Virtual Symposium Post COVID-19 Condition

VIRTUAL SYMPOSIUM POST COVID-19 CONDITION - FOCUSED REHABILITATION MEDICINE \"FRONTING THE CHALLENGES TOGETHER\" 7TH MARCH 2022 0800-1700 ORGANIZED BY: REHABILITATION MEDICINE DEPARTMENT & POST GRADUATE SOCIETY HOSPITAL SUNGAI BULOH

ORGANIZING COMMITTEES Organizing Chairman: Dr Akmal Hafizah Zamli Dr Kavitha Andiappan Dr Shafiq Eiman Abdul Razak Dr Izuan Effendi Abdul Wahab Dr Amitha Na Sherng Lhung Dr Reginald Valentino Rapieng Dr Fatnin Faqiha Azmi Mahmud Dr Noor Aqeela Othman Talib Dr Nur Izianty Zool Kafli Dr Siti Nadiah Md Sabri Dr Tan Bee Cher Dr Hajar Zainon Dr Ho Wan Yi Madam Juliana Ibrahim Madam Ruhini Md Isa Miss Nur Hazrina Iderus

ORGANIZING COMMITTEES From left Front: Dr Shafiq Eiman, Dr Izuan Affendi, Dr Reginald Valentino, Dr Amitha Na Centre: Mdm Juliana, Dr Kavitha, Dr Akmal Hafizah, Ms Nur Hazrina, Dr Siti Nadiah Back : Dr Nur Izianty, Dr Tan Bee Cher, Dr Ho Wan Yi, Dr Noor Aqeela, Dr Fatnin Faqiha

FOREWORDS

FOREWORD Firstly, my heartiest congratulations to the Department of Rehabilitation Medicine for successfully organizing the national virtual symposium titled ‘Post Covid-19 Condition Focused Rehabilitation Medicine: Fronting the Challenges Together’. It takes a great effort and commitment as showcased by this department to be able to keep their track record in deliveringa yearly national event without fail. As we all know, COVID-19 can cause persistent ill- health. Around a quarter of people who have had the virus experience symptoms that continue for at least a month but one in 10 are still unwell after 12 weeks. This has been described by patient groups as “Long COVID”.In Malaysia itself, almost 20 000 patients are reported to suffer from post covid syndrome. According to WHO, rehabilitation measures are part of an essential solution to tackle this complex problem.

FOREWORD Long COVID has a serious impact on people’s ability to go back to work or have a social life. It affects their mental health and may have significant economic consequences for them, their families and for society. This being said, I believe that this timely event will provide the opportunity for the healthcare providers to update their knowledge, competency and skills towards rendering a more holistic management of Long Covid patients. This symposium also consists of experience sharing session that could potentially be an eye opener besides being an inspirational tool for the patients themselves. As Malaysia enters into a possible ‘living with the virus’ phase, Long Covid becomes inevitable. As such, patients displaying post covid syndrome must be accessible to good rehabilitation care and servicesto improve their physical and mental wellbeing which is proven as of now to be an effective way to curb Long Covid which is growing to be a huge public health concern. DR KULDIP KAUR A/P PREM SINGH HOSPITAL SUNGAI BULOH DIRECTOR

FOREWORD “Long COVID” is a term being used to describe illness in people who have either recovered from COVID- 19 but still report lasting effects of the infection or have had the usual symptoms for far longer than would be expected. Long COVID is still evolving but the condition can be very debilitating. It is associated with a range of overlapping symptoms including but not limited to generalized chest and muscle pain, fatigue, shortness of breath, and cognitive dysfunction. As the call for multidisciplinary, multispecialty approaches to assess and manage Long COVID rises worldwide, I am very proud to say that the Rehabilitation Medicine Department of Hospital Sungai Buloh has not only initiated the post- Covid rehabilitation care in Malaysia but also has paved and lead the way in developing these services nationwide. Additionally, this department has played a vital role in involving patients both to foster self-care and self-help and in shaping awareness of Long COVID. They have also implemented a well-functioning patient register; creating cohorts of patients; and following up those affected as a means to support the research which is so critical to understanding and treating Long COVID.

