A frontliner’s perspective

A conversation with Dr. Mohammad Farhan Rusli, Public Health Specialist, IIUM and Director, Selangor Task Force Operations

By Dr. Rabiah Tul Adawiyah Mohamed Salleh, Covid Psychosocial Support, IIUM

 We are currently in the second year (the second half) of the COVID-19 pandemic. The virus has upended and disrupted nearly every aspect of our lives. Contrary to what we all believe (and hope for) in 2020,  COVID-19 is here to stay, and it is a bitter pill to swallow. As I wrote this, the COVID-19 cases in Selangor alone have reached 7000-8000 cases daily. Like many of us, I am also in a state of confusion, shock, and after a while, numbness to see the reported increasing numbers. To better understand the situation, I had the privilege of speaking to Dr. Mohamad Farhan Rusli, IIUM’s Public Health Specialist, who is also the Director for Selangor Task Force Operations (STFO). Here, Dr. Mohammad Farhan elucidates on the comprehensive mass testing screening, which is now in full operation in Selangor since May 2021, and some of the measures put in place by the state to facilitate those who are tested COVID-19 positive. 

1. Dr, can you explain this mass testing in Selangor and what initially sparked the process?

In March 2020, when the first Movement Control Order (MCO) was enforced, I observed that the COVID-19 testing procedures were a bit unfeasible; at that point, in a specific locality, we were only able to do up to 300 tests daily. In the first half of 2020, until October 2020, testing was not implemented to get as many cases as we could. Hence, when we thought we had the cases under control, in reality, it was mainly because there were no proper and comprehensive mass testing procedures in place. When I looked at this, I thought there must be a more efficient way to resolve this issue, and the solution may not necessarily stem from the medical point of view. I then adopted Henry Ford’s moving assembly line in the mass testing screening. Ford’s assembly line incorporated repetition and was proven to cut costs and increase productivity. The general idea in testing is this; the more a medical personnel swabs (for COVID-19 cases), the faster that person becomes as he/she is getting adept in the process. When I took over the mass testing operation in Selangor, we gave a very unrealistic number of tests to achieve daily. Alhamdulillah, the outcome was that we achieved five times the number we projected, all attributed to the assembly line concept. At one point, we managed to conduct 5200 tests in six hours. Because of this, we are able to detect cases much, much faster now. 

2. Why do you think having efficient mass testing procedures is essential?

The procedures are crucial because there are preponderant discussions about stress and burnout in health care workers during the COVID-19 pandemic. In reality, it is more about effectively utilising, managing and strategising the available human resources. Malaysia has among the highest number of civil servants. Yet, we keep hearing about issues of understaffed hospitals. This perhaps may be due to the mismanagement of the staff workload, which is already present prior to the pandemic. The pandemic only reveals the ‘crack’ in the system, and there is no way to hide it any further. As a nation, when the pandemic struck, we only recently realised that we have never invested in public health measures. In public health matters, we will not see the outcome of the investment instantaneously. The earliest we may be able to see the ‘fruits’ of the investment is perhaps, a generation later, approximately 15-20 years later. Thus, public health measures have always been underfunded because they have never been a political mileage, until now.

3. But Dr, the cases in Selangor have gone through the roof. How are we going to stop the numbers from rising?

The numbers will continue to spike because we will continuously find new cases. For me, it is not about bringing down the numbers; it is about stopping the infections from spreading further. To do this, we need to find the cases as many as we can and isolate them. 

4. Now, with the current lockdown, do people go out and get tested?

Yes, they do. Especially during the lockdown because people have no other places to go. 

5. So, let’s say I want to get tested. Do I simply go to the COVID-19 Assessment Centre (CAC) and get tested on the spot?

Yes, you may go and we will test you. 

6. If I am tested positive, what should I do next?

Once you are confirmed positive, we will call you back at the site where you are tested. It will only be one to two hours to get the result after you have been tested. You will be given a home assessment kit; in that kit, there is a pulse oximeter (so you may check your oxygen levels), face masks, cough syrup, panadol and other necessities. We will also ask about your financial and family background; whether you have a stable income and if there are other family members at home. If you need help, we may refer you to the state counsellors. These are some measures that we put in place to help those confirmed positive while waiting for the call from the Ministry of Health (KKM). 

7. Are there many asymptomatic cases in Selangor? People with no symptoms but tested positive.

Most of the positive cases in Selangor are 90% asymptomatic/ mild symptoms. Healthy individuals like you may be safe, but you may be a vector to COVID-19. For instance, because you thought you are COVID-19 free, you may becoming lax in taking precautions against COVID-19. Consequently, you may spread the infection to other high-risk, immunocompromised individuals, the very people we want to protect. As I mentioned earlier, this is why we need to test as many as we can to prevent the spread. In the current situation, until everybody is fully vaccinated, we have to view that everyone is a possible COVID-19 carrier. With the Delta variant, which is highly contagious and easily transmissible via air, we need to fully observe the Standard Operating Procedures (SOP). 

Listening to Dr. Mohammad Farhan’s explanations about the mass testing screening, I cannot help but felt extremely humbled by our  frontliners’ invaluable sacrifices and dedication in their unwavering efforts to contain and manage the ever-raging pandemic. One key takeaway I obtained from the discussion is that as a society, we are all interdependent and interconnected. The only way out of this public health crisis is through collective efforts; everyone must practise the recommended SOPs and get inoculated as soon as possible. 

first published: 18th August 2021