Prepare for a wave of Covid-19 Delta variant infections outside the Klang Valley

MUCH of the nation's focus for Covid-19 has been on the Klang Valley, including Negeri Sembilan – and rightly so.

The outbreak there continues to rage and the multi-sectoral task force set up to deal with the region, the Greater Klang Valley Task Force (GKVTF), is working hard to make a difference.

However, we may not be aware that other states outside the Klang Valley are gradually slipping into crisis.

If you track intensive care unit (ICU) bed use by Covid-19 patients in Perak, Kedah and Pulau Pinang, you can see a steep rise in the past three to four weeks. Remember that this data does not show the full picture as for every one Covid-19 patient documented in an ICU bed, there are perhaps twice as many Category 4 and 5 patients in non-ICU beds, often in casualty departments.

Much of the rapid change in situation is due to the Delta variant, which is most likely the predominant strain spreading nationwide. The Delta variant is highly infectious as it has a very high viral load and infects more people at a faster rate.

In addition, the number of people fully vaccinated in many states outside the Klang Valley is lower due to limited vaccine supply. Data for July 25, shows that vaccination rates (with two doses) for states (by total population percentage) were 14.4% for Perak, Kedah (11.5%) and Pulau Pinang (14.5%). With the Delta variant, two-dose protection is important.

What can we do to prevent a Klang-Valley-Like disaster?

We need to act now to prevent the situation in many states from getting worse. We possibly have a narrow three to four week window to act. Some suggestions are:

1. Advocate for increased vaccine supply and ramp up vaccinations to the maximum possible. Leave no vaccine vials in storage. Avoid using large PPVs and instead do drive-by vaccinations and use existing vaccination infrastructure (maternal and child health clinics, school health teams, GPs, private hospitals). We want to reduce the risk of mega PPVs being a location for Covid-19 transmission.

2. Reduce all non-critical social interaction to cut community spread of the virus. Avoid social, travel and religious activities. Avoid the use of vaccination passports at this time for travel, and especially avoid interstate movement.

3. Use PCR tests only for hospital admissions and dramatically expand RTK-Ag (rapid) testing for all contacts, whether symptomatic or not. Enable the public to self-test with the availability of reliable, cheap saliva-based RTK-Ag tests at pharmacies and health centres/GP clinics. The state government should consider subsidising these tests.

Anyone whose RTK-Ag test is positive should be considered a case and be isolated and monitored.

4. Activate a state-level multi-sectoral disaster team, similar to the GKVTF. Get the plans in place, activate teams and resources and place them on standby as quickly as possible so when the Delta wave hits, we will be better prepared. This includes increasing the number of hospital beds, oxygen delivery capacity and electrical power supply.

5. The state-level disaster management teams must be empowered to act immediately (decentralised decision making) and supported by state governments. Remember that the Federal Government has invested significant resources to support the Klang Valley and may have limited funds for other states. Hence, state governments must come together with wealthy business leaders to act now for their state.

6. We need to send a clear message that vaccination alone will not stem the Delta wave; we need all public health measures as well (masks, ventilation, physical distancing, etc). We need to encourage the public to be vigilant and maintain their SOPs even if vaccinated.

7. Finally, transparent data sharing with the public to comprehensively explain the true situation is crucial. We cannot say "everything is under control" when we know it is not. Granular, down to district level, will encourage an all-of-society involvement to reduce the impact of the Delta wave. A concerned public is one that acts.

We have an opportunity to avoid the anguish that the greater Klang valley residents are going through. If we have good, strong regional leadership stepping up now, we just may avoid the worst of the crisis that is impending.

Datuk Dr Amar-Singh HSS, consultant paediatrician

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