COVID-19 outbreak at an aged-care facility in Selangor, Malaysia, March-April 2020.

Objective: Aged-care facilities are high-risk settings for coronavirus disease 2019 (COVID-19) outbreaks because residents have risk factors such as advanced age and multiple comorbidities. This report details a COVID-19 outbreak at an aged-care facility in Selangor, Malaysia during March-April 2020. Methods: Epidemiological and environmental data were gathered via telephone interviews and field investigations. Swab samples were taken from all residents and staff for laboratory investigation. Possible contributing factors to the outbreak were explored. Results: There were a total of 18 individuals at the institution: nine elderly residents and nine staff. The attack rate was 66.67% (6/9) among the elderly residents and 55.56% (5/9) among the staff. The most common symptoms reported were fever, cough, shortness of breath and diarrhoea. The fatality rate among COVID-19 cases was 18.18% (2/11). Both fatal cases occurred in people of advanced age (86 and 92 years old), who had comorbidities and had fever at presentation. The factors contributing to the outbreak included a delay in isolating symptomatic residents, the use of common facilities, caregivers providing support to more than one resident and a lack of natural ventilation. Discussion: Prevention and control measures must be aggressively implemented in high-risk sites to significantly reduce the risk of morbidity and mortality during COVID-19 outbreaks. Specific guidelines should be developed detailing the management of outbreaks in institutions such as aged-care facilities.

Progression of the Pathway for Public Health Care during the COVID-19 Outbreak at District Health Office.

Public health activities under district health offices (DHOs) play a major role in Malaysia's fight against COVID-19. This article aims to describe and illustrate the public health activity pathway in combating the COVID-19 pandemic, and a team of public health workers who are familiar with DHO work settings was created in April 2020 for that purpose. Review of documents and the Ministry of Health's updates was carried out, followed by a series of discussions with stakeholders. Based on the steps in the outbreak investigation tasks, the flow of activities from January to May 2020 was listed in line with the phases of the country's National Movement Control Order 2020. Results show that the activities can be classified into three different sections-namely, the main action areas, category of cases, and level of care. The main process flow of activities comprised the case management and support activities. Case management flow was split into tasks for patients under investigation and persons under surveillance, while the support services existed throughout the phases. The pathways illustrate that the progression of the pandemic translated directly to changes in the pattern of activities, with additional subgroups of activities in accordance with all imposed guidelines.