Coronavirus Disease 2019 (COVID-19) Situation Report Weekly report for the week ending 11 July 2021

Malaysia Situation summary  As of 11 July, there have been a total of 836 296 confirmed cases of COVID-19 in Malaysia.  In the past seven days: o A total of 57 644 new cases have been reported – a 29.2% increase compared to the previous week. o Another 661 new deaths have been reported, bringing the total number of COVID-19 deaths in Malaysia to 6158. The overall case fatality rate is 0.74%. The highest single-day increase in COVID-19 deaths was reported on 8 July with 135 deaths. o The number of critically ill cases requiring intensive care unit (ICU) support or ventilator support is currently at a plateau, with a less than 5% increase from the previous week. o The number of COVID-19 tests conducted has increased by 13.5% compared to the previous week.  Twelve states and territories have reported an increase in new COVID-19 cases in the past week. o The highest numbers of cases were reported in (26 485), Federal Territory (FT) (8357) and (4983). o Selangor reported the highest number of deaths at 295 new deaths.  Despite Malaysia being under a movement control order (MCO) since 12 May 2021 and implementing Phase 1 of the National Recovery Plan since 16 June, the trends in reported cases, severe cases, deaths and test positivity rates have not gone down. Due to consistently high COVID-19 case burdens, districts and subdistricts in Selangor, , and Negeri Sembilan have been placed under an enhanced movement control order (EMCO).  Potential risks and vulnerabilities: o High proportions of reported cases categorized as “sporadic” and “unlinked at the time of reporting” indicate widespread community transmission. o SARS-CoV-2 variants of concern (Alpha, Beta and Delta) continue to be detected among local cases. The Beta variant has been detected in 15 out of 16 states/territories. To date, no cases bearing the Gamma variant have been reported. o Relatively high test positivity rates (above 5%) and an increase in the daily number of tests conducted are being reported across the country. o There is a burden on the health-care system, especially in regions around the country that are more affected, such as Selangor and FT Kuala Lumpur.  As of 11 July, 10.8% of Malaysia’s total population have received their second dose of the COVID-19 vaccine.

Upcoming events and priorities  The Ministry of Health (MOH) aims to soon present guidelines for fully vaccinated individuals to the National Security Council (NSC). Preliminary details in the guidelines will refer to other countries’ best practices in COVID-19 management.  As of 14 July, a total of eight states (, Pahang, Perak, , , , and ) have transitioned into Phase 2 of the National Recovery Plan. Furthermore, several localities in Selangor, FT Kuala Lumpur, Negeri Sembilan, Perak and Pahang have been placed under EMCO.

1 of 3

1 Malaysia Coronavirus Disease 2019 (COVID-19) Situation Report Weekly report for the week ending 11 July 2021

National transmission assessment

National transmission stage assessment: Stage 3 (high confidence) – Large-scale community transmission1 Week 25 (5–11 July 2021)

The number of cases reported in the past seven days (57 644) has increased by 29.2% compared to the previous week. This translates to an average of 8234 cases per day. The number of tests conducted in the past week averaged 89 947 tests per day, an increase of 13.5% compared to the previous week. The seven-day test positivity rate was 9.2%, an increase from the previous week. Of the newly reported cases, 109 (0.2%) were imported, and 57 535 (99.8%) were locally transmitted. Twelve states and territories reported an increase in the number of new COVID-19 cases, with six of these states reporting increases of more than 20%. The states of Selangor, FT Kuala Lumpur and Negeri Sembilan reported the highest numbers of new cases. Of newly reported cases, 15 887 (27.6%) were unlinked at the time of reporting. Among newly reported clusters,2 62.9% were linked to workplaces, while 26.4% were linked to the community or social gatherings. The number of critically ill cases requiring ICU support has increased, with a difference of 4.8% in the past week. Nationwide, 961 cases required ICU support on 11 July, compared to 917 the previous week, and of these, 455 required ventilator support (compared to 443 the previous week). The number of deaths increased by 19.5%, with 661 deaths recorded this past week. Selangor reported the highest number of new deaths in the past seven days.

