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

Malaysia Situation summary  While COVID-19 cases decreased after an initial peak in late January 2021, Malaysia has seen a resurgence of cases since mid-March 2021. As of 2 May, there have been a total of 415 012 confirmed cases of COVID-19 in Malaysia.  In the past seven days: o 22 070 new cases have been reported – a 23.4% increase compared to the previous week; o 97 new deaths have been reported, bringing the total number of COVID-19 deaths in Malaysia to 1533; and o the number of critically ill cases requiring intensive care unit (ICU) support and ventilator support have increased by 21.9% and 44.6%, respectively.  Most states and territories (14 out of 16) reported an increase in new COVID-19 cases in the past week, including the states reporting the highest numbers of cases: (6828 cases), (3776 cases) and (3057 cases). Kelantan is the state with the highest concentration of actives cases – 324.88 active cases1 per 100 000 population. Additionally, Federal Territory (FT) recorded 2161 new local COVID-19 cases in the past week, a 19.3% increase compared to the previous week.  Potential risks and vulnerabilities for a continued increase in transmission: o As of 2 May, the estimated national real-time reproductive number (Rt) was 1.11 (95% confidence interval [CI]: 1.10–1.13). An Rt value of 1 and above indicates the potential for continued transmission of SARS-CoV-2 and a resurgence of cases. o Public health and social measures: relaxation of previous restrictions, enforcement and adherence. 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. In the past week, Malaysia has reported more variants of concern, despite the relatively low numbers of testing for whole genome sequencing. o The health-care system is burdened, especially in certain regions that are more greatly affected by COVID-19, such as in Selangor, Kelantan and Sarawak.  As of 2 May, health authorities reported the detection of locally transmitted cases bearing the B.1.351 and B.1.1.7 variants of concern. Such cases were detected in Selangor, , Kelantan and .  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 1 May, 2.34% of Malaysia’s total target population (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 2 May 2021

Upcoming events and priorities  Malaysian authorities are reviewing the movement control orders (MCOs) currently in force across the state. The Hotspots Identification for Dynamic Engagement (HIDE) system is currently used to identify areas or premises that are high risk for COVID-19 transmission. HIDE is part of an intervention strategy based on targeted projections of risk and response, identified at various levels, including state, district, subdistrict as well as specific localities.  Implementation of MCOs continue to be done on the basis of subnational assessments of risk and burden: The recovery MCOs (RMCOs) previously implemented in , , Perak, , FT , , FT , (except district) and (except specific districts) has been extended to 17 May 2021. Sabah, , Sarawak and have been placed under conditional MCOs (CMCOS) until 17 May. Kelantan has been placed under MCO. Moreover, five districts in Kedah (i.e. Kota Setar, Kuala Muda, Bandar Baharu, Baling and Kulim) have been placed under MCO until 14 May. Six districts in Selangor (i.e. Hulu Langat, Klang, Petaling, Kuala Langat, Gombak and Sepang) have been placed under MCO until 17 May. Additionally, FT Kuala Lumpur, three districts in Johor (Johor Bahru, Kulai, ), 14 subdistricts (Besut) in Terengganu and one subdistrict (Taiping) in Perak have been placed under MCO until 20 May. Interstate and interdistrict travel in MCO areas for non-essential purposes remains prohibited.  The government has announced new standard operating procedures for the upcoming Eid festivities.  Effective 17 May, travel between Malaysia and Singapore will be permitted for compassionate reasons. This includes visiting critically ill loved ones. Further instructions will be announced soon by the Immigration Department of Malaysia.  Following the rise in COVID-19 cases in India, effective 28 April, all foreign travellers departing from India will be prohibited entry into Malaysia. The directive will include those travelling via flights (including transiting) or ships. Malaysian nationals and their spouses departing from India will be permitted entry but will be required to undergo a 14-day quarantine at designated centres upon arrival.  All travellers from Bangladesh, Pakistan, Nepal and Sri Lanka will be prohibited 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 2 May 2021

National transmission assessment

National transmission stage assessment: Stage 3 (moderate confidence) – Large-scale community transmission2 Week 17 (26 April – 2 May 2021)

