent through the MySejahtera app.

  1. Am I allowed to go out or go to work while I wait for my results?

No. After a Covid-19 test at any swabbing centre under the COSC, you will be issued a three-day quarantine order. Please isolate yourself while you wait for your result.

  1. I’m sure that I’m a close contact, but why did I not get a quarantine order or wristband?

It is most likely that your name is not mentioned by the index case during his contact tracing investigation, thus your information as a close contact is not registered in the system.

However, please do not panic and remain calm. Knowing for sure that you have been in close contact with a positive case, you should isolate yourself for 14 days. Meanwhile, be aware of your health conditions. If you were to start developing symptoms such as sore throat, fever, diarrhea, or loss of taste and smell, seek medical help immediately.

  1. Why is the queue at the COSC sometimes so long?

Long queues can be triggered by the formation of a new cluster at a workplace or housing area due to social events or gatherings, which could lead to a high number of close contacts.

For example, one index case is on average expected to have a minimum of 10 close contacts (five from the workplace and five from home) in the span of 14 days. So, if 1,000 individuals have tested positive, there would be at least 10,000 more close contacts who will be visiting the centre to receive their swab tests and quarantine orders. The number of visitors will only increase if taking into consideration individuals who go for self-initiated tests.

  1. What can I expect when I go to the CAC?

If you have tested positive, officers from the Ministry of Health (KKM) will first give you a call requesting you to visit the CAC for an assessment to identify whether you are fit to be quarantined or need constant monitoring in a hospital.

At the CAC, medical teams will be present to check your vital signs such as blood pressure, blood oxygen level and heart rate. Then, your body mass index (BMI) will be measured to check for obesity. If necessary, additional assessments will be carried out.

Following the assessments, doctors on duty at the CAC will decide whether you are to be sent back home for home quarantine, to the CAC quarantine centre (PKCAC), or to be referred to infectious disease (ID) physicians for admission. Individuals arranged to be quarantined at PKCAC are usually those who do not have the right living condition for proper isolation.

  1. Will Covid-19 high-risk groups also be called to be assessed at the CAC?

Only those between the ages of three and 59 will be assessed at the CAC. Individuals under three and above 59 will be contacted by hospital personnel to be admitted to hospitals or Low-risk Treatment and Quarantine Centres (PKRCs) where there is constant monitoring by medical doctors and nurses.

During the assessments at CAC, high-risk individuals who have comorbidities, heart disease, history of cancer and other sicknesses will also be referred to ID physicians to be assessed for admission to hospitals or PKRCs.

  1. Can I choose to be home quarantined?

You will be allowed to be quarantined at home only if you are sufficiently fit and your living condition is approved by doctors. For your home to be suitable for quarantine, there must be a room or enclosed compound where you could isolate yourself from others.

  1. Can I do my own Covid-19 test using a saliva-based self-test kit before I travel?

No, because saliva-based self-test kits are very much operator dependent.

For proper documentation that you are indeed negative for Covid-19, it is necessary for you to get tested at swabbing centres including hospitals and clinics that are recognised by KKM.

This way, the entire testing process will be monitored by trained personnel and your results can be keyed into the Public Health Laboratory Information System (SIMKA) where information will also be available in your MySejahtera app.— Dayakdaily