Coronavirus Disease 2019 (COVID-19) Situation Report Weekly report for the week ending 9 May 2021

Malaysia Situation summary  As of 9 May, there have been a total of 440 677 confirmed cases of COVID-19 in Malaysia.  In the past seven days: o 25 665 new cases have been reported – a 16.3% increase compared to the previous week; o 150 new deaths have been reported, bringing the total number of COVID-19 deaths in Malaysia to 1683; and o the numbers of critically ill cases requiring intensive care unit (ICU) support and ventilator support have increased by 20.6% and 23.4%, respectively.  Most states and territories (12 out of 16) have reported an increase in new COVID-19 cases in the past week, including the states reporting the highest numbers of cases, i.e. , and Federal Territory (FT) . o Selangor and Sarawak contributed the highest numbers of new local cases in the past week, with 8407 cases and 3465 cases, respectively. FT Kuala Lumpur is the state/territory with the highest concentration of active cases – 227.64 active cases1 per 100 000 population. Additionally, FT Kuala Lumpur recorded 2707 new local COVID-19 cases in the past week, a 25.3% increase compared to the previous week. o In , in the past week, an estimated 42% of cases detected were unlinked at the time of reporting. An estimated 37% of new cases detected in FT Kuala Lumpur were unlinked at the time of reporting.  On 7 May, Malaysia recorded 4498 new COVID-19 cases. This is the highest daily increase in cases reported since 4 February 2021. On 9 May, Malaysia recorded 26 COVID-19 deaths, the highest number of COVID-19 deaths since the start of the pandemic.  Potential risks and vulnerabilities for a continued increase in transmission: o As of 9 May, the estimated national real-time reproductive number (Rt) was 1.11 (95% confidence interval [CI]: 1.09–1.15). An Rt value of 1 and above indicates the potential for continued transmission of SARS-CoV-2 and a resurgence of cases. o Possible decrease in community adherence to public health and social measures. o Global and regional resurgences, coupled with the increased transmission of SARS-CoV-2 variants of concern, pose a threat of importation of cases. While point-of-entry control measures are in place, risks associated with the illegal crossing of borders cannot be discounted. o Detection of SARS-CoV-2 variants of concerns, such as the B.1.351 and B.1.1.7 variants, among locally transmitted cases. o Burden on the health-care system, especially in certain regions that are more greatly affected, such as in Selangor, FT Kuala Lumpur, , , Penang and Sarawak.  On 7 May, the Ministry of Health (MOH) reported that 506 COVID-19 patients and suspected SARS- CoV-2 cases were being treated in the ICU. Of them, 211 patients required ventilator support.  Phase 2 of the National Immunization Programme, which commenced on 19 April 2021, prioritizes adults aged 60 years and above, persons with disabilities and those with co-morbidities. As of 9 May, 2.85% of Malaysia’s total target population (an estimated 23.7 million individuals) have received their second dose of the COVID-19 vaccine.

1 Calculated with state-level reporting on a 14-day rolling basis of active cases, excluding imported cases. Source: MOH Malaysia and Department of Statistics Malaysia. 1 of 3

1 Malaysia Coronavirus Disease 2019 (COVID-19) Situation Report Weekly report for the week ending 9 May 2021

Upcoming events and priorities  Authorities have announced new public health and social measures, including: o The enforcement of a nation-wide movement control order (MCO) from 12 May to 7 June. Alongside the MCO, new public health and social measures affecting Eid celebrations, travel and workplace conditions have been announced. o Effective 10 May, interdistrict and interstate travel without prior approval from authorities will be prohibited across Malaysia. o Changes will be made to standard operating procedures related to social gatherings, workplaces and eateries. o Effective 10 May, all Ramadan and Eid bazaars will no longer be permitted to operate.  Authorities have launched the new COVID-19 data analytics system to carry predictive analysis to identify potential COVID-19 hotspots. The Hotspot Identification by Dynamic Engagement (HIDE) system uses variables such as the number of COVID-19 cases in a particular premise, exposure time and ventilation to carry out this analysis. The system aims to enable premises owners and individuals to undertake COVID-19 pre-emptive measures. Effective 7 May, officials will publish a list of premises identified as potential COVID-19 hotspots through HIDE. Premises identified as potential hotspots in FT Kuala Lumpur and Selangor will include shopping complexes, eateries, supermarkets, bazaars and office premises. Any individual who has visited a HIDE hotspot will be identified as a ‘casual contact’ and will be encouraged to undergo COVID-19 testing if they develop symptoms. Premises identified as hotspots may be instructed to minimize occupancy limits, and police will increase standard operating procedure compliance in affected areas. Authorities have noted that 90% of potential COVID-19 transmission in Malaysia occurs in only 0.2% of premises registered on the national contact tracing application, MySejahtera. Moreover, any premise listed as a hotspot through HIDE will be shut down for three days with immediate effect.  All travellers from Bangladesh, Pakistan, Nepal and Sri Lanka will be prohibited from entry into Malaysia. Exceptions to this directive will be given to diplomatic and official pass holders as stipulated under the Vienna Convention on Diplomatic Relations in 1961.