The total number of cases reported in the past seven days (22 070) increased by 23.4% compared to the previous week, signalling an increasing trend in the number of daily new cases recorded. On average, 67 805 tests were conducted per day, with a positivity rate of 4.35%. Daily reported cases increased to above 3000, averaging 3153 cases daily. Of the newly reported cases, 58 (0.3%) were imported, and 22 012 (99.7%) were locally transmitted. Most states are signalling an increase in the number of new COVID-19 cases. The states of Selangor, Sarawak and Kelantan reported the greatest numbers of new cases. Additionally, FT Kuala Lumpur recorded a 19.3% increase in the number of newly reported local COVID-19 cases compared to the previous week. While most cases are linked to existing clusters, 4849 (22.0%) cases were reported as unlinked at the time of reporting. Up to 90% of new clusters3 are linked to workplaces, educational institutions and the community. As the number of reported cases is increasing, there has likewise been an increase (21.9%) in the number of critically ill cases requiring ICU support. Nationwide, 345 cases required intensive care on 25 April (compared to 283 the previous week), and of these, 175 required ventilator support (compared to 121 the previous week). The number of deaths has increased by 67.2%, with 97 deaths this week.

EPI Update Tests Cases Deaths ICU COVID-19 22 070 Data reported for 474 635 97 63.5% New cases in the EPI week ending Tests in the Deaths in the ICU utilization rate past 7 days 2 May 2021 past 7 days past 7 days (+21.9%) (+2.2%) (+23.4%) (% difference (+67.2%) compared to the previous 7 days) 9 540 805 415 012 1533 543 Cumulative tests Cumulative cases Cumulative ICU beds for COVID-19 deaths patients (including 4.35% private hospitals) Positivity rate 0.37% Case fatality rate

Imported 58 4849 396 n/a Active clusters Active clusters with cases and (0.3%) (22.0%) more than three clusters Imported cases in the Cases in the past 7 generations past 7 days days with no link

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 Cluster types are categorized based on the narrative provided by the MOH, usually based on the profile of the index case. Cases within each cluster, especially beyond the first generation transmission, may not necessarily be limited to the same setting as the index case. 3 of 3

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

Epidemiology Fig 1. Daily reported COVID-19 cases, Malaysia, as of 2 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 implementation of the CMCO while the green band refers to the RMCO.

Table 1: Active cases and real-time reproductive number (Rt) estimates by state, as of 2 May 2021 State Active casesa Active cases/100 000 7-day incidence/100 000b Rt estimate 95% CI Selangor 11 100 170.53 104.9 1.18 1.16–1.20 Sarawak 7623 244.2 120.96 1.02 1.00–1.04 Kelantan 6122 324.88 162.23 1.16 1.13–1.19 FT Kuala Lumpur 3955 305.11 166.71 1.11 1.08–1.15 Johor 2291 59.01 41.54 1.05 1.01–1.09 Penang 1761 99.65 57.83 1.08 1.03–1.13 Sabah 1518 37.96 16.35 0.94 0.89–0.98 Kedah 928 42.07 30.06 1.26 1.18–1.33 Negeri Sembilan 792 69.42 54.43 1.15 1.08–1.22 Perak 680 26.46 19.5 1.14 1.07–1.22 Malacca 522 55.85 34.45 1.23 1.13–1.33 Pahang 492 28.89 18.91 1.17 1.08–1.27 Terengganu 480 44.52 36.36 1.66 1.52–1.81 FT Putrajaya 106 102.12 57.8 1.06 0.87–1.27 FT Labuan 22 22.16 11.08 0.99 0.70–1.34 Perlis 6 2.31 4.63 1.12 0.68–1.66 a This state-level reporting is on a rolling 14-day basis, from 19 April to 2 May 2021, and excludes imported cases. b Excludes imported cases. Source: MOH Malaysia.

 Between 1 January and 1 May 2021, the overall COVID-19 incidence in Malaysia was 872 cases per 100 000 population. The state/territory with the highest incidence per 100 000 was FT Kuala Lumpur (1583), followed by Selangor (1486) and FT Putrajaya (1140).

