Experts: Too Early To Declare Covid-19 Endemic Phase

Public health experts say the government first needs to control the Covid-19 epidemic, as infections and deaths are still too high, before transitioning into an endemic stage.

KUALA LUMPUR, Sept 7 — Amid high Covid-19 infections and deaths, public health experts cautioned the government not to use Covid-19 vaccination as the sole indicator for Malaysia to transition into an endemic phase.

Other indicators like Covid-19 incidence rate, hospital admissions, fatality rate, and the rate of vaccine breakthrough cases in states and districts levels should be considered first before shifting into a new phase of living with the virus, as opposed to the epidemic phase of active outbreak control.

During an epidemic, the government pours massive resources into controlling the disease, whereas an endemic stage typically sees greater focus on personal responsibility in preventing infection.

Dr Christopher Lee, the national advisor for infectious diseases in the Ministry of Health (MOH), said that the current surges of Covid-19 infections and deaths are the result of a novel coronavirus meeting naive immune systems.

“When enough people have some immunity through either vaccination or infection, preferably the former, the coronavirus will transition to what epidemiologists call — endemic,” Dr Lee told CodeBlue.

“Whether we’ll reach a point of endemicity in October, with still high new cases, is unclear.”

Dr Lee noted that national level Covid-19 data alone is insufficient to conclude whether the country is ready to enter the endemic phase because situations in state and districts do not necessarily depict the national situation.

“National figures alone can mask the varying situations in different states. It is important to note that endemicity is not a fixed point but it’s a process over a period of time.”

Dr Lee said that increasing vaccination rates, reduction in new Covid-19 infections, as well as a decrease of critically ill patients and Covid-19 deaths will manifest if Malaysia is on the track to enter an endemic phase for Covid-19.

Average new Covid-19 cases nationwide marginally declined 8 per cent from about 21,562 cases daily in the 33rd epidemiological week (August 15-21) to an average of 19,847 cases a day the past week (August 29-September 4).

However, Covid-19 deaths increased 22 per cent from about 244 to 297 daily fatalities in the same period, including about 78 brought-in-dead (BID) victims daily in the 35th epidemiological week. This means three people died the past week from coronavirus every hour without being treated in hospital.

Last week, Health Minister Khairy Jamaluddin announced that Malaysia is expected to move into an endemic Covid-19 phase by the end of October in 55 days.

Khairy aims to reduce the intensive care unit (ICU) bed occupancy rate among Covid-19 patients to below 70 per cent and less than 50 per cent non-ICU bed occupancy across the nation by December 8 — within 100 days after swearing in as Health Minister on August 30.

So far, only Terengganu, Putrajaya, Negeri Sembilan and Labuan have reported less than 70 per cent ICU bed occupancy, whereas only Putrajaya, Negeri Sembilan, and Labuan have registered below 50 per cent capacity of non-ICU hospital beds, as of September 5.

He also targeted to bring down BID cases to 15 per cent of coronavirus-related fatalities. It is to be noted that the national BID rate was 32 per cent on September 5.

Former Health Minister Dzulkefly Ahmad speaks at the launch of the National Palliative Care Policy and Strategic Plan 2019-2030 at Hospital Selayang on November 6, 2019.

Selangor Covid-19 Task Force chairman Dzulkefly Ahmad, who concurred with Dr Lee, mentioned that the country is still recording a high number of new Covid-19 cases daily, although he acknowledged the “inevitable” need for the country to enter Covid-19 endemic phase.

He said that embracing a Covid-19 endemic phase is an admission that the country cannot eradicate the virus entirely and has to live or co-exist with it.

“You would have to regard that the SARS CoV-2 virus is a usual or normal occurrence in our country and may see some cases intermittently or sometimes an outbreak(s),” Dzulkefly told CodeBlue.

Nevertheless, the former health minister said that it is “too early” to enter the endemic phase amid extremely high fresh Covid-19 infections in the country.

“The question is whether we are now entering an endemic phase? While it is trendy to be talking about the SARS CoV-2 will eventually become ‘endemic’, albeit of a ‘low severity and incidence’, we have yet to overcome our current ‘tail-end’ of the raging third wave pandemic first.”

Dzulkefly Ahmad, Selangor Covivd-19 Task Force chairman

“More importantly, vaccination roll-out should ideally reach 80 per cent of the total population and also achieve an equitable vaccination roll throughout the Federation, both West and East Malaysia, without glaring disparity,” said Dzulkefly.

To date, although about 49 per cent of Malaysia’s total population has been fully vaccinated against Covid-19, vaccine coverage varied widely from about 71 per cent in the Klang Valley to 31 per cent in Sabah.

According to Dzulkefly, the Ministry of Health (MOH) should first work on reducing daily Covid-19 cases and deaths, including BIDs, to at least “half of what the numbers are now” before moving from epidemic control to an endemic phase.

At the same time, Dr Amar-Singh HSS, a consultant paediatrician who shared the same view as Dzulkefly, emphasised on high Covid-19 vaccine coverage of the total population in the country and not just adults.

“For vaccination we must use total population vaccination rates and not adult vaccination rates,” Dr Amar told CodeBlue.

According to Dr Amar, by October, approximately 60 per cent of the Malaysian population, predominantly adults, would have been vaccinated completely.

“However, that amount of vaccine coverage is not the only indicator that the country is ready to enter the endemic phase. Experience from other nations that have reached that stage have shown the potential for large outbreaks among the unvaccinated, especially children.”

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