KUALA LUMPUR: While hospitals are reporting a more promising picture in the fight against Covid-19 with a drop in daily admissions and photos of unoccupied beds and empty corridors, a dire Covid-19 situation with record-high deaths and escalating daily new cases are being reported.
Experts are pointing to a possible disconnect between Covid-19 data and real situations on the ground, and that patients may not be getting the help needed on time due to various reasons, which had led to a lower admission rate.
Epidemiologist Professor Datuk Dr Awang Bulgiba Awang Mahmud of Universiti Malaya said the high number of brought-in-dead (BID) cases indicated that the community spread was far greater than the official infection figures.
"On Feb 1, Malaysia's death rate was 0.35 per cent. On Aug 24, it increased to 0.91 per cent, which is more than double than the figure six months earlier, on the back of very high infection numbers. The number of deaths rose dramatically as a result."
He said death figures needed to be reported and recorded regardless of how many tests were done in a day.
"It (the death rate) is perhaps a more reliable indicator than just infection numbers alone. So when more deaths are reported, accompanied by an increase in positive rates, it means community spread is greater than the official figures," he told the New Sunday Times.
Dr Awang also raised concern over the high proportion of BIDs among migrants, which could point to high community infection rates among them, calling for an urgent need to vaccinate them.
According to the website Our World in Data, up to Thursday, Malaysia had one of the highest daily cases per million people (seven-day rolling average) at 668.17. With a fourfold increase from 164.84 cases per million people on June 26, it is the highest in the region.
Brunei came second on Thursday with 396.10 daily cases per million people, followed by Thailand (268.13), the Philippines (141.05), Vietnam (117.89), Indonesia (59.25), Laos (54.80), Myanmar (46.62), Cambodia (27.67), India (20.67) and Singapore (13.72).
Nationwide, daily Covid-19 cases increased fourfold from 5,586 on June 27 to 22,070 on Friday, while daily deaths increased from 60 cases on June 27 to 339 on Friday.
According to the Covid-19 Immunisation Task Force, 61.1 per cent of the country's adult population had been fully vaccinated up to Friday, while in the Klang Valley, 88.7 per cent of the adult population had been fully immunised.
New cases, however, continued to spike in Selangor (from 2,212 cases on June 27 to 5,920 on Friday) and Kuala Lumpur (628 cases on June 27 to 1,809 on Friday).
Death rates in Selangor also increased from 20 fatalities on June 27 to 103 on Friday. In Kuala Lumpur, it spiked from 16 deaths on June 27 to 40 on Friday.
Dr Awang Bulgiba, who is the Science, Technology and Innovation Ministry's Covid-19 Epidemiological Analysis and Strategies Task Force chairman, said the increasing number of deaths, including in Selangor and Kuala Lumpur, could be attributed to the newer and more virulent variants.
"Patients might not have been admitted into hospitals and their conditions then worsened rapidly. We do not have post-mortem reports on them, so it is difficult to know what they really died of."
As at Aug 17, Malaysia recorded 467 cases of the highly infectious Delta variant, which had been detected in almost every state.
Dr Awang Bulgiba also said infected people could have dismissed their symptoms as just a common cold or a minor cough and did not get tested, only to have their conditions deteriorating, leading to BID cases.
He said inaccessible locations of medical facilities for those in remote areas could also lead to patients dying at home before they could seek treatment.
"Signs and symptoms of (Covid-19) infection may also have changed, and not instantly recognised as a potential Covid-19 infection."
He also questioned if all migrants, particularly undocumented ones, had been included in the statistics of the population data in the context of vaccination.
"While it looks encouraging on the surface, the target for vaccination is not 80 per cent of adults, but of the entire population, including (undocumented) migrants, which we have not fully covered.
"By this admission alone, we have not truly vaccinated 80 per cent of Selangor's population."
Along with Malaysia's inaccurate population denominator to determine the country's vaccination coverage, other factors, including the Delta variant, the Jan 13 directive to reduce contact tracing, and a "half-baked" lockdown that did not target the hotspots of transmission, had all led to current Covid-19 situation, he added.
He believed states like Kedah, Penang, Kelantan, Melaka, Johor and Sabah needed to accelerate their vaccination drives promptly, with the seven-day mortality rate appeared to be rising in Johor, Penang, Kedah and Sabah.
Dr Vinod R.M.T. Balasubramaniam, molecular virologist and senior lecturer (microbiology) at Jeffrey Cheah School of Medicine and Health Sciences at Monash University Malaysia, said the surge in new cases was contributed by sporadic infections, including from asymptomatic cases.
He said nearly 70 per cent of Covid-19 infections in Malaysia this year were sporadic, with the majority of the infections coming from the Klang Valley.
"The Klang Valley has a high-density population, and the people are not only exposed to sporadic cases in the community, but also from asymptomatic cases. The virus is among us and we don't know who has it," he said.
"Other states with a high density population, like Penang, are also seeing a similar trend."
Dr Vinod said the dominant Delta variant had led to a rise in new and "breakthrough" infections in vaccinated individuals, with some indication that the variant could also result in more severe diseases.
On the high number of daily reported deaths, he said this could be contributed by the rise of BID cases and Categories 4 and 5 patients who were previously in Intensive Care Units.
"One factor contributing to the high BIDs, which also involve migrant workers, is due to people's lack of awareness on identifying symptoms while self-isolating at home. Inaccessibility to emergency medical services is another factor to the rising BIDs."
Dr Vinod said emergency services should be made available to Categories 1 and 2 patients at home, especially when they exhibit severe symptoms.
On why Selangor was not showing signs of improvement, he said this could be due to the rise of the Delta variant that was infecting those who had been fully vaccinated as well.
"The problem is when those vaccinated may have some false sense security that they are already safe and therefore fail to adhere to the standard operating procedures."
He called on the authorities to increase mass testing nationwide with at least 300,000 tests a day, improve the existing healthcare facilities and capabilities, use targeted testing and lockdowns at high-risk areas and enforce mandatory vaccinations to curb vaccine hesitancy.
Manipal University College Malaysia Community and Occupational Medicine Professor Dr G. Jayakumar said many BID victims were unable to recognise the danger signs or failed to get tested early.
"The ministry's data on Aug 25 indicated that only 1.1 per cent of the total number of cases were from Categories 4 and 5, with the majority yet to complete their vaccination," he said.
"Vaccination is an effective preventive strategy when complemented with other preventive measures."
He also believed that a big chunk of the vulnerable population, like migrant workers and undocumented foreigners, were missed out when vaccination data was reported and this needed to be scrutinised critically.
Malaysian Public Health Physicians Association president Datuk Dr Zainal Ariffin Omar said the high number of Covid-19 deaths could be due to patients not getting medical attention or were late in getting the hospital care for various reasons.
"At the hospital, patients may not be getting proper care due to overcrowding, or they could be getting the care but the conditions worsened for various reasons.
"According to statistics, most BIDs are foreigners (migrant workers). So we need to identify if factors, including poor health monitoring skills, poor living conditions and inability to access hospital care, which could involve other issues such as fees and access to transportation, contributed to the data we see," he said.
"The Greater Klang Valley Special Task Force needs to come up with a detailed analysis of their strategies and achievements."