BACHELOR OF ADMINISTRATIVE SCIENCE AND POLICY STUDIES

(AM228)

ADS 452 ETHICS IN ADMINISTRATIONS

DEDICATION OF HEALTH WORKERS IN MALAYSIA COMBATING

COVID-19

NAMAF6A

1 NURAMIRA BINTI ABDUL AZIM 2019373091

2 NOOR SHAFIKAH BINTI KULA MOIDEEN 2019505125

3 MUHAMAD FIKRI BIN MOHD SAAT 2019182463

4 SHAFIEDATUL NATASHA BINTI 2019915315

SHAMSOR
5 MUHAMMAD IRADAUDDIN BIN 2019793453
IBRAHIM
 TABLE OF CONTENT

NO. TITLE PAGES

1.0 THE MORALS AND ETHICS OF THE COVID-19 3–4

FRONTLINE

2.0 KEEP HEALTH WORKERS SAFE TO KEEP PATIENTS 5–7

SAFE

3.0 ACTORS INVOLVED IN THE ETHICAL INCIDENT 8–9

4.0 EXPECTED IMPLICATIONS FROM THE INCIDENT 10 – 12

5.0 IMPROVEMENT THAT IMPOSED TO THE 13 – 14

HEALTHCARE SYSTEM

6.0 CONCLUSION 15

7.0 REFERENCES 16

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1.0 THE MORALS AND ETHICS OF THE COVID-19 FRONTLINE

The lingering infection rate, increasing hospital admissions and deaths, and the critical
situation in aged care are creating moral stressors and ethical dilemmas for workers
on the front line. These stressors can lead to psychosocial and spiritual outcomes,
with ‘moral injury’ the most severe. Moral injury is a relatively new concept developed
in military settings and applied to soldiers returning from deployment who have been
involved in events that transgressed deeply held moral beliefs and values.

This results in harm to their psychological, social, and spiritual health that
cannot be fully explained by posttraumatic stress disorder (PTSD). Moral injury can
arise where the person does, or fails to do, something that transgresses their deeply
held moral beliefs. It can also arise when a person feels betrayed in a high threat
situation, or witnesses’ others behaving in ways they feel are morally wrong.
Healthcare workers are on the frontline of our war with COVID-19, and, like soldiers in
war, many will be exposed to traumatic stressors that involve death and threat to life
and that could give rise to PTSD.

Conflict and Covid-19

The COVID-19 environment brings exposure to a range of situations that can violate
a person’s beliefs about what is right and wrong and give rise to moral emotions
directed at oneself, like guilt and shame, or at others, like anger and disgust.

Situations where healthcare workers may be conflicted over their own actions
could include wanting to work and care for COVID-19 patients while also wanting
to protect themselves and their families from harm. Or going into quarantine, knowing
the additional stress this will place on overstretched colleagues and in the care of
patients.

Other situations may be having to avoid human touch when healthcare workers
know how important this can be to ill and frightened patients. It may be denying access
to families who want to be with their dying relatives and watching people die alone. Or
concerns that healthcare will be compromised for COVID-19 patients, or others
needing to use health services.

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 Some countries have seen extreme circumstances where healthcare workers
have had to face decisions about which patients will be given access to life-saving
treatment and those who will miss out.

Let down and betrayal

Another type of moral stressor involves behavior that leads someone to feel betrayed
or let down. In the context of COVID-19, healthcare workers may feel let down by
government decisions to manage the pandemic, or by their organisation due to a lack
of adequate personal protective equipment, poor infection control training, or lack of
responsiveness to the unfolding crisis.

They may also feel let down by members of the community who flout social
distancing rules – failing to wear masks or abusing the medical staff trying to help
them. Some degree of moral stress is inevitable in the COVID-19 environment. This
makes it important for healthcare organizations to take proactive steps to reduce risks
and support staff.

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2.0 KEEP HEALTH WORKERS SAFE TO KEEP PATIENTS SAFE
COVID-19 has exposed health workers and their families to unprecedented levels of
risk. Although not representative, data from many countries across WHO regions
indicate that COVID-19 infections among health workers are far greater than those in
the general population.

