Coronavirus Disease 2019 (COVID-19) Situation Report Weekly report for the week ending 27 September 2020

Malaysia Situation summary  As of 27 September 2020, there have been a total of 10 919 confirmed cases of COVID-19 in Malaysia.  In the past seven days, 700 new cases have been reported, an increase of 130.3% compared to the previous week.  In the past seven days, four new deaths have been reported. This brings the total number of COVID- 19 deaths in Malaysia to 134.  Of the 700 cases reported in the past seven days, 33 (4.71%) were imported.  The Ministry of Health (MOH) has reported that, as of 23 September, the estimated COVID-19 effective reproduction number (Rt) was 1.34. However, the states of and report reproduction numbers of 1.37 and 1.15, respectively.  Of the newly reported cases in the past seven days, 591 (84.4%) were reported in Sabah.The states with active cases as of 27 September are Sabah (819), Kedah (49), (5), (5), (4), (4), Federal Territory (2), Federal Territory (1) and (1).  Following the rise in cases among travellers from Sabah, the MOH has instated new COVID-19 measures to control the community transmission from the state. From 27 September to 10 October, screening tests will be made mandatory for all travellers from Sabah at all points of entry. Additionally, all such travellers will be issued Home Surveillance Orders to undergo a mandatory quarantine until a negative result from screenings is made known. Travellers who experience symptoms and have a travel history to Sabah in the past 14 days have been urged to undergo COVID- 19 screening. Travellers screened under this directive are exempt from the COVID-19 test charge.  Of the 19 currently active clusters, 13 clusters reported new cases in the past seven days.  As of 20 September, a total of 732 school students have tested positive for COVID-19. Of these cases, 108 (14.8%) were detected following school re-openings since 24 June.

Upcoming events and priorities  The police aim to ramp up compliance monitoring of standard operating procedures under the Recovery Movement Control Order (RMCO).  A snap state election was held in Sabah on 26 September.  The need to implement the Enhanced Movement Control Order (EMCO) in the affected districts in Sabah (, , , and ) is being continuously reviewed. The MOH is carrying out risk assessments and has stated that the implementation of standard operating procedures is sufficient for the time being.  The Ministry of Higher Education (MoHE) has urged all institutions of higher learning to postpone the return of students, as well as registration of new students, from red zone areas.  As of 25 September, Malaysia has yet to sign a legally binding commitment agreement or submit a non-binding confirmation of intent to participate in the COVAX COVID-19 vaccine access plan.  The Malaysian government is currently preparing an agreement with the government of China to get access to COVID-19 vaccines developed in China. Additionally, authorities have signed non-disclosure agreements with several international pharmaceutical companies to negotiate the procurement of approved vaccines. The National Institutes of Biotechnology Malaysia has also signed letters of intent (LOI) with the Russian Federation and Republic of Cuba in order to obtain further information on the COVID-19 vaccines being developed in those nations.  The MOH is working to develop a molecular laboratory in Tawau Hospital and increase Sabah state testing capacity. Additionally, the MOH awaits the delivery of GENEXPERT COVID-19 cassettes from WHO for use in Tawau Hospital, Hospital and Lahad Datu Hospital. 1 of 3

1 Malaysia Coronavirus Disease 2019 (COVID-19) Situation Report Weekly report for the week ending 27 September 2020

National transmission assessment

At the national level, Malaysia remains in Stage 2, localized community transmission. The number of cases has been increasing (700 cases this week compared to 304 cases the previous week), and in the past three days, there has been some geographical spread across the country, largely due to the movement of people in and out of Sabah. However, Sabah still recorded the highest number of cases in the past three days (83.1% of total cases in the past three days). The majority of cases were locally transmitted, with only about 5% imported cases in the past week. Almost 14% of total reported cases in the past week are not linked to any known clusters at the time of reporting. The past week has also seen four COVID-19 deaths reported. However, contact tracing, testing and treatment capacities are still adequate at this point. As a response to the high number of cases detected in Sabah and the increase in population movement, screening tests and mandatory home quarantine are now being made mandatory for all travellers from Sabah at all points of entry.

