Malaysia is waging a fierce battle against a third wave of COVID-19 cases. CNA examines the ups and downs of mitigating the pandemic.
KUALA LUMPUR: Dr Calvin Koh is a budding neurosurgeon but he has spent the last year in what he describes as “COVID mode”.
The 30-year-old has been deployed by the Ministry of Health to the frontline of Malaysia’s COVID-19 response, testing suspected cases, briefing them and treating those who require attention.
Dr Koh said the creases on his face have deepened from wearing a mask for long periods.
Dr Calvin Koh in full gear while on duty at Permai Hospital.
Besides a mask, he dons other personal protective equipment that trap heat and sweat while he works.
He does so without any complaint. “Serving the country is part of my job,” said Dr Koh.
“But I really hope this ends soon. Some Malaysians were not following standard health protocols, and this has made us quite tired,” he added.
Dr Koh has served in two designated hospitals handling COVID-19 cases – Sungai Buloh Hospital near Kuala Lumpur in 2020 and Permai Hospital at Johor Bahru in 2021.
While he works the same number of hours per shift in both hospitals, he noted that the workload has “doubled and tripled” since the number of patients have spiked over the last few months.
“Comparing between the two experiences, what we saw last year was nothing, just small numbers. We are dealing with four-digit daily increases now. In Johor where I’m based, around 600 test positive every day,” said Dr Koh.
He is among the thousands of doctors who have been called into action during different phases of Malaysia’s fight against COVID-19.
It has been over a year since the first known coronavirus cases in Malaysia were detected on Jan 25, 2020 – three Chinese nationals from Wuhan who entered the country from Singapore.
As of late February, the country has seen more than 1,000 deaths and the total number of cases is approaching 300,000.
At this juncture, question marks remain over whether Malaysia has turned the page on its darkest chapter of the pandemic.
Experts, frontliners and members of the public interviewed by CNA said there is renewed hope that the country can draw on its experiences and rally everyone to work together to eradicate the pandemic in the near future. The national immunisation programme which kicked off on Feb 24 also brings hope that Malaysia might soon turn the corner.
It is noteworthy that there have been improvements in the COVID-19 infectivity rate, or R-naught (R0). The R0 of a virus is a measure of its transmission or number of new infections generated by each case.
Information shared by the Health Ministry’s Director-General Noor Hisham Abdullah on Feb 25 indicated that the R0 for Malaysia has been trending downward over the last month.
On Jan 31, the R0 was 1.16, before lowering to 0.99 on Feb 5, and subsequently to 0.88 on Feb 11. It has since gone up to 0.99, said Dr Noor Hisham.
In early February, he highlighted that the Movement Control Order (MCO) has proved effective in triggering the decline of daily new cases.
He told reporters that he remained hopeful that the R0 would drop to 0.6, a rate he described as “manageable”.
Part of the optimism that Malaysia might be able to overcome the pandemic in 2021 stems from how it was able to keep COVID-19 at bay during the first two waves of infection last year.
The country’s initial response to COVID-19 and how it managed to flatten the infectivity curve early on drew praise from the World Health Organization (WHO).
In October 2020, WHO’s representative for Malaysia Ying-Ru Jacqueline Lo lauded Malaysia’s efforts in an online commentary entitled “A country united in the face of the pandemic”.
She noted that during the early stages of the outbreak, Malaysia invested in increasing access to quality testing, critical care beds, ventilators and mobilised doctors to areas that required manpower.
The first phase of infections in Malaysia occurred between Jan 24 and Feb 15 last year, with a total of 22 cases. Many of the cases were foreigners from Wuhan, China.
This was dealt with fairly quickly, through immediate isolation of the patients, treatment and sending them home before the virus could spread in the community. Between Feb 16 and Feb 24, 2020, Malaysia recorded zero cases.
After seemingly ceasing the spread of the coronavirus, a major challenge came in the form of a mass religious gathering which was held at the Sri Petaling mosque near Kuala Lumpur.
The event, attended by 16,000 people, eventually triggered a second wave of COVID-19 infections across the country and formed what was dubbed the tabligh cluster. The attendees who contracted the virus during the event brought it back home to their respective states, resulting in a spike in infections nationwide.
The government then imposed a lockdown in mid-March, dubbed the MCO, closing its borders and banning interstate travel.
Experts said the move to act quickly and prevent mass migration of people were key in halting the spread of infections.
Moreover, the MCO’s protocols were strict, initially allowing only one member per household to buy groceries and banning jogging or exercising in public parks.
The decision to enforce MCO was soon rewarded.