FOREWORD As such, I believe that the Rehabilitation Medicine team of Hospital Sungai Buloh is the most relevant and appropriate organizer for the first ever national level long COVID symposium titled ‘Post COVID-19 Condition Focused Rehabilitation Medicine: Fronting the Challenges Together’. Furthermore, it would be a great privilege to be able to gain first-hand knowledge and experience in managing COVID survivors from the pioneers themselves. Finally, kudos to the organizing committee for their efforts in organizing this event. To all participants, wishing you a successful and an enjoyable symposium! DR YUSNIZA MOHD YUSOF HEAD OF REHABILITATION MEDICINE SERVICES MINISTRY OF HEALTH MALAYSIA

FOREWORD On behalf of the organizing committee, we would like to extend our greatest pleasure in welcoming all highly respected participants to the Virtual Symposium Post COVID- 19 Condition - Focused Rehabilitation Medicine “Fronting the Challenges Together” 2022. Barely beyond 2 years, more than 2.5 million Malaysian populations had recovered from COVID-19, but to some their journey may have just started. Symptoms such as persistent fatigue, breathlessness, brain fog, and depression could debilitate many of them. Widely recognized as Long COVID, the World Health Organization in October 2021 termed this consequence as post COVID-19 condition (PCC). In the absence of scientifically proven treatments, it potentially led to substantial impacts on society, increased healthcare burden and economic productivity losses. PCC is indeed a medical challenge of highest priority.

FOREWORD We thanked all distinguished speakers of the diverse medical specialties for their commitments in providing us guidance in delivering comprehensive and effective care to our patients. The multi- disciplinary lecture series and cased-based inter- disciplinary rehabilitation workshop series aims to create awareness; and sharing of knowledge, skills and experiences in key practices relevant to PCC rehabilitation. Our most sincere gratitude to all participants for the inspiring interest and support for this event. The passion that we have to improve our service for those in need has brought us together today and we sincerely hope that all of us shall gain maximally and achieved the expectation for this event. We also hoped that the compilation of educational posters, video series and handbook shall add value to our current practices in providing care for the COVID-19 survivors.

FOREWORD Last but not the least, we would like to sincerely thanked the Minister of Health, Director General of Health, National Head of Rehabilitation Medicine services, Selangor State Health Department Director and the Hospital Sungai Buloh Director for their inspirational leadership, consistent support and guidance for us to provide for patients’ care. And we wish to also thanked everyone whom had directly and indirectly contributed in making this event a success. May the Al-Mighty grant with the best of His rewards for the kindness. Amin. DR AKMAL HAFIZAH ZAMLI ORGANIZING CHAIRMAN VIRTUAL SYMPOSIUM POST COVID-19 CONDITION- FOCUSED REHABILITATION MEDICINE “FRONTING THE CHALLENGES TOGETHER”

TENTATIVE PROGRAMME

Time TENTATIVE 0800-0845 PROGRAMME 0845-0900 Activity / Speaker 0900-0915 Registration 0915-0945 0845-0900 Video Message from The Global Webinar 06-10- 0945-1000 21 WHO Introduction toRehabilitation Post COVID-19 Condition Dr De Groote Wouter Head of Rehabilitation Programme, WHO Geneva, Switzerland Post COVID-19 Condition- Rehabilitation Medicine Strategies for The Nation A Plan Ahead Dr Yusniza Mohd Yusof Head of Rehabilitation Medicine Services Ministry of Health Malaysia Sneak Peek Into The Post COVID-19 Condition Database COVID-19 Rehabilitation Outpatient Specialized Services (CROSS) Dr Akmal Hafizah Zamli Head of Rehabilitation Medicine Department Hospital Sungai Buloh Tea Break

TENTATIVE PROGRAMME Time Activity/Speaker 1000-1200 Multidisciplinary Perspectives of Post COVID-19 Condition.. Lecture Series Embracing the Pandemic Storm (Issues & Challenges in Post COVID-19 Condition) Dr Nor Arisah Misnan Consultant Infectious Disease Physician Hosp Sg Buloh Tackling the Siren Call (Addressing the Psychological Impacts) Dr Lee Chung Wah Consultant Psychiatrist & Senior Lecturer Taylor's University School of Medicine Fixing the Pulmonary Wrecks (Management of Long Term Pulmonary Consequences) Dr Arvindran Alaga Kedah State Head of Respiratory Services Head of Respiratory Unit Hosp Sultanah Bahiyah Getting Back On Deck (Rehabilitation Medicine Approach to Recovery for Post COVID-19 Condition) Dr Sa'ari Mohamad Yatim Selangor State Head of Rehabilitation Medicine Services Head of Rehabilitation Medicine Hosp Serdang

