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

Malaysia Situation summary  As of 6 June, there have been a total of 616 815 confirmed cases of COVID-19 in Malaysia. For the first time since early April, there are indications that the number of new daily cases may be starting to plateau.  In the past seven days: o A total of 51 282 new cases have been reported – a 0.4% decrease compared to the previous week. o Another 649 new deaths have been reported, bringing the total number of COVID-19 deaths in Malaysia to 3378. This indicates a 34.9% increase in the number of new COVID-19 deaths reported compared to the previous week. o The numbers of critically ill cases requiring intensive care unit (ICU) support and ventilator support have increased by 5.2% and 6.0%, respectively.  Seven of the 16 states and territories have reported an increase in new COVID-19 cases in the past week. o , Federal Territory (FT) and reported the highest numbers of cases. o Selangor and FT Kuala Lumpur reported 17 314 and 4634 new local cases, respectively. o Selangor reported 185 new deaths in the past week, the highest number among states. o In FT Kuala Lumpur, an estimated 33% of cases detected in the past week were unlinked at the time of reporting.  On 2 June, Malaysia reported 126 new COVID-19 deaths, the highest single-day count of reported deaths since the start of the pandemic. The number of COVID-19 deaths recorded in Malaysia continues to increase, with 649 deaths in the past week, compared to 481 the previous week.  A nationwide movement control order (MCO) is being implemented from 1 to 14 June 2021 as a stricter extension to the earlier MCO initiated on 12 May.  Potential risks and vulnerabilities for a continued increase in transmission: o As of 6 June, the estimated national real-time reproductive number (Rt) was 0.99 (95% confidence interval [CI]: 0.98–1.00). An Rt value of below 1 suggests the potential for decreased transmission of SARS-CoV-2 and cases. o SARS-CoV-2 variants of concerns (Alpha, Beta and Delta) continue to be detected among local cases. o Relatively high test-positivity rates are being reported across the country, despite high overall testing rates. o National burden on the health-care system, especially in certain regions around the country that are more affected, such as in Selangor, Sarawak, , and FT Kuala Lumpur.  As of 6 June, 4.8% of Malaysia’s total target population (an estimated 23.7 million individuals aged 18 years and above) have received their second dose of the COVID-19 vaccine.

Upcoming events and priorities  The Home Ministry is working to improve the admissions processes at prisons and immigration depots to reduce the spread of COVID-19 among inmates. Presently, all inmates are screened for COVID-19 before being placed in temporary detention centres.  Federal and state-level authorities are working to increase COVID-19 vaccination efforts across Malaysia. The participation of private health-care providers, the construction of mega vaccine centres and mobile vaccination units work to increase the national vaccination efforts.

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

National transmission assessment

National transmission stage assessment: Stage 3 (high confidence) – Large-scale community transmission1 Week 22 (31 May–6 June 2021)

The number of cases reported in the past seven days (51 282) decreased by 0.4% compared to the previous week. This translates to an average of almost 7300 cases per day. The number of tests conducted in the past week averaged 99 095 tests per day, a decrease of 10% compared to the previous week. The test positivity rate for Epi Week 22 was 7.4%. Of the newly reported cases, 95 (0.2%) were imported, and 51 187 (99.8%) were locally transmitted. Seven out of 16 states and territories reported an increase in the number of new COVID-19 cases. The remaining regions have shown a slight decline or plateau in cases. The states of Selangor, FT Kuala Lumpur and Sarawak reported the highest numbers of new cases. Of newly reported cases, 11 593 (22.6%) were unlinked at the time of reporting. More than half (59.4%) of new clusters2 were workplace-linked clusters, while 30.9% of new clusters were linked to the community or social gatherings. There has been an increase (5.2%) in the number of critically ill cases requiring ICU support. Nationwide, 890 cases required ICU support on 6 June, compared to 846 the previous week, and of these, 444 required ventilator support (compared to 419 the previous week). Subsequently, the health-care system is reported to be overburdened, especially in highly affected areas. The number of deaths has increased by 34.9%, with 649 deaths recorded this week. Selangor reported the highest number of new deaths in the past seven days.

EPI Update Tests Cases Deaths ICU COVID-19 51 282 Data reported for 693 662 649 79.9% New cases in the EPI week ending Tests in the Deaths in the ICU utilization rate past 7 days 6 June 2021 past 7 days past 7 days (+5.2%) (-10.0%) (-0.4%) (% difference (+34.9%) compared to the previous 7 days) 12 670 559 616 815 3378 1114 Cumulative tests Cumulative cases Cumulative ICU beds for COVID-19 deaths patients (including 4.87% private hospitals) Positivity rate 0.55% Case fatality rate

Imported 95 11 593 713 n/a Active clusters Active clusters with cases and (0.2%) (22.6%) more than three clusters Imported cases in the Cases in the past 7 generations past 7 days days with no link

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 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. 2 of 3

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

Epidemiology Fig 1. Daily reported COVID-19 cases, Malaysia, as of 6 June 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). Presently, authorities are implementing a nationwide lockdown from 1 to 14 June.