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2 Malaysia Coronavirus Disease 2019 (COVID-19) Situation Report Weekly report for the week ending 9 May 2021

National transmission assessment

National transmission stage assessment: Stage 3 (moderate confidence) – Large-scale community transmission2 Week 18 (3–9 May 2021)

The total number of cases reported in the past seven days (25 665) increased by 16.3% compared to the previous week, a continuation of the increasing trend in the number of daily new cases recorded since mid-March 2020. On average, 73 528 tests were conducted per day, with a positivity rate of 4.38%. Daily reported cases increased to above 3000, averaging 3666 cases daily. Of the newly reported cases, 49 (0.2%) were imported, and 25 616 (99.8%) were locally transmitted. Most states had an increase in the number of new COVID-19 cases. The states of Selangor, Sarawak and FT Kuala Lumpur reported the greatest numbers of new cases. FT Kuala Lumpur recorded a 25.3% increase in the number of newly reported local COVID-19 cases compared to the previous week. Of the newly reported cases, 6233 (24.3%) cases were unlinked at the time of reporting, a slight increase from the previous week. In Penang, 42% of newly reported cases were unlinked at the time of reporting. As the closure of schools was one of the recent intervention measures, newly reported clusters were mostly linked to workplaces, followed by community-based clusters. Along with the increase in the number of reported cases, there has likewise been an increase (20.6%) in the number of critically ill cases requiring ICU support. Nationwide, 416 cases required intensive care on 9 May, compared to 345 the previous week, and of these, 216 required ventilator support (compared to 175 the previous week). The occupancy rate of ICU beds is at its highest (76.6%) since the start of the pandemic. The number of deaths has increased by 54.6%, with 150 deaths this week. After announcing that MCOs would be implemented in selected states, including FT Kuala Lumpur and six districts in Selangor, the government on 10 May 2021 announced that a nationwide MCO would be imposed beginning 12 May 2021.

2 The transmission stage assessment is made based on three sets of indicators relating to i) trends in cases (including confirmed cases and positivity rates); ii) severe illness (including ICU admissions, mortality and severe acute respiratory illnesses case reporting); and iii) sources of infection (including the proportion of local/imported cases, unlinked cases and clusters). Having more than 25% of locally acquired infections unlinked to known clusters is one of the main signals (but not the only indicator) for large-scale community transmission (Stage 3). 3 of 3

3 Malaysia Coronavirus Disease 2019 (COVID-19) Situation Report Weekly report for the week ending 9 May 2021

EPI Update Tests Cases Deaths ICU COVID-19 25 665 Data reported for 514 701 150 76.6% New cases in the EPI week ending Tests in the Deaths in the ICU utilization rate past 7 days 9 May 2021 past 7 days past 7 days (+20.6%) (+2.2%) (+16.3%) (% difference (+54.6%) compared to the previous 7 days) 10 055 506 440 677 1683 543 Cumulative tests Cumulative cases Cumulative ICU beds for COVID-19 deaths patients (including 4.38% private hospitals) Positivity rate 0.38% Case fatality rate

Imported 49 6233 436 n/a Active clusters Active clusters with cases and (0.2%) (24.3%) more than three clusters Imported cases in the Cases in the past 7 generations past 7 days days with no link

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4 Malaysia Coronavirus Disease 2019 (COVID-19) Situation Report Weekly report for the week ending 9 May 2021

Epidemiology Fig 1. Daily reported COVID-19 cases, Malaysia, as of 9 May 2021

Fig. 1 indicates the number of daily new cases recorded in Malaysia. The background colour bands indicate the implementation timeline of COVID-19 MCO measures throughout the epidemic. The orange band refers to the implementation of the MCO. The yellow band refers to the conditional MCO (CMCO), while the green band refers to the recovery MCO (RMCO). Presently, authorities have implemented a nationwide MCO until 7 June 2021.