EPI Update Tests Cases Deaths ICU COVID-19 57 644 Data reported for 629 626 661 72.7% New cases in the EPI week ending Tests in the Deaths in the ICU utilization rate past 7 days 11 July 2021 past 7 days past 7 days (+4.8%)* (+13.5%) (+29.2%) (% difference (+19.5%) compared to the previous 7 days) 15 529 169 836 296 6158 1322 Cumulative tests Cumulative cases Cumulative ICU beds for COVID-19 deaths patients (including 5.39% private hospitals) Positivity rate 0.74% Case fatality rate

Imported 109 15 887 865 n/a Active clusters Active clusters with cases and (0.2%) (27.6%) more than three clusters Imported cases in the Cases in the past 7 generations past 7 days days with no link

* The ICU utilization rate is calculated as the number of COVID-19 cases in the ICU at the end of the epi week against the total available COVID-19-designated ICU beds. This value excludes ICU bed utilization for suspected and probable COVID-19 cases.

1 The transmission stage assessment is 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). 2 Cluster types are categorized based on the narrative provided by the Ministry of Health, usually based on the profile of the index case. Cases within each cluster, especially beyond first-generation transmission, may not necessarily be limited to the same setting as the index case. 2 of 3

2 Malaysia Coronavirus Disease 2019 (COVID-19) Situation Report Weekly report for the week ending 11 July 2021

Epidemiology Fig 1. Daily reported COVID-19 cases, Malaysia, as of 11 July 2021

Fig. 1 indicates the number of daily confirmed 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 an MCO. The yellow band refers to a conditional MCO (CMCO), while the green band refers to a recovery MCO (RMCO). A nationwide MCO has been in place since mid-May 2021 and the National Recovery Plan since 1 June. Eight states (Kelantan, Pahang, Perak, Terengganu, Penang, Sabah, Sarawak and Perlis) are in Phase 2. Selected localities in Selangor, Pahang, Perak and Negeri Sembilan and FT Kuala Lumpur have been placed under EMCO.

Table 1: Active cases and real-time reproductive number (Rt) estimates by state, as of 11 July 2021 State Active casesa Active cases/100 000 7-day incidence/100 000b Rt estimate 95% CI MALAYSIA 87 841 269.8 177.1 1.15 1.14–1.16 Selangor 43 932 674.9 406.9 1.18 1.17–1.19 FT Kuala Lumpur 13 598 1049.0 644.7 1.17 1.15–1.19 Negeri Sembilan 9044 792.7 436.8 1.02 1.00–1.04 4740 122.1 59.2 1.02 0.99–1.04 Sarawak 4680 149.9 73.6 0.85 0.83–0.88 3696 167.6 105.7 1.17 1.13–1.20 3474 371.7 247.4 1.08 1.05–1.12 Sabah 3264 81.6 46.4 1.08 1.05–1.12 Pahang 2930 172.1 97.7 1.14 1.10–1.18 Perak 2804 109.1 64.8 1.07 1.03–1.11 Penang 2419 136.9 72.2 1.05 1.01–1.09 Kelantan 1580 83.9 46.5 0.95 0.91–1.00 FT 1276 1285 532.7 0.90 0.85–0.95 Terengganu 486 45.1 33.3 1.08 1.00–1.17 FT 347 334.3 226.4 1.31 1.17–1.45 Perlis 11 4.2 0.2 – – a This state-level reporting is on a rolling 14-day basis, from 28 June to 11 July 2021, and excludes imported cases. b Excludes imported cases. Source: MOH Malaysia. 3 of 3

