www.jogh.org 3 2 1 Monica Danial clusters inMalaysia Mitigation ofCOVID-19 JoGH ©2020ISGH © 2020TheAuthor(s) Clinical ResearchCenter, SeberangJayaHospital,MinistryofHealthMalaysia,, Medical Department,SeberangJayaHospital,Penang,Malaysia Pharmacy Department,SeberangJayaHospital,Penang,Malaysia duced infectioninthepopulation. role inthemitigationeffortsandre movement controlplayedacrucial Early detection,containment,and • doi: 10.7189/jogh.10.0203105 sia. A COVID-19 cluster will be considered inactive if no new case were reported within 28 days. The top sia. A COVID-19 cluster willbeconsideredinactive if no new case were reported within 28 days. The top As of16September2020,therewereabout91(10activeand81inactive)COVID-19clustersinMalay Malaysians. About 653positivecaseswere reported fromthiscluster[ cessities [ equipped withmedicalprofessionals, healthfacilities,timelymealsupto4timesper dayandotherne an initiative to contain the spread, theimmigrants were retained at an immigration depo which were COVID-19 positivecase.The clusterwasreportedon21May2020andended8September 2020.As The DTIBukitJalilclusterwas mainlyconstitutedofillegalimmigrantswhohadbeen incontactwitha cluster wasconfirmedtobeinactiveon8July2020with atotalof3375positivecasesidentified[ allowed tooperate,andonlyonepersonperfamilywas tobuydailynecessities[ were lar toareasthathavebeendesignatedcoronavirus-affected areasorredzones.Onlycriticalservices dered. Malaysianbordershavebeenclosedinadditionto restrictions ontravelbetweenstates,inparticu and culturalactivities.Theclosingofalleducationalinstitutions, schoolsandkindergartens wasalsoor main goaloftheMCO.Theseincludebansonallmassgatherings, includingreligious,recreational,social ment ControlOrder(MCO)wasenforcedon16March 2020[ The numberofcasesgrewrapidlyand,withaviewtocontrol thespreadwithinpopulation,Move in Malaysiaandabroad.Theindexcasefromthiscluster wasreportedon11March2020inMalaysia. The Tabligh cluster was linked to a religious gathering, which caused a massive increase in positive cases THE CLUSTERSWITHMORETHAN200POSITIVECASES T 1 , AnnLisaArulappen virus clusteremerges whenanumberofinfectionsoccursimultaneouslyinthesamelocation[ contain andslowdowntheprogressioninfectionrateintheirrespectivecountries.Acorona he abrupt emergence of the novel coronavirus has led to the efforts of all nations in the world to 5 ]. This measure has successfully curbed virus transmission among illegal immigrants and also ]. Thismeasurehassuccessfully curbedvirustransmissionamongillegalimmigrantsand also

- number ofdeathsassociatedwiththerespectiveclusters. reported inMalaysiaupto16September2020.Aserieslineshowsthe the numberofpositivecasesbasedonnationalityfortop5clusters with the number of cases reportedly increasing [ Only the Benteng Lahad Datu cluster remains active among these clusters, Lahad Datu(BentengLD)cluster, PedasclusterandPesanterancluster. ter, DepoTahananImigresenBukitJalil(DTIJalil)cluster, Benteng 5 clusterswithmorethan200positivecasesreportedwereTablighclus 2 , AlanSweeHockCh’ng 1

December 2020•Vol. 10 No. 2•0203105 3 ]. Enforcing social distancing was the ]. Enforcingsocialdistancingwasthe