Daily number of cases sank to single-digit figures in July and August. By the end of August, Malaysia had less than 10,000 cumulative cases, one of the lowest in the region.
Dr Zainal Ariffin Omar, president of the Malaysian Public Health Physicians’ Association, told CNA that what was effective during the early phases was the decision to impose a strict lockdown.
“The government imposed a total lockdown, and it helped reduce the risk of public interactions,” said Dr Zainal Ariffin.
“They also admitted all positive cases to centralised hospitals and did proper contact tracing and quarantine for them. These are the basic principles of handling the pandemic, and they did it successfully,” recounted the epidemiologist.
STRONG LEADERSHIP BY HEALTH DIRECTOR-GENERAL
Another likely reason for Malaysia’s initial success was a capable health workforce, marshalled by Dr Noor Hisham, said Ms Nazihah Muhamad Noor, a health expert at Khazanah Research Institute.
“A large part of Malaysia’s success in the early stages of the pandemic can be attributed to the country’s highly capable and dedicated health workforce,” said Ms Nazihah.
“They worked tirelessly to carry out the ‘trace, test, treat’ package of interventions that saw Malaysia reach zero daily new local cases in July 2020,” she recounted.
Meanwhile, Dr Noor Hisham was also praised for his reassuring leadership, combined with strong medical knowledge and ability to communicate clearly. He was awarded the honorary royal title of Tan Sri, the second-highest civilian honour that can be granted in Malaysia.
Netizens tuned into his press conferences on updates regarding the pandemic and saw him as a national hero.
One of them is IT executive Bala Murugan, who lives in Kuantan, Pahang.
The 39-year-old said that Dr Noor Hisham exudes calming confidence and even when the number of cases increased in 2020, he was confident that the health ministry had the expertise and know-how to overcome the second wave of infections.
Mr Murugan tested positive for COVID-19 in May 2020, and was admitted to Hospital Tengku Ampuan Afzan for two weeks.
“I never felt worried because thankfully I had only mild symptoms,” he said.
“I recovered and many of those around me who tested positive did so as well. Whatever strategy the health ministry was doing, it was working,” added Mr Murugan.
TURNING POINT: SABAH STATE ELECTIONS
While Malaysia managed to overcome the first two waves of infection with relative success, a much tougher test awaited.
The third wave, arguably the darkest chapter of Malaysia’s fight against the pandemic thus far, was triggered in September through the Sabah state elections. After the polls, the cases spiked and eventually hovered at 4-digit figures daily.
At one point in January 2021, there were consistently 50,000 active cases, taxing the healthcare resources in the country.
The Sabah State Elections were held after a series of political maneuvering.
After former Sabah state chief minister Musa Aman’s total acquittal and discharge of 46 criminal charges involving corruption and money laundering, he announced on Jul 29 that he had a simple majority to form a new multiparty government for the state, and would seek an audience with the Sabah’s head of state Juhar Mahiruddin.
However, the Sabah governor consented to dissolve the Sabah state assembly after then chief minister Shafie Apdal met with him on the morning of Jul 30, pre-empting Mr Musa’s attempted takeover and thus setting the stage for an election.
Dr Zainal Ariffin opined that the decision to hold an election was not a good move, particularly given that there were cases of COVID-19 outbreaks in cities like Lahad Datu and Semporna, along the east coast of Sabah, before nomination day.
“There were cases reported in some of the immigrant settlements in Sabah, but they still held it.”
“When the campaigning started, it presented an opportunity for the virus to spread rapidly. Free movement of people and politicians between the peninsular and Sabah made it worse, and the cases got exported back to Kuala Lumpur, Selangor and the rest of Malaysia soon after,” he said.
“The situation exploded after September, and clusters of cases in settlements and communities sprouted across the country,” he added.
The Gabungan Rakyat Sabah (GRS) coalition led by Prime Minister Muhyiddin Yassin successfully toppled the Warisan Plus state government helmed by Mr Shafie.
However, in other aspects, the state polls proved costly for the federal government.
By November, Mr Muhyiddin admitted that the Sabah state elections was the cause of the third wave of COVID-19 infections in the country.
He was speaking during an address on national television, making the case for why he wanted to postpone the Dec 5 by-election for Batu Sapi, a parliamentary constituency in Sabah.
Mr Muhyiddin highlighted that although the Election Commission had set strict health protocols for the Sabah State Election, compliance was very weak.
He added that the number of cumulative cases in the state was 808 on nomination day on Sept 12, increasing by 91.5 per cent to 1,547 cases on polling day on Sept 26.