Table 1: Active cases and real-time reproductive number (Rt) estimates by state, as of 6 June 2021 State Active casesa Active cases/100 000 7-day incidence/100 000b Rt estimate 95% CI Selangor 33 409 513.3 266.0 1.06 1.05–1.07 FT Kuala Lumpur 9190 709.0 357.5 1.05 1.03–1.07 Sarawak 8681 278.1 144.0 1.02 1.00–1.04 7430 191.4 92.5 1.03 1.00–1.05 Kelantan 7223 383.3 161.8 0.97 0.95–0.99 6795 595.6 343.6 1.18 1.15–1.20 Penang 4985 282.1 138.9 1.02 1.00–1.05 Kedah 4850 219.9 91.0 0.96 0.93–0.98 3637 389.1 192.3 1.10 1.06–1.13 3472 135.1 79.6 1.02 0.99–1.05 3415 85.4 45.8 1.16 1.12–1.20 2731 160.4 80.3 1.02 0.98–1.06 2562 237.6 121.0 1.00 0.97–1.04 FT 2029 2043.3 1203.4 1.36 1.30–1.42 FT 330 317.9 136.8 1.03 0.92–1.14 77 29.7 0.6 0.95 0.78–1.14 a This state-level reporting is on a rolling 14-day basis, from 24 May to 6 June 2021, and excludes imported cases. b Excludes imported cases. Source: MOH Malaysia.

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

Clusters

 Of the 2338 clusters identified in Malaysia since the start of the pandemic, 713 are currently active.  In the past week: o 175 new clusters were identified o 104 (59.4%) new clusters were linked to the workplace.  Sarawak health authorities have noted an increase in COVID-19 cases linked to social gatherings such as funerals and weddings. As of 31 May, a total of 12 clusters, 3725 cases and 31 deaths have been linked to funeral gatherings in the state.  The MOH reported that, as of 31 May, a total of 82 341 cases have been recorded among infants and children. Of them, 19 851 (24.1%) cases were among children aged 4 years and below, 8237 (10%) cases were among children aged 5 to 6 years, 26 851 (32.6%) cases were among children aged 7 to 12 years, and 27 402 (33.3%) were among young people aged 13 to 16 years.  In 2020, Malaysia recorded three COVID-19-related deaths among children aged 5 years and below. In the first five months of 2021, Malaysia has recorded three COVID-19-related deaths among children in the same age group. Similarly, in 2020, a total of eight paediatric cases required intensive care unit (ICU) treatment, including six children aged 5 years and below. However, in 2021, a total of 27 paediatric cases have required ICU treatment, including 19 children aged 5 years and below.

Health-care capacity  Following the reopening of the COVID-19 quarantine and low-risk treatment centre at the Malaysia Agro Exposition Park Serdang (MAEPS) 2.0 on 9 December 2020, the centre has received 105 797 COVID-19 patients. The centre houses mobile X-ray machines, ultrasound machines and has increased the number of health-care workers.

Testing and surveillance  From 5 June 2021, residents in three public housing areas and people’s housing projects located in FT Kuala Lumpur will be offered free COVID-19 screening tests. The testing initiative will run from 5 to 12 June and will be limited to 300 residents per day. Screening activities will be carried out with the use of RTK-antigen.  Selangor state authorities conducted mass voluntary screenings from 8 May to 5 June 2021. From that, a total of 3211 cases have been detected from a total sample of 90 363 individuals across 46 constituencies. This indicates an overall positivity rate of 3.6%. This screening exercise is expected to end on 10 June 2021.  Between 24 May and 4 June 2021, Malaysia detected 19 new cases bearing variants of concern. Four were of the Delta (B.1.617.2) lineage, while the remaining 15 samples bore the Beta (B.1.351) lineage.  In total, Malaysia has recorded 138 cases bearing variants of concern or interest. Of those, 122 (88.4%) cases were variants of concern. Currently, 13 out of 16 states/territories have reported variants of concern among locally acquired infections.  Variants of concern: o Beta (B.1.351): Of the 15 new cases detected, six were reported in Johor, five in Kelantan, and one each in FT Kuala Lumpur, Kedah, Malacca and Terengganu. As a result, a total of 104 Beta variant cases have been detected in 12 out of 16 states/territories. Therefore, the Beta variant accounts for 85.2% of the total number of variants of concern detected in Malaysia. o Delta (B.1.617.2): Of the four new cases detected, three were reported in FT Labuan, and one was reported in FT Kuala Lumpur. All three cases detected in FT Labuan were linked to imported transmission, while the one case detected in FT Kuala Lumpur was linked to local transmission.

