Coronavirus Disease 2019 (COVID-19) Situation Report Weekly report for the week ending 18 April 2021

Malaysia Situation summary  As of 18 April, there have been a total of 375 054 confirmed cases of COVID-19 in Malaysia. In the past seven days, 14 198 new cases have been reported – a 43.5% increase compared to the previous week. In the past seven days, 49 new deaths have been reported, bringing the total number of COVID-19 deaths in Malaysia to 1378.  Most states and territories (11 out of 16) have reported an increase in new COVID-19 cases in the past week, including the states reporting the highest numbers of cases (i.e. , and ). Sarawak and Selangor contributed the highest number of new local cases in the past week, with 3936 cases and 3521 cases, respectively. Sarawak also had the highest density of active cases in Malaysia, with 193.36 active cases1 per 100 000 population. On 16 April, Sarawak recorded its highest number of daily new cases at 960. Once more, the number of new local cases in Kelantan have doubled from the previous week.  There was also a marked increase (19.7%) in the number of critically ill cases requiring intensive care. The number of deaths reported increased by 19.5% as compared to the previous week.  Several signals suggest a potential COVID-19 resurgence: o As of 18 April, the estimated national real-time reproductive number (Rt) was 1.16 (95% confidence interval [CI]: 1.15–1.18). An Rt value of 1 and above indicates the potential for continued transmission of SARS-CoV-2 and a resurgence of cases. o Overall, data from the Google Mobility Report suggests that nationwide population movement is on the rise in workplace settings. o Media reports related to religious and social traditions, including the Ramadan bazaars, have indicated a possible decrease in community adherence to public health and social measures. Authorities nationwide are increasing efforts to promote public awareness and compliance with standard operating procedures.  Vigilance and adherence to public health and social measures continue to be important in response to the observed increasing trend in cases reported.  The detection of SARS-CoV-2 variants of concerns among locally transmitted cases in Malaysia warrants further study and increased vigilance. Presently, cases bearing the B.1.351 variant lineage have been reported among locally transmitted cases in Selangor.  Phase 2 of the National Immunization Programme began on 19 April 2021, prioritizing those aged 60 years and above, persons with disabilities and those with co-morbidities. As of 18 April, 1.9% of Malaysia’s total target population (estimated 23.7 million individuals) have received their second dose of the COVID-19 vaccine through Phase 1 of the immunization programme.

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 18 April 2021

Upcoming events and priorities  Authorities have announced the extension of movement control orders (MCOs) across Malaysia. The conditional MCOs (CMCOs) placed on Selangor, , Kelantan, Federal Territory (FT) and have been extended to 28 April 2021. Sarawak has been placed under CMCO until 26 April 2021. , , , , , FT , FT , , and have been placed under recovery MCO (RMCO) until 28 April 2021. Furthermore, following the rise in cases, all districts in Kelantan have been placed under MCOs to curb COVID-19 transmission.  Following the rise in cases detected in Sarawak, state authorities have strengthened COVID-19 standard operating procedures. Inter-district travel across the state is now prohibited except for urgent matters.  In Kelantan, all schools and learning institutions located in MCO districts have been ordered to close for one week from 18 to 24 April 2021. Students residing in respective school hostels have been instructed to remain in their dormitories.  Health and police authorities nationwide are increasing vigilance on standard operating procedure compliance related to Ramadhan bazaars. Moreover, measures related to the upcoming Eid festivities are being developed and await official announcements. National transmission assessment

National transmission stage assessment: Stage 3 (low confidence) – Large-scale community transmission2 Week 15 (12–18 April 2021)

