Deriving new insight
In contextualizing the situation in Malaysia with other nations globally, the rankings paint a picture of continuous active COVID-19 transmission in many parts of the world. Incidence in Malaysia remains much lower than many countries including those in Europe and the America. However, the chain of infection in Malaysia remains unbroken.
Singapore, which has reported the highest drop in rankings within this analysis, is one such model that has used an aggressive test-trace and isolate policy. Taiwan, China, South Korea, and New Zealand have similarly used a national policy that comprises of multiple policy interventions that are tailor-made to the needs of each of their countries needs and resources. Deriving key lessons from these models and integrating them into a comprehensive sustainable and cost-effective national policy is key towards weathering this pandemic.
There has been a resurgence of COVID-19 infections, this third wave still appears cluster based except for Sabah region. Malaysia (Global Rank of 114) has a lower incidence density ranking compared with many other countries in the world. However, the rankings do vary by the different grouped regions of Sabah (76), Central (109), and rest of Malaysia (147).
Yardsticks lend perspective
COVID-19 has swept across the globe in rapid fashion. Malaysia has not been spared of this crisis and have in this last three months experienced a resurgence of infections within the community. This has resulted in the perpetuation of anxiety, fear and panic within the hearts and minds of the people. However, as this crisis progresses it is important to ‘take a deep breath’ and reposition ourselves within the greater scheme of things in the hopes of developing fresh perspective on our local situation. As such, we aimed to estimate and compare the burden of COVID-19 infections in Malaysia with other countries.
We extracted data from the Ministry of Health Malaysia’s Daily Press Release and the Our World in Data database. We approximated three-monthly cumulative densities of 216 countries including Malaysia in three-monthly intervals of 1st March to 31st May, 1st June to 31st August and 1st September to 28th November. We further stratified estimations at the level of Malaysia to: 1) Sabah (Sabah & Federal Territories of Labuan); 2) Central region (Selangor, Federal Territories of Kuala Lumpur and Putrajaya, Negeri Sembilan) and 3) Rest of Malaysia (All other states within Malaysia). We selected 25 countries of from four geographical regions with comparable trajectories, as well as Malaysia and its regions, for visualisation within a bump chart.
In observing the trend of incidence within Malaysia, the global rankings of Malaysia (119-183-114), its central region (85-170-109) and the rest of Malaysia (149-190-147) is now similar to the March to May period with a rather large drop in rankings between June and August as can be seen in Figure 1 to 4. As the rankings suggest, the first and second waves we experienced were dealt with rapidly and effectively resulting in a large drop in our rankings within three months (alongside large outbreaks beginning concurrently in other regions). The rise of infections within the last three months have unsurprisingly increased our rankings but not beyond that which we experienced in March to May. Sabah and WP Labuan however, reported the lowest 3-monthly incidence in March and May (165) and June to August (191) but increased 116 ranks in September to November (76).
Looking beyond our borders, incidence rankings within South East Asia reveal three markedly different trajectories (Figure 1). Singapore reported the 8th highest incidence in the world between March and May. Impressively, incidence within the country has drastically declined since then and is ranked 158 for the last 3 months. Indonesia, Philippines, and Vietnam experienced their spikes mid-year. Both Vietnam and Thailand have reported low numbers throughout this pandemic.
Most intriguing within the current epidemic has been the progress of COVID-19 propagation within East Asia and Oceania (Figure 2). China, Taiwan, Japan, South Korea, Australia and New Zealand have all consistently reported low incidence densities and have been largely successful in quickly flattening their curves for new outbreaks.
Across the Middle East and South Asia, incidence of all nations here peak somewhat later, reporting higher incidence between June and August (Figure 3). Israel had reported higher incidence density followed by United Arab Emirates, Iran, and India.
Like Malaysia, there appears to be a bimodal peak in incidence in European countries such as Belgium, United Kingdom, France, and Germany. (Figure 4) The United States and Sweden appear to have continuous transmission through this period but their relative ranking have reduced since September.
In summary. There also appears to be distinct patterns of transmission between the regions across the time periods. Transmission in Europe, and in Malaysia peaked between March and May before a period of relative reduced transmission before spiking again between September and November. Transmission in the Middle-East, South Asia and several other countries like Brazil, the Philippines and Indonesia peaked between June and August followed by a reduction in the ensuing months. Transmission in East Asia and Oceania and also several nations in South East Asia were at their highest between March and May and have subsequently remained consistently low throughout. Additionally, burden of COVID-19 appears to much higher as we move further West, whilst the most efficient models of control can all be observed closer to home- especially in East Asia and Australasia.
More insights into the Epidemiology of COVID-19 in Malaysia is available at: https://spm.um.edu.my/knowledge-centre/covid19-epid-live/
Prepared by Dr Vivek Jason Jayaraj, Doctor of Public Health (DrPH) candidate, and Prof Dr Sanjay Rampal, Professor of Epidemiology and Public Health Medicine Specialist, University of Malaya.