- With the imminent state elections, looming general elections, reopening of interstate borders and designation of more travel bubbles; is Malaysia at risk of another covid outbreak?
- The real threat is the risks of breakthrough infections, in which fully vaccinated individuals contract covid.
- On August 30, 2021, the World Health Organization (WHO) designated Mu (B.1.621) as a new SARS-CoV-2 variation of interest (VOI).
Is Malaysian Healthcare Equipped To Handle Another Covid Outbreak As Mu Variant Threatens 4th Covid Wave
The whole world has come to a complete standstill over the last nearly 2 years battling the covid-19 pandemic. With “normal” being flipped on its head, we as a people have had to rapidly adapt to new normals, every day bringing its own sets of challenges.
Despite this, humanity has never before worked in such unison to fight for one united cause – ending this gripping pandemic and recovering together. As countries all over the world prepare to transition into endemic Covid-19, the world stands to watch in wonder. Countries will begin emerging forward, with those that rapidly adapt, becoming the ones that survive and thrive, through the repercussions and aftermath of this pandemic.
Bearing all this in mind, is Malaysia ready for this transition?
With the highlight of the pandemic being that Malaysia is one of the world’s leading countries in the pursuit of achieving high vaccination rates, will this be enough?
With the iminent state elections, looming general elections, reopening of interstate borders and designation of more travel bubbles; is Malaysia at risk of another covid outbreak?
Where Malaysia Stands Right Now
As of October 1, 2021, there were no states in Phase 1 of Malaysia’s National Recovery Plan. This development indicates that the pre-endemic phase is doing well and highlights that better things are on the way.
Once all of Malaysia’s states reach Phase 4 of the National Recovery Plan, the scene will be set for an endemic plan, which aims to restore life and livelihood to as close to pre-pandemic levels as feasible, albeit with the necessity to co-exist with the deadly virus.
The Malaysian Government has learnt a valuable lesson in inter-state travel since last year’s Sabah state election, causing a surge in covid cases that Malaysia has yet to recover from. Langkawi remains the only tourism bubble destination open in its pilot project. This is despite Langkawi's success for the country's tourism model, with 9,500 domestic tourist arrivals as of September 20th, since the island's travel bubble commenced on September 16th 2021.
Similar plans for Tioman Island and Genting Highlands as tourism bubbles have been placed on hold indefinitely. Based on the current vaccination rate of 87.6% and reports that over 200,000 individuals are getting their second dose every day, the two tourist sites are expected to reopen in the upcoming weeks.
The only saving grace in this instance is Malaysia’s high vaccination rate, with the fully vaccinated showing asymptomatic or mild infections, accounting for the majority of the exponential increase in daily cases, (about 96 percent to 98 percent). Those who are not vaccinated make up the majority of the remaining severe cases requiring hospitalisation and ICU admission. Non-vaccinated people also accounted for the majority of COVID-19 fatalities across several countries, according to national statistics.
The real threat is the risks of breakthrough infections, in which fully vaccinated individuals contract covid. Although these individuals generally do not require hospitalisation, and where they do, lives are not impacted; the overall numbers are generating an exponential increase in daily cases.
At present, the Malaysian healthcare system is not overwhelmed because the exponential increase in breakthrough infections does not necessitate hospitalisation. But this can drastically change due its exponential nature, in which covid cases will exponentially double weekly, and what started out as a small number of breakthrough infections that do necessitate hospitalisation, will rapidly snowball, swiftly overwhelming the local healthcare system.
An important lesson to be learnt from Singapore's experience is that while the current vaccination rates of 80% of the population being fully vaccinated, a high rate which helps to keep the mortality rate controlled, it does not prevent an exponential increase in daily infections later on once border restrictions are eased and the economy is opened up.
Perhaps the most significant issue is how high of a vaccination rate is required to prevent the exponential increase? Clearly, as the Singapore experience demonstrates, 80% is insufficient, with the country projecting over 5000 daily cases in the upcoming weeks.
Fears Of A Repeat Of Previous Events
Once Melaka goes to the elections, Prime Minister Datuk Seri Ismail Sabri Yaakob warns that another Covid-19 outbreak, such as the one that occurred during the 2020 Sabah election, must be prevented.
