Insights into Malaysia’s 30k Covid-19 death milestone

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COVID-19 - Malaysia crossed the grim milestone of more than 30,000 Covid-19 deaths over the weekend on Nov 21. How does one even make sense of such a mind-boggling number?

To help put some context and make sense of Malaysia’s Covid-19 situation, Malaysiakini has pulled together some numbers and spoke to several experts to shed some light on the issue.

Here is what we learned.

Malaysia is a regional Covid-19 hotspot

Malaysia had a seemingly strong start against the pandemic with a respected public healthcare system already in place.

Just months before the start of the pandemic, the Global Health Security Index even ranked Malaysia 18th in the world – and third in Asia – out of 195 countries that are most prepared to face a disease outbreak.

Unfortunately, nearly two years on, the Covid-19 death toll compiled by the website Our World in Data tells a different story.

According to its data up to Nov 22, the death rate in Malaysia is 917 per million population, which places it seventh highest in Asia and the worst in Southeast Asia.

The worst performer in Asia so far is Georgia with 2,903 deaths per million population, followed by Armenia (2,462 per million) and Iran (1,518 per million).

Malaysia is doing slightly better than Kazakhstan (930 per million) but worse than Turkey (885 per million) and Israel (885 per million).

The global picture is more modest though, with Malaysia ranking 71 out of 182 countries where data is available.

In Southeast Asia, Malaysia’s top position is followed by Indonesia (520 per million) and Philippines (426 per million).

(Non-UN member states in Our World in Data’s dataset have been excluded from this analysis.)

Most of the deaths in Malaysia would have occurred in July and August, amid a large Covid-19 wave that coincided with a vaccination campaign that was finally picking up steam after a slow start.

The hotspot is still hot

While Malaysia has caught up with its Covid-19 vaccination campaign and is now the 11th most vaccinated country on the New York Times’ vaccine tracker, relaxed restrictions and waning immunity has given the disease more opportunities to spread to vulnerable populations.

In terms of deaths in the two weeks up to Nov 22, data from Our World in Data shows that Malaysia has the ninth highest toll in Asia with 22 deaths per million population during that period.

This compared favourably to countries like Georgia (262 per million), Singapore (29 per million) and the Philippines (25 per million), but worse than Thailand (10 per million), South Korea (6 per million), and Myanmar (4 per million).

In Southeast Asia, Malaysia has the third-highest number of recent Covid-19 deaths per capita, behind Singapore and the Philippines.

Singapore is notable because it is one of few countries with a higher vaccination rate than Malaysia and is second in the world with 88 percent of its population fully vaccinated.

Globally, Malaysia has the 53rd highest recent Covid-19 deaths, with many Eastern European countries dominating the top of the list.

Some notable outliers include Austria (#29 with 58 deaths per million), the US (#31 with 48 deaths per million) and the UK (#39 with 31 deaths per million).

Commenting on the rankings, independent health policy specialist Dr Khor Swee Kheng explained that country rankings for pandemic preparedness are not a reliable indicator of real-world performance because such rankings are usually prepared using self-reported data.

“(This) makes it prone to bias or optimism,” he told Malaysiakini.

One lesson that Malaysia could learn from other countries, he said, is that vaccination programmes need to be accompanied by a minimum level of social and behavioural changes.

“In other words, vaccines must be paired with face masks, some reasonable and non-disruptive social restrictions, and a population that must remain careful and vigilant.”

Heart diseases dethroned as leading cause of death

While the economy took a punishing blow in 2020 amid the pandemic and the movement control orders meant to contain it, the overall number of deaths (including non-Covid-19 deaths) have actually fallen for the first time in decades and Covid-19 was not even in the top 10 leading causes of death.

There were only 514 Covid-19 deaths that year, but this year looks set to be a very different year.

According to the latest Health Ministry data, there have been 29,596 Covid-19 deaths this year up to yesterday.

In comparison, the leading cause of medically certified deaths in Malaysia for over two decades was ischaemic heart diseases. The number of deaths due to ischaemic heart diseases have increased last year, but still accounts for only 18,515 deaths in the entirety of 2020.

The year 2021 is not over yet, but Covid-19 already exceeds ischaemic heart diseases’ toll last year by about 60 percent.

A full accounting of deaths in Malaysia this year is expected in November 2022, when the Statistics Department releases its annual report on causes of death.

A statistical illusion

Since late October, the number of Covid-19 deaths among fully vaccinated people began to exceed the number of deaths among unvaccinated people. This can be seen on the Health Ministry’s CovidNow website.

In the week from Nov 1 to Nov 7, for example, there have been 211 Covid-19 deaths involving fully vaccinated people versus 147 deaths among unvaccinated people.

However, it would be erroneous to conclude on this basis that vaccinated people are unprotected against Covid-19 or are at higher risk than unvaccinated people.

Instead, much of the phenomenon can be attributed to the fact that unvaccinated people are now a minority in Malaysia’s population – many of whom are children, who are least vulnerable to the disease.

Only an estimated 21.4 percent of the population is unvaccinated as of Nov 23, and the figure shrinks to just 2 percent when it comes to people aged 18 years old and above.

This still means there are over 400,000 adults who are unvaccinated, however, and remains highly susceptible to the disease.

Meanwhile, Universiti Sains Malaysia biostatistician Dr Wan Nor Arifin Wan Mansor pointed out there are still other factors to consider apart from the shrinking number of unvaccinated people.

She said unvaccinated people are still subject to many restrictions under the National Recovery Plan. Together with their shrinking numbers, this means unvaccinated people as a whole have less exposure to Covid-19.

They are also protected by the fact that they are largely surrounded by vaccinated people, who are less likely to transmit the disease.

“So, this may explain why, when it comes to the raw number of deaths, we observe a smaller number of deaths as compared to the fully vaccinated group. But, when we compare the rates, the fully vaccinated group has a lower risk of death,” she told Malaysiakini in an email.

Based on her calculations using data posted by the Health Ministry on its GitHub data repository, she estimated that partly vaccinated people are still at 1.9 times lower risk of death compared to unvaccinated people, while fully vaccinated people are at 2.5 times lower risk of death.

The estimate accounts for differences in age, presence of co-morbidities, sex, and change in vaccine coverage over time.

For the record, a Health Ministry study has found both the Pfizer/BioNTech and Sinovac vaccines both highly effective in preventing Covid-19 deaths at five months after the second dose, even though protection against infection and ICU admission may have weakened significantly by that time.

The Pfizer vaccine is found to be 91 percent effective in preventing Covid-19 deaths by that time, while the Sinovac vaccine is 76 percent effective.

What about the state level?

When broken down to the state level, the incidence of Covid-19 can fluctuate wildly at times, particularly in states with smaller populations.

Overall, however, the incidence of death plummets after a surge in vaccination efforts.

Examples include efforts to rush vaccines into Labuan in late May to stem a record-high death rate as the Delta variant makes its first appearance in Malaysia, and Operation Surge Capacity in late July to vaccinate Klang Valley adults.

Sarawak experienced a surge in Covid-19 deaths in October. This has now subsided, but there is an uptick in Terengganu instead. Nevertheless, the daily number of Covid-19 deaths have mostly stayed in the single digits, at least for now.

You can interact with the animation below by moving the time slider near the top left, or simply allow the animation to run its course by clicking the “Play” button.

It shows each state and region moving towards the left over time as more people get vaccinated and the number of unvaccinated people shrinks. The circles representing each state and region also move up as the incidence of Covid-19 deaths (averaged over seven days) increases, and down when it decreases.

The size of the population in each state or region is represented by the size of the circle.

Note that the chart does not account for booster shots. - Mkini