3 Malaysia Coronavirus Disease 2019 (COVID-19) Situation Report Weekly report for the week ending 11 July 2021

Table 2: Total cases and case fatality rates by states, as of 11 July 2021 State Total cases Total deaths Case fatality rate (%) MALAYSIA 836 296 6158 0.7 Selangor 286 352 2013 0.7 FT Kuala Lumpur 88 958 688 0.8 Negeri Sembilan 52 392 477 0.9 Sarawak 68 869 432 0.6 Johor 74 828 643 0.9 Kedah 28 584 382 0.8 Malacca 21 875 204 0.9 Sabah 72 313 559 0.8 Pahang 16 148 147 0.9 Perak 29 110 141 0.5 Penang 36 619 130 0.4 Kelantan 36 141 242 0.7 FT Labuan 9141 136 1.5 Terengganu 11 759 82 0.7 FT Putrajaya 2599 15 0.6 Perlis 608 8 1.3

Clusters

 Of the 3077 clusters identified in Malaysia since the start of the pandemic, 865 are currently active.  In the past week: o 159 new clusters were identified o 100 (62.9%) new clusters were linked to workplaces.

Health-care capacity  As of 4 July, the MOH has stated that of the 1224 COVID-19 cases in ICU, 567 (46.3%) are located in the Valley. Owing to insufficient ICU bed capacity in the , some patients have been placed in emergency and trauma departments in hospitals.  As of 1 July, 112 private hospitals (53.1%) out of a total 211 private hospitals nationwide have begun to provide COVID-19 treatment. As of 1 July, private health-care has provided 1277 COVID-19 beds located in general wards and 129 COVID-19 ICU-designated beds.  As of 7 July, the MOH has reported a national ICU bed occupancy rate of over 90%. Moreover, front- line health-care workers have reported symptoms of burnout. Four states have reported an increase in the daily number of new cases exceeding the maximum COVID-19 hospital capacity. Moreover, the seven-day average ICU utilization rates for FT Labuan (127%), Negeri Sembilan (166%), FT Kuala Lumpur (102%) and Selangor (129%) are all over 100%. As such, authorities are accelerating efforts to provide additional COVID-19 beds, oxygen supply and medical workers to affected hospitals.  The Malaysia Agro Exposition Park Serdang (MAEPS) COVID-19 quarantine and low-risk treatment centre has a total bed capacity of 5198. Of those, 154 beds are designated for category 4 (requiring ventilator support) patient use. According to the MOH, the centre receives an average of 800 COVID- 19 patients per day, with 200 patients being category 4.

Testing and surveillance  Studies conducted by the Institute for Medical Research showed a sensitivity above 90% for two self- administered antigen rapid test kits (RTK-Ag). Guidelines on the use of such kits are expected to be published next week.  FT Labuan has established COVID-19 RT-PCR testing capacity at the Labuan Nucleus Hospital. The centre is expected to carry out 200 tests per day. Prior to this, all COVID-19 RT-PCR samples collected in the territory were sent out-of-state for processing.  All workers permitted to operate in EMCO-affected areas in Selangor will be required to undergo RTK-Ag testing twice a week. Only those who test negative will be permitted to operate. Moreover, 4 of 3

4 Malaysia Coronavirus Disease 2019 (COVID-19) Situation Report Weekly report for the week ending 11 July 2021

the MOH aims to increase COVID-19 screenings conducted in EMCO areas in FT Kuala Lumpur and Selangor.  As of 8 July, the national RT-PCR capacity stands at 116 803 tests per day in a total of 92 laboratories.  A total of 509 private general medical practitioners across Malaysia have been given authorization letters to issue home surveillance and observation (HSO) orders to COVID-19 patients.