Epi Update Tests Cases Deaths ICU COVID-19 700 Data reported for 65 704 4 1.4% New cases in the epi week ending Tests in the Deaths in the ICU utilization rate past 7 days 27 September past 7 days past 7 days (-40.0%) 2020 (-9.4%) (+130.3%) (-) (% difference compared to the

previous 7 days) 1 510 390 10 919 134 431 Cumulative tests Cumulative cases Cumulative ICU beds for COVID-19 0.72% deaths patients Positivity rate 1.2% Case fatality rate Imported 33 (4.7%) 97 (13.9%) 19 2 cases and Imported cases in the Cases in the past 7 Active clusters Active clusters with clusters past 7 days days with no link more than three generations

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2 Malaysia Coronavirus Disease 2019 (COVID-19) Situation Report Weekly report for the week ending 27 September 2020

Epidemiology Fig 1. Daily reported COVID-19 cases and Movement Control Order measures, Malaysia, as of 27 September 2020

Pre-MCO Movement Control Conditional MCO Recovery MCO Order

Mortality  In the past seven days, four new deaths were reported in Malaysia: o 23 September, Sabah: Case #10 495 was a 48-year-old Indonesian woman with a history of diabetes and hypertension. She developed symptoms of lethargy, vomiting, cough and fever on 14 September. She was brought to Tawau Hospital on 18 September in a semi-conscious state. Her condition deteriorated. She was transferred to the ICU on 19 September and was pronounced deceased on the same day. Post-mortem testing on 22 September confirmed she had been positive for COVID-19. o 23 September, Sabah: Case #10 493 was a 54-year-old Malaysian man. He was treated for symptoms of fever, cough and shortness of breath on 18 September in Semporna Hospital. His condition deteriorated. On 20 September, he was referred to Tawau Hospital where he was subsequently admitted to the ICU. The patient was pronounced deceased on 22 September, and the COVID-19 test result came back positive on the same day. o 23 September, Kedah: Case #9224 was a 72-year-old Malaysian man with a history of stroke. He was identified as a close contact of Case #9124 (death #127), a confirmed case from the Tawar cluster. He was asymptomatic and found to be positive for COVID-19 on 19 August. The patient was admitted into Sultanah Bahiyah Hospital, and was later transferred to the ICU. He was pronounced deceased on 23 September 2020. o 27 September, Sabah: Case #104 91 was an 81-year-old Malaysian woman. She displayed symptoms of fever and cough on 14 September and was brought to Semporna Hospital on 17 September. Her COVID-19 screening test result was found to be positive on 22

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3 Malaysia Coronavirus Disease 2019 (COVID-19) Situation Report Weekly report for the week ending 27 September 2020

September. She was transferred to Tawau Hospital on 26 September. Subsequently, her condition deteriorated. She was moved to the ICU on the same day before passing away.