TENTATIVE PROGRAMME Time Activity/ Speaker 1200-1230 Post COVID-19 Condition... The Survivor 1230-1300 Perspective Their True Stories 1300-1400 Dr Kavitha Andiappan 1400-1630 Rehabilitation Medicine Physician Hosp Sg Buloh Officiating & Launching Post COVID-19 Condition Educational Leaflets & Video Series Dr Yusniza Mohd Yusof Head of Rehabilitation Medicine Services Ministry of Health Malaysia Lunch & Zohor Prayer Interdisciplinary Rehabilitation Medicine Perspectives of Post COVID-19 Condition Case Based Workshop Series Breathing Is Beginning (Home Oxygen therapy) Dr Akmal Hafizah Zamli Head of Rehabilitation Medicine Department Hosp Sg Buloh Priorities & Interventions (Rehabilitation Nursing Perspectives) Madam Ruhini Md Isa Head of Rehabilitation Nursing Unit, Hosp Sg Buloh

TENTATIVE PROGRAMME Time Activity/ Speaker The Short & Long of It! (Physiotheraphy Management of Respiratory & Musculoskeletal Impacts) Miss Nur Hazrina Iderus Head of Physiotheraphy Unit, Hosp Sg Buloh Tackling the Wax & Wane (Occupational Therapy Management for Fatigue, Brain Fog, Insomnia & Psychological Distress Madam Juliana Ibrahim Head of Occupational Therapy Unit, Hosp Sg Buloh COVID 19: Stroke & Spasticity – Our Experience Dr Kavitha Andiappan Rehabilitation Medicine Physician, Hosp Sg Buloh The Ultimate Target (Return to Work Programme for Post COVID-19 Condition) Dr Faznita Abdul Talib Head of Rehabilitation Medicine Department Social Security Organization (SOCSO) Rehabilitation Centre Tun Abdul Razak 1630-1700 Question & Answer All Workshop Series Facilitators

SPEAKERS BIOGRAPHY

DR WOUTER DE GROOTE Dr De Groote works for the Rehabilitation Programme in the Department of Noncommunicable Diseases at the WHO Headquarters in Geneva, Switzerland, where he is dedicated to COVID-19 related activities and strengthening rehabilitation in health information systems. He has a specialty in Physical and Rehabilitation Medicine, and has been head of the inpatient Rehabilitation Department at AZ Rivierenland (Belgium) for 10 years. He has a postgraduate in ‘International Development Cooperation’ and ‘Rehabilitation Management in the Global South’. He has been working as a consultant for the development of rehabilitation guidelines at the Ministery of Health in Vietnam, and for the International Federation for Spina Bifida and Hydrocephalus. He is the founder of CBR International and has joined the CBR task force at the International Disability and Development Consortium. He has been chairing the ISPRM ‘Capacity building in low resource countries’ Working Group for several years. He has experience in the strategic planning and monitoring of rehabilitation service implementation, and has been involved in numerous trainings for rehabilitation professionals around the globe

DR YUSNIZA MOHD YUSOF Dr Yusniza Mohd Yusof graduated with MBBS from University of Malaya, Kuala Lumpur and obtained her Master Degree in Rehabilitation Medicine from University of Malaya, Kuala Lumpur. She then pursued her area of interest study in Spinal Cord Injury Rehabilitation at University of Chang Mai,Thailand. Dr Yusniza sits on many professional bodies’ committee locally and internationally. She is currently the Head of Rehabilitation Medicine services in the Ministry of Health Malaysia, Head of Clinical Services, Hospital Rehabilitasi Cheras Kuala Lumpur. She is also actively presented at various national and international conferences notably Malaysia’s representation at various World Health Organization organized meeting and conferences. These included Global Webinar Rehabilitation 2030: A Call for Action; Second Global 2030 Rehabilitation 2030 meeting and World Health Organization Western Pacific Region Access to Quality Rehabilitation Services conference.

