Pre-impact

 

The local county had been celebrating +0 for a couple of weeks since the start of recent outbreak. A few possible clusters was noted but however did not expand into an uncontrollable state.

The outbreak started in late April where a few pilots from the local airlines were tested positive. The incident was preceded by a relaxation of quarantine rule for airline pilot by the local health authority. The initial rule was 5+9 where a pilot had to be quarantine for 5 days followed by 9 days of self monitoring period. Later the restriction was adjusted to 3+11 by mid of April.

The discovery of positive cases among pilot was later follow by case from the community. Cases by cases were noted among the resident of WH area(old town of T-city). Suddenly it had become out of control with hundred of cases were reported in a single day. Major hospital’s ICU was packed with patient, negative pressure rooms were filled up quickly and patients were referred a few hundred km down south for critical care.

Most of the virus strains noted was of the alpha strain, originated from the pilot cluster. The medium of transmission was believed to be the N- hotel which manned by the government own C- airline. The hotel had mixed its patron with the quarantined pilot at the same floor. More and more cases were noted despite contact tracing and isolation effort. An active lion club leader had spread the disease to its member after attending a few gathering. The spreader was known as the ‘Lion Ling’. A grape dealer had also formed a cluster transmitting to his relative and friends. The final hit was noted after cases emerging from Tea lounge with female GRO(guest relation officer) at the WH area.

The whole island had fallen since then. Cases with foot step tracing back to the WH area was noted. Luckily the southern part of the island had managed to stop the chain of transmission by proper contact tracing and isolation. Within 4 weeks, the southern part had managed to achieve zero case while the north was continually haunted by cases of ? origin.

We had stood at our principle of no travel, no contact history is considered safe rule.

We had wanted to purchase PCR machine however no stock was available and we had to send our sample out for testing initially. The whole process was tedious. Patient was admitted to isolation ward pending negative test result. The ED was considered as hot zone in many hospitals however we had treated our ED as grey area; not contaminated nor clean. Some of our staff had started to loosen their grip and various restricted wrong doing (swab test in the ED without proper precaution) was noted.

PCR machine had arrived later and rapid test kit was approved for after the initial hazardous weeks we been through. The arsenal was built up slowly and the line of defense had been stronger ever after.

Level 3 alert state around the island had been a suffering stage for everyone. Dine in was not allow, food joint had turned their focus to take away. Meal box was selling like hot cake from some top notch restaurant. The only place allow to eat is your own premise. Face mask was required everywhere except your house. All entertainment joint had been shut down.

The local people had confined themselves in the house and the southern part had been noted with zero case weeks after the outbreak. We were looking forward to the relaxation of critical state at the end of June but the falling boulder hit us one by one until we were knocked out…

The rise...

Although we had a small surge of cases during the January of 2021 which involved a hospital up north; the flame was controlled by the local authority quickly. The situation was quiet for a couple of months until the lower half of April. A few airline pilots were tested positive followed by their family. When the local authority rammed up the testing, more cases were revealed. The situation had lost control and the government had elevated the situation to level 3.

Peoples were requested to don mask all the time when they leave their home; restaurants were ordered to shut down dine-in. The worst part was the vaccine amount delivered.

I received my vaccination at the end of March. The only choice available was AstraZeneca vaccine. Frankly said, I had doubt to receive the vaccination but as a front-liner, I had no choice but to risk my life for it.

I remembered the day of the jab. It was my off day and I registered for my vaccination at PTC hospital 20km away from my house as my own hospital was not authorized to give any vaccination at that time. I arrived early at 9:15am and reported to the clinic after initial registration. I had gotten my jab 30minutes later and after observation for 30minutes. I left the clinic. Ving had accompanied me to the clinic and we had stopped by a local restaurant for our brunch at 11am. We finished our meal later and proceeded to the BNQ mall for some home repairing staff. When we left the shop by 1pm, I was so tired then and Ving took over the wheel and driven us home. I slept throughout the journey and continued my nap the whole afternoon.

I woke up in by 7pm with soreness over my body and eaten my dinner. By 9pm, I sunk into my bed and woke up at 6am the next morning preparing for my shift.

The next 5 days, I had experienced most of the side effect listed on the list except for fever. I had fever though and had to take medication for it. I was lucky as I did not suffer from any fatal complication.

By the time the outbreak surged up late April, only part of the medical staff was vaccination as the AZ vaccine was treated as notorious by the local people. However as cases built up, the limited AZ vaccine had become hot cake over a few weeks and the government was out of vaccine in a short period.

Cases had increased from single digit to few hundred per day. Most of the cases were noted in the northern part of the island. The south was calm and even though some infected person had placed their foot step around the area but yet no prominent cluster was noted.