1,3 3 ]. , Irene Looi 2 ]. Figure 1 1,3 4 ]. The Tabligh ]. TheTabligh

illustrates illustrates 3 ]. 1 ]. ]. ------

VIEWPOINTS Pesantren Pedas Benteng LD Jalil DTI Bukit Tabligh CLUSTER Malaysian Number of positive cases of positive Number 2550 238 214 14 3 NonMalaysian 312 258 647 825 0 Number of deaths VIEWPOINTS 34 0 0 0 1 December 2020•Vol. 10 No. 2•0203105 by theauthors). facemasksinpublicareas (photocollection physical distancesandadorning ofHealth(MOH)Malaysia inmaintaining guidelines outlinedbytheMinistry Photo: Malaysiansadheringtothestandard operatingprocedure (SOP) order (EMCO)wasimplementedto Localized enhanced movement control particularly inredzones. control andmanagelocaltransmission index case reported on 1 September 2020. To date, about 472 positive cases have been identified from index casereportedon1September2020.Todate,about472positivecaseshavebeenidentifiedfrom The BentengLDclusteroriginatedfromSabah(WestMalaysia).Itiscurrentlyanactivewiththe of 16September2020[ The Tablighclusterhadrecordedthehighestnumberofdeathsallclusters.Datareportedandtabulatedas DTI BukitJalil,BentengLDandPedasclusters,highernumbersofnon-MalaysianstestedpositiveforCOVID-19. Pesantren clustersconsistofhighernumberMalaysianstestedpositiveforCOVID-19.Onthecontrary,in Figure 1. were isolatedandplacedinquarantinecentersforatleast14daysuntilnonewcasesdetected[ dences. Therefore,inordertopreventfurtherspreadoftheinfection,workersinvolvedthiscluster eigners wasdirectlylinkedtotheovercrowdedandcongestedlivingconditionsofforeignworkers’resi jority ofthecasesfromPedasclusterwerenon-Malaysians.ThetransmissionCovid-19amongfor 27 July2020withatotalof326positivecasesrecorded[ The Pedas cluster involving a chicken processing plant in lasted from 28 June 2020 to Indonesia. Positive cases from the cluster were initially reported on 16 April 2020. A total of 238 positive Indonesia. Positivecasesfromtheclusterwereinitiallyreported on16April2020.Atotalof238positive Pesantren clusterwascausedbyMalaysianstudentsreturning backfromareligiousschoolinEastJava, The quarantinecenterswereequippedwithsimilarfacilitiesastheimmigrationdepot. Number of positive cases 1000 2000 3000 0 Primary COVID-19 clusters in Malaysia with reported more than 200 positive cases. The Tabligh and Primary COVID-19clustersinMalaysiawithreportedmorethan200positivecases.TheTablighand Tabligh 34 2 , 3

]. DTI B ukit and alsotodeterillegalmigrantsfromenteringMalaysia[ as of‘OpsBenteng’anattempttolimitmovementbetweenlocals banned. Inaddition,the police haveset up roadblocks inmany are ment inrecreationalactivitiespublicparksandmassmeetingswere ters. Asawayofpreventingthespreadvirus,publicinvolve who wereheldinpolicecustodyattheLahadDatuPoliceHeadquar cluster’s originwastracedbacktothearrestsoftwoillegalimmigrants this clusterandtheirnumbershavebeenreportedtoincrease.This 1 J Malaysian alil

2

[ to severalsub-clustersintheNorthern RegionofMalaysia itive casesreportedfromthis cluster, thisclustergaverise in Malaysia. Although there were nomorethan 200 pos The PUI Sivagangga cluster is another prominent cluster SUPER SPREADERINDEX CASE June 2020,theclusterended,withnoreportednewcase. Kuala LumpurInternationalAirport(KLIA)[ dents werequarantinedafterarrivingfromIndonesiaat it possibletosuccessfullycontrolthespread.Allstu screening anddetectionatthecountryentrypointsmade cases were identified from this cluster [ Benteng L 3 ]. Theindexcase forthisclusterwasaMalaysian per NonMalaysian 0 D 3 ]. SimilartotheDTIBukitJalilcluster, thema Pedas www.jogh.org 0 Number of deaths Number of • doi: 10.7189/jogh.10.0203105 Pesantren 0 3 ]. The initial 8 6 ]. On 20 ]. On20 ].