DR SA’ARI MOHAMAD YATIM Dr Sa'ari Mohamad Yatim graduated with MD from University of Sciences, Malaysia and obtained his Master Degree in Rehabilitation Medicine from University of Malaya, Kuala Lumpur. He then pursued his area of interest study in Cardiopulmonary Rehabilitation at Medical Department, Tung Wah Hospital, Hong Kong and Chonbuk University Hospital, Korea. Dr Saari sits on several committees locally and internationally. He is currently the Deputy Head of Rehabilitation Medicine services in the Ministry of Health Malaysia, Head of Selangor State Rehabilitation Medicine Services, Selangor State Health Department, Malaysia and the Head of Rehabilitation Medicine Department, Hospital Serdang, Selangor. He also sits as executive board members of Asia-Oceanian Society of Physical and Rehabilitation Medicine and AsiaPRevent.

DR ARVINDRAN ALAGA Dr Arvin graduated with MBBS from the Melaka Manipal Medical College, Malaysia and obtained his MRCP (United Kingdom). He subsequently pursued FRCP (Edinburgh) and completed Interventional Pulmonology Fellowship in Nagoya Japan. He then completed Fellowship in Respiratory Medicine Malaysia and Fellowship of Asia Pacific Society of Respirology. He further obtained European Diploma in Adult Respiratory Medicine (HERMES) in 2021. Dr Arvin actively presented at various national and international training and conferences in various topics including COVID-19 and Post COVID-19 conditions. He is an avid researcher and educator, having published many articles and has been heavily involved in undergraduate and postgraduate medical trainings and examinations. He also sits at various national and international committees and including as the current National Deputy Secretary of the Malaysian Medical Association.

DR AKMAL HAFIZAH ZAMLI Dr Akmal Hafizah Zamli graduated with MBBS from University of Malaya, Kuala Lumpur and obtained her Master Degree in Rehabilitation Medicine from University of Malaya, Kuala Lumpur. She then pursued her area of interest training in Spinal Cord Injury and Brain Injury Rehabilitation at Hampstead Rehabilitation Centre. South Australia. She subsequently pursued further training at the Spinal Cord Medicine & Rehabilitation at Burwood Spinal Unit, Christchurch New Zealand. Since the unprecented global pandemic, Hospital Sungai Buloh being one of the primary centre for COVID- 19 has led to her active involvement in post COVID-19 rehabilitation. She had contributed as development group member of the National Guideline Post COVID-19 Guideline Rehabilitation Chapter; initiated the COVID-19 Rehabilitation Inpatient Specialized Services (CRISS) and COVID-19 Rehabilitation Outpatient Specialized Services (CROSS) framework. She has since presented at national webinars including at the World Health Organization Global Webinar Post COVID-19 Condition 2021.

DR NOR ARISAH MISNAN Dr Nor Arisah Misnan graduated with MBBS from University of Nottingham, United Kingdom and obtained her Master Degree in Internal Medicine from University of Malaya, Kuala Lumpur. She is currently the Consultant Infectious Disease Physician at Hospital Sungai Buloh. She actively presented at various national and international conferences and participated in clinical audits, research activities and trainings in various infectious disease topics including COVID-19 and Post COVID-19 conditions. She has contributed as trainer, advisor and development group members of the diverse COVID-19 related National Guidelines, Ministry of Health Malaysia. She has co-initiated the establishment of COVID-19 Rehabilitation Outpatient Specialized Services (CROSS) framework. She also sits at various national committees and including as the executive board committee of the Malaysia Society of Infection Control and Infectious Disease (MyICID).

DR LEE CHUNG WAH Dr Lee Chung Wah graduated with MBBS from Kasturba Medical College Manipal and obtained his Master Degree in Medicine (Psychiatry) from University Science Malaysia. During the COVID-19 pandemic he served as Consultant Psychiatrist in Hospital Sungai Buloh and had contributed to the establishment of Psychological First Aid (PFA) service for those affected by COVID-19. He has also provided psychiatry consultation for referrals of patients with psychological impacts at COVID-19 Rehabilitation Outpatient Specialized Services (CROSS). His enthusiasm and passion for academic teachings has led him to the career pathway as academician and senior lecturer at Taylor’s University School of Medicine.