Clusters  Of the 118 clusters identified in Malaysia, 19 are currently active. Seven new clusters were identified in the last week. These were: o Kuarters cluster: First reported on 21 September in , Sandakan, Sabah. The cluster was identified following the detection of a health-care worker in the Tongod district who tested positive for COVID-19 on an RTK-Antigen test on 4 September. Subsequent RT-PCR tests have since found the worker to be negative. Screening in Tongod had started on 6 September and as of 26 September involved 330 local community and health-care workers in the Tongod Health Clinic. Five cases have been detected. o Bangau-Bangau cluster: First reported on 22 September in Semporna, Sabah. The index case was a patient detected upon admission screening at Semporna Hospital. As of 26 September, 351 individuals have been screened, and of them, 179 confirmed cases have been linked to this cluster. o Udin cluster: First identified in Tawau, Sabah on 23 September 2020. The index case, #9894, is a 72-year-old Malaysian woman. She was detected through the routine screening of older adults at Merotai Health Clinic, Tawau, on 12 September 2020. A total of 138 individuals have been screened, and three cases have been confirmed in this cluster. o Orkim cluster: First reported in Port, on 25 September. The cluster involves the crew of a ship anchored at port. The first case in the cluster, #10 572, is an Indonesian ship crew member. He signed on in on 10 September and developed fever, cough, shortness of breath, diarrhoea and vomiting from 13 September. He failed to inform his employer of his symptoms and signed off on 17 September. He received treatment at a private clinic on 22 September and was subsequently referred to Permai Hospital where he tested positive for COVID-19 on 23 September. As of 26 September, 30 individuals linked to this cluster have been screened, and two cases were confirmed. o Buang Sayang cluster: First reported in , Sabah on 27 September. The index case, #10 265, had a history of travel to Sipitang from 7 to 20 September. The case first displayed symptoms of fever and sore throat on 19 September and was admitted into a medical facility. The COVID-19 screening came back positive on 20 September, and the case was transferred to Queen Elizabeth Hospital, Sabah. As of 27 September, four of the 10 individuals screened have been confirmed COVID-19 positive. o Kg. Sakong cluster: First reported in Semporna, Sabah on 27 September. The index case, #10 154, was asymptomatic and detected positive on 18 September through a community screening activity. A total of 66 individuals have been screened, and nine cases have been linked to this cluster. o Setapak cluster: First reported in the Federal Territory of Kuala Lumpur on 27 September, with three total cases to date. The index case, #10 689, had a history of travel to Tawau and Semporna, Sabah from 17 to 20 September. The case began to experience symptoms of fever, cough, sore throat, muscular pain and diarrhoea on 21 September. The case was admitted to a medical facility on 25 September and tested positive for COVID-19 on the same day. As of 27 September, two more cases have been detected, i.e. the index case’s housemate (#10 770) and friend (#10 771). Active case detection has resulted in the screening of 20 individuals.  Other currently active clusters that also reported cases in the past seven days: o Benteng LD (Sabah): 834 total cases. This cluster was first reported on 1 September at the Police Headquarters lock-up. An increase of 256 cases in the past week has been reported, as well as four generations of transmission. o Sungai (Kedah): 98 total cases. This cluster was first reported on 7 September among health- care workers in a medical facility. Four generations of transmission have been reported. o Pulau (Sabah): 47 total cases. This cluster was first reported on 15 September in the local community of Kunak, Sabah. 4 of 3

4 Malaysia Coronavirus Disease 2019 (COVID-19) Situation Report Weekly report for the week ending 27 September 2020

o Selamat (Sabah): 25 total cases. This cluster was first reported on 17 September in Semporna, Sabah. o Bakau (Sabah): 17 total cases. This cluster was first reported on 19 September in Semporna, Sabah. o Laut (Sabah): 24 total cases.  The Alam cluster has been declared closed.

