COVID-19 Epidemiology for Malaysia – Epidemiological Week 27, 2021 (4–10 July 2021)

The Overall Situation

Malaysia has entered the sixth week of full movement control (FMCO). Enhanced Movement Control Order (EMCO) was imposed in selected sub-districts and localities within Selangor and Kuala Lumpur from July 3 until July 16, 2021, as the number of cases has continued to surge despite the FMCO. The sharp rise in the number of cases daily in the previous weeks continues to this Epid week 27. It culminated in the highest recorded number of new daily cases (9353 on 10 July 2021) and daily death (135 on 8 July 2021) this week since the start of the pandemic last year.

COVID-19 Statistics 10 July 2021, reporting the highest number of daily cases (9,353)
COVID-19 Statistics 08 July 2021, reporting the highest number of death (135)

The number of cases has continued to surge, where most of them are unlinked (sporadic). There is also a high number of workplace clusters, increased mortality and the reported of more contagious variants in the community. The recent surge of cases nationwide had overwhelmed the healthcare system, which is reaching the breaking point.

The nationwide vaccination program was recently reported to cover 22.97% (July 9, 2021) of the population with at least 1 dose of Covid-19 vaccination, and 10.24% of the population completed 2 doses. It was an increase of 4.06% and 2.63 respectively from a week earlier (July 2, 2021), which is the largest increase since the beginning of the National COVID-19 Immunisation Programme.

What is New This Week

A total of 827,191 cases and 6067 deaths of COVID-19 have been reported as of July 10 2021. Over the past week, the new daily cases ranged from 6045 to 9353, the highest number of cases occurred on July 10, and the lowest number occurred on July 4. The number of reported deaths increased in trend, with 633 deaths reported during this Epid week 27 compared to 550 (Epid week 26) and 536 (Epid week 25). The daily reported death ranging from 63 (July 4, 2021) to 135 (July 8, 2021). The case fatality rate for this Epid week 27 is 0.01, which was similar to the previous Epid week 26. The number of brought-in-dead (BID) cases was 77, a slight increase from the previous week’s figure. The highest number of BID cases recorded for this past week, 20, was on July 8, 2021. This week, the workplace clusters remained high, with 98 new workplace clusters of 157 new clusters (62.4%) and an increase of 12.6% from the previous week.

The surge in new daily cases may be due to the mass screening of higher risk areas during the EMCO and screening in factories because of the increase of investigation of compliance of SOP among factories and sporadic cases, which indirectly resulted in the sharp increase of Test Positivity. Besides, it may be due to cases recorded in June that that has not been reported which was carried over to July. The high community-wide transmission with the presence of more virulent variants of COVID-19 that are now widespread is another reason for the high number of cases. The increase in mortality probably due to low awareness of warning signs, and the healthcare system is highly strained, reflecting the quality of care is alarming as the Case Fatality Ratio (CFR) in June had increased by 4.47 times compared to March 2021.

Trends in Reported Cases and Hospitalisation

The seven-day moving average for the week shows a rising trend of 6,830 cases on July 4 to 7,797 cases on July 10, 2021. All states reported an upward trend in the cumulative incidence of COVID-19 cases. As of July 10, 2021, all states except Perlis, Terengganu, Sabah, and Kelantan reported a 14-day cumulative incidence exceeding 100 cases per 100,000 population.  The 14-day cumulative incidence in W.P. Labuan still exceeded 1000 cases per 100,000 population; while Negeri Sembilan, Selangor, and W.P. Kuala Lumpur exceeded 500 cases per 100,000 population per state.

As for the capacity of Malaysia’s healthcare system, the demands for intensive care and hospital beds strain were still apparent. There was a sharp increasing trend of general bed utilisation of more than 100% since the previous week reaching 224% as of July 10, 2021, and the intensive care unit (ICU) utilisation of 56.4% has slightly increased compared to previous weeks. As of July 10, 2021, four states (W.P. Kuala Lumpur, Selangor, Negeri Sembilan, and W.P. Labuan) have shown an increase in new daily cases exceeding the maximum hospital capacity. With new daily reported cases showed no signs of a reduction, the health system in the states will be crippled and collapse if the situation continued. The ventilator utilisation rate has plateaued over the past four weeks at approximately 21%.