DR KAVITHA ANDIAPPAN Dr Kavitha Andiappan graduated with MBBS from the Crimea State Medical University, Ukraine and obtained Masters in Rehabilitation Medicine from the University of Malaya. She is interested in a wide variety of rehabilitation medicine specialities including Spinal Cord Injury, Amputee, Musculoskeletal, Paediatrics and Cardiac Rehabilitation, with a focus on the field of neurorehabilitation. Hospital Sungai Buloh being one of the primary centre for COVID-19 has also led to her active involvement in post COVID-19 rehabilitation. She has significantly contributed to the establishment of the COVID-19 Rehabilitation Inpatient Specialized Services (CRISS) and COVID-19 Rehabilitation Outpatient Specialized Services (CROSS).

DR FAZNITA ABDUL TALIB Dr Faznita Abdul Talib graduated with Medical Degree in University Kebangsaan Malaysia. She then obtained Masters of Occupational Safety and Health Management System at University Utara Malaysia. She achieved various certification including Certified Disability Management Professional National Institute of Disability Management & Research (NIDMAR Canada); Certification in Training the Trainer Course (HRDF Malaysia); Certification in Occupational Health Doctor (NIOSH Malaysia); Certified Independent Medical Examiners (CIME USA) and Certified Medical Impairment Assessor (CMIA NIOSH Malaysia). She sits in many committees and task force most notable including as trainer for Certified Disability Management Professional (CDMP Canada). Apart from Pusat Rehabilitasi PERKESO Tun Abdul Razak, she also manages its satellites in Ara Damansara Medical Centre, Quill City Mall and Kuala Terengganu medical affairs. She is also part of Task Force for COVID-19 and had contributed significantly to the Return to Work Program for survivors with Post COVID-19 condition; referral by COVID-19 Rehabilitation Outpatient Specialized Services (CROSS) Hospital Sungai Buloh as well as in other centres

MADAM JULIANA IBRAHIM Madam Juliana Ibrahim graduated from College of Kuala Lumpur with a Diploma in Occupational Therapy. She then pursued her Bachelor of Occupational Therapy with Honours from the National University of Malaysia. She obtained certificates in Hand Rehabilitation from the Klinert Institute Kentuck USA. She is currently is the Head of Occupational Therapy Unit of Hospital Sungai Buloh. Hospital Sungai Buloh being one of the primary centre for COVID-19 has also led to her active involvement in post COVID-19 rehabilitation. Since its establishment, she has served the COVID-19 Rehabilitation Inpatient Specialized Services (CRISS) and COVID-19 Rehabilitation Outpatient Specialized Services (CROSS).

MS NUR HAZRINA IDERUS Miss Nur Hazrina Iderus graduated from University Technology MARA with a Degree in Physiotherapy. She currently is the Physiotherapy Unit of Hospital Sungai Buloh. Hospital Sungai Buloh being one of the primary centre for COVID-19 has also led to her active involvement in post COVID-19 rehabilitation. Since its establishment, she has served the COVID-19 Rehabilitation Inpatient Specialized Services (CRISS) and COVID-19 Rehabilitation Outpatient Specialized Services (CROSS).

MADAM RUHINI MD ISA Madam Ruhini graduated from Nursing College Kuala Lumpur and subsequently obtained her post basic midwivery from Nursing College Kuala Lumpur. She later pursued further studies and obtained post basic rehabilitation nursing from the Seremban nursing college. She is currently pursuing Bachelor of Science (Hons) nursing post registration from the University of MAHSA. Madam Ruhini had served in rehabilitation nursing practice for more than 16 years for various services including amputee, spinal cord injury, neuromedical and neurosurgical rehabilitation services. Hospital Sungai Buloh being one of the primary centre for COVID-19 has also led to her active involvement throughout the acute, subacute and post acute COVID-19. Since its establishment, she has served the COVID-19 Rehabilitation Inpatient Specialized Services (CRISS) and facilitated the COVID-19 Rehabilitation Outpatient Specialized Services (CROSS).