Strategic approach

Non-pharmaceutical interventions (NPI)  Effective 7 July, additional economic sectors located in Selangor have been approved to operate during the EMCO period. The maximum workforce capacity will be maintained at 60%. Essential sectors approved to operate include: o Electrical and electronics and its supply chains o Aerospace maintenance o Repair and overhaul o Machinery and equipment for the production of health-care and food and beverage products.  Penang o Under Phase 2 of the National Recovery Plan, most public parks in the state will reopen for visitors. Parks will open from 07:00 to 19:00 daily with a 100% capacity limit, subject to safe physical distancing measures. o From 9 July, Friday congregational prayers will be permitted to take place in mosques or prayer halls located in the state. The maximum number of permitted congregants will be limited to 150 individuals at state mosques and 50 individuals at prayer halls. Aidiladha prayers will also be permitted to occur in mosques and prayer halls.  Federal territories o The number of worshippers permitted to perform Friday and Aidiladha prayers in FT mosques will be limited to 300 people. The number of worshippers permitted to perform obligatory prayers in FT mosques will be limited to 100 people.  Terengganu: o The maximum number of worshippers will be permitted to attend prayers in mosques and prayer halls throughout the state, subject to maintaining physical distancing measures.  Perlis: o Congregational prayers held in open areas will be permitted for the upcoming Aidiladha celebrations. The maximum number of congregants will be limited by venue capacity and physical distancing measures.  Sarawak o COVID-19 vaccination will now be one of the conditions for business licensure renewal and application in the Sibu division.  From 12 July onwards, students of higher learning institutes residing on campus will be allowed to return home for semester break. This directive will not apply to students residing in EMCO-affected areas.

5 of 3

5 Malaysia Coronavirus Disease 2019 (COVID-19) Situation Report Weekly report for the week ending 11 July 2021

Vaccines Fig 2. Proportion of national population that have received COVID-19 vaccines (%), as of 11 July 2021

30.0

25.0

20.0

15.0

10.0 Proportionvaccinated (%)

5.0

- 1/3/2021 1/4/2021 1/5/2021 1/6/2021 1/7/2021

Dose 1 Dose 2

Fig. 2 indicates the proportion of the total population vaccinated (%) with one dose (blue) and two doses (orange) of the COVID-19 vaccine.

 As of 11 July, a total of 11 366 710 COVID-19 vaccine doses have been administered across Malaysia. Of those, a total of 3 526 676 individuals, or 10.8% of Malaysia’s total population, have completed the vaccination with two doses.  As of 10 July, through routine testing, the MOH has reported that 2341 fully vaccinated health-care workers have tested positive for COVID-19. Of those, 778 cases (33.2%) were category 1 (asymptomatic), 1559 cases (66.6%) were category 2 (mild symptoms), two cases (0.1%) were category 3 (symptomatic with lung infection) and two cases (0.1%) were category 4 (requiring ventilator support).  As of 5 July, the MOH has reported that for every 1000 vaccine doses administered, 18.6 self- assessment reports indicated normal and minor adverse events following immunization. An estimated 1.4 reports per 1000 doses were classified as serious adverse events, needing hospital admission. Most of those cases only required short-term admissions.  Former COVID-19 patients who test negative for the infection are permitted to undergo COVID-19 vaccination according to given appointments. However, former patients who received either anti- SARS-CoV-2 monoclonal antibodies or convalescent plasma during treatment will be required to wait 90 days from the date of recovery to receive their COVID-19 vaccine.  Authorities have made it clear that COVID-19 vaccination for adolescents with underlying medical conditions will be prioritized for vaccination. Underlying health conditions include immunocompromised systems, cancer, chronic lung disease and other co-morbidities. Adolescents will be vaccinated with the Pfizer-BioNTech vaccine.  Selangor’s Vaccination Programme (SelVAX) has received registration for participation in the COVID- 19 vaccination initiative from 62 000 companies involving 2.9 million workers located in the state. The programme aims to vaccinate 1 million workers by the end of October 2021. 6 of 3

6 Malaysia Coronavirus Disease 2019 (COVID-19) Situation Report Weekly report for the week ending 11 July 2021

 The Retail Industry Vaccination Programme (RiVAC) will commence on 26 July. The programme aims to vaccinate front-line economic workers such as cashiers, supermarket workers and petrol station workers.  Selangor authorities will continue to expand the mobile community vaccination programme (Movak) to target vaccination among plantation and public housing project residents.  Sabah authorities aim to vaccinate at least 60% of the state-level population by October 2021. As of 13 July, approximately 34.5% of the state population has registered for COVID-19 vaccination.  Selangor will prioritize COVID-19 vaccination for individuals participating in animal sacrificial rites for the upcoming Aidiladha celebrations.

7 of 3

7