“Because of the Sabah elections, we saw how Covid-19 cases went up”, PM Sabri said.
Prof Dr Mohd Azizuddin Mohd Sani, Universiti Utara Malaysia political lecturer, said “the Election Commission (EC) will have to come up with a strict standard operating procedure (SOP) to limit the gathering of people and ensure there are no ceramah. Campaigning can be allowed online only. We can also see the performance of the EC in conducting an election during the pandemic,” he said; as Covid-19 still poses a threat to Malaysia.
“Many countries in the world have conducted elections during Covid-19 and as long as people comply with the SOP, it will be fine. You can’t run away from elections. It’s democracy,” Prof Dr Sani echoed.
Threats Of New Variants Of Concern
Throughout the pandemic, several SARS-CoV-2 variants have circulated throughout the world. A viral variant has one or more genetic modifications, known as mutations, that influence how the virus behaves and distinguishes it from other variants. On August 30, 2021, the World Health Organization (WHO) designated Mu (B.1.621) as a new SARS-CoV-2 variation of interest (VOI).
The Mu variation is found in less than 0.1 percent of the population in the United States and less than 0.1 percent of the population worldwide. Although the Mu variant has a worldwide prevalence of less than 0.1 percent, it has steadily risen in Colombia (39 percent) and Ecuador (13 percent).
According to preliminary data, the Mu variant may confer immune escape in the same way as the Beta variant can. The ability of a virus to evade the body's immune system or the protection provided by vaccinations is known as immune escape.
Dr. Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases, explained in a White House COVID-19 Response Team briefing, “This variant has a constellation of mutations that suggest that it would evade certain antibodies, not only monoclonal antibodies but vaccine and convalescent serum-induced antibodies. But there isn’t a lot of clinical data to suggest that — it is mostly laboratory, in vitro data.”
He further added, “We have some early laboratory data that indicate that our current vaccines might have some diminished capacity […] against Mu, but we need more information to be secure about that. So, strike one, strike two, and, at the moment, a foul ball.”
Dr. Fauci also iterated: “Bottom line, we’re paying attention to it. We take everything like that seriously, but we don’t consider it an immediate threat right now.”
With SARS-CoV-2 Mu (B.1.621) variant not being considered a current threat, what of its threat level in the near future?
Delta variant (B.1.617.2) was also a VOC in its initial stages, first detected in India in late 2020. It was coined the Delta variant on 31 May 2021 and had spread to over 163 countries by 24 August 2021, with it now being the dominant strain globally.
Could the Mu (B.1.621) variant of SARS-CoV-2 be Malaysia’s doomed 4th wave of covid?
source- news medical
Vaccines Losing Effectiveness 6 Months After Administration
The effectiveness of the Pfizer Inc (PFE.N)/BioNTech SE vaccine in preventing infection by the coronavirus dropped to 47% from 88% six months after the second dose. This was revealed according to data published on Monday that U.S. health agencies considered when deciding on the need for booster shots.
This data was published in The Lancet Medical Journal and had been previously released in August ahead of peer review. Delving deeper into the analysis, it showed that the vaccine’s effectiveness in preventing hospitalization and death remained high at 90% for at least 6 months, even against the highly contagious Delta variant of the coronavirus.
The vaccine's effectiveness against the Delta variant was 93% after the first month, declining to 53% after four months. Against the other coronavirus variants, however, efficacy declined to 67% from 97%.
In this case, third doses of booster shots are believed to boost vaccine effectiveness back up to the ranges of above 90%, protecting hosts from risks of breakthrough infections.
Will Malaysia Administer Booster Doses To Entire Population?
According to Muhyiddin Yassin, chairman of the National Recovery Council (MPN), the government has acquired sufficient Covid-19 vaccinations to administer booster doses to all adult residents in Malaysia.
“As a whole, we’re satisfied with Khairy Jamaluddin’s presentation on the latest development on Covid-19 cases and the bed occupancy rates in intensive care units (ICU) that show a decline, as well as our preparedness with sufficient vaccines for booster shots for all adult residents in this country,” Muhyiddin said at a press conference.