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

Clusters  Of the 1680 clusters identified in Malaysia, 396 are currently active. A total of 44 clusters have been declared closed in the past week. A total of 89 new clusters were identified in the past week. Of these, 25 (28.1%) were linked to educational facilities, and 23 (25.8%) were linked to workplaces. Up to 34% of clusters, however, were categorized as “other” – relating to various community-based clusters of cases, plus an additional 6% that were specifically linked to social gathering events.  A total of 11 clusters involving interstate travel of the index case were recorded in April 2021.  In 2020, a total of 8369 COVID-19 cases were detected among children aged 12 years and below in Malaysia. Between 1 January and 25 April 2021, a total of 23 739 cases in Malaysia were from the same age group.

Health-care capacity  The MOH has mobilized an estimated 8302 health-care workers to facilitate ongoing COVID-19 efforts across Malaysia. A total of 648 and 366 health-care workers have been deployed to Sarawak and Kelantan, respectively.  The COVID-19 Low-Risk Quarantine and Treatment Centre constructed at the Malaysia Agro Exposition Park Serdang (MAEPS) 2.0 will increase the number of COVID-19 beds for category 3 and 4 patients. The Centre aims to dedicate 800 single beds for treating COVID-19 cases with pneumonia (category 3) and cases experiencing pneumonia and requiring oxygen in treatment (category 4).  As of 28 April, Sarawak has a total of 7347 COVID-19 beds, of which 58% are occupied. Moreover, it has 80 intensive care unit (ICU) beds reserved for COVID-19 use, with an occupancy of more than 70%. Additionally, 15% of the state’s 206 ventilators are currently in use. An estimated 520 health- care workers have been mobilized to Sarawak. Authorities have allocated RM 7.7 million to and RM 9.18 million to Sibu Hospital to assist in purchasing ventilators and ICU beds for COVID-19 patients.  As of 28 April, the MOH reports that Kelantan hospitals are close to exceeding the state’s COVID-19 bed capacity: o Ismail Petra Hospital in : 111% o Tanah Merah Hospital: 100% o Tumpat Hospital: 95% o Machang Hospital: 96% o Kuala Krai Lama Hospital: 82%. Only category 4 and 5 cases will now be treated in hospitals. Category 3 patients will be stepped down to Low-risk Quarantine and Treatment Centres. Category 1 and 2 patients will be treated at home through the COVID-19 Assessment Centres (CACs).  In Selangor, FT Kuala Lumpur and FT Putrajaya, there are seven COVID-19 hospitals. A total of 152 critical care beds have been allocated for COVID-19 treatment, with a current occupancy rate of approximately 88%. Five hospitals reported an ICU occupancy exceeding 70%, while the remaining two hospitals recorded an ICU occupancy of more than 50%.

Testing and surveillance  The Sarawak COVID-19 Advisory Group (Scovag) announced that the P.3 SARS-CoV-2 variant had been detected among cases in Sarawak. Eight samples bearing this variant were detected, with four samples received from both Kuching and Samarahan. The P.3 Sars-CoV-2 variant has previously been reported to be in circulation in the Philippines.  Between 24 April and 2 May 2021, a total of 30 cases bearing variants of concern and one case bearing a variant of interest were detected. A total of 27 new local cases possessed the B.1.351 variant, while an additional three cases bore the B.1.1.7 variant. One imported case bore the B.1.617.1 variant of interest. In total, Malaysia has recorded 48 COVID-19 cases bearing the B.1.351 variant of concern. Cases bearing the B.1.351 variant have been detected in Selangor, Perak and Kelantan. In total, Malaysia has recorded eight cases bearing the B.1.1.7 variant. Three newly reported cases were detected among local cases from Selangor and Sabah.