The total number of cases reported in the past seven days (14 198) increased by 43.5% compared to the previous week, suggesting an increasing trend in the number of daily new cases recorded. On average, 56 675 tests were conducted per day, with a positivity rate of 3.58% – an increase compared to 2.87% the previous week. Daily reported cases increased to above 2000, averaging 2028 cases daily. Of the newly reported cases, 97 (0.7%) were imported, and 14 101 (99.3%) were locally transmitted. Most states are reporting or observing an increase in the number of new COVID-19 cases. The states of Sarawak and Selangor reported the greatest numbers of new cases. On 16 April, Sarawak recorded its highest single-day increase in COVID-19 cases at 960 cases. Moreover, Kelantan once again recorded a doubling of the number of new local cases in the past week (1329) compared to the previous week (694). Nationwide, while most cases are linked to existing clusters, 3133 (22.1%) cases were reported as unlinked at the time of reporting, a slight decrease from the previous week. There has been an increase in the number of new clusters reported (61) compared to the previous week (54). Clusters remain mostly linked to workplaces. While the number of reported cases is increasing, there has likewise been an increase (19.7%) in the number of critically ill cases requiring ICU support. Nationwide, 219 cases required intensive care on 18 April, compared to 183 the previous week, and of these, 90 required ventilator support (compared to 81 the previous week). The ICU utilization rate has increased to 40.3% nationwide. The number of deaths has increased by 19.5%, with 49 deaths this week.

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). 2 of 3

2 Malaysia Coronavirus Disease 2019 (COVID-19) Situation Report Weekly report for the week ending 18 April 2021

EPI Update Tests Cases Deaths ICU COVID-19 14 198 Data reported for 396 730 49 40.3% New cases in the EPI week ending Tests in the Deaths in the ICU utilization rate past 7 days 18 April 2021 past 7 days past 7 days (+19.7%) (+15.0%) (+43.5%) (% difference (+19.5%) compared to the previous 7 days) 8 601 726 375 054 1378 543 Cumulative tests Cumulative cases Cumulative ICU beds for COVID-19 deaths patients (including 4.36% private hospitals) Positivity rate 0.37% Case fatality rate

Imported 97 3133 338 n/a Active clusters Active clusters with cases and (0.7%) (22.1%) more than three clusters Imported cases in the Cases in the past 7 generations past 7 days days with no link

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3 Malaysia Coronavirus Disease 2019 (COVID-19) Situation Report Weekly report for the week ending 18 April 2021

Epidemiology Fig 1. Daily reported COVID-19 cases, Malaysia, as of 18 April 2021

Table 1: Active cases and real-time reproductive number (Rt) estimates by state, as of 18 April 2021 State Active casesa Active cases/100,000 Rt estimate 95% CI Sarawak 6036 193.36 1.17 1.14–1.20 Selangor 5839 89.70 1.08 1.05–1.11 Kelantan 1897 100.67 1.43 1.37–1.49 Penang 1793 101.46 0.89 0.85–0.94 FT Kuala Lumpur 1790 138.09 1.24 1.18–1.29 Sabah 1661 41.53 1.18 1.12–1.23 Johor 1533 39.48 1.19 1.13–1.25 Perak 431 16.77 0.69 0.64–0.75 Kedah 426 19.31 1.06 0.98–1.15 Negeri Sembilan 384 33.66 1.17 1.08–1.27 Pahang 266 15.62 0.98 0.88–1.10 Terengganu 243 22.54 1.20 1.06–1.34 Malacca 122 13.05 1.02 0.90–1.14 FT Putrajaya 90 86.71 0.96 0.79–1.16 FT Labuan 45 45.32 0.69 0.52–0.89 Perlis 8 3.09 1.31 0.77–1.98 a This state-level reporting is on a rolling 14-day basis, from 5 to 18 April 2021, and excludes imported cases. Source: MOH Malaysia.

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4 Malaysia Coronavirus Disease 2019 (COVID-19) Situation Report Weekly report for the week ending 18 April 2021

 Of the 1520 clusters identified in Malaysia, 338 are currently active. A total of 61 new clusters were identified in the past week. A total of 66 clusters have been declared closed in the past week. Furthermore, in the past week, 13 new clusters were linked to educational facilities.  On 17 April, Ministry of Health authorities noted that a total of 40 health-care workers in Malaysia had contracted COVID-19 infections following completion of COVID-19 vaccination. Of these, 31 health-care workers were infected less than two weeks after receiving their second vaccine dose, while the nine remaining cases were infected more than two weeks following their second dose. Moreover, a total of 142 health-care workers (out of an estimated total 280 000 health-care workers in Malaysia) had been infected with COVID-19 following their first dose of the vaccine. All cases exhibited less severe symptoms.