While health workers represent less than 3% of the population in most countries
and less than 2% in almost all low- and middle-income countries, around 14% of
COVID-19 cases reported to WHO are among health workers. In some countries, the
proportion can be as high as 35%. However, data availability and quality are limited,
and it is not possible to establish whether health workers were infected in the
workplace or in community settings. Thousands of health workers infected with
COVID-19 have lost their lives worldwide.

In addition to physical risks, the pandemic has placed extraordinary levels of

psychological stress on health workers exposed to high-demand settings for long
hours, living in constant fear of disease exposure while separated from family and
facing social stigmatization. Before COVID-19 hit, medical professionals were already
at higher risk of suicide in all parts of the world. A recent review of health care
professionals found one in four reported depression and anxiety, and one in
three suffered insomnia during COVID-19. WHO recently highlighted an alarming rise
in reports of verbal harassment, discrimination, and physical violence among health
workers in the wake of COVID-19.

This unprecedented public health emergency has demonstrated that health

facilities, medical transport, patients as well as health care workers and their families
can – and do – become targets everywhere. This alarming trend reinforces the need
for improved measures to protect health care from acts of violence. During the COVID-
19 pandemic more than ever, protecting the health and lives of health care providers
on the frontline is critical to enabling a better global response.

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Defining attacks on health care

Ensuring access to health services is the cornerstone of a successful health response.

Any verbal or physical act of violence, obstruction or threat that interferes with the
availability, access and delivery of such services is defined as attack on health care
by the World Health Organization (WHO).

The nature of attacks on health care related to COVID-19 varies greatly across
contexts and can range from the use of heavy weapons targeting health facilities to
the stigmatization of health care workers. Ultimately – whether they take the form of a
cyber-attack or a physical assault – they deprive people of urgently needed care,
endanger health care providers, and undermine health systems.

Impact on the response

The COVID-19 pandemic has put some health systems under immense pressure and
stretched others beyond their capacity. As such, responding to this public health
emergency and successfully minimizing its impact requires every health resource to
be leveraged. Failure to protect health care in this rapidly changing context exposes
health systems to critical gaps in services when they are most needed and can have
a long-lasting impact on the health and wellbeing of populations.

In fragile and conflict-affected countries, acts of violence during the COVID-19

pandemic have already deprived hundreds of medical services and severely hindered
the response. Among others, the bombardment and destruction of a 400-bed facility
in Libya1 (United Nations, 2020) further reduced the ability of health authorities and
aid agencies to prepare for a full-blown epidemic.

In other countries where attacks on health care have been noticed, the COVID-
19 pandemic has sometimes created hostile environments for health care providers
who have reported incidents of violence, discrimination, and harassment. Stigmatized
as vectors of contagion in many countries, some have been assaulted, others were
denied transport while commuting to work, and entire families were evicted from their
homes. Furthermore, reports of attacks on medical vehicles carrying COVID-19
samples, on-duty COVID-19 drivers as well as patients are accumulating and raising
concerns worldwide.

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 However, attacks on health care not only have a direct impact on the ability of
health systems to deliver services to those most in need, but also take a heavy toll on
the psychosocial health of patients, critical health care providers on the frontline and
their families. As those continue to be targeted by acts of violence during this public
health emergency, health systems must – among other things – prepare for shortages
of health care workers unwilling or unable to report to work due to unsafe environments
or obstruction in their personal lives.

The role of stigma

Acts of violence related to the COVID-19 pandemic take place against the backdrop
of growing social stigma and discriminatory behavior against anyone perceived to
have been in contact with the virus. Health resources, patients, health care providers
and their family members are at particularly high risk of experiencing attacks due to
the wrongful belief that they have become vectors of contagion in a community.

COVID-19 misinformation plays an important role in shaping such beliefs and

behaviors across the world. The ‘infodemic’ of false information about the disease
exacerbates fear of contagion, misconceptions, and myths about the virus. Amid
growing mistrust, health care providers increasingly come to be seen as a risk to
communities rather than the solution to this public health emergency. To illustrate,
health care workers have reported being spat on, called ‘contagious rat’, assaulted
after boarding public transports, having their belongings vandalized and their children
discriminated against by their classmates.