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

Table 2: Summary table of SARS-CoV-2 variants detected by state, as of 4 June 2021 States Beta Alpha Delta Kappa Eta Theta TOTAL (B.1.351) (B.1.1.7) (B.1.617.2) (B.1.617.1) (B.1.525) (P.3) Selangor 34 5 2 1 0 0 42 Sarawak 7 0 0 0 1 12 20 Kelantan 23 0 0 0 0 0 23 FT Kuala 6 3 2 0 2 0 13 Lumpur Perak 10 0 0 0 0 0 10 Kedah 8 0 0 0 0 0 8 Penang 3 0 0 0 0 0 3 Negeri 2 0 0 0 0 0 2 Sembilan Johor 7 0 1 0 0 0 8 Perlis 2 0 0 0 0 0 2 FT Labuan 0 0 4 0 0 0 4 Sabah 0 1 0 0 0 0 1 Malacca 1 0 0 0 0 0 1 Terengganu 1 0 0 0 0 0 1 TOTAL 104 9 9 1 3 12 138

Clinical management  The MOH and the Institute for Clinical Research (ICR) have initiated a multicentre open-label randomized controlled trial to evaluate the use of Ivermectin in high-risk COVID-19 patient treatment. The study is named the I-TECH Study and will be conducted at 12 MOH hospitals across Malaysia. The estimated sample size will be 500 individuals, and the sampling criteria will target those who belong to high-risk groups, those aged 50 years and above and those admitted into hospital with mild/moderate COVID-19 symptoms. The study aims to determine the efficacy of Ivermectin in preventing the progression of COVID-19 to severe disease.

Strategic approach

Non-pharmaceutical interventions (NPI)  Students will be required to continue home learning following the expected completion of Phase One of the national lockdown on 14 June, i.e. until 16 or 17 July 2021.  Under the newest total lockdown, stricter directives have been introduced. They include: o Children aged 12 years and below are prohibited from appearing in public except for essential purposes. o Only essential economic activities are permitted to operate. o All social activities are prohibited. o Travel will be limited to within a 10 km radius from an individual’s residence. o Private vehicles will have a maximum capacity of two individuals. o A total of 60% of the private workforce is permitted to operate.  Federal territories: o Friday and obligatory prayers in mosques will be limited to 12 congregants at a time. o Friday and obligatory prayers in prayer halls will be limited to three congregants at a time.  Perak o Friday and obligatory prayers in mosques and prayer halls will be limited to 12 congregants at a time. 5 of 3

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

 Penang: o Friday and obligatory prayers in mosques and prayer halls will be limited to 15 congregants at a time. o Employers of factories that have recorded COVID-19 cases are required to postpone the intake of new workers. o Factories must screen all new workers for COVID-19 prior to beginning work.  Sabah: o Services and economic sectors are permitted to operate from 07:00 to 19:00 hours daily. o Wholesale and public markets are permitted to operate from 06:00 to 15:00 hours daily. o Public transport services will operate at 50% vehicle capacity from 06:00 to 20:00 hours daily. o Only one passenger is permitted in taxis and e-hailing vehicles. o Interdistrict travel is prohibited. o Travel for necessities will be restricted to a 10 km radius from the point of residence. o A maximum of three people will be permitted to travel in private vehicles for essential services. o Children aged 12 years and below are prohibited from entering business premises and public areas. Exceptions to be made for essential purposes.  Sarawak o Effective 1 June, interzone travel is prohibited. o A maximum of two people will be permitted to travel in private vehicles for essential services.

Table 3: Movement control orders currently being implemented3 State Location Type of MCO Effective dates Sarawak State-wide MCO Until 14 June 11 longhouses and SK Stalon, Tanjong EMCO 2–15 June Manis Wun anak Ering Longhouse, Tanjung Extended to 16 June Manis, Mukah Kampung Bunut, Mukah 4–17 June Undum anak Anchih longhouse, Sungai Duan, Mukah Rh. Sigah anak Lak, Mukah 5–18 June Jerry Lai Kampung Siga longhouse, Sri 2–15 June Aman Kampung Jaie, Asajaya 3–16 June Kampung Empila, Samarahan 4–17 June Ajing Selepong Lop longhouse, Sri Extended to 15 June Aman Aji Sungai Ban longhouse, Sri Aman 22 localities in Dalat, Bukit Mabong, 7–20 June Sri Aman, Kapit and Julai Pahang Kampung Pagi, Ulu Tembiling, EMCO 2–15 June Jerantut Taman Bentong Makmur, Bentong 4–17 June Taman Harmoni, Bentong Taman Kolej, Bentong Taman Desa Damai, Bentong Ladang Chin Teck, Rompin 5–18 June Kampung Jaya Gading, Jaya Gading 8–21 June Bandar Baru Jaya Gading