Table 1: Active cases and real-time reproductive number (Rt) estimates by state, as of 9 May 2021 State Active casesa Active cases/100,000 7-day incidence/100 000b Rt estimate 95% CI Selangor 15 019 230.73 129.2 1.18 1.16–1.20 Sarawak 7106 227.64 111.0 0.97 0.95–0.99 Kelantan 5411 287.15 128.8 0.96 0.94–0.99 FT Kuala Lumpur 4837 373.16 208.8 1.13 1.10–1.16 Johor 3397 87.49 53.3 1.18 1.15–1.22 Penang 2915 164.95 102.8 1.24 1.19–1.28 1539 69.77 48.1 1.27 1.21–1.33 1330 116.57 74.0 1.26 1.19–1.32 1176 29.41 13.6 0.88 0.83–0.93 1035 40.28 1.1 1.16 1.10–1.23 784 83.88 54.6 1.19 1.11–1.27 768 45.10 30.5 1.26 1.18–1.35 756 70.12 39.8 1.22 1.14–1.30 FT 129 124.28 74.2 1.16 0.97–1.36 FT 22 22.16 18.1 1.12 0.80–1.49 10 3.86 0.2 - - a This state-level reporting is on a rolling 14-day basis, from 26 April to 9 May 2021, and excludes imported cases. b Excludes imported cases. Source: MOH Malaysia. 5 of 3

5 Malaysia Coronavirus Disease 2019 (COVID-19) Situation Report Weekly report for the week ending 9 May 2021

Clusters

 Of the 1788 clusters identified in Malaysia, 436 are currently active. In the past week, 108 new clusters were identified, and 68 previous clusters were declared closed. In the past week, 46 (42.6%) newly reported clusters were linked to workplaces.  On 8 May, authorities reported that two COVID-19 deaths had been linked to the B.1.351 variant in Selangor. Both cases were linked to the Teknologi Emas workplace cluster in the Kuala Langat district.

Health-care capacity  The MOH has obtained approval to recruit 8302 additional health-care workers, including 82 science officers, 4472 nurses, 2249 assistant medical officers, 666 medical laboratory technologists, 340 assistant environmental officers, 293 diagnostic X-ray technicians and 200 counsellors, to facilitate ongoing COVID-19 efforts. Since 26 April, 648 and 366 health-care workers have been mobilized to Sarawak and Kelantan, respectively.  The MOH is in ongoing discussions with the Ministry of Defence to establish field hospitals in Kelantan and Sarawak. The hospitals will be used to treat non-COVID-19 patients. In , Sarawak, a field hospital with about 40 beds has been set up at the Kapit Malay Community Hall to treat non- COVID-19 patients. Seven medical officers and 35 medical assistants will operate in the field hospital.  In Kelantan, COVID-19 health-care capacity in hospitals and Low-Risk Quarantine and Treatment Centres are now at critical levels. Hospitals have reached almost 100% ICU capacity. Additionally, over 2000 COVID-19 patients have been placed under Home Isolation Order (HIO) due to insufficient beds at quarantine centres. Therefore, state authorities are working on setting up a field hospital in Padang Perdana to accommodate about 1000 patients.  As of 3 May, Johor health officials have reported that the state-level COVID-19 ICU bed occupancy rate is 114%. State authorities have allocated all ICU beds (43) to treating COVID-19 cases. All public hospitals in Johor are functioning as COVID-19-hybrid hospitals during this period, and all elective surgeries have been postponed. Presently, Johor has 11 COVID-19 Assessment Centres (CAC) in operation.  As of 7 May, Penang authorities have noted that the state-level ICU capacity has reached 83%.  On 7 May, the MOH reported that 22 COVID-19 hospitals had recorded ICU bed utilization rates higher than 70%. Some facilities reported ICU bed utilization rates exceeding 90%.

Testing and surveillance  Selangor authorities are providing free mass COVID-19 screening to all state residents from 8 May to 10 June. The programme will be implemented across all 56 state constituencies.