These attacks on health care speak to the importance of adequate risk

communication at all levels of society to reduce fear, stigma and – ultimately –
violence. How we communicate about COVID-19 is critical in supporting people to take
effective action to combat the disease and protect health care.

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3.0 ACTORS INVOLVED IN THE ETHICAL INCIDENT

The main actors involved to combat against the current outbreak is the Ministry of
Health (MoH) supported also with other public institutions and private body or
volunteer body such as media and NGOs.

The world has been struck with virus so deadly that caused so many people
lose their loved one. The virus called COVID19 19, or Coronavirus is believed to be
started from China. This pandemic has been going on for years since 2019. Even in
2022 we are still handling the variant of the virus. Scientist have been working hard to
come out with the vaccine and booster shot to help people to fight the vaccine.
According to the statistic as of 12th January 2022, the number of death due to this virus
have reached 5,521,811. The number really frightened and believe be increase in the
future. All people must play their part to fight this disease if we want to live back as per
normal like before. People must get their vaccine and booster shot plus they need to
apply social distancing when they are going out.

During the crisis of pandemic COVID19, one of the issues that Malaysia faced
is dealing with information sharing by the public and the authorities. Lots of fake news
have been spread during this crisis especially through media social such as
WhatsApp, Twitter and Facebook. The spread of fake news has been caused
unnecessary concern to people. The spread of fake cure to the vaccine also have
caused a lot of confusion especially to the elderly that 100 percent believed about the
news. One of the shocking cures that have been spread through media social is to
add bleach to their drink. They believed the bleach would kill the virus inside of their
bodies. Another one is to eat a medicine specifically for an animal which call
Ivermectin. This type of news is totally a hoax as it has already been proven dangerous
for people to consume that such of things.

The sharing of personal information about patients and the posting of fake
news or misleading information are two types of information sharing on social media
that are thought to be potentially dangerous and unethical. It is suggested that the
general population develop fundamental abilities in evaluating information and
determining its validity. On the other hand, authorities should refrain from blaming
patients to avoid stigmatizing them. It's critical that everyone understands their ethical
obligations to guarantee that only ethical and accurate information is published on

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social media. One way that government dealt with this issue is with communications
and Multimedia Minister Datuk Saifuddin Abdullah calls on local media to help fight
rising threat of fake news. According to him, whether it's regarding the Covid-19
epidemic, immunization, health, social, or political issues, there's been a huge surge
in the transmission of misleading material or news recently. The situation may produce
public uncertainty and anxiety, hampering attempts to effectively battle the
development of the Covid-19 epidemic.

"In terms of spreading information, the media not only has the responsibility of
presenting true and accurate news, but also of protecting the public from misleading
information that could jeopardize the government's efforts to combat Covid-19 and
maintain the country's prosperity and stability." The government, through the Ministry
of Communications and Multimedia (KKMM) and other organizations, took significant
steps to combat the spread of fake news, particularly during the Covid-19 outbreak.
Among them is the ministry's Quick Response Team's monitoring, which has
disproved 464 fake news stories since March of 2019.

Government also takes a huge step in implementing a new Emergency

(Essential Powers) (No. 2) Ordinance 2021 to prevent and act against the spread of
fake news about Covid-19 and health. This will ensue that everyone that spread fake
news will face consequences from the government. Even though there is a backlash
from this action, but it is necessary things to do as it will help to stop any fake news to
be spread among Malaysian citizens.

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4.0 EXPECTED IMPLICATIONS FROM THE INCIDENT

The Malaysian MoH has since the outset prepared for the worst-case scenarios and
outlined the plan in clear and easily accessible guidelines. In times of crisis, the
collective collaboration of both public and private healthcare sectors is needed to
overcome the current issues. At the beginning of the pandemic, to enhance the MoH
efforts in keeping the spread and mortality under control, a Movement Control Order
(MCO) was implemented on March 18, 2020. The Director-General of the MoH
emphasized that the order enforced came under the Prevention and Control of
Infectious Diseases Act 1988 and the Police Act 1967 and would help to control the
spread of the virus.

