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Rachael Lum
On May 23 2021, Malaysia surged past India to record one of South East Asia’s highest covid-19 infection rates, with deaths per capita now exceeding India and neighbouring Indonesia.
Since then, the numbers have only grown, despite the nation being in a state of emergency for seven months and in lockdown since June. Malaysia reported a record high of 22 242 daily cases on 18 August 2021, with a total of 1.47 million cases and 13 302 deaths during the pandemic.
Doctors in east Malaysia and the southern state of Johor told The BMJ that emergency departments are seeing a surge in cases and have reached maximum capacity. The situation has been worsened by insufficient ventilators and staff.
Musa Mohd Nordin, paediatrician and resident doctor in KPJ Damansara Specialist Hospital, told The BMJ that patient-facing staff are “overstretched and overworked” and have “reported physical, occupational, psychological, and socially negative impacts.”
Musa added that the country’s failure to increase daily covid-19 testing to the basic minimum (around 250 000 tests a day according to World Health Organization recommended rates) has not helped to tackle the crisis.
“At best, we were averaging 150 000 tests a day and our positivity rate has hovered around 12-15 percent, which, according to WHO, means that the pandemic has been out of control here since May 2021,” he said.
Doctors are treating patients with dexamethasone, steroids, anticoagulants, baricitinib, and tocilizumab. Christopher Lee, the national adviser of infectious diseases at the Ministry of Health, says Malaysia has also been selected to join WHO’s Solidarity trial to evaluate the use of artesunate, infliximab, and imatinib to treat covid-19.
Lee expressed concern that many people are attempting to self-medicate using ivermectin, which is unregistered as a covid treatment in Malaysia, with some taking it as a preventive measure instead of getting vaccinated.
Accelerated vaccine rollout
Malaysia’s rapid vaccine rollout began in mid-July and offers a silver lining. The nation’s daily rate of vaccines administered per 100 people stood at 1.64 on 18 August 2021. This rate is significantly higher than countries such as Indonesia (0.17), the US (0.21), the UK (0.32), the European Union (0.52), Thailand (0.79), and Japan (1.04).2
As of 24 August 2021, 41.6 percent of Malaysians have had two doses of a covid-19 vaccine, according to the Covid-19 Vaccine Supply Access Guarantee Special Committee.3 Areas where over 60 percent of the population has received at least one vaccine dose, such as Kuala Lumpur, Selangor, Labuan, and Sarawak, saw declines in hospital admissions and ventilation numbers. The national immunisation programme currently uses Pfizer BioNTech, Sinovac, and AstraZeneca vaccines. Walk-in vaccinations have been made available to those aged 18 and above.
Marissa Wong, who normally works as a dental surgeon but is currently administering vaccines at several centres in Klang Valley, says the uptake in the capital Kuala Lumpur has been “decent,” with some centres scheduled to close earlier than expected because of the success rate. Other states like Sabah, Terengganu, and Kelantan with initially slower vaccination rates have only just started requesting more volunteers to support the programme, following the sudden surge of infections within those communities.
Lee, however, cautions that a sizeable proportion of the population remains unvaccinated and the level for herd immunity is some way off. “We will need to strengthen our public health measures in accordance with find, test, trace, isolate, and support strategies to minimise community transmission,” he said. Malaysia has concerns over new variant cases, with 467 recorded instances of the delta variant as well as 209 cases of beta.
There are positive signs: a decline in hospital admissions is now being seen throughout major urban districts. Daily covid admissions registered a 25 percent decrease from almost 1200 cases on 30 July to about 900 on 14 August, while intensive care unit daily cases dropped by 22 percent—from 818 on 4 August to 637 on 14 August.
Lee told The BMJ that the hospital situation in Klang Valley, the nation’s most populated urban area, has improved. This is mainly because of the increase in the number of covid beds in government hospitals—achieved by transferring non-covid cases to private hospitals, paid for by the Ministry of Health alongside the Association of Private Hospitals Malaysia. Two government institutions have also been converted into covid specialist hospitals.
That hasn’t been enough to appease the public. Over the past year, Malaysia’s swinging pendulum of conflicting covid-19 restrictions—travel restrictions and work from home orders, then factory reopening and some festive activities given the OK—has fuelled public frustration, while the economy see-saws as society opens and closes. This has led to Malaysia’s third change in government in three years. Yet the new prime minister, Ismail Sabri Yaakob, is part of the same government that was criticised and dissolved for its pandemic response.
There are fears that this will bring the same inconsistent policies as before, but this remains to be seen.- bmj.com
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