No triage between Covid and non-Covid patients in ICUs


IT IS unlikely for non-Covid patients to be triaged nor Covid patients to be given the priority for the intensive care units (ICUs) and ventilators in hospitals despite the overwhelming situation in hospitals due to the increasing number of cases.

The Malaysian Medical Association president Dr Subramaniam Muniandy said the country’s public healthcare system has yet to reach the stage where health workers have to triage by selecting patients for care based on their chances of survival.

“There are separate ICUs for Covid and non-Covid patients, so any triaging is not between Covid and non-Covid.

“Also, if Covid cases decline, ICUs can be switched back to general use and vice versa,” he told The Malaysian Reserve (TMR) in a phone interview.

Osel Group chief clinical and innovative scientist Dr Kris See said as public hospitals are being stretched to their limits, there are scenarios where such situations lead to non-Covid patients being reassigned to other wards.

However, he said this would be temporary, adding that the nation is in the middle of a crisis and such an unfortunate situation requires unprecedented measures.

“To manage this effectively, I have always advocated a public-private-people (PPP) liaison in managing the Covid-19 pandemic.

“Urgent critical non-Covid patients perhaps should be reassigned or even referred to the private hospitals that are equally able if not even better in handling critical non-Covid patients,” he told TMR.

However, Dr See opined that it looks like till now much of the private healthcare resources are not optimally utilised, thereby losing critical time and wasting precious resources.

“It still remains baffling to me that private healthcare in Malaysia, including clinics, medical centres and hospitals, are not given equal priority in this collective battle, despite constant lobbying from the private sector.

“Collective leadership is paramount here,” he noted.

Dr See added that the process of referring non-Covid patients to private hospitals for elective surgeries and procedures has not been progressing as effectively as it should due to different reasons.

Besides cost being a factor, he said there are instances where patients are reluctant to be treated at private hospitals due to logistics and follow-up concerns.

He also noted that health experts used to refer patients to the public hospitals in the past, but now in view of the lack of manpower, the private healthcare system is seeing an increase of referrals of non-Covid patients from government hospitals.

However, he emphasised the number of referrals issued for non-Covid patients were not up to the mark.

“I think one way to overcome this is a clearer framework be set up for both hospital administrators, doctors, patients and their families to refer to, so that options can be discussed readily whenever such concerns arise.

“Clarity is important. Again, only through a PPP liaison, can we effectively manage this on-going pandemic. This could perhaps be better engaged by the policymakers.”

Previously, Health DG Tan Sri Dr Noor Hisham Abdullah said elective surgeries and procedures in public hospitals around the Klang Valley would be reduced or postponed to enable more hospital beds to be reserved for the treatment of Covid-19 patients.

In response, the Association of Private Hospitals Malaysia president Datuk Dr Kuljit Singh had urged doctors in government hospitals to refer their non-Covid-19 patients to private hospitals for elective surgeries and procedures without further delay.

He said this was following an updated circular by the Ministry of Health (MoH) allowing government hospitals to outsource services to private hospitals to treat non-Covid patients in order to create more treatment space for Covid patients in public hospitals.

“At the moment, all private hospitals in the country have the capacity to assist the government in managing non-Covid patients effectively and this will allow public hospitals to exclusively treat Covid to meet the current increasing number of patients.

“Treatment of non-Covid-19 patients in private hospitals will be funded by the government based on the circular, but patients can only be referred by their treating doctors in public hospitals to private based on the condition of the ailment,” he said in a statement.

Dr Kuljit also pointed out that the take-up unfortunately was not satisfactory as only a small number of referrals had occurred to help patients in government hospitals who had waited for months and even close to a year to get treated in private hospitals.

He also noted that there are 31 private hospitals in the Klang Valley alone which are currently managing Covid-19 patients in normal wards as well as ICUs.

However, he said there is a limitation in expanding the capacity to accept more Covid-19 patients in private hospitals due to man- power constraints, unlike in public hospitals where there are house officers, medical officers and more specialists.