Why Sarawak Can’t Celebrate Low Covid-19 Hospital Admissions Yet

Sarawak’s high Covid-19 vaccination coverage coincides with a sharp drop in hospital admissions, ICU cases, and deaths, but infections have been rising since mid-July, along with a slight uptick in hospitalisation and ICU rates last week.

KUALA LUMPUR, August 16 — Although Sarawak’s accelerated Covid-19 vaccination drive drove down hospital admission and mortality rates, the state has seen a new surge of coronavirus cases over the past month.

Sarawak — which has one of the highest Covid-19 vaccination rates in the country — reported 1,216 new infections on August 12, a historical high since the start of the epidemic. The state reported 5,296 new Covid-19 cases in the 32nd epidemiological week (August 8 to 14), more than double the 2,403 infections reported five weeks ago in the week of July 4-10.

About 88 per cent of Sarawak’s adult population has received at least one vaccine dose and 79 per cent have been fully vaccinated, as of August 14.

Its higher vaccination rate since mid-June coincides with a drop in hospital admissions, daily intensive care unit (ICU) cases, and deaths due to the coronavirus. New Covid-19 infections also saw a brief decline from end of June to mid-July before escalating again.

Sarawak’s seven-day average daily Covid-19 cases more than doubled from 303 cases on July 12 to 757 cases on August 14.

Its seven-day average daily incidence rate, as of August 14, stood at 26.75 cases per 100,000 population, exceeding the threshold for Phase Two of the National Recovery Plan (NRP) set at 12.2 cases per 100,000 population. Sarawak is currently in Phase Three.

However, the state’s hospitalisation and ICU rates remain relatively suppressed in line with its high vaccination coverage, although both indicators saw a slight uptick last week. It is unclear if the small increase is due to the higher daily Covid-19 case numbers.

Sarawak’s daily Covid-19 hospitalisation rate has been declining since mid-June, from 611 cases on June 17 to a low 295 cases on July 17. It rose to a single-day high of 429 cases on July 19 before averaging at about 366 cases per day between July 20 and August 8. Sarawak then reported a small increase last week with 391 Covid-19 hospital admissions recorded on August 11, before a decline to 295 cases in hospital on August 14. This makes up just 27 per cent of 1,086 beds available for Covid-19 patients in Sarawak.

A similar trend can be seen in the state’s daily Covid-19 ICU cases that fell from 107 cases on June 17 to a low 22 cases on August 1. The figure doubled to 44 cases on August 6, though the past week saw a steady decline to 36 cases on August 14. This accounts for 30 per cent of 120 beds available for coronavirus patients in the state.

Sarawak’s seven-day average Covid-19 deaths have also been brought down to one case daily since the end of last month from six a day at the start of June.

Dr Christopher Lee, former national advisor for infectious diseases in the Ministry of Health (MOH), said the decline in serious infections and deaths in Sarawak are consistent with the outcome of vaccination. Still, he said the Delta variant has impacted the virus’ clinical trajectory.

“Although vaccinations will still bring down new Delta infections (Delta seems to have reduced the efficacy of most vaccines, some more than others, with regards to new infections), its negative impact there is more prominent as its impact on serious infections and death.

“So, in the Sarawak data, as vaccination rates increase, the new cases do not come down as markedly as hospital admissions and deaths,” he told CodeBlue when contacted recently.

The United States’ Centers for Disease Control and Prevention (CDC) found that while Covid-19 vaccines prevent more than 90 per cent of severe disease, they may be less effective at curbing transmission, thus more breakthrough infections and higher community spread may occur.

This is in line with trends seen in Sarawak.

Sarawak’s state health department, in a statement on Thursday, attributed the recent spike in cases to social gatherings, non-compliance with standard operating procedures (SOP), and lack of testing in workplaces. The state reported a record-high 1,216 new Covid-19 cases that day.

Dr Lee said while poor public adherence to SOPs is commonly used to explain a rise in new cases, it may be more useful to look at the settings where these transmissions occur.

“How much can better enforcement of SOPs, better ventilation and providing alternative and pragmatic methods of work interactions (including better workplace policies) help to reduce transmission?” he said.

Dr Lee added that it would be more useful if the state could provide data on how many of the new infections occur in unvaccinated and fully vaccinated individuals. “The type of vaccines used in breakthrough cases would also be of importance.”

Sarawak, like other states, has rolled out the Pfizer-BioNTech, AstraZeneca-Oxford, and Sinovac vaccines under the National Covid-19 Immunisation Programme (PICK).

A recent study published in the New England Journal of Medicine showed that two doses of Pfizer or AstraZeneca’s Covid-19 vaccine are nearly as effective against the highly transmissible Delta coronavirus variant as they are against the previously dominant Alpha variant.

Two doses of the Pfizer vaccine offer 88 per cent protection against symptomatic disease caused by the Delta variant, compared to 94 per cent against the Alpha variant that was first discovered in Britain and became dominant across the globe earlier this year, the study said.

A double dose of the AstraZeneca vaccine was 67 per cent effective against Delta, down slightly from an efficacy rate of 75 per cent against the Alpha variant.

The research confirmed earlier data released by Public Health England in May that suggested the two vaccines offered similar levels of protection — Pfizer at 88 per cent and AstraZeneca at 60 per cent — against the Delta variant when administered as a full course.

American physician Dr Eric Topol recently pointed out that vaccine effectiveness of two doses of the mRNA and AstraZeneca vaccines are much lower at between 50 and 60 per cent at best against symptomatic Delta infection.

His data tabulation showed that Israel’s study found Pfizer to be 39 per cent effective against the Delta strain, while studies by Mayo Clinic and Qatar found Pfizer to be 42 per cent and 53.5 per cent effective against Delta respectively.

Breakthrough infections and deaths involving individuals across Southeast Asia who received the Sinovac vaccine, however, have led to shifts away from China’s coronavirus vaccines.

Sinovac has defended the efficacy of its two-dose vaccine, including against Delta, although no research into the Chinese jabs’ efficacy against Delta has been published in an international journal with peer review to confirm the results.

CodeBlue previously reported that the Sarawak state government is planning to purchase its own supply of Covid-19 vaccine for third doses expected to be administered in the state from October.

It is likely that the state may procure either Sinovac or the recently authorised Moderna, an mRNA vaccine, for its supply of booster shots as Pfizer and AstraZeneca only deal with national governments.

It is unknown if the Sarawak state government plans to mix-and-match vaccines between the third shot and initial two-dose regimens, which may have to be the case if the state is unable to get Pfizer and AstraZeneca from the federal supply for booster shots.

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