3 EMCO refers to enhanced MCO. 6 of 3

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

Kampung Seri Damai Kawasan Perindustrian Gebeng, Kampung Gunung Senyum, Kuala 7–20 June Krau, Temerloh Bentong town 6–14 June Perak Felda Trolak Utara, Sungkai, Batan EMCO 2–15 June Padang Eco Medi Glove factory hostel, 7–20 June Taiping Kampung Jelapang, Hulu Kinta Kampung Sungai Tapah, Hulu Kinta Localities in Larut, Matang and 6–14 June Selama, Kinta, Kerian, Manjung and Hulu Perak Sabah Kampung Kuala Menggatal, Kota EMCO 2–15 June Kinabalu Jalan Klias 2, Kampung Klias Baru, Beaufort Jalan Klias 3, Kampung Klias Baru, Beaufort Three localities in Kota Belud 3–16 June Kampung Simpangan, Tuaran Pantai Manis religious school (SMU), Extended to 17 June Papar 15 localities in Pekan, Kunak 4–17 June Four localities in 5–18 June Kampung Pengabaran, Kudat Kampung Sugud, Penampang Kampung Ongkilan, Kota Marudu 8–21 June Kampung Pulutan, Nabawan Kampung Murni C, Nabawan Kampung Bolong Baru, Tuaran Kampung Tamalang, Kota Belud Kampung Tugusan, Kota Belud Kampung Bergosong, Pulau Sebatik, Tawau Five localities in Tawau, Kalabakan 7–20 June and Sandaka Localities in Papar, Sandakan, Kota 6–14 June Kinabalu and Kudat Kedah 28 localities in Kota Setar EMCO Extended to 15 June FT Labuan Labuan Financial Park Complex EMCO 2–8 June Penang 13 localities in Pekan , EMCO 4–17 June subdistrict 12 Terengganu 15 subdistricts in Besut EMCO Extended to 18 June Kelantan Kepulauan Tumpat, Mukim Sungai EMCO Extended to 18 June Pinang, Tumpat

Risk communication and community engagement  The MOH has urged the public to avoid travelling outside their homes, citing concern following the detection of variants of concern in almost every state in Malaysia. The nationwide total lockdown will be critical to inhibit the transmission of COVID-19.  Federal authorities noted that Malaysia’s road traffic flow fell by at least 70% on the first day of the nationwide total lockdown. 7 of 3

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

 The MOH has advised parents and guardians to avoid bringing their children or babies to high-risk areas such as supermarkets.

Vaccines  As of 6 June, a total of 3 574 376 COVID-19 vaccine doses have been administered across Malaysia. From that, a total of 1 130 301 individuals have received both vaccine doses. That comprises 4.8% of Malaysia’s total target population of approximately 23.7 million adults.  The number of daily vaccinations has increased in recent weeks. Authorities aim to increase the national COVID-19 vaccination rate to 200 000 doses per day by July and 300 000 doses per day by August 2021.  The COVID-19 vaccination centre located at the Malaysia International Trade and Exhibition Centre (Mitec) will further expand its vaccination capabilities from 7 June onwards. Vaccination capacity will be increased from 2800 doses per day to 8000 doses per day. The centre will administer Pfizer- BioNTech and Sinovac vaccines.  Penang authorities have extended the operations of COVID-19 vaccination centres in Penang to six days a week to increase the state vaccination coverage.  Selangor state authorities are allocating RM 200 million to purchase an estimated 2 million COVID-19 vaccine doses for front-line economic workers.  The MOH has established a drive-through vaccination centre for people living with disabilities and their carers in Selangor. The centre is expected to begin operations from next week onwards.  Authorities will set up mass COVID-19 vaccination centres in Bayan Lepas and in Penang to target factory workers specifically. The centres are expected to begin operations in two weeks.  Authorities in Kuching, Sarawak aim to carry out a minimum of 10 000 COVID-19 vaccinations per day following the construction of three large-scale vaccination centres in the district.  Sabah state authorities aim to start COVID-19 vaccination for individuals in the economic and essential service sectors by next month.

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