KUALA LUMPUR, Oct 28 — Only three per cent of mild Covid-19 patients from Malaysia’s early coronavirus wave eventually developed severe disease, according to a study led by the Institute for Clinical Research (ICR).
The study categorised mild Covid-19 patients from three stages — stage one: those who test positive but have no symptoms; stage two: those who experience Covid-19 symptoms but without pneumonia; and stage three: those with pneumonia but without hypoxia (lack of oxygen). Severe Covid-19 has two stages: stage four (pneumonia with hypoxia) and stage five (critically ill patients).
ICR’s study on 5,889 Covid-19 patients aged 12 years and above — who were admitted to 18 different hospitals between February 1 and April 30 this year — found that 30 of 2,956 stage 1 patients (1 per cent), 84 of 1,859 stage 2 patients (4.5 per cent), and 84 of 801 stage 3 patients (10.5 per cent) deteriorated into either stage 4 or 5 with severe disease.
The study sample of 5,889 Covid-19 patients showed that about half, or 2,956 people, did not show symptoms upon hospital admission as they were classified in stage 1 of the disease. About 72 per cent (4,221 patients) of the sample were male, while the median age of patients was 34.
The presentation by Wong Xin Ci et al published last August 27 also found that 92 per cent (5,418) of patients in the study had mild Covid-19 disease, 3.3 per cent (193) were admitted into the intensive care unit (ICU), while 1.2 per cent (73) of the patients died of Covid-19.
According to the study, 85 per cent of ICU admissions occurred within five days, which researchers attributed to hospitalisation of everyone who tests positive for Covid-19 in Malaysia that allows risk stratification and early ICU access.
Researchers pointed out that the median time from symptom onset to ICU admission for Covid-19 in the United States, on the other hand, was seven days.
The Malaysian study also found that the determinants of Covid-19 disease severity include age above 50 years, as well as symptoms like fever, cough, diarrhoea, breathlessness, increased breathing rate, underlying chronic kidney disease, high C-reactive protein (protein that is produced by the liver when there is an inflammation in the body), and an abnormal chest X-ray at the time of admission.
Citing previous studies, researchers said younger adults had fewer pre-existing conditions and mild Covid-19 infection as compared to older patients. A separate study found that older people have weaker immune systems and co-morbidities like diabetes further weaken their immune system, making them more prone to contracting the coronavirus.
Wong’s research — published at the 13th National Conference for Clinical Research: Conference of Very Important Disease (Covid-19) in Shah Alam, Selangor, last August — included co-authors from the Infectious Disease Department at Sungai Buloh Hospital, Selangor, and the Clinical Research Centre at Seberang Jaya Hospital, Penang.
According to the National Health and Morbidity Survey (NHMS) 2019 by the Ministry of Health, an estimated 3.9 million adults aged 18 and above in Malaysia had diabetes as of last year. The study by ICR, however, did not specify the number of Covid-19 patients who had underlying diabetes.
CNN reported that a research paper studying data on the first 72,314 people diagnosed with Covid-19 by scientists from the Chinese Centre of Disease Control and Prevention found that more than 80 per cent of them experienced only mild symptoms. A total of 14 per cent were classified as severe cases while 5 per cent were in critical conditions.
Now, Malaysia is seeing its third wave of the coronavirus epidemic and has been reporting three-digit cases continuously since September 25. On October 14, CodeBlue reported that four in 10 coronavirus patients in Sabah were ill enough to be hospitalised (stage three to five of disease).
An anonymous medical officer from Tawau also told CodeBlue that the number of Covid-19 patients requiring supplemental oxygen is increasing. Patients referred from Semporna Hospital to Tawau Hospital are in the worst condition when they arrive, most of the time intubated (tube inserted into the throat and connected to a ventilator to support one’s breathing).