Malaysia’s first three cases of Covid-19 were confirmed among tourists from China in Johor Bahru on January 24, 2020. The first two Covid-19 deaths occurred on March 17, 2020.
On October 5, 2020, a one-year-old Malaysian girl in Sabah succumbed to Covid-19, the first paediatric Covid death in Malaysia.
As of February 3, 2023, Malaysia had 5,037,242 reported cases with 36,942 deaths and 4,990,227 recovered cases. At least one in six persons in Malaysia has been confirmed to be infected with Covid-19.
Several hundred new cases are still reported daily, with 325 on February 1 and 324 on February 2, 2023. The Ministry of Health’s KKMNow website (updated February 3) has reported 14 deaths over the last 14 days.
Where are the new reported cases? Who are those who have died? What was their age, sex, and vaccination status? Who is still dying from Covid-19 in Malaysia? I have not been able to find contemporaneous cumulative tables of cases and deaths by age, sex, and comorbidities for Malaysia.
A published (March 2022) retrospective study of 1,192 Covid-19 deaths within the first year of the pandemic in Malaysia (March 2020–March 2021) showed that the overall mean age at death was 64.8 years, with 64.7 per cent male. Hypertension (61.8 per cent) and diabetes mellitus (48.2 per cent) were the most common comorbid diseases encountered.
Older age, male gender, and the presence of multi-morbidity (hypertension, diabetes mellitus, stroke, and heart disease) were risk factors that contribute to Covid-19 mortality in Malaysia, especially among those more than 65 years old. Patients who are more than 17 years old were less likely to die from Covid-19 than other age groups.
Mortality data from the Oxford Covid-19 Evidence Service indicates a risk of mortality of 3.6 per cent for people in their 60s, which increases to 8.0 per cent and 14.8 per cent for people in their 70s and over 80, respectively.
Worldwide, as of January 1, 2023, data from February 2020 to October 2022 has been collected from 118 countries by the Max Planck Institute for Demographic Research.
This data includes 366 million confirmed Covid-19 cases by age from 105 countries and 4.4 million deaths by age from 95 countries.
Of 195 countries in the world, only 82 countries have data by age for both cases and deaths. Thus, the COVerAGE age-disaggregated database only captured 56 per cent of global Covid-19 confirmed cases and 65 per cent of global Covid-19 deaths.
Among the 4.4 million Covid-19 deaths, with reported age, only 0.4 per cent (over 17,200) occurred in children and young persons (CYP) under 20 years of age. 53 per cent were 10 to 19 years, and 47 per cent 0 to 9 years of age.
In the United States, of the 1,087,198 Covid-19 deaths (January 2020 to January 4, 2023), the vast majority (93.2 per cnet) were older than 50 years. 75.1 per cent were above 65 years, and 26.6 per cent were 85 years and older.
Only 6.7 per cent of the Covid-19 deaths in the US to date were below 49 years of age. 0.13 per cent of all deaths (1,414) were 0 to 17 years of age, and 0.62 per cent (6,749) were 18 to 29 years.
From these statistics, it can be seen that Covid-19 is generally a mild disease in children, including infants. However, a small proportion do develop severe disease, requiring ICU admission and prolonged ventilation. However, fatal outcome is overall rare.
Children and young people (CYP) remain at low risk of COVID-19 mortality.
In the US, United Kingdom, Italy, Germany, Spain, France, and South Korea, deaths from Covid-19 in children remain rare up to February 2021, at 0 to 17 per 100 000 population, Deaths from Covid-19 were relatively more frequent in older children compared with younger age groups.
In the UK, Covid-19 deaths remain extremely rare in children and young persons (CYP), with most fatalities occurring within 30 days of infection and in children with specific underlying conditions.
A follow-up study showed that 81 CYP aged more than 20 years died within 100 days of laboratory-confirmed SARS-CoV-2 infection between March 1, 2020 and December 31, 2021 in the UK.
The majority of 61 (75.3 per cent) had an underlying condition, especially severe neuro-disabilities, or were immunocompromised.
This study confirmed that Covid-19 CYP death rates remain low. Fatalities are often linked to underlying conditions — most occurring in those with multiple and life-limiting underlying conditions.
Reports from South Africa and the UK also showed lower rates of hospitalisation following Omicron infection, as compared with infection by the Delta variant.
The analysis indicates that Covid-19 infections from the Omicron variant in children under 5 years of age were associated with less severe outcomes as compared to the Delta variant.
Before vaccinating younger children, and others with more doses of current or newer versions of the Covid-19 vaccines, perhaps it is timely to take a good look at all available Covid-19 statistics by age, sex, comorbidities, and also by states.
About 84.9 per cent (27.5 million) of Malaysia’s total population (32.4 million) have taken two Covid-19 vaccine doses after the government used vaccine mandates to deny entry to public premises, including government offices, for those who were not fully vaccinated.
Out of Malaysia’s total population, about three million are 0 to 4 years old. The number of people above 5 years old are approximately 29.4million. So in fact 93.5% of our eligible population are already vaccinated with 2 doses of covid vaccine.
As of February 2, 2023, 49.9 per cent of the population in Malaysia are fully vaccinated, i.e. received three doses of Covid-19 vaccine. Putrajaya, Selangor, and Kuala Lumpur have the highest fully vaccinated population rate at 70.4 per cent. The lowest coverage is in Kelantan (17.7 per cent), Sabah (24.5 per cent), and Terengganu (28.3 per cent).
Only 1.9 per cent had taken the second booster dose.
Who and where are the five million Malaysians who have recovered from natural infection? How many are children and young persons? How many are below 5 years of age? How many of the 36,942 deaths are below 5 years and below 18 years? Of these, how many were vaccinated? How many had comorbidities?
Professor Paul Offit, in his perspective article published on January 11, 2023 in the New England Journal of Medicine opined: “Booster dosing is probably best reserved for the people most likely to need protection against severe disease, specifically, older adults, people with multiple coexisting conditions that put them at high risk for serious illness, and those who are immunocompromised. In the meantime, I believe we should stop trying to prevent all symptomatic infections in healthy, young people by boosting them with vaccines containing mRNA from strains that might disappear a few months later.”
Dr. Offit is an internationally recognised expert in the fields of virology and immunology. He was a member of the Advisory Committee on Immunization Practices to the US Centers for Disease Control and Prevention, and is also a member of the US Food and Drug Administration Vaccines and Related Biological Products Advisory Committee.
Dr Tan Poh Tin is a consultant paediatrician and public health specialist.
