Penang needs to act quickly in its fight against Covid-19 to avoid experiencing what the Klang Valley went through over the last few months with the pandemic showing no signs of abating, a virologist warned.

Universiti Sains Malaysia's Infectomics Cluster, Advanced Medical and Dental Institute senior lecturer Dr Kumitaa Theva Das said once Penang hit 100 per cent of its intensive care unit (ICU)-bed capacity, it was a sign that the state should get help.

On Aug 4, it was reported that the use of ICU beds at Covid-19 hospitals in Penang was nearing 100 per cent due to the sharp increase in cases in recent weeks, prompting the health authorities to rearrange the state's healthcare facilities to cope with the rising number of cases.

Over the past week, the state had been recording more than 1,000 positive Covid-19 cases on a daily basis, with more than 40 per cent of hospital admissions comprising patients in categories 3 and 5. 

Dr Kumitaa said Penang would continue to see an increase in daily Covid-19 cases at least until more people had been vaccinated. However, she said, as Penang saw less movement compared with the Klang Valley, the cases in the state would most likely not be as high.

"Two weeks ago, when Penang's Covid-19 cases were averaging 600 to 700 a day, it was reported that at least one hospital had its patients with follow-ups referred to other clinics in the state, as the outpatient clinic was recently turned into an observation and early treatment ward for Covid-19 patients to accommodate the rising number of cases.At that point, it was an indicator that we had to be prepared.

"With Penang averaging 1,200 to 1,300 cases a day for the past week, our hospitals are pushed to the brink," Dr Kumitaa told the New Straits Times.

She said the surge in cases in Penang was largely due to factories, sporadic cases and more people opting for the Rapid Antigen Test (67.33 per cent), which has a quicker turna-round time than the polymerase chain reaction test.

She also pointed out that for states outside the Klang Valley, including Penang, the vaccination rates were not as high (only 39.3 per cent have completed the second dose in Penang).

She said when the Klang Valley saw a surge in cases, the Greater Klang Valley Special Task Force was set up to contain the pandemic. This effort, she said, played a huge role in what seemed to be a plateauing of cases in the Klang Valley.

Among the efforts taken were the redeployment of healthcare resources such as increasing the capacity of beds, ICU care, oxygen supply and manpower deployment.

The use of volunteers, as well as the movement of non-Covid-19 patients to private hospitals also helped to free up beds, she said, adding that the military also lent its assistance.

"Then, there is the ramping up of vaccination under Operation Surge Capacity, where vaccination rates were boosted in the Klang Valley. Some 71.2 per cent of the population in the Klang Valley completed their second dose, which decreased hospital admissions and usage of ICU beds.

"Other efforts included strengthening the Covid-19 Assessment Centres (CACs) by offering virtual CACs for asymptomatic and mildly symptomatic patients, allocating funding to procure additional medical equipment, public health measures such as improving communication with the public on critical issues and keeping the public updated through Github by the Health Ministry."

Penang, she said, should emulate those measures.

"We went from about 200 cases to 1,800 in a month. The average daily deaths increased from one case a day to more than 10 in that same duration.

"We also reportedly exceeded 100 per cent of our ICU bed occupancy. We need to ensure that our vaccination rate is uninterrupted and good public health initiatives are put in place to prevent this trend from continuing."

Dr Kumitaa said the increase in high-risk cases indicated that the authorities needed to increase bed capacity, ICU care, oxygen supply, manpower and volunteers.

"Recent initiatives included moving non-Covid-19 patients to private hospitals to free up beds. There has also been tremendous support from the military, including building a field ICU in Kepala Batas.

"We can also convert existing facilities into makeshift centres, similar to the state Health Department turning the Caring Society Complex (previously a vaccination centre) into a treatment and quarantine centre to cope with the cases."

Dr Kumitaa said more than 90 vaccine efficacy (VE) studies had been conducted globally and made publicly available in peer-reviewed literature.

In general, she said, the studies showed that regardless of the vaccine type, the VE was 80 to 90 per cent effective against severe diseases, hospitalisation and death.

"What this means is that the higher vaccination rates will translate to a drop in hospitalisation and ICU cases (categories 3, 4 and 5), which is what we are seeing in the Klang Valley now.

"Their categories 3, 4 and 5 cases should continue dropping in the next few weeks and this is supported by trends seen in countries worldwide with similar vaccination rates.

"In comparison, only 39.3 per cent of Penangites are fully vaccinated. Those unvaccinated have a 25-fold higher risk of being hospitalised.

"But it is not just our vaccination rate that we should look at. Public healthcare measures such as find-test-trace-isolate-support is also important, especially when there is a large percentage of sporadic cases. Many don't even realise that they have been infected until they get tested."

Dr Kumitaa said Labuan (which has completed 99.4 per cent first dose and 89.7 per cent second dose), which had the highest vaccination rate in the country, was a prime example of how it could be achieved.

In June, she said, Labuan had around 1,000 new cases a week per 100,000 people. At that time, the prevalent strain was also the Delta variant, making the cases more transmissible.

"However, the response of getting everyone vaccinated as quickly as possible turned things around. They were administered Pfizer and Sinovac vaccines, which served as proof that regardless of the type of vaccine given, they were all the protective," she said.

Now, cases in Labuan are in the single digits, with an R0 of zero.

"The hope is that we (Penang) will get there soon too. While vaccinations would reduce high-risk cases, to tackle sporadic cases, we can try to protect ourselves as much as we can.

"Self-test after returning from a high-risk area if we think that we have been exposed or before we meet anyone who is unvaccinated. This is easier now with self-test kits.

"Use an oximeter to monitor oxygen levels. With the Delta variant, because of the viral load which is 1,000-fold higher compared with the original strain, an infection may cause a sudden drop in oxygen levels, so monitoring ourselves enables us to get help quickly.

"Ensure that we are in a place with proper ventilation. This prevents the virus particles from becoming concentrated in an area for too long and reduces the risk of transmission."

Dr Kumitaa said even with the easing of restrictions recently for those fully vaccinated, many restaurant owners in the state made a safe decision to not allow customers to dine in until all staff were vaccinated.

She added that the state government had also always been quick at making sound decisions based on the current situation to protect the people as best as it could.

https://www.nst.com.my/news/nation/2021/08/720320/penang-must-follow-klang-valley-formula