Four weeks later on Oct 24, Sabah recorded 11,285 cumulative cases, becoming the first state in the country to record more than 10,000 cases.
On the ground to witness this alarming development was Dr Sean Thum, who serves in the psychiatry team at Hospital Sultan Ismail in Johor Bahru.
As the cases spiked in Sabah, the Health Ministry asked for volunteers who were willing to be deployed to Borneo. Dr Thum, who had earlier served as a COVID frontliner during phase 2 in Johor Bahru, did not hesitate.
He was deployed to a low-risk quarantine and treatment centre in Tuaran, Sabah from October until December 2020, and he recalled seeing how the pandemic spread.
“On the first day I arrived, I went to a supermarket to get some groceries. This was already when the number of cases in Sabah was in the thousands, but people were walking around not wearing masks. Two weeks later, that supermarket became a cluster,” recalled Dr Thum.
Meanwhile at the treatment centre, although the situation was still “manageable”, he said the workload increased and he felt drained after each shift.
“Every day when we saw the daily numbers being announced for Sabah, we got a sinking feeling,” said Dr Thum.
“Psychologically we felt overwhelmed, but we knew that whatever the situation was, we had to get the job done.”
The third wave of infections sparked public outcry against the politicians.
Many Malaysians were unhappy with how the third wave was triggered by an election deemed as a political move to consolidate power, during a period when the country already had an upper hand over the spread of the virus.
Advertising executive Hany Zainal Abidin, who tested positive for COVID-19 in January this year said that the Sabah State Elections should have been held at a later time, when the situation was more stable.
After she tested positive, Ms Hany was sent to recover at Malaysia Agro Exposition Park Serdang (MAEPS), a quarantine facility. During her time in MAEPS, she recalled how frontliners would work hours to ensure patients were cared for.
However, she maintained that all this could have been avoided if the Sabah State Elections were not held hastily.
She said: “We blame (the third wave) on them, on the government. They should have waited for things to be under control before allowing hundreds of people to gather (for campaigning and voting) in Sabah.
“But things have already happened and it spread as quickly as common flu. They should not have done it,” added Ms Hany.
Auditor Farhan Iqbal shared similar sentiments. The 29-year-old newly-wed, who is based in Selangor, tested positive for COVID-19 in January, days after returning from his honeymoon in Langkawi.
He said: “We were doing so well and one decision announced at a press conference (to trigger the Sabah State Election) made us slip back.”
“It’s quite frustrating to see how bad the situation we have gotten ourselves into – with 4,000 to 5,000 daily cases being a norm. The government could have done better,” added Mr Farhan.
MIGRANT WORKER CLUSTERS
As cases started to spread to the peninsula, clusters started forming among workplaces and dormitories of foreign migrant workers in the Klang Valley.
Glove maker Top Glove made global headlines after the Malaysian government announced in December that it opened 19 investigation papers into six subsidiaries of the company over offences involving workers’ dormitories.
The world’s largest manufacturer of rubber gloves initially benefited from the pandemic due to the surge in demand for medical supplies.
However, it later suffered as the dormitories were later identified as epicentre of infections in the area.
The government later placed some of these areas under Enhanced MCO to curb the spread of infections.
Some media reports claimed that Top Glove, in its frenzied efforts to boost its supply of protective equipment, failed to adequately protect its own workers from the coronavirus.
Nepalese national Yubaraj Khadka, one of Top Glove’s workers in Malaysia, was sacked after took two photos in May of fellow employees crowding into a factory.
The photos showed dozens of workers lined up less than a metre apart to have their temperatures checked before starting the night shift.
Dr Zainal Ariffin that such workplace-related clusters should be given “special attention” to prevent the situation from worsening.
He called on the authorities to ensure that factories and dormitories have an environment that is safe, hygienic and enables social distancing.
“Premises that are not suitable for living or working should be closed. The government must play a larger role in doing a risk assessment and undertake preventive actions to pre-empt the issues,” added Dr Zainal Ariffin.
MCO 2.0: BALANCING PUBLIC HEALTH AND THE ECONOMY
One issue that has puzzled Malaysians during this third wave is the implementation of MCO 2.0, which was initially enforced in January for all states in the country except Sarawak.
Unlike the first MCO which was implemented in March last year, the restrictions imposed under MCO 2.0 were seen as being more lenient.
MCO 2.0 saw more economic sectors allowed to continue functioning, such as the automotive sector and retailers like gold and jewellery shops. Residents could also dine in at restaurants and visit night markets.
