scholarly journals COVID-19 Epidemic in Malaysia: Epidemic Progression, Challenges, and Response

2021 ◽  
Vol 9 ◽  
Author(s):  
Jamal Hisham Hashim ◽  
Mohammad Adam Adman ◽  
Zailina Hashim ◽  
Mohd Firdaus Mohd Radi ◽  
Soo Chen Kwan
Keyword(s):  
Communicable Disease ◽  
Heart Diseases ◽  
Nipah Virus ◽  
Herd Immunity ◽  
Case Fatality ◽  
Movement Control ◽  
Vulnerable Groups ◽  
Contact Tracing ◽  
Successful Implementation ◽  
Hospital System

COVID-19 pandemic is the greatest communicable disease outbreak to have hit Malaysia since the 1918 Spanish Flu which killed 34,644 people or 1% of the population of the then British Malaya. In 1999, the Nipah virus outbreak killed 105 Malaysians, while the SARS outbreak of 2003 claimed only 2 lives. The ongoing COVID-19 pandemic has so far claimed over 100 Malaysian lives. There were two waves of the COVID-19 cases in Malaysia. First wave of 22 cases occurred from January 25 to February 15 with no death and full recovery of all cases. The ongoing second wave, which commenced on February 27, presented cases in several clusters, the biggest of which was the Sri Petaling Tabligh cluster with an infection rate of 6.5%, and making up 47% of all cases in Malaysia. Subsequently, other clusters appeared from local mass gatherings and imported cases of Malaysians returning from overseas. Healthcare workers carry high risks of infection due to the daily exposure and management of COVID-19 in the hospitals. However, 70% of them were infected through community transmission and not while handling patients. In vulnerable groups, the incidence of COVID-19 cases was highest among the age group 55 to 64 years. In terms of fatalities, 63% were reported to be aged above 60 years, and 81% had chronic comorbidities such as diabetes, hypertension, and heart diseases. The predominant COVID-19 strain in Malaysia is strain B, which is found exclusively in East Asia. However, strain A, which is mostly found in the USA and Australia, and strain C in Europe were also present. To contain the epidemic, Malaysia implemented a Movement Control Order (MCO) beginning on March 18 in 4 phases over 2 months, ending on May 12. In terms of economic impacts, Malaysia lost RM2.4 billion a day during the MCO period, with an accumulated loss of RM63 billion up to the end of April. Since May 4, Malaysia has relaxed the MCO and opened up its economic sector to relieve its economic burden. Currently, the best approach to achieving herd immunity to COVID-19 is through vaccination rather than by acquiring it naturally. There are at least two candidate vaccines which have reached the final stage of human clinical trials. Malaysia's COVID-19 case fatality rate is lower than what it is globally; this is due to the successful implementation of early preparedness and planning, the public health and hospital system, comprehensive contact tracing, active case detection, and a strict enhanced MCO.

scholarly journals Experiential learnings from the Nipah virus outbreaks in Kerala towards containment of infectious public health emergencies in India

2020 ◽  
Vol 148 ◽  
Author(s):  
Rima R. Sahay ◽  
Pragya D. Yadav ◽  
Nivedita Gupta ◽  
Anita M. Shete ◽  
Chandni Radhakrishnan ◽  
...  
Keyword(s):  
State Government ◽  
Single Case ◽  
Point Of Care ◽  
Nipah Virus ◽  
Case Fatality ◽  
Control Measures ◽  
Contact Tracing ◽  
Effective Control ◽  
Hospital Infection Control ◽  
Kerala State

Abstract Nipah virus (NiV) outbreak occurred in Kozhikode district, Kerala, India in 2018 with a case fatality rate of 91% (21/23). In 2019, a single case with full recovery occurred in Ernakulam district. We described the response and control measures by the Indian Council of Medical Research and Kerala State Government for the 2019 NiV outbreak. The establishment of Point of Care assays and monoclonal antibodies administration facility for early diagnosis, response and treatment, intensified contact tracing activities, bio-risk management and hospital infection control training of healthcare workers contributed to effective control and containment of NiV outbreak in Ernakulam.

