KUALA LUMPUR, April 13 — Malaysia’s low Covid-19 case fatality rate of 0.4 per cent obscures the high risk of death for critically sick patients, said an infectious disease consultant.
Dr Benedict Sim Lim Heng from Sungai Buloh Hospital, Malaysia’s main Covid-19 facility, also revealed that Covid-19 patients who die post-recovery — either from complications due to lengthy hospitalisation or from persistent effects of the disease — are not officially classified as Covid-19 deaths.
Some non-coronavirus patients diverted from Sungai Buloh Hospital, a large public hospital based in Selangor, ended up dying when they couldn’t get treated during the epidemic, he said.
Dr Sim shared a study conducted in Malaysia on 6,368 Covid-19 patients, where half of them were asymptomatic and about 50.3 per cent patients showed symptoms. Out of the symptomatic patients, 88.2 per cent recovered after undergoing mild or moderate Covid-19 disease.
About 11.8 per cent, or 379 patients, of the symptomatic Covid-19 patients developed severe disease and were put under ventilator support. Of them, 62.3 per cent were admitted into the intensive care unit (ICU). There, 34.3 per cent or 81 of them died.
Dr Sim mentioned that although the mortality rate from this study among 6,386 Covid-19 patients was only 1.27 per cent, the death rate among ICU patients was high.
“At this stage, the 0.4 per cent death rate doesn’t mean anything anymore,” Dr Sim said in a webinar last Wednesday on Covid-19 vaccines organised by the Institute for Clinical Research, referring to Malaysia’s overall Covid-19 case fatality rate.
“The mortality rate among patients who develop severe Covid-19 disease is quite substantial.”
As of April 12, Malaysia has reported 1,333 Covid-19 deaths, or a 0.37 per cent fatality rate out of 362,173 cases. However, Dr Sim said that this low case fatality rate does not mean that the virus should be allowed to take its course.
Dr Sim emphasised that the Covid-19 mortality rate affects people differently across age groups.
According to Dr Sim, as of June 15 last year, 40.13 per cent of Covid-19 cases among those aged 60 and above had died. People aged 40 to 49 recorded a 0.91 per cent case fatality rate, while those aged 50 to 59 reported a 1.97 per cent case fatality rate.
Dr Sim stated that the Covid-19 deaths affect different groups of patients differently. Thus, he pointed out that it is important to look at the mortality rate from the patient’s perspective too.
Last February, Malaysiakini cited figures from the Department of Statistics that showed Sabah recorded 868 more deaths in the final quarter of last year compared to the same period in 2019. However, only 252 Covid-19 related deaths were officially reported in the state in the fourth quarter of 2020.
Dr Sim, who commented on the excess deaths, said: “Perhaps there might be patients who died, who were not tested for Covid or missed that they had Covid, or perhaps they were just scared to come to hospital?”
He explained that people with comorbidities might miss hospital appointments to receive treatment for their underlying health conditions.
“Reports of death will lag behind cases like the ICUs in hospitals. You’ll find that ICUs are still full and we have patients in ICU for two weeks and we have got patients in ICU for more than two months and these patients may not be able to survive Covid-19,” Dr Sim said.
“They come out in [the official] numbers for having contracted Covid-19, but the ultimate outcome of the disease hasn’t taken place yet. So, the death rate always lags behind the number of people who have Covid.”Dr Benedict Sim Lim Heng, infectious disease consultant from Sungai Buloh Hospital
“Of course when we are talking about a disease that has been going on for a year, then this number will not be so significant,” Dr Sim added.
He also pointed out the different classification of deaths among sick Covid-19 patients, where the morbidity of Covid-19 is not taken into account in their deaths after recovery from the disease.
“Sometimes, deaths are classified differently. If somebody has been in a hospital for a long time, they would have seen steroids, ended being bed bound, severe Covid, or bed sore, or high doses of immunosuppressants, steroid treatments.”
“They may have recovered from Covid now, but later on, they get other infections, complications of being bed bound, and that death may not be classified under Covid deaths.”Dr Benedict Sim Lim Heng, infectious disease consultant from Sungai Buloh Hospital
Dr Sim highlighted that people who die but are not suspected for Covid-19 will not be tested for the virus.
At the same time, the infectious disease expert said Covid-19 patients who recover from the acute phase of the infection might later die from other causes due to the persistent effects of the disease, but their deaths are not categorised as Covid-related. The Ministry of Health has yet to reveal any research into “long Covid” in Malaysia, or symptoms that can last weeks or months after Covid-19 infection.
He also noted that Sungai Buloh Hospital, which has been turned into a full Covid-19 facility that only treats coronavirus cases, was a very busy hospital prior to February or March 2020 at the early phase of the Covid-19 epidemic in Malaysia.
“It was a 900-bed hospital and we had neurosurgical patients coming in — patients with dengue, HIV, and other surgeries — they were all coming to the hospital,” Dr Sim said.
“When Hospital Sungai Buloh converted to a full Covid hospital, all these patients had to go elsewhere and understandably, there’ll be some patients actually at disadvantage because this whole Covid thing has taken up a lot of resources, space, and they get left behind.
“Some of the cases have even resulted in death. So there are other indirect causes of deaths due to this Covid outbreak.”
The United States recorded an average of 2.8 million deaths every year from 2015 to 2019 before the annual death toll increased to 3.36 million last year. In 2020, the US also reported more deaths from heart disease, diabetes, kidney disease, and stroke than the usual average from 2015 to 2019.
Dr Sim noted that the excess deaths in the US might have occurred among patients with comorbidities before they were tested for the coronavirus.
Amendment note at 11.15am: Paragraph 11 was amended to specify that the percentage figures referred to case fatality rates among different age groups.