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

Strategic approach

Non-pharmaceutical interventions (NPI)  All primary and secondary schools in Malaysia will return to home-based teaching and learning methods (PdPR) after the Eid holidays. All schools located in Johor, Kedah, Kelantan and Terengganu will conduct teachings through the PdPR scheme until 28 May, while schools in the remaining states will use PdPR teaching until 29 May. Presently, all schools will operate as usual until the school holiday commences. In Kelantan, however, schools and educational institutions will remain closed from 3 May until the Eid school holidays.  Sarawak authorities have announced that the closure of schools under the Ministry of Education (MOE) and private educational institutions has been extended to 10 May 2021. Affected schools are all those located in red zones. Only Form 6 students sitting their final year exam, the Sijil Tinggi Persekolahan Malaysia (STPM), will be allowed to attend school until 27 May.  For the upcoming Eid school holidays, the MOE will permit students residing in boarding schools, Form 6 colleges and vocational colleges to return home. Students in Group A states (schools located in Johor, Kedah, Kelantan and Terengganu) will be permitted to travel from 6 May. Students in the remaining states will be allowed to travel home from 7 May.  Effective 27 April, any traveller with a travel history to India in the past 30 days will not be permitted to enter Sarawak state.  Effective 28 April, Sabah state authorities will prohibit the entry of travellers entering from countries that have reported COVID-19 variants of concerns. These countries include India, France, the United States of America, all African countries and Brazil. Moreover, effective 3 May, travellers from Bangladesh, Nepal, Pakistan and Sri Lanka will be prohibited from entering Sabah.  Under the new MCO directives in Selangor, operating hours for eateries, stores, markets and petrol stations will be limited. Moreover, dine-in activities will no longer be permitted. Additionally, Ramadan bazaars are prohibited from operating.  For the upcoming Eid celebrations, visiting will be permitted in MCO, CMCO and RMCO areas. However, the number of visits permitted per household as well as visitation days will differ according to the type of MCO implemented. Open houses will not be permitted throughout Malaysia. Eid prayers will be permitted in mosques and prayer halls located in MCO, CMCO and RMCO regions. However, the number of congregants will be determined by state-level religious authorities. Grave visiting will only be permitted in CMCO and RMCO areas.

Table 3: Movement control orders currently being implemented4 State Location Type of MCO Effective dates Kelantan Machang Science Secondary school EMCO Extended to 14 May Maahad Tahfiz Al Azhari (MTAZ) 29 April to 12 May Machang Maahad Tahfiz Sains Tanah Merah Extended to 16 May State-wide MCO Extended to 17 May Selangor State-wide CMCO 29 April to 17 May FT Kuala Lumpur Johor Penang Sabah Kampung Baru Pasir Putih, Sri EMCO Extended to 12 May Tanjung, Tawau PPR Batu 2 Lorong Habib Abdul 28 April to 11 May Rahman, Tawau Felda Umas, Kalabakan

4 EMCO refers to enhanced MCO. 6 of 3

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

PPR Abedon Complex (Bumiwealth, Kolopis and Tanaki), Kinabatangan PPR Bt.8 Jalan Apas, Tawau Kampung Skim Cocos, Kunak 1–14 May Madai Secondary School, Kunak Kampung Bergosong, Tawau 2–15 May Sarawak State-wide CMCO 27 April to 17 May Longhouses in Sungai Duan, EMCO 27 April to 6 May Baleh Hydroelectric Dam construction 27 April to 26 May site, Secondary school (SMK) Ulu Balingian, 28 April to 11 May Sibu Kampung Sagah, Kuching 30 April to 13 May Rampai Sungai Anyit Selangan longhouse Chan Minggat longhouse, Sungai Kesa, Sarikei Payau Emperan Datuk longhouse, Sungai Pinang, Pakan Luni anak Jugah longhouse, Mukah 3–16 May Jali anak Empaling longhouse, Mukah Lanyau anak Tuli longhouse, Mukah Manna anak Mulok longhouse, Mukah Nelson Chuat anak Glong longhouse, Mukah Perlis State-wide RMCO Extended to 17 May Terengganu Perak Malacca FT Putrajaya FT Labuan Negeri Sembilan State-wide (except Seremban) Kampung Bangkahulu, EMCO 29 April to 12 May Pahang State-wide RMCO Extended to 17 May Two residential areas near Sungai EMCO 29 April to 12 May Chalit, Raub Five residential areas near Sungai Klau, Raub Kedah State-wide (except five districts) RMCO Extended to 17 May Kota Setar MCO 1–14 May Bandar Baharu Baling Kuala Muda Kulim

Vaccines  As of 1 May, a total of 1 453 382 COVID-19 vaccine doses have been administered across Malaysia. From that, a total of 555 288 individuals have received both vaccine doses. That comprises 2.34% of Malaysia’s total target population of approximately 23.7 million adults.  Authorities have announced that the AstraZeneca vaccine will initially be offered on a voluntary, opt- in basis for residents in FT Kuala and Selangor. Registration for the vaccine opened on 2 May. Screening will be conducted prior to inoculation. Officials have made it clear they aim to expand the programme to community clinics in Malaysia.

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