Strategic approach

Non-pharmaceutical interventions (NPI)  Sabah: o Travellers departing from Sabah will not need to undergo a compulsory 14-day quarantine. Authorities, however, encourage travellers returning from selected areas such as Tawau, Lahad Datu, Semporna and Kunak to take swab tests. It will be compulsory for travellers displaying symptoms to undergo a swab test when exiting Sabah. o The government has extended the EMCO placed at Tawau Prison and Taman Ehsan Tawau Prison Quarters to 9 October 2020. o Night markets and public parks in nine Sabah districts have been closed, while wet markets have been ordered to shorten their operating hours. Restaurants operating in the affected districts have been ordered to close by 6 PM. o A total of 30 schools in Lahad Datu, Sabah will be temporarily closed starting tomorrow until further notice. Lahad Datu district police have set up roadblocks in four locations to limit public movement in and out of the affected areas to curb the spread of COVID-19.  Sarawak: o Effective 21 September, all non-Malaysians entering Sarawak through Kuala Lumpur International Airport (KLIA) will be required to undergo quarantine in Kuala Lumpur prior to entry into the state. Travellers entering Sarawak through Labuan or Sabah will be required to complete the EnterSarawak form and provide supporting documents. Travellers will be required to undergo RT-PCR tests three days before their travel date. Malaysians entering Sarawak through flights from Penang will be subject to random COVID-19 tests upon their arrival at International Airport (KIA). o Malaysian citizens and non-citizens who frequently travel between Sarawak, Sabah and Labuan, including essential travel, must apply for a special travel pass from the Sarawak Divisional Disaster Management Committee. Travellers with this pass will be required to submit to COVID-19 testing every 14 days.  Effective 24 September, all non-Malaysians entering the country will have to pay the mandatory quarantine fee, as well as additional operations fee, in full. The amount is RM 4700 (~US$ 1100).  The EMCO in Kota Setar had been lifted on 25 September. However, it remains in place for the Tongkang Yard flats in Alor Setar until 7 October.  Operating hours for all sports-related premises have been extended to 2 AM.

Surveillance and testing  The MOH has intensified screening of close contacts of confirmed COVID-19 cases and targeted screening for high-risk groups. These groups include older adults, influenza-like illness (ILI) and severe acute respiratory illness (SARI) cases, undocumented migrants, hospital referral patients, health-care workers, and enforcement personnel.  The daily testing capacity for COVID-19 has been increased to 38 236 tests per day. Currently, there are 58 laboratories across the country that are capable of conducting RT-PCR tests. Of those, 28 laboratories are under the MOH. They comprise 18 hospital laboratories, one national public health laboratory, four public health laboratories, and one laboratory from the Institute for Medical 5 of 3

5 Malaysia Coronavirus Disease 2019 (COVID-19) Situation Report Weekly report for the week ending 27 September 2020

Research (IMR). Additionally, two army laboratories, one Ministry of Science, Technology, and Innovation (MOSTI) laboratory, and 13 private laboratories are able to conduct RT-PCR testing.  An emergency procurement procedure for personal protective equipment (PPE) was implemented in early February 2020 to accommodate the increased need. Currently, PPE stocks available in MOH hospitals and clinics are estimated to last for at least two months.  Sabah: o The total daily RT-PCR testing capacity in Sabah has now been increased to 2500 tests per day across three laboratories. These facilities include the Queen Elizabeth Hospital, Public Health Laboratory, and Universiti Malaysia Sabah laboratories. o As of 23 September, there are 23 laboratories in MOH hospitals and 26 laboratories in health clinics that are capable of conducting Rapid Test-Antigen (RTK-Ag) in Sabah. Since May 2020, a total of 23 900 RTK-Ag kits have been distributed to Sabah. An additional 15 000 RTK-Ag kits were distributed on 17 September. o Travellers displaying symptoms and having travelled from a red zone are now required to undergo a COVID-19 screening test. Individuals without symptoms who have visited red zones are strongly encouraged to undergo self-screening and home quarantine. o The MOH aims to widen COVID-19 screening in the community on a large scale in Tawau and Lahad Datu. An estimated 30 000 individuals will be targeted for screening. Additionally, a risk assessment is being conducted in Semporna.

Health-care capacity  The MOH has provided hospital beds for confirmed COVID-19 cases in several Sabah hospitals, including Lahad Datu Hospital (251 beds), Tawau Hospital (401 beds) and Kunak Hospital (40 beds).  Quarantine centres have been set up in several locations in Sabah to house persons under investigation (PUI). Tawau has a total of 720 designated beds, Lahad Datu has 354 beds, Kunak has 127 beds, and Semporna has 180 beds.

Risk communication and community engagement  The MOH has reminded the public that even if Malaysia obtains a COVID-19 vaccine, it would not mean the end of the battle against COVID-19. The public must make continuous efforts to break the chain of infection by adhering to the standard operating procedures and physical distancing requirements.

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