Covid-19: What Is Coming Our Way? — Dr Amar-Singh HSS

The Covid-19 crisis is now fully established in six states — Sabah, Kedah, Johor, Perak, Kelantan and Penang — with total completed vaccination rates of only 30% or less (four states have rates less than 25%).

We have all been occupied by the political situation in the country, but the Covid-19 virus is not. It is continuing its relentless march forward, whether we are focused on it or not.

While an efficient government that deals with the pandemic decisively is crucial for the country, Malaysians need to be prepared for what is coming our way. I would like to share with you some possible scenarios for the coming weeks and months, and some thoughts and opinions based on current data.

Continued Recovery In The Greater Klang Valley

The Greater Klang Valley, comprising Selangor, Kuala Lumpur, Putrajaya and Negeri Sembilan, is starting to see an improvement with a plateau and slow drop in case numbers and hospitalisations.

Taking into account high vaccination rates of the total population, with 54 per cent in the Klang Valley and 48.8 per cent in Negeri Sembilan, this is to be expected.

The number of patients in hospital and ICUs will take longer to go down, as case numbers are often delayed by 10 to 14 days.

However, this does not mean the end of the crisis for the Klang Valley, and we still have to be vigilant. But it is a welcome sign for all the exhausted health care workers.

Worsening Crisis Outside The Klang Valley

The crisis I wrote about in recent weeks is now fully established in six states, namely Sabah, Kedah, Johor, Perak, Kelantan and Penang. Sadly, these six states are facing a worsening situation.

A rising number of cases is detected daily. When ICU beds are full, tracking hospitalisations and ICU bed numbers becomes less helpful, as real numbers that need care are not shown.

Information from the ground reveals a grim situation not unlike what happened in the Klang Valley in recent weeks. We can expect a catastrophic number of deaths in the coming six to eight weeks.

We can also expect that national Covid-19 numbers in the coming weeks to be driven by these states. For example, 45 per cent of all cases (10,401 out of 22,948) on August 19, 2021 were from these six states.

These states have a completed vaccination rate of only 30 per cent or less; with four states having less than 25 per cent. Malaysia has so far only received 34 per cent of the Covid-19 vaccine supply ordered; therefore, ramping up vaccination in these states will take time.

Even if we could boost vaccination rates to 50 per cent of the population in these states in four weeks, it will still require two weeks, post vaccination for us to see any positive results.

Therefore, we are in for a very difficult and painful two months. I have written extensively about what we should do, and will not repeat it here.

I would like to stress here that any discussion on vaccination rates in Malaysia must take into account total population vaccination rates, and that we should stop using adult population vaccination rates.

Infections In Children The Next Wave?

In countries where adult vaccination rates are high, a rise in infection numbers in children has been seen. The highly infectious Delta variant also appears to cause more harm to children, but international data on this is still preliminary.

Locally, we will see this wave happening first in the Greater Klang Valley and Sarawak, where adult vaccination rates are high. There has been a recent upsurge in the number of children with Covid-19 admitted locally.

We need the Ministry of Health to closely monitor this trend and reflect it in the daily data shared with the public; in particular the number of children with severe illness and deaths.

There have been calls to commence vaccinating children in Malaysia. As a paediatrician, I am keen to support and protect children, but as a Malaysian, I am thinking of all our adults who have yet to be vaccinated in many states, especially those with chronic illnesses.

Remember that adults are 30 to 40 times more likely to die than children when infected. If vaccine supply was not limited, we could vaccinate adults and children (teenagers) vaccination simultaneously, with parents being made aware of the increased risk of side effects in children.

To control infection in the community, to get children back to school (and reduce their emotional and mental strain), and for economic recovery, we will have to vaccinate children aged between 12 and 17 years old.

When do we start doing this is the difficult decision. We may want to make this decision on personal choice to protect our children, but we should also think of the nation as a whole. This is a difficult choice indeed.

Resolving Sinovac Vaccine Efficacy Issues

There have been different opinions expressed on the effectiveness of the Sinovac vaccine, especially with regard to the Delta variant. Published data supports the Sinovac vaccine as effective against the original virus strain, but there remains uncertainty with the Delta variant.

How effective is the Sinovac vaccine towards the Delta variant? Is a booster dose required? If so, which booster vaccine?

While we wait for international data to be made known, we have an opportunity to get answers from the vaccination programme in Sarawak. Of the 1,679,000 vaccinations in Sarawak, 80.3 per cent got vaccinated with Sinovac, 18.2 per cent Pfizer, and 1.4 per cent AstraZeneca.

With work being done by the genome laboratory at Universiti Malaysia Sarawak (UNIMAS), we have an option for local answers to these questions, due to the sizeable use of Sinovac in Sarawak.

Remember that data from all vaccines suggests a waning of immunity after five to six months. Sarawak has just completed mass vaccination of adults, so we may not see the impact of the Delta variant on Sinovac-vaccinated persons for some months yet.

The Myth Of Herd Immunity And A Resurgence Of Delta As Immunity Wanes?

The reality that vaccination immunity wanes with time in some individuals is now sinking in, with data coming from a number of countries and studies. The US’ Centers for Disease Control (CDC) recently gave reduced estimates of vaccine effectiveness (VE) for Pfizer and Moderna vaccines. 

Israel has reported an increase in breakthrough infections in the vaccinated due to the Delta variant; breakthrough infections seem to occur more commonly in people who had been vaccinated (Israel uses the Pfizer vaccine) earlier in the year, and those over 60 years of age.

While some have mild infections that can still be transmitted to others, there are those that require hospitalisation. Hence, Israel has introduced a booster for those aged 50 years or older.  

Together with this is the realisation that a high vaccination rate of 60 to 70 per cent in any country does not seem to stop outbreaks. Hence most nations have moved away from the concept of herd immunity as being useful.

We will have to watch the data closely as it comes out of Israel, the UK and the US as it will inform our decision on if, when and in whom a booster is required, and which vaccine to use.

We still have some time as many Malaysians have been vaccinated in the past three months, and we need to take care of unvaccinated individuals first.

Everyone needs to keep abreast of the evolving situation and data. Consuming viral, unsubstantiated messages is not useful, and will hinder our ability to protect our families and ourselves.

To the incoming new government, we ask that you share data transparently, for this is what builds trust.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.

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