scholarly journals A COVID-19-Based Modified Epidemiological Model and Technological Approaches to Help Vulnerable Individuals Emerge from the Lockdown in the UK

Sensors ◽  
2020 ◽  
Vol 20 (17) ◽  
pp. 4967 ◽  
Author(s):  
Dario Ortega Anderez ◽  
Eiman Kanjo ◽  
Ganna Pogrebna ◽  
Omprakash Kaiwartya ◽  
Shane D. Johnson ◽  
...  
Keyword(s):  
Case Fatality ◽  
The Elderly ◽  
Vulnerable Groups ◽  
Contact Tracing ◽  
Smartphone Apps ◽  
Epidemiological Models ◽  
Mean Values ◽  
Vulnerable People ◽  
Severity Of The Disease ◽  
The Uk

COVID-19 has shown a relatively low case fatality rate in young healthy individuals, with the majority of this group being asymptomatic or having mild symptoms. However, the severity of the disease among the elderly as well as in individuals with underlying health conditions has caused significant mortality rates worldwide. Understanding this variance amongst different sectors of society and modelling this will enable the different levels of risk to be determined to enable strategies to be applied to different groups. Long-established compartmental epidemiological models like SIR and SEIR do not account for the variability encountered in the severity of the SARS-CoV-2 disease across different population groups. The objective of this study is to investigate how a reduction in the exposure of vulnerable individuals to COVID-19 can minimise the number of deaths caused by the disease, using the UK as a case study. To overcome the limitation of long-established compartmental epidemiological models, it is proposed that a modified model, namely SEIR-v, through which the population is separated into two groups regarding their vulnerability to SARS-CoV-2 is applied. This enables the analysis of the spread of the epidemic when different contention measures are applied to different groups in society regarding their vulnerability to the disease. A Monte Carlo simulation (100,000 runs) along the proposed SEIR-v model is used to study the number of deaths which could be avoided as a function of the decrease in the exposure of vulnerable individuals to the disease. The results indicate a large number of deaths could be avoided by a slight realistic decrease in the exposure of vulnerable groups to the disease. The mean values across the simulations indicate 3681 and 7460 lives could be saved when such exposure is reduced by 10% and 20% respectively. From the encouraging results of the modelling a number of mechanisms are proposed to limit the exposure of vulnerable individuals to the disease. One option could be the provision of a wristband to vulnerable people and those without a smartphone and contact-tracing app, filling the gap created by systems relying on smartphone apps only. By combining very dense contact tracing data from smartphone apps and wristband signals with information about infection status and symptoms, vulnerable people can be protected and kept safer.

A Modified Epidemiological Model to Understand the UnevenImpact of COVID-19 on Vulnerable Individuals and theApproaches Required to Help them Emerge from Lockdown (Preprint)

2020 ◽  
Author(s):  
Eiman Kanjo ◽  
Dario Anderez Ortega ◽  
John Hunt ◽  
Shane Johnson ◽  
Ganna Pogrebna
Keyword(s):  
Case Fatality ◽  
The Elderly ◽  
Vulnerable Groups ◽  
Contact Tracing ◽  
Epidemiological Models ◽  
Modified Model ◽  
Severity Of The Disease ◽  
Different Levels ◽  
Modified Epidemiological Model ◽  
Significant Mortality

UNSTRUCTURED COVID-19 has shown a relatively low case fatality rate in young healthy individuals, with the majority of this group being asymptomatic or having mild symptoms. However, the severity of the disease among the elderly as well as in individuals with underlying health conditions has caused significant mortality rates worldwide. Understanding this variance amongst different sectors of society and modelling this will enable the different levels of risk to be determined to enable strategies to be applied to different groups. Long established compartmental epidemiological models like SIR and SEIR do not account for the variability encountered in the severity of the SARS-CoV-2 disease across different population groups. To overcome this limitation, it is proposed that a modified model, namely SEIR-v, through which the population is separated into two groups regarding their vulnerability to SARS-CoV2 is applied. This enables the analysis of the spread of the epidemic when different contention measures are applied to different groups in society regarding their vulnerability to the disease. A Monte Carlo simulation adopting the proposed SEIR-v model indicates a large number of deaths could be avoided by slightly decreasing the exposure of vulnerable groups to the disease. From this modelling a number of mechanisms are proposed to limit the exposure of vulnerable individuals to the disease in order to reduce the mortality rate among this group. One option could be the provision of a wristband to vulnerable people and those without a smartphone and contact-tracing app, filling the gap created by systems relying on smartphone apps only.

