While hospitalisations and intensive care unit admissions are dropping in states with higher vaccination rates, including the Klang Valley, it does not mean the Covid-19 situation is improving, experts believe.
They called into question the accuracy of Covid-19 vaccination administration data and reiterated calls for targeted lockdowns while stressing the importance of leaving out political elements in the Covid-19 response action.
Epidemiologist Professor Datuk Dr Awang Bulgiba Awang Mahmud of Universiti Malaya said only the bed utilisation rate appeared to be decreasing in Kuala Lumpur, Putrajaya and Negri Sembilan.
This could be due to the new policy of home isolation or virtual Covid-19 Assessment Centre (CAC) monitoring system instead of patient isolation in hospitals, with a smaller number of categories three to five patients.
"The seven-day Covid-19 incidence density for Selangor and Kuala Lumpur is roughly the same as before, that is above 700 per 100,000 population. So there isn't much change there.
"It is lower in Putrajaya (less than 400 per 100,000 population). So perhaps there is some hope. The seven-day case fatality rates for Kuala Lumpur (17 per 100,000 population) and Selangor (10 per 100,000 population) are at their highest points, although these seem to have plateaued," he told the New Sunday Times.
Recently, the government had said Malaysia's Covid-19 situation was getting better, including in the Klang Valley, due to the Operation Surge Capacity and improved vaccination rates.
The number of new infections, however, continued to rise as the country logged a record 23,564 cases on Friday and 101 deaths in Selangor. Sixty out of the 233 deaths reported nationwide were "brought-in-dead" (BID) cases.
On Aug 9, BID represented seven per cent of the fatalities, but it rose to 25.8 per cent on Friday. The Health Ministry reported 246 BID in May and June, a seven-fold increase from April when only 35 cases were recorded.
Health director-general Tan Sri Dr Noor Hisham Abdullah had said that of the 4,856 Covid-19-related deaths reported up to July 2, 670 (or 13.8 per cent) were BID. Last year, only 136 were reported.
Dr Awang Bulgiba, who is the Science, Technology and Innovation Ministry's Covid-19 Epidemiological Analysis and Strategies Task Force chairman, said Malaysia, which had once feared becoming a "mini-India", had surpassed the south Asian country's number of daily infections per capita.
"New infections in India has dropped despite having a slower vaccination rate than Malaysia. India has done well because it implemented a tight lockdown."
He said the worsening Covid-19 situation had exposed Malaysia's poor management of the pandemic, ranging from the prolonged and "half-baked" total lockdown that allowed most economic sectors to operate, to political interference in decision-making and poor diagnostic policies.
"On May 9, the positivity rates (seven-day rolling average) were greater than 20 per cent for India, greater than 10 per cent for Indonesia and greater than five per cent for Malaysia.
"Now, they are greater than five per cent for India, greater than 20 per cent for Indonesia and greater than 10 per cent for Malaysia. These indicate that community transmission is increasing in Indonesia and Malaysia, but is under control in India."
He added that India and Malaysia's fatality rates were similar, but it was higher for Indonesia.
On Thursday, Malaysia's daily cases per million people rate stood at 649.91 and its daily deaths per million rate were at 7.70, while India at its peak (on May 8) reached 283.50 and 3.04, respectively, according to Our World in Data.
He also said the high BID rates indicated that community spread could be greater than official figures.
"The proportion of BID among migrants based on the ministry's data is worryingly high, which points to high community infection rates among them.
"There is an urgent need to vaccinate this sector soonest possible," he said, echoing fears that Malaysia, like the United States, had unvaccinated migrants that could lead to more infections.
He said that with the more virulent variants, infected individuals could brush off their symptoms as just the common cold or a minor cough.
"So they did not get tested. When their conditions deteriorated, they came in as brought-in-dead. With medical facilities that could not be accessible, especially in remote areas, the conditions of those infected might have worsened at home before they could seek treatment.
"The symptoms of Covid-19 infection may have changed too. So one may not recognise the illness as Covid-19," he said.
He said to avoid a sharp increase in new cases among the unvaccinated, non-pharmaceutical interventions should be eased gradually and only when there was evidence of reduced transmissions.
"We need swift and targeted lockdowns by locality, based on data and analyses instead of a general lockdown. We should not rely on vaccination numbers alone, especially when the actual population numbers are not accurately known if we factor in the migrants' population.
"While the vaccination rate of the population looked encouraging on the surface, one questions if the denominators used were incorrect because not all migrants were included, particularly the undocumented ones.
"This has led to the weird situation of first dose recipients exceeding 100 per cent of all adults in Kuala Lumpur, which is impossible unless there is something wrong with the denominator in the first place."
Public health expert Dr Safiya Amaran, a medical lecturer from Universiti Sultan Zainal Abidin, said the rise in BID cases could be from a shift in policy for those seeking Covid-19 assessment as they could now do so through the virtual CAC system.
"Are people generally assessing their symptoms at home? Are their assessments accurate? Do they have the means to buy thermometers and oximeters for self-assessment?" she said, adding there could be sick people at home and that no one knew about their condition until it was too late.
Malaysian Public Health Physicians Association president Datuk Dr Zainal Ariffin Omar said the focus should be on pandemic management and empowering states with real experts, detailed analyses, targeted interventions, including lockdowns and leaving out political elements from the Greater Klang Valley Special Task Force (GKV STF).
"The daily cases seem to be constantly on the rise. There are a lot of cases in the community. The increasing number of BID cases is worrying as this indicates the level of burden on hospitals, suggesting that the monitoring of Covid-19 cases could be compromised."
Universiti Putra Malaysia epidemiologist and biostatistician Associate Professor Dr Malina Osman said the understanding given by authorities on the level of Covid-19 improvement could be based on CAC management and emergency admissions.
She said the number of patients with severe symptoms had greatly reduced compared with four to six weeks ago, with a drop in serious cases that needed further treatment, particularly in ICUs.
"We require further information on the BID cases as some of the patients might be unable to get treatment."
Health deputy director-general (Public Health) Datuk Dr Chong Chee Kheong, who is GKV STF commander said there had been no significant number of cases where the condition of categories one and two patients had worsened to category three and beyond in the Greater Klang Valley area.
"(The situation) is stable in the Greater Klang Valley area. Things look the same as before," he said.
Associate Professor Dr Tan Toh Leong, who treats seriously ill Covid-19 patients at Canselor Tuanku Muhriz Hospital, said doctors were now seeing more cases of Covid-19 with diarrhoea and nausea as its first symptoms.
Tan said previously, the first few symptoms of the disease were fever and cough.
This shift was among the factors that led to an increase in transmission and the higher rate of BID cases among asymptomatic or mildly symptomatic patients, he said.
The UKM clinical consultant in emergency medicine said besides the less typical symptoms, the surge in BID could be related to silent hypoxia and a spike in asymptomatic infections, a trend that hospitals have flagged for some time now.
He said the new variants were more contagious, reportedly spreading faster than previous strains and transmissible within seconds in closed rooms.
Dr Tan said the onslaught of cases versus the limited tracing and testing services meant that a sizeable number of cases were slipping under the radar.
"We don't know how severe the new mutations are, but the death rate has risen 0.2 per cent compared with two weeks ago, coinciding with the period we breached 20,000 cases.
"On Monday, the fatality rate was 0.9 per cent, so the death and BID rates have also risen with the surge as a result." - NST
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