Stay the course

Although the number of Covid-19 infections has come down to below 700 for the first time in two weeks, epidemiologists caution about letting our guard down. The three-figure daily cases, they say, is likely to go on for some time, especially in Sabah.

PETALING JAYA: The good news is that Malaysia’s Covid-19 infectivity level has gone down to 1.1.

It was 1.5 about two weeks ago. But hold your horses on seeing a big dip in the number of cases, especially in Sabah.

Health director-general Tan Sri Dr Noor Hisham Abdullah estimated it could take about one month to contain the outbreak in Sabah.

Epidemiologists contacted earlier indicated that the trend was likely to continue for some time yet.

“The situation seems to be out of control in Sabah and the community transmission is really widespread with many unlinked cases,” said Universiti Malaya epidemiologist Prof Datuk Dr Awang Bulgiba Awang Mahmud.

“The health facilities are overwhelmed, as we can see from the number of active cases in Sabah and the window for using containment as a strategy appears to have closed.”

Since Oct 17, the number of new infections in Malaysia has hit above 700 daily.

The “lowest” was recorded on Oct 23 with 710 cases; while the highest was at 1,240 (Monday). This was the largest number seen since the outbreak began in the country.

Sabah formed most of the number of cases recorded. For instance, the state had 72% of the 1,228 infections recorded last Saturday.

Dr Awang Bulgiba noted the number of cases in Sabah currently would double within a faster period.

“There is no indication that the number of new cases has reached its peak. This situation is likely to continue for some time.

“The proportion of more severe cases is also rather high in Sabah, with bed utilisation and intensive care unit (ICU) usage very high.

“A shift in overall strategy in Sabah is likely with this kind of situation, as it will become incredibly difficult to manage with the current strategy,” he said.

In Klang Valley, he said, the virus was primarily concentrated in a few districts in Selangor.

“If the spread can be contained in those districts, the number of new cases can be lowered with aggressive contact tracing and isolation.

“It can still be contained in the Klang Valley, but the current official messaging during the conditional movement control order is confusing people,” he said.

Dr Awang Bulgiba also proposed a comprehensive index to measure the severity of the virus outbreak, as the Rt value alone did not reflect the seriousness of the current situation.

Rt, which is the effective reproduction number, shows the average number of people who contracted Covid-19 from an infectious person.

“I would suggest using an index which includes, among others, indicators such as cases per capita, deaths per capita, test positivity rate, ratio of new cases to discharges, percentage in each clinical stage, percentage of beds occupied, locality-specific Rt and cluster-specific Rt,” he said.

Universiti Putra Malaysia medical epidemiologist Assoc Prof Dr Malina Osman said for the past few weeks, about 50% to 70% of the active cases in Malaysia were from Sabah.

“The number of new and active cases in Sabah has been rising despite major measures taken by the ministry.

“It is worrying as it reflects that some recommended preventive measures may be compromised.

“These may be due to issues like logistics, poor public compliance, the presence of ‘lorong tikus’ (alternative routes) and issues related to illegal immigrants.

“The situation in Sabah and some parts in Peninsular Malaysia was expected due to some delay during outbreak management,” she said.

She does not think Malaysia has hit its peak nor will the number of new cases gradually reduce.

“Although cases are plateauing in Selangor and are declining in Kedah and Penang, the number of new cases is still increasing in Sabah, with new clusters in Negri Sembilan and Labuan.

“Selangor may observe declining patterns in the next two to four weeks, but other states like Negri Sembilan and Labuan may need further aggressive approaches.

“All other states which have a majority of green zones should protect their areas vigilantly,” she said.