scholarly journals Vaccine Prioritisation Using Bluetooth Exposure Notification Apps

2021 ◽  
Author(s):  
Mark Penney ◽  
Yigit Yargic ◽  
Lee Smolin ◽  
Edward Thommes ◽  
Madhur Anand ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Workers ◽  
Percolation Theory ◽  
Herd Immunity ◽  
Vulnerable Groups ◽  
Contact Tracing ◽  
Care Workers ◽  
Contact Data ◽  
Total Exposure Time ◽  
Individual Contact

Abstract After vaccinating health care workers and vulnerable groups against COVID-19, authorities will need to decide how to vaccinate everyone else. Prioritising individuals with more contacts can be disproportionately effective, in theory, but identifying these individuals is difficult. Here we show that the technology underlying Bluetooth exposure notification applications, such as used for digital contact tracing, can be leveraged to prioritise vaccination based on individual contact data. Our approach is based on the insight that these apps also act as local sensing devices measuring each user's total exposure time to other users, thereby enabling the implementation of a previously impossible strategy that prioritises potential super-spreaders. Furthermore, by generalising percolation theory and introducing a novel measure of vaccination efficiency, we demonstrate that this ``hot-spotting" strategy can achieve herd immunity with up to half as many vaccines as a non-targeted strategy, and is attractive even for relatively low rates of app usage.

scholarly journals Vaccine Prioritisation Using Bluetooth Exposure Notification Apps

2020 ◽  
Author(s):  
Mark D Penney ◽  
Yigit Yargic ◽  
Lee Smolin ◽  
Edward W Thommes ◽  
Madhur Anand ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Workers ◽  
Percolation Theory ◽  
Herd Immunity ◽  
Vulnerable Groups ◽  
Contact Tracing ◽  
Care Workers ◽  
Contact Data ◽  
Total Exposure Time ◽  
Individual Contact

After vaccinating health care workers and vulnerable groups against COVID-19, authorities will need to decide how to vaccinate everyone else. Prioritising individuals with more contacts can be disproportionately effective, in theory, but identifying these individuals is difficult. Here we show that the technology underlying Bluetooth exposure notification applications, such as used for digital contact tracing, can be leveraged to prioritise vaccination based on individual contact data. Our approach is based on the insight that these apps also act as local sensing devices measuring each user’s total exposure time to other users, thereby enabling the implementation of a previously impossible strategy that prioritises potential super-spreaders. Furthermore, by generalising percolation theory and introducing a novel measure of vaccination efficiency, we demonstrate that this “hot-spotting” strategy can achieve herd immunity with up to half as many vaccines as a non-targeted strategy, and is attractive even for relatively low rates of app usage.

scholarly journals Role of efficient testing and contact tracing in mitigating the COVID-19 pandemic: a network modelling study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e045886
Author(s):  
Yiying Hu ◽  
Jianying Guo ◽  
Guanqiao Li ◽  
Xi Lu ◽  
Xiang Li ◽  
...  
Keyword(s):  
Real World ◽  
Case Fatality ◽  
Contact Tracing ◽  
Secondary Outcome ◽  
Time Interval ◽  
Fatality Rate ◽  
Real World Data ◽  
Network Modelling ◽  
World Data ◽  
Quantitative Evidence