This crucial step was significant, as the situation in China had proved that by
isolating the infected group of individuals and practicing social distancing, the
pandemic could be contained according to WHO. Besides that, the MoH has arranged
various disinfection activities to be conducted by the Ministry of Housing and Local
Government, local authorities, and the DBKL (Kuala Lumpur City Council). This
procedure has been conducted mainly in high-risk areas. The MoH has also sought to
be transparent in handling the pandemic by providing sufficient and up-to-date
information to the public through three major platforms including the Official Portal of
the MoH, creation of a special Facebook user account called the Crisis Preparedness
and Response Centre (CRPC), Kementerian Kesihatan Malaysia (KKM), and CRPC
KKM Telegram.

Moreover, The Ministry has provided awareness programmes on basic

protective and hygiene measures to minimize transmission of SARS-CoV-2 in simple
diagram form to reach the public easily. This includes hand-washing techniques and
the use of hand sanitizers and face masks. In addition, various infographics associated
with COVID-19 have frequently been prepared and uploaded onto the website. In
addition, The MoH has also conducted daily press briefings, conference recordings,
and has published relevant news on COVID-19 to increase public engagement and
ensure public awareness and access to accurate information.

As we know, WHO defines a confirmed COVID-19 case as “a person with

laboratory confirmation of COVID-19 infection” and the recommended routine testing
is through detection of COVID-19 virus RNA by nucleic acid amplification testing

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(NAAT) such as RT-PCR. In the beginning of the cases, as with the government policy
to indiscriminately test locals and foreigners during contact tracing, active case
detection, and mass sampling, most tests were carried out in government laboratories,
and they were able to cope with the daily demand of testing. However, with the
increasing amount of testing per day and increased workload of these laboratories to
cope with the turnaround time, private hospitals and laboratories opened their services
with significantly reduced fees to share the burden and dependence on public
laboratories.

By the end of April 2020, the total tests conducted in Malaysia were estimated
to exceed 150,000 with the ratio of about 4,700 tests per million population. Tests were
carried out indiscriminatingly on symptomatic or asymptomatic local or foreign
individuals who were either close contacts (family, workplace, marketplace, school),
or those who live in red zone areas, tahfiz (religious) school students, homeless
centers, old folk’s homes, wet markets, construction workers, healthcare workers,
returning travelers, and many other risk groups. Meanwhile, the MOH has also
approved, and recessions affected by COVID-19, avoid direct contact with
symptomatic people.

MOH has prepared several contingency plans looking into different best to
worst case scenarios. Early on, the government designated 34 public hospitals as the
admitting and treating hospitals for COVID-19 nationwide. These hospitals were
selected based on stringent criteria, among others the number of beds, healthcare
staff (specialists, doctors, and nurses) To put into perspective, there are about 150
public hospitals throughout Malaysia. The MOH also introduced “step down” centers
where cases who are asymptomatic and clinically stable can be transferred to these
centers. This may free up beds in the designated hospitals and reduces the risk of
stretching the resources needed.

The COVID-19 pandemic has truly challenged the ability of the healthcare
system in many countries globally, and Malaysia to some degree experienced the
same problem. ICU beds and ventilators are two critical commodities in times of crises.
The MCO imposed by the government had generated positive consequences with the
number of incidences dropping to two digits toward the end of the third phase of MCO
(from April 15 to 28, 2020). Some 40 cases (from the total 1,758 active cases) were

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receiving treatments in ICU with 18 of them requiring ventilation support. As of early
May 2020, the health system was able to cope with the demand, with utilization of
ventilators standing at around 30% of the total capacity allocated for COVID-19
management. The government also allocated a special RM500 million budget to
purchase equipment like ventilators and PPE.