Strategic approach

Non-pharmaceutical interventions (NPI)  The Ministry of Rural Development has clarified that any individual, group or nongovernmental organization (NGO) must obtain a permit from the Department of Orang Asli Development before organizing community service programmes or sending aid to Orang Asli (indigenous people) settlements. This directive was implemented based on concerns that people and NGOs entering such settlements to organize breaking fast programmes had arrived from COVID-19 red zones.  Following the implementation of new MCO directives across Malaysia, new public health and social measures have been announced. The new MCO directives include: o Interdistrict and interstate travel is permitted only for emergency or work-related movements. o Dine-in activities in the specified areas are not permitted. o Formal and informal social gatherings are not permitted.

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6 Malaysia Coronavirus Disease 2019 (COVID-19) Situation Report Weekly report for the week ending 9 May 2021

o All spas, reflexology centres, nightclubs, theme parks, indoor playgrounds and movie theatres are prohibited from operating. o Only sports and recreational activities that do not involve physical contact are permitted. o The open house tradition will not be permitted during Eid celebrations. o Prayers are permitted in mosques and prayer halls. For venues with a capacity of 1000 people, a maximum of 50 congregants will be permitted. For venues with a capacity of less than 1000 people, a maximum of 20 congregants will be permitted. o All educational facilities will be closed. Childcare centres, nurseries and kindergartens are permitted to operate subject to compliance with regulations.  All congregational prayers are subject to physical distancing and public health and social measures.  Only individuals categorized as “low risk” in the national contact tracing application, MySejahtera, will be permitted entry into specific shopping, health and judicial premises.

Table 3: Movement control orders currently being implemented3 State Location Type of MCO Effective dates All Nation-wide MCO 12 May to 7 June states/territories Sarawak Rh. Bonifave Manggie, EMCO 10–23 May Rh. Andin, Kanowit Rh. Tatom, Batang Oya, Stapang, Selangou Rh. Nyawin, Sg Rian, Bintangor, 4–17 May Meradong Rh. Mut.Nanga Maong, Sungai Mujok, 3–9 May Julaue Rh.Malong, Sungai Melaban, Sare, 4–10 May Rh. Sibat, Penurin, Betong 4–17 May Rh. Ukam, Nanga Engkamop, 1–14 May Rh. Dinggai, Pakan, Sarikei Extended to 19 May 5 Jalan Bukut longhouses, , Extended to 20 May Giman longhouse, Batu 13, Jalan Engkamop, Pakan, Sarikei Kampung Rayang, Serian Pahang Taman Tanah Putih Baru, EMCO 5–18 May 16 localities in Sungai Ruan, Raub 8–21 May 7 localities in , Raub Genting View Resort, Apartment 10–23 May Meranti, Windmills Condominium, Vista Residence, Mawar Apartment, Midhill Apartment and Ramin Apartment Kampung Meripoh and Kota Bahagai, Muadzam Shah, Rompin Johor Tunku Mahkota Ismail (SSTMI) sports 8–21 May school Bandar Penawar, Kota Tinggi Perak Kampung Lubok Katak, Tapah, Batang EMCO 7–20 May Padang

3 EMCO refers to Enhanced MCO. 7 of 3

7 Malaysia Coronavirus Disease 2019 (COVID-19) Situation Report Weekly report for the week ending 9 May 2021

Malacca Kampung Permatang Tulang, Sebatu, Jasin Sabah Ugama secondary school (SMU) Pantai Manis, Papar Kampung Keramat, Semporna 11–24 May Kelantan Three villages in Bunut Susu, Pasir Mas 9–22 May

Vaccines  As of 9 May, a total of 1 754 156 COVID-19 vaccine doses have been administered across Malaysia. From that, a total of 674 862 individuals have received both vaccine doses. That comprises 2.85% of Malaysia’s total target population of approximately 23.7 million adults.  Those selected to perform Haj in the upcoming religious month will be vaccinated with Pfizer- BioNTech or AstraZeneca vaccines before travelling to the Kingdom of Saudi Arabia.  Authorities aim to expand the AstraZeneca COVID-19 vaccine opt-in programme under the National COVID-19 Immunisation Programme to community clinics. This will ensure higher vaccine equity across the population.  An estimated 1.1 million additional doses of the AstraZeneca vaccine are expected to arrive in May 2021. The shipment will be part of the COVID-19 Vaccine Global Access (COVAX) facility.  As of 6 May, a total of 2448 private hospitals and clinics across Malaysia have registered as vaccination centres under the National COVID-19 Immunisation Programme. From that, 299 premises are ready for operation.

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