Health-care capacity  An estimated 430 Ministry of Health staff will be deployed to Sarawak following the rise in COVID-19 cases in the state. Personnel will include doctors, nurses, medical assistants, laboratory officers and radiologists from across Malaysia.

Testing and surveillance  As of 18 April, a total of 1 013 800 non-Malaysians have been screened, of which 131 960 (13%) tested positive. Among them, 131 006 (99.3%) cases were locally transmitted, and 954 (0.7%) were imported. To date, 154 deaths have been reported among non-Malaysians, making up 11.2% of total deaths. The proportion of fatal cases (PFC) was 0.1% among non-citizens, compared to 0.5% PFC among Malaysians.  On 14 April, authorities announced that they had identified 17 locally transmitted cases bearing the B.1.351 variant. Of the total, 13 (76.5%) cases had been detected among clusters originating from Selangor districts (Kuala Langat and Sepang), including the Jalan Lima, Kebun Baru and Teknologi Emas clusters. The four remaining cases bearing the B.1.351 variant were detected through close contact screening in Selangor and are presently unlinked to any clusters. Phylogenetic and geographical analysis indicates that it is likely all cases originated from the same source of infection.  In total, health authorities have conducted 273 genomic sequencings of SARS-CoV-2 virus in Malaysia. Of the 145 genomic sequencings conducted in 2021, 22 (15.2%) cases involved variants of concern, most of which were the B.1.524 variant. Since 3 February 2021, the MOH has detected two cases bearing the B.1.1.7 variant and two cases bearing the B.1.525 variant among imported samples. On 15 April, the MOH reported two newly detected cases bearing the B.1.1.7 variant, bringing the total number of cases bearing this variant to five. Other variants (i.e. B.1.524, B.1.466.2, B.1.36.16 and B.1.1.163) have similarly been detected across Malaysia.

Strategic approach

Non-pharmaceutical interventions (NPI)  Government authorities have announced that Ramadhan buffets and fast-breaking events will be permitted during this fasting period. Fast-breaking events held in halls or hotel ballrooms will be limited to 50% venue capacity in CMCO regions and 100% venue capacity in RMCO areas. Ramadhan buffets held in restaurants or eateries are permitted at 100% venue capacity. Standard operating procedures at all locations must be strictly adhered to.  Eateries and food delivery services are permitted to operate until 06:00 am daily during the month of Ramadhan.  Sarawak authorities will no longer permit civil servants to hold physical meetings until 30 April 2021. Moreover, inter-district travel in the state is prohibited unless it is urgent and approved by the department head. Any programme and event scheduled to be held in the next two weeks will be postponed.

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5 Malaysia Coronavirus Disease 2019 (COVID-19) Situation Report Weekly report for the week ending 18 April 2021

 Kelantan authorities will permit Friday and terawih prayers to be held in mosques and prayer halls located in the seven MCO districts in the state. The announcement was made on 16 April, reversing a previous statement made on 11 April regarding the cancellation of Ramadan terawih prayers in the state. However, the number of congregants will be limited to 70% mosque capacity. In prayers halls, capacity is reduced to 50% of the venue’s maximum congregant size. Prayers will be limited to only eight raka’ats (the minimum required practice) or less than 45 minutes. Other religious activities will not be permitted to take place in mosques.