Since MCO 2.0 was enforced in January, Malaysia has continued to battle consistent four-digit daily increases in COVID-19 cases.
Ms Hany, who is based in Selangor, told CNA that she felt the first MCO was more effective, as the tighter restrictions led to lower infectivity rates and the number of daily cases eventually dropped to single digits.
“Currently we are under MCO but it’s not really a total lockdown so it’s a bit confusing,” she said.
“I understand that it’s a decision made keeping in mind our economy, but I think most Malaysians wish that the restrictions could be tighter for now. The numbers are dropping, but we hope it’ll go lower before loosening restrictions,” added Ms Hany.
Dr Zainal Ariffin noted that the government is trying to strike a balance between keeping the economy functioning and mitigating the spread of the virus.
However, he fears that being in two minds would mean that the pandemic would take longer to be eradicated at the grassroots level.
“On one hand, it is good because the economy is open. But on the other hand, the number of cases are still very high. The government needs to focus on the latter first, because the (lack of) restrictions during MCO 2.0 are leaving many confused,” he added.
While some Malaysians are keen for the government to tighten health restrictions during MCO, others, especially those struggling to cope with the current economic situation, are hoping for more leeway.
Even though some sectors are open during MCO 2.0, others like tourism and mass events still remain shut.
Mr Ahmad Khalid Zainal, a freelance wedding photographer based in Hulu Langat, Selangor, said that he is desperate for the government to loosen restrictions and allow wedding banquets to be allowed, albeit on a smaller scale.
“It has been a struggle for me over the last year. My wife and I are forced to do odd jobs like sell finger food, fix computers and so on,” said the 30-year-old.
“We are barely making it. I know the government wants to restrict mass gatherings but for some of us, it’s our livelihood,” he added.
Responding to CNA’s queries, Dr Norhayati Rusli, the director of the Health Ministry’s disease control division noted that there needs to be a balance between “overcoming COVID-19 and restoring the economy before irreparable damage is caused”.
“A prolonged MCO is economically not sustainable, but a premature lifting of the MCO before the disease transmission is under control can backfire with a new wave of infection greater than the previous one,” Dr Norhayati said.
“This leaves slippery middle ground of easing of certain public health measures in a controlled manner (or as much as control as there can be) and slowly releasing the brakes on the economy.”
She acknowledged that at this point of the pandemic, people are tired of being cooped up at home due to restrictions. However, Dr Norhayati stressed that it is key for Malaysia residents to continue complying with the health protocols.
“People are experiencing a type of burnout that experts are calling the pandemic fatigue, which can lead to careless behaviours and a sharp rise in cases.” she said.
“Nevertheless, the most important thing is not to give up. The COVID-19 pandemic isn’t going away anytime soon. Therefore accepting this new reality and staying committed to good habits as a new normal are very critical to prevent COVID-19 infection,” added Dr Norhayati.
THIRD WAVE STRAINS HEALTHCARE RESOURCES
The situation was made worse for Mr Ahmad Khalid, the photographer, recently when he tested positive for COVID-19.
In late January, he had symptoms such as fatigue, chills and a headache, and decided to go to a government clinic to get tested.
After a few days, the clinic called to inform him that he was positive for COVID-19.
Mr Ahmad Khalid said he was hoping at that point to be hospitalised or taken to a quarantine centre, but he was told by a health ministry officer over the phone to stay at home instead and isolate himself from his loved ones.
“I was worried because I did not want to risk infecting my wife and young son. They were negative (for COVID-19) and I did not want them to be sick too,” said Mr Ahmad Khalid.
Mr Ahmad Khalid tested positive shortly after Health Minister Adham Baba announced in January that COVID-19 patients who are asymptomatic or have mild symptoms, will undergo treatment and quarantine at home, monitored by health workers.
This preceded Mr Muhyiddin’s admission, during a televised address, that the country’s public health system was at a breaking point, and that more than 15 of the country’s public hospitals were nearing full capacity.
Recovering from COVID-19 at home was not all bad for some patients.
Mr Farhan, the auditor who tested positive when returning from his honeymoon in Kedah, was also asked to isolate himself at home as he had mild symptoms.
He said that initially there was a sense of frustration as he did not have the same access to medical care as some of the other patients who were hospitalised.
However, his family eventually coped with the restrictions and came up with their own system to ensure that those who tested negative were not infected.
Mr Farhan said that besides him, his mother and sister tested positive for COVID-19 but his wife and the rest of the family members were fine. The three of them had to be isolated in three bedrooms and were not able to access the rest of the house.