0 10 20 30 40

of deaths of 7 Number ]. ------www.jogh.org REFERENCES •

7  6  5  4  3  2  1  doi: 10.7189/jogh.10.0203105 2020. tre.org/2020/06/22/pedas-cluster-started-by-malaysians-who-infected-foreign-workers-moh/ Pedas ClusterStartedByMalaysians WhoInfectedForeignWorkers.MOH.2020.Available: tion/2020/09/625505/-enforcing-control-measures-manage-covid-19-outbreak Sabah enforcing‘controlmeasures’ tomanageCovid-19outbreak.2020.Available: sional/2020/05/687977/tangkap-pendatang-asing-tanpa-izin-dilakukan-sepanjang-tahun PATI diDepotTahananImigresendijaga,diurusdenganbaik.2020. Available: cessed: 18September2020. com.my/news/nation/2020/03/575177/covid-19-movement-control-order-imposed-only-essential-sectors-operating Covid-19: MovementControlOrderimposedwithonlyessential sectorsoperating.2020.Available: able from: Covid-19 Updates[Internet].CrisisPreparedness&ResponseCenter (CRRC)MinistryofHealthMalaysia.2020.Avail 2020. Covid-19 inMalaysia.2020.Available: 2020. news/2020/03/coronavirus-terminology-explained-covid-19-glossary-200323064432820.html What doescoronavirusclustermean?COVID-19termsexplained. 2020.Available: from thecorrespondingauthor),anddeclarenoconflictsofinterest. Competing Authorship Funding: mittee (MREC),Malaysia(Referencenumber:KKM/NIHSEC/P20-1920(4)anddated:10September2020) Ethical publish thisarticle. the COVID-19pandemic.WethankDirector-General ofHealthMalaysiaforhissupportandpermissionto Acknowledgements: Major COVID-19 transmission in Malaysia was prevented due to vigorous screening and identification at Major COVID-19transmissioninMalaysiawaspreventedduetovigorousscreeningandidentificationat reduced infectioninthepopulation. Early detection,containmentandmovementcontrolplayedacrucialroleinthemitigationefforts CONCLUSION fected areas. [ Procedures) outlinedbytheMinistryofHealthMalaysia(MOH,Malaysia),wasobserved es asawaytolocalizeandcontainthespread.Also,strictadherenceSOPs(StandardOperating Enhanced MCO (EMCO) was implemented thereafter with immediate closure of a few schools and offic sia. Moreover, theindexcasewasaconfirmedcarrierofsuperspreadervirusstrainD614G.Localized attributed tothefailureofindexcasecomplywithquarantineorderafterhisreturnMalay manent resident(PR)thathadreturnedfromSivagangga,India.Thespreadinthelocalcommunitywas ing becamethenewnormal. ‘Work from home’, wearing mask and frequent hand washing cum sanitizing, physical and social distanc and the public work closely and hand in hand around the clock to prevent COVID-19 transmission. (US$244) andinsomecasesfacesimprisonment.Healthauthorities,lawenforcementofficers,volunteers public andprivatevehicles.ThosewhodidnotadheretotheSOPswillbefinedasminimumMYR1000 be checkedbytheauthoritiesdoingregularinspectionsinpublicareas,businesspremises,and ence inmaintainingphysicaldistancesfromoneanotherandpracticeofcorrectlywearingfacemaskwill track thepublics’strictadherencetoSOPguidelinesillustratedbyMOH,Malaysia.Publicadher manage localtransmissionparticularlyinredzones.Moreover, lawenforcementofficerswillroutinely various entrypointsandillegalroutes.Furthermore,localizedEMCOwasimplementedtocontrol https://www.facebook.com/CPRCKebangsaanKKM/posts/1442751895917490 approval:

None. interests: declaration: ThisviewpointwaswrittenafterobtainingthepermissionofMedicalResearch&EthicalCom

This article honours all quarters of people in Malaysia who are working tirelessly to mitigate This article honours all quarters of people in Malaysia who are working tirelessly to mitigate The authors completed the ICMJE Unified Competing Interest form (available upon request TheauthorscompletedtheICMJEUnified Competing Interestform(availableuponrequest Allauthorscontributedtowritingandconceptualizingthemanuscript. https://newslab.malaysiakini.com/covid-19/en/clusters 3

December 2020•Vol. 10 No. 2•0203105 https://www.bharian.com.my/berita/na . Accessed:23September2020. https://www.nst.com.my/news/na . Accessed:18September2020. . Accessed:9September2020. https://www.aljazeera.com/ https://codeblue.galencen . Accessed: 17 September . Accessed: 17 September . Accessed: 18 September . Accessed:18September . Accessed: 18 September . Accessed:18September https://www.nst. 9 ] intheaf . Ac ------

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. Accessed:23September2020. https://www.facebook.com/kementeriankesihatanmalaysia/posts/keputusan-sa 4

[email protected] Malaysia Penang Ministry ofHealthMalaysia Seberang JayaHospital Clinical ResearchCenter Dr MonicaDanial Correspondence to: www.jogh.org

• . Accessed: 15 September . Accessed: 15September doi: 10.7189/jogh.10.0203105

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