Facing a new Covid-19 wave

A NEW wave of Covid-19 infections in Malaysia is here, and it’s only just begun.

The new Omicron subvariants, BA.4 and BA.5 – reportedly more contagious than the original Omicron strain – have sparked a rise in cases in Singapore, the United States and Europe, among other countries.

These strains are here too, and we can expect the number of cases to go up in days to come, said Health Minister Khairy Jamaluddin on Friday.

Daily new cases in Malaysia even overshot the 3,000-mark for the first time since April on Wednesday, when there were 3,561 new Covid-19 cases. On Thursday, the number jumped to 4,020.

Subvariants of Omicron (BA.5 and BA.2.12.1) were first detected in Malaysia on June 9.

Public health experts also observe that some people in Malaysia have started to go easy on the standard operating procedure, like refusing to wear a mask and failing to report themselves after testing positive.

Universiti Malaya epidemiologist Prof Datuk Dr Awang Bulgiba Mahmud says there have been cases of masking not being followed at indoor public events even though indoor masking is still compulsory for such activities.

“If those SOPs are strictly followed, then we can avoid a huge increase in the number of cases.

“Unfortunately, there are people who simply refuse to mask up even during indoor public events and in crowded places.

“So I believe a wave of new infections is inevitable,” Dr Awang Bulgiba says.

He is hopeful, however, that population-level immunity against a severe form of the disease will hold and Malaysia will be able to cope with the number of severe cases.

Bring back some restrictions

To defend ourselves against the wave, some feel certain measures should be reintroduced to control the virus from spreading rampantly.

Medical Practitioners Coalition Association of Malaysia president Dr Raj Kumar Maharajah says the government should consider re-imposing restrictions like physical distancing.

“There is no need to have another movement control order that could hamper livelihoods. But rather, the authorities should stress SOPs like wearing masks and maintaining hand hygiene.

“Let’s start with these first,” he suggests.

Dr Raj Kumar says because much is not yet known about the Omicron subvariants, it is best if people continue to follow simple rules like avoiding crowded places.

As for the second booster shots for the general public without comorbidities, he believes they can afford to wait first.

“Vulnerable groups like senior citizens and those with comorbidities should get it. As for the rest, just follow SOPs for now,” Dr Raj Kumar advises.

Consultant paediatrician and neonato-logist Datuk Dr Musa Mohd Nordin suggests that the ministry should step up restrictions for certain high-risk events in anticipation of this threat “rather than react when it has often proven to be belated”.

Examples of such events are concerts, football games, conventions and weddings, he lists.

On high-risk groups receiving their second booster, Dr Musa points out that many eligible folks are still hesitating over it.

“For persons above 50 years old, there is a 14-fold reduction of mortality with the fourth shot.

“There is a 99% reduction of mortality for four shots versus 86% for three shots versus 81% for two shots,” he adds.

Like other experts, Dr Musa believes that Malaysia may be missing a considerable volume of cases due to home tests.

“Thus, the daily reported cases are not a true reflection of the burden of cases in the country,” he says.

He says the Omicron subvariants BA.4 and BA.5 are causing an upsurge of cases not just in the United States and Europe but also in the Asia Pacific, namely Australia and New Zealand.

“This has also been translated into hikes in hospital admissions,” he says.

Dr Musa explains that BA.5 is the dominant virus and is of concern because it is much more infectious.

“It grows 35% faster than the original Omicron strain and has greater potential for immune escape (evading protection from vaccines and past infection),” he says.

The severity of BA.5 infections is, however, less clear, but there have been upticks in hospitalisations, though not yet in associated deaths.

Steps like high-quality masking, physical distancing, ventilation and air filtration have been effective in mitigating the spread of Covid-19 but now, many countries have dropped mask mandates, Dr Musa points out.

“Pandemic fatigue has similarly led to poor compliance with SOPs,” he says.

We must resist pandemic fatigue, Dr Musa says, during this period when the BA.5 subvariant could spread and everyone must remain even more vigilant.

“Ensure that you are masked with a high-quality mask when indoors and avoid crowds, which may include indoor dining.

“If you are unwell or have signs and symptoms suggestive of Covid-19, test regularly with the RTK-Ag [rapid antigen test] and take the appropriate actions as mandated,” he says.

Not as bad as the past

While we are facing a new wave now, Universiti Putra Malaysia epidemiologist Assoc Prof Dr Malina Osman believes the impact will not be as bad as the previous Delta variant infections.

However, she still adds, “Going through the pandemic, all of us need to be cautious. We have to always be prepared to face any possibilities.”

Based on our experience in the past two-and-a-half years, most of us now are surely familiar with the situation.

“This helps very much in implementing all of the sociobehavioral preventive measures if we need to introduce those rules all over again.

“In addition, the high coverage of vaccination would help protect most cases from becoming severe.

“The situation, in my opinion, would be very much different compared with Delta and previous original Omicron variant,” Dr Malina says.

For the time being, she believes second boosters should be given to all high-risk workers, including frontliners.

“There is no need yet for it to be given to non-high risk groups unless there is evidence of breakthrough infections in these groups or evidence that our healthcare system is potentially in a threatened state.

“To impose second booster doses to all groups needs support from the data,” she adds.