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Experts: Low vaccination rate, Delta variant linked to ICU bed use spike

KUALA LUMPUR: Low vaccination rate and prevalence of Covid-19 variants of concern (VOC) have contributed towards the upward trend in Intensive Care Unit (ICU) bed usage in several states.

Experts said the widespread presence of the Delta variant in the community (which is 50 per cent more transmissible than the original strain first detected in Wuhan) — coupled with poor adherence to standard operating procedure (SOP) — had led to a rise of new infections, while brought-in-dead and hospitalisation rates remained high.

They also believed that the actual number of Covid-19 positive cases in the country could be well beyond the reported figures due to "severe under-testing rates".

Molecular virologist Dr Vinod Balasubramaniam, a senior lecturer of microbiology at the Jeffrey Cheah School of Medicine and Health Sciences in Monash University Malaysia, said the consecutive increases in cases and Delta-driven infections were closely related.

"The Delta variant may also result in more severe disease. A study in Scotland, published in The Lancet, found the hospitalisation rate of patients with that variant was about 85 per cent higher than patients with the Alpha variant.

"The current vaccination programme worldwide is the only way to contain this strain. A study by Public Health England found that two doses of the Pfizer-BioNTech vaccine and two doses of the AstraZeneca vaccine were 96 per cent and 92 per cent effective, respectively, at preventing hospitalisation in people infected with the Delta variant.

"The Delta variant is also able to infect people who are fully vaccinated, but this does not mean that vaccines don't work.

"Almost everyone is protected from severe Category 4 and 5 types of symptoms and mortality after vaccination."

The surge in cases, he said, was also contributed by sporadic infections, which illustrated just a small proportion of a much larger outbreak in a locality due to the lack of contact tracing.

He said severe under-testing rates nationwide with a positivity rate hitting close to 20 per cent was another factor.

"On Sept 8, 158,501 people were screened followed by 143,921 on Sept 9, 132,221 on Sept 10, 124,648 on Sept 11 and 99,660 on Sept 12 (based on the Health Ministry's data on the CovidNow portal).

"No data were shared on Sept 13, 14, 15 and 16.

"So, the trend of lower number of cases during the dates are actually not accurate due to severe under-testing. We have missed too many infections and asymptomatic infections in the community. This is a never-ending vicious cycle."

Malaysia logged 19,733 new Covid cases on Sept 8, 19,307 on Sept 9, 21,176 on Sept 10, 19,550 cases on Sept 11, 19,198 on Sept 12, 16,073 on Sept 13, 15,669 on Sept 14, 19,495 on Sept 15 and 18,815 on Sept 16.

The country's positivity rate peaked at 15.3 per cent on Aug 31.

It dipped to 12.9 per cent on Sept 7 and had been rising steadily, with 13.9 per cent reported on Sept 14.

Dr Vinod said states with lower vaccination rates were bound to have more hospitalisations and ICU admittance.

"Take Kelantan for example. It is one the lowest vaccinated states (35.92 per cent of the population are fully vaccinated) in comparison with others.

"The Delta variant is known to cause a severe form of disease. Besides, a higher rate of infection in compromised groups, such as people with metabolic diseases, hypertension, cardiovascular disease and the elderly, may have contributed to the spike."

Other states that showed a significant spike in ICU admissions were Penang (55.68 per cent of its population fully vaccinated as of Sept 16), Sarawak (64.54 per cent) and Terengganu (48.45 per cent).

Dr Vinod said statistics showed that over 90 per cent of the mortality cases were from the unvaccinated and partially-vaccinated patients. And the figure was similar for patients who were in Category 4 and 5 in the ICU.

"I believe we will see improvement, especially in lower number of serious cases, hospitalisations and mortality in the coming months, when we have at least 90 per cent of our adult population, especially those 50 years and above and people with comorbidities, fully vaccinated."

Dr Vinod said the government should introduce mandatory vaccination for those eligible, especially groups with comorbidities and young children.

"It is also high time for the government to do what is morally right and explore legal options for compulsory vaccination to protect our larger group of citizens who want to be vaccinated, and needs vaccination against this debilitating disease."

While there was a need to re-open more sectors, he said the government could have waited until at least 80 to 90 per cent of the overall adult population were vaccinated, or until the country's positivity rate was close to the recommended five per cent set by the World Health Organisation.

"While the vaccination rate is high in certain states, there are states with very low vaccination turnout, which can pose setbacks to our overall plan.

"All current vaccines do not prevent us from getting re-infected by the virus, and with the Delta variant being predominant, we can transmit the virus to the immune-compromised, children and the unvaccinated."

Dr Vinod also said booster doses were needed because the immunity from vaccination would wane, and new variants might be able to evade antibodies generated from the current vaccines.

Universiti Putra Malaysia epidemiologist and biostatistician Associate Professor Dr Malina Osman said the prolonged movement restrictions might have caused some people to become exhausted or less convinced on the importance of maintaining SOP compliance.

"New infections are still happening because we have the Delta variant spreading widely and, at the same time, some of those in public areas still do not bother to adhere fully to the SOP."

She said while the decision to reopen sectors would have been based on risk analysis and other important key indicators, the public should never let their guard down.

"We have to understand that the nature of the onset of this infection takes time. The data we have currently is coming from the compilation which had been backlogged for a few months."

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