The Beginning of the COVID19 Outbreak in Malaysia

At the end of December 2019, Chinese public health authorities reported several
cases of acute respiratory syndrome in Wuhan, China. When the Malaysian
authorities heard that an ‘unknown virus’ had precipitated these cases, the
Malaysian health authorities were on high alert and believed that these could
culminate into a major health concern in the region.[6] Planning and
preparedness began then, including coordination with public health teams, plans
for renovation of hospitals for surge capacity, and plans for procurement of
reagents.

But it would be a month or so before the first cases were detected in Malaysia.
On 23 January 2020, eight Chinese nationals entered Malaysia via Johor Bahru
on Malaysia’s Southern border with Singapore. These travellers had been close
contacts with a COVID-19 index case detected in Singapore, and all eight were
tested for COVID-19. On 25 January 2020, a public announcement was made
that three of these individuals had tested positive for COVID-19. In total, Malaysia
recorded 22 cases in January 2020, all of which occurred via imported cases.[7]
On 26 January 2020, the Ministry of Health (hereinafter MOH) first advised
Malaysians to avoid crowded places when travelling to China.

Cases in February 2020 were largely imported cases as well. According to Dr

Noor Hisham,

“A serious concern for a more massive COVID-19 outbreak in Malaysia was

when we received notification on 9 March 2020 from our counterpart in Brunei
Darussalam about a positive COVID-19 case detected in their country. The case
was epidemiologically linked to an annual mass religious assembly at Seri
Petaling Mosque, Kuala Lumpur held between 27 February to 1 March 2020
involving more than 14,500 local and 1,500 international attendees.”[8]

By mid-March, more than half of Malaysia’s 673 confirmed cases were linked to
this mass religious event.[9] By 10 March 2020, the newly-appointed Malaysian
Prime Minister advised the public to practice social distancing, and on 11 March
2020, the WHO declared the COVID-19 outbreak as a pandemic. On 12 March
2020, the government made the decision to designate Sungai Buloh Hospital, a
public hospital approximately 25kms northwest of Kuala Lumpur, as the country’s
main COVID-19 hospital.[10]

Following the substantial number of COVID-19 cases reported domestically

following the religious gathering in Sri Petaling, the Government of Malaysia
made the decision to implement lockdown via a Movement Control Order (MCO)
nationwide, beginning from 18 March 2020.

Planning and Preparedness for ‘Surge Capacity’

Planning and preparedness activities began relatively early in Malaysia, with

initial planning starting in December 2019, diagnostic reagents procurement in
January 2020, and a number of renovations to hospital facilities done in February
2020. In the West, the EU had made an announcement that they would assist
countries in the EU in COVID-19 joint procurement schemes on 31 January 2020,
with countries in the EU being at various stages of procurement for both
protective and medical gear in April 2020.[11]

According to Dr Suresh Kumar, an infectious diseases clinician at Sungai Buloh

Hospital:

“In February we started emptying the hospitals. Surgeons had to do surgeries

elsewhere so we could clear ICU beds of post-op patients. Other hospitals took
the brunt so that we could focus on COVID-19. We started building capacity
when we heard how Wuhan was overwhelmed. We knew that a lot of the
mortality in Wuhan was because of the surge (in cases) and the fact that their
hospitals couldn’t cope. So we started building surge capacity. I’ll give you an
example of this – Sungai Buloh is actually a 900-bedded hospital. We made
renovations to make sure it could accommodate over 2000 bedded patients.
There was an old hospital next door that we immediately renovated and brought
in beds to get it ready. We also learned from China that their ICUs were totally
overwhelmed – so we then reviewed our own ICUs to see what else we could
convert into ICUs. We saw that the daycare centre could become ICU beds, that
the operating theatre could include ICU beds. We seem to have come out of this
without our hospitals getting overwhelmed.”