Malaysia’s Fourth Covid-19 Wave Inevitable: Epidemiologists

Public health experts say as Covid-19 is here to stay, a mitigation approach should be used to prevent severe disease and death, instead of containment through MCOs.

KUALA LUMPUR, April 19 — As Covid-19 cases rise in Malaysia again, epidemiologists say the fourth wave of the epidemic is inevitable and the government should switch its public health strategy from containment to mitigation.

Public health experts highlighted that as Covid-19 is here to stay, a mitigation approach to prevent deaths and severe disease should be used, instead of ineffective lockdowns that cannot control multiple outbreaks and widespread community transmission of the virus.

Besides ramping up testing and isolation, vaccinating the vulnerable population is part of the mitigation approach towards handling the epidemic, they said.

Since January 30, Malaysia’s average daily Covid-19 cases reduced continuously only for six weeks, before the epidemic started showing a rising trend over the past two weeks.

Average reported coronavirus infections nationwide increased to about 1,376 cases a day in the week of April 3 to 9, before rising to 1,846 cases daily in the past week from April 10 to 16.

Malaysia has been reporting more than 2,000 new Covid-19 cases daily for the past four consecutive days since April 15. Sarawak recorded its highest-ever 24-hour increase on April 16 with 960 cases, while Kelantan notched a record high 332 infections yesterday. Sabah, after daily Covid-19 cases fell to double digits earlier this month, reported 202 new infections on April 15.

In Selangor, since January 30, average daily Covid-19 cases showed a decline for six weeks, similar to the national trend. The average daily Covid-19 cases in the country’s most developed state then increased slightly in the week of March 20 to 26, but maintained below 400 daily cases on average for the subsequent fortnight. Coronavirus infections in Selangor then increased to 472 daily cases in the past week of April 10 to 16.

On the other hand, average daily Covid-19 cases in Sarawak have been showing a gradual increase since the beginning of the year with only an occasional decline. Over the past three weeks, there has been a steep increase in the number of Covid-19 cases in Sarawak, reaching 523 infections a day on average in the week of April 10 to 16.

Dr Sanjay Rampal, an epidemiologist and public health expert from University Malaya, pointed out that there’s a huge likelihood of continuous large outbreaks of Covid-19 for the next few years.

“Another wave is inevitable in the coming future. This is because of the susceptibility of large proportions of Malaysians and global population to the virus,” he told CodeBlue.

Health Minister Dr Adham Baba reportedly claimed over the weekend that the fourth wave of the Covid-19 epidemic could only occur if locally transmitted infections fell to the baseline, or zero, before rising sharply. However, epidemiologists define epidemic waves as being usually preceded by a trough period. In Malaysia’s case, there was a defined peak in end January, followed by a decline in cases, before an increase the past two weeks.

Dr Sanjay said that the government should use a mitigation approach (prevention of severe diseases and deaths) in tackling the epidemic, rather than using a containment approach like border controls and restrictions under Movement Control Orders (MCOs).

“MCOs are very costly and not a long-term solution. A mitigation approach becomes more important with the establishment of community transmission.”

Dr Sanjay Rampal, epidemiologist and public health expert from University Malaya

The UM public health expert said that herd immunity of a country may also not be enough, as high global infection rates may still introduce new mutations that make current vaccines less efficacious.

Hence, he said that vaccines will help in the short-term but are not a prime solution. Dr Sanjay highlighted that a more sustainable long-term solution is to improve preventive public health capacity and the economy.

“National preparedness should entail vigilant monitoring for changes in the disease transmission and the severity of infection. Our standard operating procedures (SOPs) should acknowledge that we will be living with this virus for at least a few more years,” the UM expert added.

Sarawak Bucks National Trend

Since January 2, average daily Covid-19 cases in Sarawak increased gradually for three weeks until the week of January 23 to 29, before dropping the subsequent fortnight, more or less mirroring the nationwide trend.

However, in contrast to the national epidemic that saw a six-week decline in average cases since the week starting February 6, Sarawak saw a gradual increase in reported infections across nine weeks from February 13 until the week ending April 16, except for two separate weeks in that period when average daily Covid-19 cases dropped slightly.

Over the past three weeks, the average daily Covid-19 cases in Sarawak showed a steep increase, with the highest number of average infections recorded at 523 daily cases between April 10 and April 16.

This pattern was similarly seen in Sabah when it became the epicentre of the third wave of the Malaysian epidemic last October. Sabah recorded a steady increase in the average daily Covid-19 cases for five weeks since October 3, reaching about 680 infections a day in the week of October 31 to November 6.

Dr Lokman Hakim Sulaiman, epidemiologist and public health expert from International Medical University (IMU), pointed out that despite strict border controls being implemented in Sarawak, Covid-19 cases still continued to increase.

“Meaning, it is the local transmission that drives the cases,” Dr Lokman said.

He suggested for the Ministry of Health (MOH) to focus on infectious disease control, such as early detection and early isolation in order to reduce the harms of another Covid-19 outbreak.

“Every close contact must be investigated quickly and when a cluster occurs, the entire community should be investigated,” the former Health deputy director-general told CodeBlue.

“Covid-19 is here to stay. MOH must consider a dedicated team to do case investigation, contact tracing, managing quarantine, and community mobilisation.”

Dr Lokman Hakim Sulaiman, epidemiologist and public health expert from International Medical University

He also said that people will live with Covid-19 just like any other infectious disease, but the vulnerable population who are prone to severe disease and deaths from the coronavirus should be protected first.

“How? By vaccinating those vulnerable, elderly especially, as fast as possible.”

General Elections Can Be Held Once Vulnerable Population Vaccinated

Recently, minister in charge of the National Covid-19 Immunisation Programme (PICK) Khairy Jamaluddin said that the 15th general election can be held even before Malaysia reaches herd immunity.

Dr Lokman said that as long as a general election does not lead to an exceptional Covid-19 death rate, it should be considered safe to call nationwide polls.

“As I said before, we should tolerate Covid-19 cases if it is mild and asymptomatic, especially the young adults and children. If we have vaccinated all the elderly, it should be safe to conduct an election,” the public health professor from IMU said.

“Unstable and weak government to me is as dangerous as the Covid-19 pandemic itself. True for both sides, the current government needs fresh and strong mandates for the rakyat to be a stable and strong government and the same for the opposition.”

Dr Lokman also pointed out that in many countries like Croatia, Malawi, South Korea, Dominicon Republic, North Macedonia, and Trinidad, their new daily coronavirus cases remained on the same trajectory even after elections were held.

For example, in Croatia, new Covid-19 cases remained on a flat trend after elections, while daily infections decreased after elections in South Korea.

There were some countries in which new Covid-19 cases showed a steeper increase after elections. For instance, Belarus saw an increase in cases, although other factors like protests could have affected it.

Meanwhile, new Covid-19 cases increased in Siberia after elections, but Dr Lokman highlighted that it could also be due to underreporting of coronavirus cases before the elections. In Poland and Singapore, new Covid-19 cases increased after elections but it could be due to early easing of movement restrictions.

Dr Lokman suggested that in order to have a general election, 80 per cent of the elderly population, above 50 years of age, should be vaccinated.

Secondly, he said the Election Commission should consider additional standard operating procedures (SOPs) to be safe during the elections, such as extending polling day to one week to reduce crowding; expansion of postal voting while prohibiting border crossings, mass rallies and house to house campaigning; and facilitating fair campaigning through mainstream media.

On the other hand, Dr Sanjay said that on paper, the health impact of elections may be minimised by current pillars of prevention of Covid-19, but these measures may be very difficult to be universally operationalised.

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