Since our first three cases of Covid-19 were confirmed on 24 January 2020, and the first two deaths on 17 March, Malaysia has, as of 4 September, 9,385 cases with 128 deaths.
The youngest Covid-19 case was a newborn baby born to a positive mother. Although at least 20% of all cases were aged 18 years and below, there has been no death in this age group. The youngest to have died was a 23-year-old female Malaysian university student, the oldest was 101-years-old.
In the course of duty, only one health care worker (HCW), a nurse, had died from Covid-19. The two doctor fatalities acquired Covid-19 from travel (Turkey) and the community respectively. This is in sharp contrast to the 100 doctors who have died in Indonesia, and 196 in India, among the many HCW fatalities in many countries.
Worldwide, 867,000 have died out of 26.2 million known cases (3 Sept). The top five countries for deaths (3 Sept) are the United States of America (USA) with 190,000 deaths (6.25 million cases), Brazil with 125,000 deaths (4.05 million cases), India with 67,376 deaths (3.85 million cases), Mexico with 66,329 deaths (617,000 cases) and United Kingdom (UK) with 41,527 deaths (340,000 cases). Note that Indonesia with 7,750 deaths (177,571 cases) is 19th and Philippines with 3,688 deaths (228,000 cases) is 32nd on this death ranking. Turkey is 22nd (6,511 deaths, 275,000 cases).
Risk Factors For High Mortality Rates
An observational study of 11,721 adult Covid-19 inpatients in 38 states in USA between 15 Feb and 20 April revealed that older patients were significantly more likely to die, particularly those older than 60 years. Men were more likely to die than women.
The mortality rates were 2% for ages 18-40 years, 14% for 41-60 years, and 84% for those above 60. 21% of patients died after a median hospital stay of eight days.
Male sex, age above 40 years, obesity, and presence of cardiovascular or chronic kidney disease were risk factors for mechanical ventilation and death during hospitalisation. Among the nearly 2,000 hospitalised adults requiring mechanical ventilation, only 27% were discharged alive. People who needed mechanical ventilation were 32 times more likely to die compared with other Covid-19 cases.
Covid-19 patients with an underlying condition are six times more likely to be hospitalised and 12 times more likely to die, compared with those who have none, according to the USA Centers for Disease Control and Prevention. Among those with underlying conditions such as cardiovascular disease or diabetes, 45.4% of patients with Covid-19 were hospitalized versus 7.6% of patients without an underlying condition.
A team of researchers in a recently published report (21 July) performed a meta-analysis of data from 15,794 hospitalised Covid-19 patients. The data were derived from 65 publications from 1 December 2019 to 6 April 2020. They showed that the ICU admission rate for hospitalised Covid-19 patients with Diabetes (Type 1 or 2), was 96% higher than among those without diabetes and the mortality was 2.78 fold higher.
The rate of ICU admissions among those hospitalised with Covid-19 who also had hypertension was 2.95-fold above those without hypertension, and mortality was 2.39-fold higher. The differences were statistically significant.
Your Risk Of Getting Severely Ill From Covid-19 Increases As You Get Older
Age is the single most important factor predicting when coronavirus kills. Out of every 100 people who die from Covid, 88 are over 65. Only two out of every 100 people who die of coronavirus are under 50 years of age.
Age and gender are well-established risk factors for severe Covid-19 outcomes: over 90% of Covid-19-related deaths in the UK have been in people over 60, and 60% in men.
Although many infected individuals will have mild symptoms, older patients are disproportionately more likely to progress to severe disease. US infected adults aged 65 to 84 are hospitalised at a rate of 31–59%, and those over 85 at a rate of 31–70%.
US CDC data released on 16 June show that America’s Covid-19 death toll skews significantly younger. People in their 80s account for 46.1% of all US Covid-19 deaths. 41% deaths were in the 60-79 age group. The median Covid-19 sufferer in America is a 48-year-old. In Italy it is a 63-year-old.
This outlier might be due to the fact that America has a younger population with a median age of just 38. Italy’s median age is 45 (Malaysia 28.9). Another reason, perhaps, is that middle-aged Americans tend to be more obese than most.
Obesity (BMI>30) A Risk Factor For Severe Covid-19 And Death
People with a body mass index (BMI) of 30 kg/m2 or above are at significantly increased risk for severe Covid-19, while a BMI of 35 and higher dramatically increases the risk for death. The study included 482 adults admitted with confirmed Covid-19 to a single Italian hospital between 1 March and 20 April 2020.
Among those with obesity, 51.9% experienced respiratory failure, 36.4% were admitted to the ICU, 25% required mechanical ventilation. 29.8% died within 30 days of symptom onset.
Patients with BMIs of at least 30 had significantly increased risks for respiratory failure, ICU admission, and death, compared with those with lower BMIs.
Worldwide obesity has nearly tripled since 1975, with about 13% of adults being obese and about 39% of adults being overweight (BMI 25 to <30). Nauru has the highest obesity rate in the world at 61.0%, followed by many of the other Pacific Island nations. Vietnam has the lowest obesity rate of 2.1%. The United States has the 12th highest obesity rate in the world of 36.2%.
The National Health and Morbidity Survey 2019 showed that 50.1 percent of Malaysian adults were either overweight or obese. 30.4 percent were overweight and 19.7 percent obese.
Malaysian Covid-19 Deaths
The Health Director General in his Facebook posting on 7th Sept reviewed Malaysia’s 128 deaths, from the first death on 17 March to 30 August. Eighty-eight were above 60 years old (68.7%), the youngest 23-years-old, the oldest 101-years-old. 9.7% were aged 21-40, 7.8% (10-50 years), 14.1% (50-60 years), 32.8% (61-69 years), 35.9% (>70 years). A large proportion had history of chronic conditions. Six were foreigners: Filipino (2), Indonesian (1), Pakistani (1), India (1), and others (1).
On 16 April, he had said that 80.7 per cent of deaths involved those suffering from chronic illnesses such as diabetes, hypertension, kidney problem, heart and other diseases. He emphasised the importance for senior citizens to get immediate treatment, even for mild symptoms like fever, cough, flu or sore throat, as the ability to recover and prognosis for Covid-19 recovery was better with early treatment.
The majority of deaths (99) occurred in the seven weeks from 17 March to 3 May. In this initial group, 17 deaths were female, aged 23 – 91, with the average age of 65.
The estimated population of Malaysia (2019) aged 55-64 years is 8.46%, and 6.35% for 65 years and over, but they contribute more than 75% of deaths from Covid-19.
A fusion opinion from a Sarawakian public health specialist, paediatrician, ex-associate professor, disaster relief and medical volunteer, passionate about helping people learn.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.