To support MoH and the frontlines to create awareness and reducing the cases,
actions also had been taken by the media and NGOs. Malaysia was one of the first
countries to come out with various quick responses to protect its citizens from COVID-
19. The main aim was to minimize economic and social impacts, limit its spread, and
provide care for its citizens. All frontliners are required to wear PPE. However, due to
the rapid increase in COVID-19 cases, there have been shortages in PPE equipment.
This shortage could have endangered the health of frontliners.

Therefore, several NGOs and public figures have helped to sew PPE for
medical frontliners. For example, several Malaysian fashion designers associated with
the Malaysian Official Designers Association (MODA) have produced PPE for local
medical staff (Cheong, 2020). Prison inmates have also been involved in sewing
protective gear for frontliners regardless of their current situation. Volunteer tailors
have helped to prepare PPE for frontliners. In other hand, NGOs have been actively
helping those who are affected by this pandemic. They have been providing food,
shelter for the homeless, and have even given out money to help those in need. Some
NGOs have helped by providing protective masks, disinfection chambers and helping
to educate citizens on COVID-19.

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5.0 IMPROVEMENT THAT IMPOSED TO THE HEALTHCARE SYSTEM

1. Provide adequacy of manpower and sufficiency of PPE supply.

In this time of disaster, PPE are valuable assets hoarded and “hijacked” by
some leading to huge demand and inadequate supply to others. The scarcity
of PPE in certain parts of the world has led to infections and deaths of
healthcare staff from COVID-19 infection. In Malaysia, the MOH use every
possible method of acquiring adequate supplies of PPE for every healthcare
staff involved in COVID-19 management.
Healthcare workers are advised to strictly adhere to guidelines given by the
ministry in using the appropriate level of PPEs for different activities they
perform during their daily involvement with COVID-19 management.
Nevertheless, it is worth acknowledging that many individuals, local
entrepreneurs, businesses, and private companies have donated PPEs and
even provided monetary funding to buy PPEs. They contributed to ensure that
all MOH frontliners are well-protected. Everybody is coming together to do their
part to help the country battle the COVID-19 pandemic.

2. Increased number of hospitals and provisional hospitals

Besides that, the subsequent key step taken by the MoH along with the
government to overcome the spread of COVID-19 was to increase the number
of hospitals and other provisional hospital that could treat COVID-19 cases.
There was also a group effort between public and private hospitals to
accommodate the growing numbers of cases of infection, comprising university
hospitals and Ministry of Defense hospitals.
The MoH in its effort to control the COVID-19 infection also set up a provisional
hospital in the Agro Exposition Park Serdang (MAEPS) in coordination with The
National Disaster Management Agency. This makeshift hospital, which was
initially Malaysia's largest convention center, is equipped with computers,
televisions, Wi-Fi connection, a lounge area, and some other basic facilities for
use by patients and medical staff. This hospital is to be used as a quarantine
and treatment center for low-risk patients. Around 604 beds have been
prepared to cater for confirmed cases with or without symptoms of COVID-19,
as there is a possibility of cases increase.

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 Furthermore, as part of the MoH action plan, public halls and indoor stadiums
will also be utilized if cases hit 1000 per day. Three thousand retired nurses will
return as volunteers to fight COVID-19 along with the country's frontliners.

3. Increase the crucial equipment and hired contract frontliners

Moreover, the Economic Action Council meeting held on March 23, 2020 was
the allocation of RM 600 million to the MoH to battle COVID-19 around RM 500
million would be utilized to buy ventilators and personal protective equipment
(PPE) and another RM 100 million would be used to appoint 2000 nurses on a
contract basis.
To cushion the impact of COVID-19 MoH was setting up of a special fund known
as the COVID-19 Fund, to raise money to be channeled to patients, particularly
those affected financially due to the quarantine procedure. This fund initially
received RM 1 million from the government and private sectors. The money
collected was used to cover medical expenses such as buying crucial
equipment and other supplies. Through this fund also, RM 100 was given daily
to those who had no source of income throughout the quarantine and treatment
processes.