The atmosphere was tensed up north, but the south was still a land of peace in 5/2021. We still practice the ‘negative TOCC’ means no risk of infection principle. The screening rate was still low as sending PCR test means the patient need to be quarantined in his house for 1D1N before the result could be obtained.

However we hit the rock one month later…..

new year new wave

The new wave finally strikes my homeland and northern part of the island since few days ago 

Homeland had been well controlled even though it had been noted with 2-3 daily figures of new cases. The loosening of the control order had brought hope to economy recovery; however it did not last long. Non compliance to the control order had eventually fueled up the gas tank leading to a blast after the state election in the Borneo. The blast’s shock wave had however expanded and over crumbled the medical system. Daily ICU case raised and mortality had increased steadily since 1+ months ago. I am not concerned about the daily cases but had been tracing the ICU cases and ventilated cases rise during that period. These two figures reflected the final burden of the medical care. The expo center neared the agricultural university was transformed into a hospital for low risk group with bed of 600 initially. Each bed had cubicle with cupboard, bed, table, chair and a spacious personal space. Recent 2 weeks, it had been expanded into 10000 beds where it had been more crowded than a Bangla workers dorm…And even with such facility, it was not enough, the ministry had planned to build more facility and allowed low risk patient to be treated in their own HOME!!! The decision might lead to a further worsening of the condition as peoples have not and will not comply to the order....

Finally, the boleh land had reached it breaking point. Darurat was announced and government had the power to mobilize everything including private hospitals. Political struggles was still going on despite of the Darurat. The DG was playing his part well but without a full mandate and authority to run the situation all he could do was plead everyone to stay home. The leaders of the country had been breaching the SOP like don't know what; solid evidence? Look at the amount of positive test result among the ministers; if they had complied to the order, they would not get infected….if the head cannot be straight, don't hope the body to do so...

The northern part is currently at the verge of outbreak after a nosocomial infection originated from a resident physician treating a covid 19 patient.

The contact tracing of such event had led to a massive screening event and currently it had spread beyond the boundary of the relevant hospital. One of the patients was a husband infected by his wife and he worked in a fast food joint at one of the airport express station. The command center had extended it screening and isolated the in patient service initially. Tension had built up as more and more positive cases were noted and further closing down the service was done by stage. Some local authorities up north had ordered postponing of some events.

Since earlier this month, the authority had demanded us to upgrade of screening. We were given a quota to performed screen on patient with diagnosis of pneumonia. Few months ago, we were encouraged to screen patient with severe acute respiratory illness case and especially hinted us to screen those with diagnosis of pneumonia. We had however known that it would be an index later on and started to refrain ourselves from coding pneumonia in our diagnosis. Most of the hospital except one did similarly except one. Their quota was 30 as they had coded pneumonia for 150+ cases for the last few months.

I had a referral case down south for pneumonia which favor pulmonary tuberculosis reactivation yesterday. I had decided to screen it as he will be staying in the negative pressure isolation room anyway. So after months of easiness, I had donned the PPE again…Smooth process and it was a good drill for me to revise the procedure.

I had called my dad on regular basis to check on them every few days. Life definitely is bored and the only things they could do is to walk along the jalan for exercise. Both of us shared the same feeling: accept the faith and coup with it....

 

 

 

 

 

Flash back

 It is a good time to flash back what had happened this year. I had continued to advance as required; gaining some new skill on programming, sharpened my skill on pocus and build up some muscle. I had completed the long term care course and acquired the registration qualification.

Yun had gotten into what she wanted and doing well. Xian had decided what he wished in the future and preparing for the path.

We had lost one of our pets; Titi had succumbed to malignancy around spring. Dragoncat is still holding on and hopefully we could keep her longer.

I had upgraded our projector to 4k after Xian won a buying option for PS5 on a lucky draw. For optimal performance, I had replaced our receiver and added 2 speakers onto the roof for Atmos. Well, stunning experience with UHD, but cost me a hand and a leg, good news was I am not looking forward to go to any cinema for movie in the near future.

I had been to the cinema three times in the midst of this pandemic, twice for TENET and once for the movies with the prohibited 3 letter words.

It was a rewarding and memorable year for me…however I reminded myself, not to be over joy as many had lost their life and more had suffered due to the pandemic….

The last day of the year

 Last day of the year and it is freaking cold as the island is stormed by the most severe cool front in 15 years; 12degree C when I climbed out from my warm bed...

I had to sit in front of the desk until 10pm and head back for the count down; it is an easy shift until now; travelling will only start tomorrow as today are still a working day.

The identification of 2 Covid19 cases related to the B117 British strain had shut down the country. Although no massive of local transmission was noted, the local authorities had halted most of the countdown event. Only 2 events are active; a concert going on at the east coast and the countdown around 101 building at T city.

I had several occasion taking swab test with full gear for suspected cases but however none of them came back positive. Although most of the places on the earth had shortened the quarantine period to 10 days, the island had still follow the 14+7 standard(14 days of quarantine with 7 days of strictly mask wearing when you are not alone). Play on the safe side is still the key....