“The challenge was trying to figure out how to manage interactions. For instance, food would be delivered to the bedroom doors and after we were done eating, all the cutlery had to be washed inside and sprayed with disinfectant before putting them outside,” said Mr Farhan.
“There were a lot of things we had to figure out by ourselves, such as when were we allowed to leave our rooms. So we decided that after we had been isolated for 10 days and were symptom-free, we would leave because I read that the patient would no longer be infectious,” he added.
The Health Ministry reportedly said on Feb 17 that with active COVID-19 cases decreasing, hospitals suffering from overcapacity are becoming less of a problem.
Dr Noor Hisham also said bed occupancy at hospitals as well as COVID-19 quarantine centres fell within the first two weeks of February.
“The bed occupancy for COVID-19 patients at hospitals has dropped to 47 per cent, and at quarantine centres, to 37 per cent,” he reportedly said.
Dr Koh, the frontliner based in Permai hospital, a COVID-19 treatment centre in Johor, told CNA that this new strategy to place COVID-19 patients at home was a positive move, as it would reduce the workload of the healthcare workers.
“It is a more systematic way of doing things. It’s completely fine for patients with no symptoms or mild symptoms to stay at home, with Ministry of Health officers in close contact with them to ensure they are monitored and keeping well,” he added.
Ms Nazihah of the Khazanah Research Institute noted that the health ministry’s efforts in contact tracing was effective in combating the first and second waves of infections. However, she noted that when the daily new cases started to rise to 4-digit levels in the third wave, the system “started to get overwhelmed”.
“MySejahtera is supposed to help facilitate contact tracing, but towards the end of last year, reports emerged that contact tracers weren’t able to take the time to sift through the MySejahtera database to find close contacts. So they ended up relying more on manual interviews of people who have tested positive,” said Ms Nazihah.
“But this too is very time consuming, especially when there are thousands of new cases every day with thousands of potential close contacts,” she added.
Commenting on how the MySejahtera app has assisted the government, Dr Norhayati of the Health Ministry said it is an avenue for users to conduct their own health self-assessment to analyse their risk of being infected by COVID-19, and its database serves as a tool for district health offices to do contact tracing.
“Users who are potential close contacts to confirmed COVID-19 cases can be traced through this app,” she said.
Moreover, she said that as of Feb 18, the total number of confirmed COVID-19 cases detected through the use of the app was 127,644.
She cited how it was used when tackling the Utama cluster – an outbreak at Selangor’s 1 Utama shopping mall in October.
More than 450 individuals were confirmed as close contacts to positive cases at the mall, and subsequent testing detected 221 confirmed cases.
NATIONAL VACCINATION PROGRAMME INJECTS HOPE
Looking ahead, there is optimism within the community that Malaysia will prevail against COVID-19.
On Wednesday, Mr Muhyiddin and Dr Noor Hisham, alongside some health frontliners, were among the first in Malaysia to receive the COVID-19 vaccine.
The national COVID-19 immunisation programme, which kicked off on Feb 24, is expected to vaccinate at least 80 per cent of its 32 million people within a year.
The programme outlines that this will be conducted in three phases – the first phase involving politicians and frontline staff, the second phase involving high risk groups like the elderly and those suffering from chronic conditions, and lastly the third phase, for all adults aged 18 and above.
In a recent Facebook post, Dr Noor Hisham referred to the arrival of the COVID-19 vaccine in Malaysia as a “historical” moment, and one that could spark a turnaround in the battle against the coronavirus.
“It’s a new dawn, a new frontier, (a) different battlefront and additional strategy to fight against the virus, giving a glimmer of hope to see the light at the end of the tunnel,” he wrote.
Dr Norhayati added: “When at least 70 to 80 per cent of the population are vaccinated, the population immunity is high enough to make it even harder for the virus to find a susceptible person. This is what we term as herd immunity.”
“Once herd immunity is achieved, as a large proportion of the population is protected, virus transmission can be reduced, and this will in turn reduce disease incidence … Herd immunity will enable us to also protect those who are not suitable to be vaccinated, such as babies and children from COVID-19 disease,” she said.
Frontliner Dr Koh is looking forward to receiving the vaccine to protect himself and loved ones. But more importantly for him, it is the start of a journey that will drive down the number of COVID-19 cases in the country.
“We’ve already seen how the vaccine is taking effect in countries like the United States and United Kingdom,” said Dr Koh.
“When we roll them out, I hope Malaysia will follow in their footsteps and eventually, we will be COVID-free soon,” he added.