ABSTRACTS

Lecture Series: Introduction to Rehabilitation for Post COVID-19 Condition DR DE GROOTE WOUTER According to current data, approximately 10–20% of people experience persistent or new onset symptoms after 3 months following SARS-CoV-2 infection, which occurs irrespective of initial disease severity. In people with persistent symptoms; limitations in functioning are common and rehabilitation needs are high; people experience limitations in self-care, mobility, and return to work, among other. People recovering from COVID-19 may require close monitoring of rehabilitation needs and adequate referral. Rehabilitation services should be developed as an integral part of the model of care for people with post COVID-19 condition, and aim at reducing the physical, cognitive and mental health impacts of COVID-19. During this session, we are extremely honoured to be granted the approval by Dr De Groote Wouter to highlight his video presentation at the 6 October 2021, the World Health Organization (WHO) Expanding our understanding of Post COVID-19 Condition webinar series: Rehabilitation Care entitled “Introduction to Rehabilitation for Post COVID-19 Condition”.

Lecture Series: Sneak Peek into the Post COVID-19 Condition database COVID-19 Rehabilitation Outpatient Specialized Services (CROSS) DR AKMAL HAFIZAH ZAMLI Hospital Sungai Buloh (HSgB) being one of the designated epicenter hospitals for COVID-19 manages an increasingly surmountable number of cases including the moderately severe categories as the current third wave of the pandemic hit hard on our country. This has resulted in an absolute shift in the profile demand for rehabilitation medicine services in HSgB, from those related to neuromedical, musculoskeletal, spinal and neurosurgical services to a new rehabilitation medicine services related to the COVID-19 response. On 6th November 2020, the need to formalize a specialized, structured and comprehensive Rehabilitation Medicine services to cater for the intermediate and long-term effects of COVID-19 in the moderately severe Stage 4 & 5 survivors was agreed upon between the multidisciplinary team involved in COVID-19 management.

The main goals were to identify and manage any residual impairments expected primarily in the pulmonary, musculoskeletal and cognitive domains to optimize the COVID-19 survivors’ return to their best functional level or in severe cases to adapt to living with residual disabilities. Known as COVID-19 Rehabilitation Outpatient Specialized Services (CROSS), the ultimate aim of this initiative is for full re-integration of the survivors back into society. This lecture shall highlight the key analyses of the CROSS database (November 2020 – December 2021) related to PCC incidence, prevalence, multi-system spectrum of symptoms and most importantly the impacts on rehabilitation medicine services provision.

Case Based Discussion Series: Breathing is Beginning - Home Based Oxygen Therapy DR AKMAL HAFIZAH ZAMLI As the current COVID-19 inpatient strategy depends heavily on managing oxygenation, selected patients could be discharged home if oxygen administration could be addressed in a safe manner. Home oxygen therapy can be defined as oxygen delivered in a home, also known as domiciliary oxygen. It includes not only long-term oxygen but also short-term, nocturnal, palliative, ambulatory, and short-burst oxygen. It excludes oxygen use in healthcare and emergency settings. This lecture shall discuss rehabilitation medicine assessment and prescription involving 3 post COVID- 19 condition case scenarios. This includes ambulatory oxygen defined as oxygen delivered during exercise or activities of daily living; short term oxygen therapy (STOT) defined as oxygen provided temporarily during a period of severe hypoxemia; and long-term oxygen therapy (LTOT) defined as oxygen that is delivered to patients with chronic hypoxemia, in most cases for the remainder of the patient’s life indicated if therapy is prescribed for at least 15 h/d.

Case Based Discussion Series: The Ultimate Target – Return to Work for Post Covid-19 DR FAZNITA ABDUL TALIB Pertubuhan Keselamatan Pekerja (PERKESO) collaborated with Rehabilitation Medicine Services fraternity both within the Ministry of Health, Ministry of Education and private entities to provide support for eligible insured worker affected by Post COVID-19 condition. This session shall highlight and elaborate on the PERKESO’s role in PCC management which includes but not limited to empowerments of the survivors with impairments with the required skills under the Return to Work (RTW) Program; provision of intensive and holistic care based on the survivors unique requirements; supporting those clinically indicated with appropiate rehabilitation aids and devices; financial benefits to those eligible and enrollment of suitable insured individuals for intensive program provided at the main PERKESO Rehabilitation Centre Tun Abdul Razak in Melaka and its satellite branches.

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