Critically Sick Covid-19 Cases Rising In Malaysia

By A Concerned Nationalist | 09 April 2021

Malaysia’s rising trend of Covid-19 cases in ICU was similarly seen during the end of October or early November last year.

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KUALA LUMPUR, April 9 – Critical Covid-19 cases in Malaysia have been increasing since the middle of March, reaching a third of intensive care unit (ICU) beds on average this week.

Based on seven-day averages, the proportion of ICU beds occupied by Covid-19 patients rose from 28.2 per cent on March 16 to 32.81 per cent on April 7. The percentage figures were based on 543 ICU beds allocated for Covid-19 patients, as revealed by Health Minister Dr Adham Baba.

This rise of nearly 5 percentage points came at the heels of a downward trend from the height of a near 60 per cent ICU bed occupancy rate due to Covid-19 at the end of January this year. Some six weeks later, the number of Covid-19 ICU cases increased from 152 patients on March 16 by about 28 per cent to 194 patients on April 7.

Based on seven-day averages, the number of Covid-19 patients in ICU on ventilator support rose from about 61 individuals on March 23 to 85 people on April 7.

Malaysia’s rising trend of Covid-19 cases in ICU was similarly seen during the end of October or early November last year during the beginning of the third Covid-19 wave in the country.

Some medical experts have been warning about the possibility of an incoming fourth wave, amid a resurgence of the virus in many other parts of the world like Europe, India, and South Korea.

Why is there an increase in critically ill Covid-19 patients in Malaysia? Let’s take a look at some of the possibilities:

Late Detection Due To Inadequate Testing

As many epidemiologists have advocated in the past, testing is vital in this pandemic. Why? The reason is that the earlier we detect a Covid-19 case, necessary medical remedials and public health measures of isolation can occur so that we reduce the severity and spread of the virus.

The logic behind it is, if more people are tested, we detect early and we can mitigate early. There was much talk about the cost and turnover time of tests. Thus, many advocates and epidemiologists have suggested the use of RTK-Ag for quick results for mitigation. It is also relatively cheaper than the RT-PCR test.

Mass and periodic screenings allow the early detection of cases, preventing these people from progressing into severe Covid-19. An example was the sudden surge of Covid-19 cases to nearly 500 at a factory in Manjung, Perak, on April 3 – the Jalan Pelabuhan cluster — which could have been due to inadequate testing and asymptomatic spread despite detection activities in February.

Thus, it is important to test periodically. Failure will see more of the same. This is especially true for workplace clusters.

Increase In Moderate To Severe Covid-19 Cases

Dr Adham said Monday that 37 per cent of 6,755 hospital beds allocated for Covid-19 patients were currently utilised. This indirectly says that 37 per cent [95 per cent confidence interval: 36.21- 37.79 per cent] of our cases are coming with a moderate to severe form of Covid-19 (Tier 3 to 5), while 63 per cent of Covid-19 patients [CI: 62.21 – 63.79 per cent] were those asked to self-isolate at home.

In the past, more than 70 per cent of Covid-19 cases in Malaysia were asymptomatic (Tier 1) or mild (Tier 2). This means that there has been a rise in the number of severe Covid-19 cases.

In other words, more than one in every three Covid-19 cases detected are the severe types who land in hospital. Those who require ICU or ventilation care face a higher risk of mortality. The increase of severe Covid-19 cases could be due to inadequate and infrequent testing as explained earlier.

However, we are also seeing a rise in community cases and areas where there might be some neglect. For example, there is a surge of coronavirus cases within the educational centres, shopping areas, and in plantations.

What many keep forgetting is the science behind mitigation. Firstly, good ventilation, avoiding high-density areas, and ensuring that the public health measures of masking, physical distancing, and hand hygiene are thoroughly carried out.

Failure and poor compliance with these measures are among the reasons behind the increasing case numbers. The issue with this is that as we see a surge of cases, including many asymptomatic or pre-symptomatic people who are potential super-spreaders.

The virus spread from these undetected cases can lead to an increase in the number of Covid-19 cases and cause the number of severe infections to go up if they are detected late. Some of the ways to counter this is to ensure that no sector is left behind (including plantations, schools etc), ensure that testing methods are provided (preferably ones that can be done at home or smaller centres like saliva analysis), and period screening in work sectors to ensure that areas of high density do not become super spreaders.

A New Strain?

Though only nine locally transmitted Covid-19 cases involving the South African variant (B.1.351) have been officially identified, this strain or other variants could possibly be driving the rise in coronavirus cases.

The Selangor cases with the South African variant were linked to individuals working at the KLIA airport. It brings us back to the point that screening at workplaces must be done thoroughly and periodically.

The spread in certain states might be linked to a new strain, though reporting whole case numbers are meaningless unless reported as per 100,000 population. But the fact remains that we might be dealing with a new strain.

We must be vigilant and think about our Covid-19 mitigation plan, along with ensuring efficient vaccine uptake and rollout, so that we can control the situation better.

Note: CodeBlue is publishing this analysis anonymously because the author says: “Malaysia today punishes those who want to put things right”.

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