INTERACTIVE: How Malaysia needs to prepare for the Omicron surge

Nurses, doctors, and a respiratory therapist intubate a coronavirus disease (Covid-19) patient as the Omicron coronavirus variant continues to put pressure on Humber River Hospital in Toronto, Ontario, Canada January 20, 2022. REUTERS/Carlos Osorio

PETALING JAYA: With Malaysia now bracing for an increase in Covid-19 infections due to the arrival of the Omicron variant, many are wondering how big the rise in cases will be.

On Wednesday (Jan 26), Health Minister Khairy Jamaluddin said the Omicron wave had already begun in Malaysia with the number of cases set to go up.

He however assured Malaysians that the situation was under control due to the country's high vaccination rate. The Health Ministry had earlier prepared several measures for any increase in cases.

Health experts said that with the surge of the Omicron variant reported in many countries worldwide, Malaysia must be fully prepared to face a possible wave of cases.

The first Omicron variant in the country was detected on Dec 2 and as at Jan 25, the country had recorded 601 such cases, the second highest variant of concern after Delta with 6,188 cases.

While the number of reported Covid-19 cases, hospitalisations, intensive care unit (ICU) admissions and patients on ventilators have not shown any spike so far, the country’s infectivity rate (R value) has shot up from 0.98 on Jan 17 this year to 1.09 on Jan 25.

The R value refers to the number of people that a person who has the coronavirus will infect. If the R value is 1 for example, it means that on average, one infected person will spread Covid-19 to one other individual.

An R value higher than 1 means that the number of cases will increase.

The following is a comparison of Malaysia’s Covid-19 situation with the United Kingdom and Germany, which are among the countries that has seen a surge in cases due to Omicron.

Universiti Malaya epidemiologist Prof Datuk Dr Awang Bulgiba Awang Mahmud said the low number of Omicron cases in the country may be due to low genome sequencing rates or the population level immunity holding for the time being.

“Countries which had high levels of vaccination are reporting an Omicron-fuelled wave.

“Reports suggests that the doubling time of Omicron is around two to three days, which is extremely short so if Omicron were to take root, you can expect cases to rise rapidly within days leading to renewed pressure on our healthcare facilities,” he warned.

In order to outpace the spread of the Omicron variant, Dr Awang Bulgiba said the country needs to establish widespread population level immunity by administering booster shots to 80% of the population.

“If booster doses are administered quickly enough, Omicron may lead to a short, sharp surge of infections due to waning antibody levels, followed by a rapid fall in infection numbers as booster doses re-establish widespread population-level immunity.

“If we intend to accomplish this by the end of February, we need to step up and administer the booster shots to around 360,000 doses per day,” he said.

He added that although boosting circulating antibodies via a booster jab protects against severe effects caused by the Omicron variant, administering boosters regularly would not be a sustainable public health strategy.

Dr Awang Bulgiba, who heads the Independent Covid-19 Vaccination Advisory Committee (ICVAC), suggested that the world needs to consider vaccines that focus on T-cell responses in addition to the current vaccines, which may reduce the need for repeated booster shots and be more sustainable in the long run.

All current Covid-19 vaccines encourage the body to generate antibodies that target the spike protein of SARS-CoV-2, the virus that causes the disease. However, Covid-19 variants usually contains mutations of this spike protein.

T-cells are a type of white blood cell that can ‘remember’ antigens for decades. Vaccines developed using this new approach may provide more lasting protection by inducing ‘cellular immunity’, according to medical experts, where the body recognises infected cells and kills them.

Meanwhile, in order to identify the extent of local infections, Dr Awang Bulgiba urged that more Covid-19 swabs should be sent for genome sequencing and that it should be conducted randomly.

“If only swabs taken from imported infections were sequenced, then it would not be truly representative of local infections, and we would not know the true proportion of Omicron infections in the community,” he said.

He added that if only a small percentage of samples are being sequenced, there would be a lower probability of finding the true number of Omicron infections.

“According to Our World in Data, at the end of December 2021, Israel reported that it managed to sequence 20% of all its new infections, while the figures for Singapore, the United Kingdom, Australia and the United States were 16%, 7%, 6% and 4% respectively.

“On Jan 10, 2022, more than 90% of all sequenced samples in the United States and United Kingdom were found to be Omicron while in Israel and Australia, more than 80% were Omicron,” he said.

In comparison, he said, more than 70% of Malaysia’s sequenced Covid-19 samples were of the Omicron variant but Malaysia’s genome sequencing rate was less than 1%, which is insufficient to understand the degree of the Omicron threat to the country.

Dr Awang Bulgiba suggested that S-gene target failure (SGTF) Covid-19 tests should be used in the country as a quick way of identifying the Omicron variant, where certain samples can then be prioritised to be sent for whole genome sequencing (WGS).

“WGS takes time but is needed for confirmation. This kind of data then needs to be combined with epidemiological analysis,” he said.

Prof Dr Sharifa Ezat Wan Puteh of Universiti Kebangsaan Malaysia said the delay in the spread of Omicron infections in Malaysia can be attributed to the country’s high vaccination rate, its strict border control, and good Covid-19 case tracing and control.

“We have high vaccine rates for adults and adolescents, and we have also reached almost 40% of population being boosted.

“However, the Omicron will land on our shores and overtake Delta, as has happened in many countries.

“Looking at other countries, it’s just a matter of time before we are faced with an Omicron surge of cases, and we best be prepared with protection from Covid-19 vaccines,” she added.

The community health professor said in many of the countries with a high number of Omicron cases, many their Covid-19 regulations have been relaxed.

“In countries like the United States, United Kingdom and Israel, they lifted their mask control a bit too prematurely, allowed congregations and do not have standardised SOPs (standard operating procedures), which differ by state or areas,” she noted.

In Malaysia, she said, public health measures which include mass vaccination and strict SOPs, especially masking, have contributed to the country’s success in containing Covid-19 cases.

READ ALSO > Bracing for the Omicron tsunami

Dr Sharifa Ezat said, however, Malaysia may lag behind such developed countries in terms of testing per million population.

“Hence, the situation in Malaysia may not project the true burden of infection. Genetic analysis is also lacking in Malaysia compared with such countries,” she added.

Besides controlling the country’s borders, increasing testing and getting booster shots, Dr Sharifa Ezat suggested that the country should also strengthen its surveillance system, which includes profiling new variants or viruses through genetic analysis and sequencing.

“Omicron may not be the last variant of concern to occur and we may face other pandemics in the future,” she warned.

She said the healthcare system need to be ready for surges of cases, hospitalisation and deaths.

“In many countries, among those highly infected with Covid-19 are those vaccinated but have comorbidities and are among the elderly,” she said.

Universiti Putra Malaysia epidemiologist Assoc Prof Dr Malina Osman agreed that the country needs to maintain strict monitoring of Covid-19 cases and current risk-reduction measures to avoid a potential surge of cases.

She suggested that the Covid-19 spike in many European countries and the United States due to Omicron may have been triggered by high transmission during winter.

“We know that during winter, (incidences of) infectious diseases that are related to the lungs such as flu and Covid-19 are higher compared to other seasons,” she said.

Dr Malina said current updated measures that were announced by the recent detection of Omicron in the country should be continued.

“As long as people are adhering to instructions and SOPs, as well as taking their booster shots, it should be safe for us,” she said.

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