By Dato' Dr Amar-Singh HSS

Much of the recent focus of the nation 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.

We however may not be aware that other states outside the Klang Valley are gradually slipping into a crisis. If you track the intensive care (ICU) bed use by COVID-19 patients for Perak, Kedah and Penang, as examples, you can see this steep rise in the past 3-4 weeks (see Figure). 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 1-2x as many Category 4 and 5 patients in a non-ICU bed, 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 in the nation. The Delta variant is highly infectious as it has a very high viral load and infects more persons faster. In addition, the fully vaccination rates for many states outside the Klang Valley are lower due to limited vaccine supply. Data for 25th July 2021 shows that completed vaccination rates (two doses) for the states (percentage of the total population) was 14.4% for Perak, 11.5% for Kedah and 14.5% for Penang. 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 3 to 4 week window to act. Some summary suggestions are:

1. Advocate for more vaccine supply and ramp up vaccination to the maximal possible. Leave no vaccine vials in storage. Avoid using large PPVs and instead do drive-by vaccination and use the existing vaccination infrastructure (maternal & 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, especially avoid interstate movement.

3. Use PCR only for hospital admissions and expand dramatically RTK-Ag testing for all contacts, whether symptomatic or well. Enable the public to self-test with the availability of reliable, cheap saliva-based RTK-Ag tests at pharmacies and health centers/GP clinics. The state government should consider investing in subsidizing these tests. Anyone who is RTK-Ag test positive should be considered a case and be isolated and monitored.

4. Activate a state level multi-sectoral disaster team, not unlike the GKVTF. Get the plans in place, teams activated and resources on standby as quickly as possible, so that 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 (decentralized decision making) and supported by state governments. Remember that the federal government have 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 give 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.

(Dato' Dr Amar-Singh HSS is a Senior Consultant Pediatrician.)