Sarawak Explains Why Covid-19 Hospitalisation Rate Appears High

Sarawak officials say the state’s hospital admission data includes suspected Covid patients and asymptomatic or mild cases isolating in quarantine centres.

KUALA LUMPUR, Jan 27 — Thirty-seven Covid-19 hospital admissions were reported in Sarawak from January 16 to 22, comprising 39 per cent of 94 new coronavirus infections detected in the state.

Sarawak’s 39 per cent Covid hospitalisation rate was the highest in Malaysia in the third epidemiological week of 2022, followed by Negeri Sembilan (18 per cent) and Terengganu (17 per cent).

The other states with Covid-19 hospitalisation rates exceeding the national 9 per cent rate were Perlis (16 per cent), Perak (14 per cent), Kuala Lumpur (13 per cent), and Sabah (10 per cent).

Covid-19 hospitalisation rates in other states ranged from 9 per cent to the lowest in Melaka at 4 per cent.

In terms of absolute figures, Selangor reported the highest number of Covid-19 hospital admissions from January 16 to 22 at 376 admissions, followed by Kuala Lumpur (288), Johor (282), and Negeri Sembilan (257). Other states recorded fewer than 200 admissions for the coronavirus.

Sarawak’s 39 per cent rate of hospital admissions relative to positive cases last week was preceded by similarly high hospitalisation rates in previous weeks: 25 per cent in the January 9-15 week, 32 per cent in the January 2 to 8 week, 25 per cent in the last week of December, and 26 per cent in the preceding week.

The numbers of Covid-19 hospital admissions taken from the Ministry of Health’s (MOH) GitHub database exclude patients-under-investigation.

Acting Sarawak state health department director Dr Rosemawati Ariffin, however, said that the Covid-19 situation in the state is relatively fine and that hospitals are returning to treating non-Covid patients.

“The admission data reported includes cases suspected Covid-19. Sometimes they are not confirmed cases of Covid-19,” Dr Rosemawati, who is also the Sarawak state health deputy director (public health), explained to CodeBlue.

In other words, Sarawak’s admission protocol for Covid-19 appears more liberal than other states, which could push up official figures of hospitalisations for the virus compared to other areas in the country with stricter admission criteria.

Therefore, Sarawak’s high hospitalisation rates do not necessarily indicate that a greater proportion of the state’s positive Covid-19 cases are severely ill compared to those in other states.

Sarawak General Hospital (SGH) director Dr Ngian Hie Ung said her Kuching-based facility is currently seeing much fewer admissions of patients who are seriously sick from Covid-19.

“In fact, our bed usage is near normal state,” Dr Ngian told CodeBlue. “Near normal means we still have some rooms with Covid patients, but there are no longer any Covid wards.”

She explained that SGH currently operates a low-risk centre for high-risk people with mild or asymptomatic Covid-19, which may also have been included in Sarawak’s hospital admission data. SGH itself only admits those with moderate Covid-19 from Category Three and above to its wards.

“We’re trying to clear non-Covid cases now during this lull,” she said. “If Covid-19 cases don’t spike in February, then we should be okay.”

Dr Ngian also raised the possibility of under-reporting of Covid-19 infections in Sarawak, where some who test positive for the virus through self-test kits may not necessarily report their positive test results on MySejahtera, especially if they do not have symptoms.

“This will affect the denominator,” she said, referring to the hospitalisation rate derived from the percentage of admissions out of the denominator of positive Covid-19 cases.

According to the CovidNow site, Sarawak’s test positive rate has been reported at below 1 per cent since December 30. A positive rate above 5 per cent indicates possible under-testing with asymptomatic cases not being captured by Covid-19 surveillance and testing programmes. Nationwide, the positive rate is currently just above 3 per cent.

CodeBlue understands from a source that SGH last treated a Category Five case with severe Covid-19 in its intensive care unit (ICU) two weeks ago. The source also said Sarawak’s reported hospital admission data likely included people isolating in quarantine centres.

Dr Sim Kui Hian, who is the Sarawak deputy chief minister and state minister in charge of public health, said yesterday during a visit to SGH that Sarawak’s main public hospital was “back to normal with just a handful of Covid-19 (cases) in ICU”. SGH saw more than 80 Covid-19 patients in ICU at the height of the state’s epidemic last year.

Dr Mahesh Appannan, head of data at MOH’s Crisis Preparedness and Response Centre (CPRC), told CodeBlue that Sarawak’s hospitalisation criteria differ from other states.

When comparing Covid-19 hospital admission rates relative to the population – as opposed to positive cases – Sarawak actually has the lowest admissions per capita in the country.

In the past week from January 16 to 22, Sarawak reported just one Covid-19 hospital admission per 100,000 people, six times below the national rate of six.

Negeri Sembilan recorded the highest rate of hospital admissions for Covid-19 last week at 23 per 100,000 population, followed by Kuala Lumpur (16), Kelantan (9), Putrajaya (8), Johor (7) and Pahang (7).

About 76 per cent of the total population in Sarawak — a rural state that is almost as large as the peninsula — is fully vaccinated, slightly under the national 79 per cent coverage. Sarawak, however, is the most boosted state, with 50.4 per cent of its total population having received additional or third Covid-19 vaccine doses.

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