MOH: Why Daily Covid-19 Cases Aren’t Main Focus Anymore

CPRC data head Dr Mahesh Appannan says it’s important to look at how vaccines are weakening the link between Covid-19 infection and severe outcomes like hospitalisation and death.

KUALA LUMPUR, Sept 20 — As Malaysia abandons its Covid-19 elimination strategy, mortality and hospitalisation rates are more important than daily new infections, a Ministry of Health (MOH) official said.

Dr Mahesh Appannan, head of data at MOH’s Crisis Preparedness and Response Centre (CPRC), said daily new infections are the main indicator for monitoring in countries like New Zealand and China that seek to eliminate the virus through lockdowns.

“Now, for Malaysia, although we definitely want cases to be as low as possible, is it realistic to pursue 0 Covid?

“Probably not. Singapore also has accepted endemic Covid. Targeting 0 Covid also comes at a high cost,” Dr Mahesh tweeted today.

The senior principal assistant director at CPRC’s disease control division said MOH monitors Covid-19 deaths, intensive care unit (ICU) cases, and hospitalisations, besides daily infections, to look at the effectiveness of vaccines in preventing severe outcomes from infection and to prevent the health care system from being overwhelmed.

Last year, before the rollout of the Covid-19 vaccination programme, daily coronavirus infections were important to monitor because a rise in cases leads to increased hospitalisations and deaths. 

“Now, with vaccines, the link is much weaker — a much smaller % of those who get infected end up with serious outcomes,” the data scientist said.

However, Dr Mahesh, citing Health Minister Khairy Jamaluddin and Health director-general Dr Noor Hisham Abdullah, noted that Malaysia’s Covid-19 mitigation strategy still requires keeping outbreaks under control.

He pointed out that for example, if 10 per cent of 1,000 Covid-19 cases are hospitalised in the absence of vaccination, compared to just 1 per cent under a vaccine rollout, both scenarios would still lead to 100 people in hospital.

“So, it’s a constant balancing act. Our surveillance has to be more sophisticated than just looking at the number of cases,” Dr Mahesh said.

He added that daily Covid-19 cases must also be matched to incidence rates that take into account population sizes, noting for example that although the Klang Valley records more daily infections than other states, the industrialised region’s case incidence rate was fifth lowest in Malaysia at five cases per 1,000 people in the past fortnight.

MOH has long pursued virus elimination strategies through lengthy lockdown measures — even when the vaccination programme was underway — and only publicly embraced a mitigation approach when Khairy declared that the country would live with Covid-19 as an endemic disease after assuming office on August 30.

The epidemic appears to have peaked on August 31 with nearly 21,000 cases on average that day, before subsequently declining. Daily mortality and hospitalisation rates have similarly fallen. 

However, the national positive rate trend has not shown a decline, remaining at 14.8 per cent on September 15, suggesting that the epidemic may not be truly abating yet as many infections may go unreported.

The World Health Organization (WHO) recommends a maximum 5 per cent positive rate as an indicator of sufficient testing, while MOH maintains that 10 per cent or lower is adequate.

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