4. Enforcement of health screening at all points of entry

To overcome the current outbreak, the Ministry of Health take a crucial role in
ensuring maximum readiness to control the spread of the virus. The earliest
efforts taken by the MoH to prevent outbreak transmission was the enforcement
of health screening at all points of entry. According to the Director-General of
the MoH Datuk Dr. Noor Hisham Abdullah, one of the strategies was the
placement of thermal scanners. This was done to further enhance the detection
of fever amongst tourists or locals returning from abroad. Malaysians who
returned from Wuhan were screened, identified, and isolated in special
quarantine areas for COVID-19. This measure also involved all airline crews as
well as the staff of the MoH.

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6.0 CONCLUSION
A novel coronavirus, named SARS-CoV-2, has caused major outbreaks of COVID-19
disease with severe effects worldwide when compared to the previous two deadly
pneumonia diseases, SARS, and MERS. More than 1.5 million positive cases of
SARS-CoV-2 infection had been recorded globally 4 months after it was first
discovered in China. At the time of writing this report, Malaysia was ranked 34th in the
world based on the number of positive cases. Perceiving the alarming trend shown in
other countries, constructive actions, and effective measures to overcome this
pandemic became the main agenda of the Malaysian government in the early stage
of its emergence in the country.

Specific hospitals were assigned to handle COVID-19 cases as a measure to

isolate the patients and prevent them from affecting others. The capacity and capability
of laboratories were enhanced to speed up sample testing and the provision of results.
An MCO was enforced as the biggest decision by the government to break the chain
of COVID-19 strictly and seriously within the community. This tough decision has
obviously affected all sectors, especially the economy, from the smallest scope of
individual income to the largest of international trade. However, all Malaysians showed
their full support of the MCO enforcement to ease the burden of frontliners, especially
medical personnel, in handling the increasing numbers of cases each day. To lessen
the effects of the MCO, the Malaysian government has granted a huge budget to
various sectors to lessen the effect of this pandemic, initiate people-based economic
growth, and encourage quality investments.

The PRIHATIN Package has been one of the beneficial initiatives announced
by the government, followed by drastic measures of a 6-month moratorium offered by
BNM to reduce the financial impact. In addition to these collective measures, all
Malaysians have played their role through different channels to help the nation in
facing this major outbreak. Everyone is playing a big role in ensuring the community
and country become free from COVID-19.

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7.0 REFERENCES

1. N.H. Abdullah, Situasi semasa jangkitan penyakit Coronavirus 2019 (COVID-

19) di Malaysia [Press release] (2020) Retrieved from
https://kpkesihatan.com/2020/03/31/kenyataan-akhbar-kpk-31-mac-2020-
situasi-semasa-jangkitan-penyakit-coronavirus-2019-covid-19-di-
malaysia/ [Accessed 5 April 2020]
2. Ahmad, 2020, D. Ahmad, Situasi terkini jangkitan 2019-nCoV dan pengesahan
kes baharu di Malaysia [Press release] (2020). Retrieved
from https://www.penerangan.gov.my/japenv2/wp-
content/uploads/2020/02/Kenyataan-Akhbar-KPK-Situasi-2019-nCoV-4-
FEBRUARI-2020_edited-2.pdf [Accessed 30 March 2020]
3. Ang, 2020, A. Ang, Health Ministry prepared to use training institutes for
COVID-19 patients, The Star (2020). Retrieved
from https://www.thestar.com.my/news/nation/2020/03/29/health-ministry-
prepared-to-use-training-institutes-for-covid-19-patients [Accessed 7 April
2020]
4. Annuar, 2020, A. Annuar, Bank Negara announces automatic six-month
moratorium on all bank loans — except for credit card balances Malay
Mail (2020). Retrieved
from https://www.malaymail.com/news/malaysia/2020/03/24/bank-negara-
announces-automatic-six-month-moratorium-on-all-bank-loans-
exce/1849820 [Accessed 9 April 2020]
5. Bernama, 2020, Bernama Coronavirus: Health Ministry beefs up screening at
entry points into Malaysia Bernama (2020). Retrieved
from https://www.theedgemarkets.com/article/coronavirus-health-ministry-
beefs-screening-entry-points-malaysia [Accessed 1 April 2020]

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