Table 3: Movement control orders currently being implemented State Location Type of MCO Effective dates Sabah district MCO 17–30 April district Extended to 30 April Kampung Tanjung Batu Keramat, EMCO 15–28 April Tawau Pasar Sim-sim, Berhala and 14–27 April Kampung Sungai Obar, Mukim Sentosa, Sandakan Flat Sim-sim, Mukim Berhala and Kampung Sungai Obar, Batu 7, Mukim Sentosa, Sandakan Phase 2 Taman Semarak, Mukim Extended to 28 April Balung, Tawau Kampung Simpang 3A, Merotai Besar, Extended to 29 April Tawau Kampung Melangkap Tomis, Kota 14–27 April Belud Taman Villa Mas, Tawau Kampung Baru Pasir Putih, Mukim Sri Extended to 28 April Tanjung, Tawau Kampung Ranggu Batu 10, Mukim Balung, Tawau Kampung Meruntum, 13–26 April University Malaysia Sabah (UMS), Kota Extended to 2 May Kinabalu Taman Tawau Lama and Kampung Batu 17–30 April Payung, Tawau Kampung Bikang, Kampung Kadumu, 18 April to 1 May Taman Khazanah Indah, Taman Hilltop, Taman Bukit Bintang, 18 April to 1 May Taman Berkley, Tawau State-wide (except Lahad Datu, Tawau, RMCO Extended to 28 April Sandakan) Kedah State-wide (except Kuala Muda) Negeri Sembilan State-wide (except Seremban) Perak State-wide FT Labuan Terengganu Perlis FT Putrajaya Pahang Kampung Paya Pulai Tengah, Temerloh EMCO 14–27 April Kampung Pulau Terap, Temerloh Kampung Paya Pulai-Kg Batu 4, Temerloh

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6 Malaysia Coronavirus Disease 2019 (COVID-19) Situation Report Weekly report for the week ending 18 April 2021

Kampung Paya Pulai-Kg Batu 5, Jalan Maran Ladang Leepang, Ladang Laukin, 15–28 April Kampung Inoi, Muadzam Shah, Rompin Institute Aminuddin Baki, Sri Layang, 17–30 April Bentong Malacca State-wide RMCO Extended 28 April Henry Gurney School, Telok Mas EMCO Extended to 30 April Selangor State-wide CMCO Extended to 28 April Johor FT Kuala Lumpur Penang Kelantan Extended to 28 April district MCO 16–29 April district Pasir Puteh district district SMU (A) Tarbiah Diniah Tahfiz Bunut EMCO 16–29 April Sarang Burung, Tumpat Maahad Tahfiz Sains Tanah Merah 19 April to 2 May Tahfiz Science Nurul Aman college, Kok 17–30 April Lanas, Kota Bharu Secondary science school Machang 18 April to 1 May Sarawak State-wide CMCO Extended to 26 April Police Training Centre (Pulapol) and EMCO 16–29 April quarters, Kuching Kampung Tengah, Betong 18 April to 1 May Taman Mesra Bako, Kuching

Risk communication and community engagement  State authorities across Malaysia have reminded the public to stringently follow all COVID-19 standard operating procedures, especially at Ramadan bazaars. If non-compliance is observed, authorities may cancel Ramadan bazaars in selected areas.

Vaccines  As of 18 April, a total of 1 144 841 COVID-19 vaccine doses have been administered across Malaysia. A total of 443 029 individuals have received both vaccine doses. That comprises 1.9% of Malaysia’s total target population.  COVID-19 vaccine doses will not be administered at night throughout the month of Ramadhan.  With the commencement of Phase 2 of the immunization programme on 19 April, medical officers will be sent to interior regions in Malaysia to administer the single-dose CanSino vaccine. The outreach programme aims to target communities such as the indigenous (Orang Asli) populations.  Authorities have announced that the Sinovac vaccine will be used under Phase 2 of the National Immunization Programme. Phase 2 will target vaccination among those aged 60 years and above, persons with disabilities and those with chronic illnesses.  Private hospitals across Malaysia will serve as vaccination centres under Phase 2 and 3 in national COVID-19 vaccination efforts. The government will provide free vaccines to private hospitals to maximize vaccine distribution among the population. Private general practitioners are also likely to be involved in vaccination efforts under Phase 2 and 3. As of 11 April, a total of 2304 private general practitioners have registered to aid COVID-19 vaccination efforts.

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7 Malaysia Coronavirus Disease 2019 (COVID-19) Situation Report Weekly report for the week ending 18 April 2021

 On 4 April 2021, Selangor state authorities launched a COVID-19 vaccine registration platform known as ImuniSel. The platform aims to aid registration for those in the state without access to mobile phones or Internet connectivity.  Authorities will now permit inter-state travel for the purpose of bringing family members or dependents to their COVID-19 vaccination appointments. Travellers will need to present their vaccination appointment letter to the authorities at state borders.

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