Malaysia Coronavirus Disease 2019 (COVID-19) Situation Report Weekly report for the week ending 25 April 2021 Malaysia Situation summary As of 25 April, there have been a total of 392 942 confirmed cases of COVID-19 in Malaysia. In the past seven days, 17 888 new cases have been reported – a 26% increase compared to the previous week. In the past seven days, 58 new deaths have been reported, bringing the total number of COVID-19 deaths in Malaysia to 1436. There were also increases in the number of critically ill cases requiring intensive care (+24.2%) and ventilator support (+34.2%). Most states and territories (12 out of 16) have reported an increase in new COVID-19 cases in the past week. The highest numbers of new local cases in the past week were reported in Selangor (4398) and Sarawak (3972). Sarawak reported 247.12 active cases1 per 100 000 population, the highest concentration of actives cases in Malaysia. On 22 April, Kelantan recorded its highest number of daily new cases (662). Once more, the number of new local cases in Kelantan (3169) has more than doubled from the previous week. Additionally, Federal Territory (FT) Kuala Lumpur recorded 1812 new local COVID-19 cases in the past week, a 57.3% increase compared to the previous week. Despite a decrease in cases reported after a peak in late January 2021, there are signals of a resurgence in cases in Malaysia. Potential risks and vulnerabilities for a continued increase in transmission: o As of 25 April, the estimated national real-time reproductive number (Rt) was 1.12 (95% confidence interval [CI]: 1.10–1.14). An Rt value of 1 and above indicates the potential for continued transmission of SARS-CoV-2 and a resurgence of cases. o A possible decrease in community adherence to public health and social measures, along with some relaxation of previous restrictions. o Global and regional resurgence, coupled with the increased transmission of SARS-CoV-2 variants of concern poses a threat of importation of cases. While point-of-entry control measures are in place, risks associated with illegal border crossing cannot be discounted. o There is a burden on the health-care system, especially in regions such as Kelantan and Sarawak that are more greatly affected. As of 2 May, Malaysia has detected 48 locally acquired COVID-19 cases bearing the B.1.351 variant of concern. Moreover, a total of three locally acquired COVID-19 cases bearing the B.1.1.7 variant of concern have been detected in Malaysia. Phase 2 of the National Immunization Programme began on 19 April 2021. Priority is given to those aged 60 years and above, persons with disabilities and those with co-morbidities. As of 25 April, 2.1% of Malaysia’s total target population (estimated 23.7 million individuals) have received their second dose of the COVID-19 vaccine. Upcoming events and priorities Effective 24 April, all foreign travellers entering Malaysia from countries that have reported SARS- CoV-2 variants of concerns will be required to undergo a 14-day quarantine upon entry instead of the 10 days currently implemented. Following the recent increase in cases detected across Malaysia, authorities have ordered the temporary closure of schools located in Kelantan, Selangor and Sarawak (i.e. red zones). This precaution was undertaken to facilitate the sanitization of the affected premises as well as to aid contact tracing efforts. Similarly, any schools that have confirmed COVID-19 cases will be ordered to close for a minimum of two days. Moreover, following the end of the upcoming Eid school holidays, all primary and secondary schools in Malaysia will return to home-based teaching and learning 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 25 April 2021 methods (PdPR) until 28 May (for Johor, Kedah, Kelantan and Terengganu) or 29 May (the remaining states). Inter-state travel will be permitted from Monday to Thursday for work-related trips or emergency reasons only. From Friday to Sunday, inter-state travel will be strictly prohibited, with an exception for emergency reasons. The directives will also apply during the upcoming Eid festivities. Following the increase in COVID-19 cases in Kelantan, all districts in the state have been placed under a movement control order (MCO). Moreover, authorities have announced the extension of recovery MCOs (RMCOs) in