Adeeba: With Hospital Bed Shortage, Premature To Reopen Even With 100% Vaccination

Prof Dr Adeeba Kamarulzaman highlights potentially worse Covid-19 outbreaks in states with less health care resources than the Klang Valley, such as Johor, Kedah, Penang and Terengganu with fast rising cases.

KUALA LUMPUR, August 9 — It is too early to relax movement restrictions solely based on high vaccination rates amid surging Covid-19 infections and hospital admissions, said infectious disease expert Prof Dr Adeeba Kamarulzaman.

Dr Adeeba, who is also a member of the World Health Organization (WHO) Science Council, said several indicators like the Covid-19 case incidence rate per 100,000 population, positive rates, and intensive care unit (ICU) utilisation rates should also be taken into account before easing lockdown measures.

“I think what we need to do now is really try to bring the numbers down in locations where the numbers are very high,” Dr Adeeba mentioned last Friday in “MIDF Conversation”, a sharing session organised by MIDF Amanah Investment Bank Berhad.

“Unfortunately, it would be dangerous to reopen, even if our vaccination rate is high right now. Right now, we are desperately looking for beds and creating ICUs to keep people alive. So to reopen, even if our vaccination has reached 100 per cent, is a little bit premature.”

Yesterday, Prime Minister Muhyiddin Yassin announced the relaxation of lockdown measures for fully vaccinated individuals, including mandating vaccine passports for interdistrict and interstate travel, religious prayers, and for states under Phase Two and beyond of the National Recovery Plan (NRP), double jabs for adults for dine-ins, sports and recreational activities, and domestic tourism.

As of August 8, just 37.5 per cent of Malaysia’s adult population has been fully vaccinated with double doses. Rates of complete inoculation of adult populations vary from 85 per cent in Labuan to 17 per cent in Sabah.

Despite complete inoculation of half of Klang Valley’s adult population, the country’s commercial region with the highest Covid-19 case incidence rate does not qualify for vaccination privileges open to only states under Phase Two and beyond. Selangor, Kuala Lumpur, Putrajaya, Negeri Sembilan, Kedah, Johor, and Melaka are still under Phase One of the NRP.

Dr Adeeba said that several states may face worse consequences from emerging Covid-19 outbreaks compared to the Klang Valley whose hospitals are currently full. The media has also reported full hospitals in Penang, Kedah, Sabah, and Melaka.

She mentioned that scarcity of resources in public health care facilities in several states — such as in testing, isolation, contact tracing, and initiatives to ramp up vaccination — will make it difficult for them to come out from the epidemic.

“What worries me right now is that several states like Johor, Kedah, Penang and Terengganu are also showing up with more than an upward and fast rising numbers of infection,” said Dr Adeeba.

“I don’t want to see what happened to us in Klang Valley and Selangor be replicated in those other states where they’re going to be even less able to provide the hospital beds to the intensive care unit as needed.”

Based on the data compiled by CodeBlue, the average case incidence rate in the past week as of yesterday stood at about 62 daily cases per 100,000 population in Kedah, followed by Penang (47), Terengganu (38), and Johor (33). In the Klang Valley, Kuala Lumpur recorded an average of 123 daily cases per 100,000 population in the past week, Selangor (112), and Putrajaya (59).

The NRP Phase Two threshold for seven-day daily case incidence rate is set at between 6.1 and 12.2 cases per 100,000 population.

According to Dr Adeeba, the idea of achieving herd immunity for Covid-19 is redundant because eliminating the coronavirus completely is impossible. “The whole idea of herd immunity is slowly being abandoned.”

Public Health England released last August 6 initial findings that suggested vaccinated people infected with the Delta variant could spread the virus, as similar viral loads were found between vaccinated and unvaccinated individuals. The UK’s new findings corroborate research by the United States’ Centers for Disease Control and Prevention (CDC) that also found similar viral loads were shed between vaccinated and unvaccinated people infected with Delta in an outbreak in Massachusetts.

Dr Adeeba added that vaccination can prevent serious illness from the coronavirus, which will eventually help health care facilities in the country to regain capacity.

“Of course we want to vaccinate anyone and everyone, but also learn to live with the virus and get to a level where hospitals can cope.”

Dr Adeeba noted that it is impossible to vaccinate 100 per cent of the Malaysian population because of undocumented migrants who are not willing to come forward to take the Covid-19 vaccine.

So she stressed that all public health measures, including effective contact tracing measures and adherence to standard operating procedures (SOPs), are the key to control the spread of the coronavirus as it is impossible to eradicate the virus.

“First of all, forget about getting to zero, we will not get to zero.”

Dr Addeba noted that policies and strategies that focus on zero Covid-19 goals will drive Malaysia to “continuous lockdown” measures that can be “disastrous” to the economy of the nation.

Malaysia is suffering from large Covid-19 outbreaks partly due to ineffective contact tracing measures and testing, noted the infectious disease expert.

“So we really need to continue to expand testing in contact tracing and isolating and supporting those who are infected. I think that’s been our number one handicap, because we haven’t got an automated system.

“Many things are still manual, there’s delays in informing people, they’re positive, there’s delays in isolating them, delays on the forward and backward tracing.”

When it comes to schooling, Dr Adeeba highlighted the importance of knowing the epidemic and responses to handle the education sector. She disagreed with the blanket closure of all schools in Malaysia at the same time.

“Why did we shut down schools in Perlis when they hardly had any cases, particularly in areas where perhaps, access to digital technologies is not so good?”

Malaysia is due to reopen schools nationwide next month.

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