“This is a result of our previous decision to order more than enough vaccines for the needs of residents in our country.”
Image Source: Reuters
Booster Shots Not Compulsory For All
In defending Malaysia's booster programme amid worldwide concerns over Covid-19 vaccine inequity, Health Minister Khairy Jamaluddin stated that third vaccination doses will be “very targeted" to high-risk individuals like the immunocompromised and the elderly with severe medical conditions.
People with weakened immune systems, elderly citizens with comorbidities, frontline health workers, and residents and staff at long-term care facilities would be given priority over the general public, according to Khairy.
Where does that leave the rest of us Malaysians who do not fall into this category?
Would herd immunity then be what we solely rely on to protect those that are ineligible to receive booster doses?
Can Malaysia’s Healthcare System Survive Another Covid Surge?
Hospital Occupancy Rates
High levels of hospital bed occupancy are a key indicator of a pressured health system. Hospitals cannot function at 100 percent occupancy, as extra bed space is required to handle fluctuations in demand and ensure patient flow. Hospital bed demand peaks at various times of the day, week, and year. To meet these peaks, a sufficient number of beds must be available to accommodate this overflow.
A shortage of available beds in a health system may have far-reaching implications. It may, for example, lengthen wait times in emergency rooms, lead patients to be admitted to clinically inappropriate wards, and raise the incidence of hospital-acquired infections, while putting pressure on staff to free up beds can jeopardise patient safety. Staffing is also linked to bed availability, since beds cannot be safely filled without adequate staffing levels.
Resignation letters put on the Hartal Doktor Kontrak Twitter page.
Ministry Of Health KKM Staff Burnouts
“Doctors are resigning with 24 hours’ notice. Simply too tired and can’t take it anymore,” a post on Hartal Doktor Kontrak’s Twitter account stated in July 2021.
This 24-hour notice which was dated on July 19th 2021 depicts that the resignation was based on being a contract medical officer, not being able to acquire a permanent contract, not being qualified to pursue their Masters, and an uncertain future.
The contract system restricts medical officers to five years in the public sector, following which they must either transfer into the private sector or fund their own specialist training.
The contract system, which was implemented in 2016 to cope with an excess of medical graduates, has almost 20,000 doctors working for the government under this contract system.
With increasing rates of staff burnouts, the threat of contract doctors resigning with 24-hours notice, and the burdens on an already overwhelmed healthcare system, how will Malaysia handle another covid surge?
What Does Malaysia’s Future Hold
The 12th Malaysia Plan, released at the Dewan Rakyat on 27th September 2021, overlooks significant public health reforms needed to prepare for the next pandemic. The 12MP only includes strengthening multi-hazard public emergency response teams at the country's entry points, especially the Kuala Lumpur International Airport, as well as increasing awareness and mitigation programmes on various communicable diseases in Malaysia's preparedness for health crises.
PM Ismail Sabri also suggested establishing a new centre for infectious diseases in Negeri Sembilan, despite the fact that the Institute for Public Health (IKU), one of the National Institutes of Health (NIH) research institutes under the Ministry of Health (MOH), already exists. The Infectious Disease Research Centre is part of the Ministry of Health's Institute for Medical Research (IMR).
Source- Twitter - Khairy Jamaluddin
“As we transition towards endemicity, we cannot police things anymore i.e. set up roadblocks to see if you have been fully vaccinated or tested. Much will now depend on personal responsibility and behaviour. I believe we can rise to the challenge in #ReopeningSafely.” – Khairy Jamaluddin
Health Minister Khairy has alluded to the reality that Malaysians are facing a grim future where we will each have to fend for ourselves.
Source- Twitter - Khairy Jamaluddin
“Another key message as we learn to live w/ COVID is the need to increase health seeking behaviour. This means actively seeking help from healthcare services, especially for the elderly & those w/ chronic illness. For these groups: if you have symptoms, get tested. If +, seek help.” – Khairy Jamaluddin
It has become clear that it is our own responsibility to observe SOPs and remain vigilant. The fight is not over. Sit back, hold tight, and don’t hold your breath.