Perlis, Terengganu, Perak, Malacca, FT Putrajaya, Pahang, FT Labuan, Negeri Sembilan and Kedah until 17 May. Conditional MCOs (CMCOs) in Selangor, FT Kuala Lumpur, Sabah, Johor, Sarawak and Penang have similarly been extended to 17 May. A total of five districts in Kedah (Kota Setar, Kuala Muda, Bandar Baharu, Baling and Kulim) have been placed under MCO until 14 May. National transmission assessment National transmission stage assessment: Stage 3 (low confidence) – Large-scale community transmission2 Week 16 (19–25 April 2021) The total number of cases reported in the past seven days (17 888) increased by 26% compared to the previous week, averaging about 2555 newly reported cases daily. On average, 66 349 tests were conducted per day, with a positivity rate of 4.34%. Of the newly reported cases, 101 (0.6%) were imported, and 17 787 (99.4%) were locally transmitted. Most states and territories (12 out of 16) are signalling an increase in the number of new COVID-19 cases. The states of Selangor and Sarawak reported the greatest numbers of new cases. On 22 April, Kelantan recorded its highest single-day increase in COVID-19 cases at 662 cases. Moreover, Kelantan once again recorded more than double the number of new local cases in the past week (3169) compared to the previous week (1329). FT Kuala Lumpur recorded a 57.3% increase in the number of newly reported local COVID-19 cases compared to the previous week. While most cases are linked to existing clusters, 3794 (21.2%) 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 (71) compared to the previous week (61). Clusters3 remain mostly linked to workplaces. However, up to 33.8% of newly reported clusters have been linked to educational facilities. Along with the increase in reported cases, there has also been an increase in the number of critically ill cases requiring intensive care unit (ICU) support (24.2%) and those on ventilators (34.2%). Nationwide, 283 cases required intensive care on 25 April, compared to 219 the previous week, and of these, 121 required ventilator support (compared to 90 the previous week). The ICU utilization rate rose to 52.1% nationwide by 25 April. The number of deaths increased by 18.4%, with 58 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). 3 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 25 April 2021 EPI Update Tests Cases Deaths ICU COVID-19 17 888 Data reported for 464 444 58 52.1% New cases in the EPI week ending Tests in the Deaths in the ICU utilization rate past 7 days 25 April 2021 past 7 days past 7 days (+29.2%) (+17.1%) (+26.0%) (% difference (+18.4%) compared to the previous 7 days) 9 066 170 392 942 1436 543 Cumulative tests Cumulative cases Cumulative ICU beds for COVID-19 deaths patients (including 4.34% private hospitals) Positivity rate 0.37% Case fatality rate Imported 101 3794 351 n/a Active clusters Active clusters with cases and (0.6%) (21.2%) more than three clusters Imported cases in the Cases in the past 7 generations past 7 days days with no link 3 of 3 3 Malaysia Coronavirus Disease 2019 (COVID-19) Situation Report Weekly report for the week ending 25 April 2021 Epidemiology Fig I. Daily reported COVID-19 cases, Malaysia, as of 25 April 2021 Fig 1 indicates the number of daily 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 the MCO. The yellow band refers to the implementation of the CMCO while the green band refers to the RMCO. Table 1: Active cases and real-time reproductive number (Rt) estimates by state, as of 25 April 2021 State Active casesa Active cases/100,000 7-day incidence/100 000b Rt estimate 95% CI Selangor 7778 119.49 67.56 1.13 1.10–1.15 Sarawak 7714 247.12 127.24 1.12 1.09–1.14 Kelantan 4390 232.97 168.17 1.36 1.32–1.40 FT Kuala Lumpur 2945 227.2 139.79 1.21 1.17–1.26 Johor 1824 46.98 24.88 1.12 1.07–1.17 Sabah 1794 44.86 21.83 1.05 1.00–1.09 Penang 1600 90.54 44.02 0.96 0.91–1.01 Kedah 531 24.07 17.77 1.10 1.02–1.19 Perak 519 20.2 12.73 1.00 0.92–1.08 Negeri Sembilan 499 43.74 32.96 1.13 1.05–1.22 Pahang 366 21.49 14.86 1.12 1.02–1.23 Malacca 265 28.35 28.35 1.08 0.98–1.19 Terengganu 245 22.73 12.24 1.01 0.89–1.13 FT Putrajaya 94 90.56 49.13 0.97 0.79–1.18 FT Labuan 28 28.2 16.11 0.80 0.56–1.09 Perlis 13 5.02 2.7 1 case – a This state-level reporting is on a rolling 14-day basis, from 12 to 25 April 2021, and excludes imported cases.