The national time-varying reproductive number (Rt) had slightly increased to above 1.0 this past week. Overall transmissibility of COVID-19 in Malaysia had increased by approximately 8% to an Rt of 1.20 in week 27. As of July 10, 2021, all states except Sarawak and W.P. Labuan had recorded an Rt above the epidemic threshold of 1.0. The highest transmissibility was recorded in W.P. Putra Jaya (Rt of 1.59), followed by Terengganu (Rt of 1.53) and W.P. Kuala Lumpur (Rt of 1.4). In week 27, Perlis’s Rt has increased from 0.88 to 1.04. Nevertheless, a reducing trend of Rt was noted in W.P. Labuan from 1.02 to 0.79. This shows that the intense mitigation effort by the Labuan Health Office is taking its effect.

The graph showed that the daily positivity rate and positivity rate of the 7-day average in Epid week 27 was creeping up.

The test positivity ratio (TPR) was highest in W.P. Labuan (11.41%), followed by W.P. Putra Jaya (10.17%) and Selangor (10.07%). The state that had the highest test rate was Selangor which is 94.43 per 1000 population.

Reflection

Despite FMCO and EMCO, Covid-19 daily new cases still remain high and increasing trend with daily cases above 9,000, and 6067 total deaths. The problem is that the total lockdowns were not strict enough as the manufacturing sector and businesses have continued to operate even in areas under the tightest enhanced movement control order (EMCO).

Many new cases were found in the population-dense area in Selangor and Kuala Lumpur. A substantial number of workplace clusters is also reported in these areas. Thus, enforcement of standard operating procedures (SOPs) in the workplace should be enhanced, and mitigation steps need to be taken.

A recent announcement on social media of reopening departmental stores in particular area perplexed the netizen. The inconsistency of information and compliance to the SOP as well as a plan of action of the respective authority resulting in confusion, constantly fear, and uncertainty of public eventually lead to loss of trust.

The current situation is alarming and reaching the critical point with soaring infection figures, overloading of the healthcare system, particularly in Selangor and Kuala Lumpur, plus burnout of the front-liners. Besides, the public has shown signs of mental distress from increasing suicidal rates and financial distress by waving “White Flag“.

Stringent movement restrictions with tightened standard operating procedures coupled with acceleration of the vaccination drive are needed to bring the numbers down to a manageable level. There is a need for multi-sectoral public-private partnerships among the health care, public health, and business sectors focused on a careful balance of health and economic factors, emphasising the importance of both.  Leadership’s role is to set a vision for a future state and to mobilise resources that help us get there safely and constructively using a “creating shared value” approach that provides benefits to each stakeholder while generating social value in the interests of public health (Pronk & Kassler, 2020).

Public support of public health measures including physical distancing, masking, staying home while sick, avoiding crowded indoor spaces and contact tracing/exposure notification applications remains critical for reducing the spread of COVID-19. The public should be aware of the danger of the new variants, warned of the early sign of COVID-19 and compliance to SOP. Thus, understanding current behaviours and attitudes towards public health measures and barriers individuals face in following public health measures are of utmost importance. Human behaviour is central to the spread of COVID-19, and therefore behavioural science must inform the public health response and communication strategies (Lang et al., 2021).

Few measures were taken pertaining to the overwhelmed hospitals capacity, such as converting few hospitals in Klang Valley to Full COVID hospitals, repurpose beds, mobilisation of healthcare workers and outsourcing through a public-private partnership. However, this is not the long-term solution in curbing this issue but to reduce the cases. We will not be able to overcome this pandemic by focusing solely on the virus. A broader, more integrated whole of society effort is needed. SOPs and interventions for this pandemic must be holistic and sustainable. A better-equipped public health workforce will help the nation better mitigate this pandemic.  The respective authority should be vigilant in monitoring and enforcement of the compliance of SOP.

This report was prepared by Dr Tham Sin Wan, a DrPH candidate at Universiti Malaya, and revised by Prof. Dr Victor Hoe Chee Wai (Public Health Medicine Specialist, Epidemiology (Occupational Epidemiology) and Occupational Health Discipline) and Dr. ‘Abqariyah Binti Yahya@Ahmad Noor (Epidemiology Discipline), Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya.

The report is based on the information from Covid-19 Epidemiology for Malaysia dashboard and the Ministry of Health.

References

Lang, R., Benham, J. L., Atabati, O., Hollis, A., Tombe, T., Shaffer, B., . . . McCormack, B. (2021). Attitudes, behaviours and barriers to public health measures for COVID-19: a survey to inform public health messaging. BMC public health, 21(1), 1-15.

Pronk, N. P., & Kassler, W. J. (2020). Balancing health and economic factors when reopening business in the age of covid-19. Journal of occupational and environmental medicine, 62(9), e540-e541.

Rampal, P. S. (2021). Situational analysis of COVID-19 in Malaysia (July 10 2021) : Worse yet to come?

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