The peace of mind however did not pacify my disturbing soul; I still missed homeland, everything of it, relatives, food….

Homeland had eventually given up on zero cases. We are seeing daily cases of four figure; 100+ ICU cases and 60+ respirator dependent cases. The strategy had apparently shifted to as long as the medical capacity is not overburden by the active cases, we can live with it. Indeed, you will not die if you got infected, but if no job, you are going to die every soon without income…

I had no idea how bad was the condition but some of my relatives were affected, they are still hanging on but would not hold on longer if the condition continues.

How long? It would be at least 8 months to execute a massive immunization and another 6 months to see the effect. So I don’t see any possibility I could step on the blood spilling land for another year...

Few more hours before going off and I had prayed deeply that everything would be the same when I laid my foot on the land again…  

three for a night

 It was a calm night shift until I expanded my portable army bed preparing for a good night retreat at midnight. Just after the setting up of my bed, I was called to see a patient came in for chest pain. The initial EKG12L had ruled out myocardial infarction and he was treated accordingly. The first round of pain killer combo however  did not resolve the pain and I had ordered an aortagram to rule out aortic dissection.

As I was stepping back into the call room, a police had brought in a patient complaining chest pain. The police claimed that he had run amok around the village and finally calm down after a chase. They had stressed that they did not used force to apprehend the patient. A friend that came in with them had however said that the police had forced him down from the roof. He had added that the patient was his construction co-worker who came from the east side. A relative had introduced the patient to him and had withheld that he had psychiatric disease.

The patient was tachycardic and normotensive. A immediate EKG12L was done and no sign of ischemic change. I had used to accept all the history input even if they were contradicted each other; I presumed that he had sustained trauma and most probably had an injury to his chest as his abdomen was flat and no tenderness was noted.

While preparing him for a CT with enhancement (he was 2^nd place in order awaiting the completion of the aortagram), another patient had presented to our ED. The patient was diagnosed as acute myocardial infarction and referred to a hospital up north for intervention as requested by the patient. On enroute, the patient had desaturated and the nursing personnel had decided to stop over at our hospital for further management.

Patient was irritable due to hypoxia and the initial bed-side sonography had revealed poor cardiac contractility and pulmonary edema. I had to intubate him prior to emergency percutaneous coronary intervention. His BP had crushed after the intubation as expected and I had to insert a central line and infuse dopamine to hold him long enough to the cath room.

It was 1+ hour later when I came back to see the trauma patient. He had looked paler and his abdomen had bloated. Apparently he had internal bleeding I had started another round of resuscitation in ED for this trauma patient. As the first patient, he was intubated and central line was inserted plus a load of blood product.

During the resuscitation for the 2 patients, their BP had reached a low of 30mmHg and with aggressive intervention, both of them had made it to the cath room and OR. The traumatic patient had proven to have a splenic rupture later by cat scan.

The other patient was a dud...after concluding three of them, I had managed to sunk into my bed at 5:45am...It was 20 minutes later when the swamp of morning patient rushed in....

It was a exciting night; with only 2 nurses and a aide, I was able to get the appropriate job done despite of the manpower issue. I just don't know how long can I keep myself in this shape to tackle similar scenario...

At my age, I am at the verge of going downhill, learning had become harder for me due to aging; however I thank the great one for his kindness to allow me to go through all this thrill and excitement...

The license path...

 I remembered one of the most important events for high school student back in my days was getting a bike license or driving license. Unfortunately due to financial constrain, I had left for my study abroad without getting any of them.

I got my bike license few months after I entered med school. The local authority had come to our school setting a exam track and tried to pass every student who took the exam.

However I got my driving license after I returned to the homeland just prior to my service with the MOH. I still remembered my solo drive from my house to buy chicken rice at noon after a big sweep in the house before CNY.

Compare to homeland, the local traffic condition is more friendly to bikers and a bike is a more convenient way of transport than car. I had urged Yun to get her bike license when she attained the required age however there was always something going on and she never gotten the chance to go for it.

As we don’t own a bike in the house, we had no way of letting her to practice her skill and prepare for the exam.

I had bought an electric bike for her to learn and however without proper coaching she failed her first test. After a few inquires, I had located a driving school nearby our house and she had signed up for a car and bike course.

The whole journey was eventful; she had  failed undang(over confident without proper studying) and also road test(just couldn’t explained why)….

The best and worst part was an motorbike accident on her first solo ride…a skidded attempt at cornering ended up with multiple wound (BAD!!!!)and good lesson for her to be very cautious later when she go on the road.(GOOOD!!!)

Yun had gotten the bike of her choice later and the electric bike was left to me. The bike was more convenient when we went around the town as parking lot had been less and less nowadays