ObjectivesThis study quantified how the efficiency of testing and contact tracing impacts the spread of COVID-19. The average time interval between infection and quarantine, whether asymptomatic cases are tested or not, and initial delays to beginning a testing and tracing programme were investigated.SettingWe developed a novel individual-level network model, called CoTECT (Testing Efficiency and Contact Tracing model for COVID-19), using key parameters from recent studies to quantify the impacts of testing and tracing efficiency. The model distinguishes infection from confirmation by integrating a ‘T’ compartment, which represents infections confirmed by testing and quarantine. The compartments of presymptomatic (E), asymptomatic (I), symptomatic (Is), and death with (F) or without (f) test confirmation were also included in the model. Three scenarios were evaluated in a closed population of 3000 individuals to mimic community-level dynamics. Real-world data from four Nordic countries were also analysed.Primary and secondary outcome measuresSimulation result: total/peak daily infections and confirmed cases, total deaths (confirmed/unconfirmed by testing), fatalities and the case fatality rate. Real-world analysis: confirmed cases and deaths per million people.Results(1) Shortening the duration between Is and T from 12 to 4 days reduces infections by 85.2% and deaths by 88.8%. (2) Testing and tracing regardless of symptoms reduce infections by 35.7% and deaths by 46.2% compared with testing only symptomatic cases. (3) Reducing the delay to implementing a testing and tracing programme from 50 to 10 days reduces infections by 35.2% and deaths by 44.6%. These results were robust to sensitivity analysis. An analysis of real-world data showed that tests per case early in the pandemic are critical for reducing confirmed cases and the fatality rate.ConclusionsReducing testing delays will help to contain outbreaks. These results provide policymakers with quantitative evidence of efficiency as a critical value in developing testing and contact tracing strategies.

scholarly journals 1787. The Effects of a Systemwide Diagnostic Stewardship Change on West Nile Virus Disease Ordering Practices

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S658-S658
Author(s):  
Andrew H Karaba ◽  
Paul W Blair ◽  
Kevin M Martin ◽  
Mustapha O Saheed ◽  
Karen C Carroll ◽  
...  
Keyword(s):  
West Nile Virus ◽  
Virus Disease ◽  
Case Fatality ◽  
Cost Savings ◽  
Primary Objective ◽  
Neurological Deficits ◽  
West Nile ◽  
Hospital System ◽  
Elisa Testing ◽  
Before And After

Abstract Background Neuroinvasive West Nile Virus (WNV) often leads to prolonged neurological deficits and carries a high case fatality rate. The CSF IgM (MAC-ELISA) is preferred over the CSF nucleic acid-based test (NAAT) by the CDC due to its higher sensitivity. However, our hospital system was observed to have an over-utilization of NAAT testing compared with MAC-ELISA testing. The primary objective was to compare the number of MAC-ELISA and NAAT WNV tests ordered before and after a diagnostic stewardship intervention. The secondary objectives were to determine whether this change to lead to any cost savings and increased detection of probable cases of WNV-ND. Methods In an effort to increase the use of the MAC-ELISA and to decrease unnecessary NAAT testing, the NAAT test was removed in April 2018 from the test menu in the electronic health record of a health system comprising five hospitals in the Maryland and Washington, D.C. area. NAAT testing remained possible via a paper order form. This study was a retrospective review of WNV testing done on CSF samples from July 2016 through December 2018. The seasonal and yearly number of total tests, positive tests, and total costs were determined from the period of July, 2017 to April, 2018 and were compared with May, 2018 to January, 2019. A paired t-test was performed to evaluate for differences in total testing, total positives, and total costs during non-winter months before and after the intervention. Results A total of 12.59 MAC-ELISA tests/month (95% CI: 10.29, 14.89) increased to 41 tests/month (95% CI: 34.35, 47.65) which was significantly different (P < 0.001). In contrast, there were 46.23 NAAT tests/month (95% CI: 39.55, 52.91) which decreased to 0 NAAT tests/month after the intervention (P < 0.001). This resulted in an average decrease in WNV test spending from $7200 per month to $471 per month (P < 0.001). Preceding the intervention in test ordering, 0.23% of WNV CSF tests were positive (NAAT+MAC-ELISA) while 2.44% WNV CSF tests were positive after the intervention (P = 0.03). Conclusion Elimination of electronic WNV NAAT ordering is an effective way of decreasing inappropriate WNV NAAT testing, decreasing associated costs, and may lead to improved diagnosis of WNV-ND. Disclosures All authors: No reported disclosures.

Malaysian Enhanced Movement Control Order (EMCO): a unique and impactful approach to combating pandemic COVID-19

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Mohd Rohaizat Hassan ◽  
Mohd Nizam Subahir ◽  
Linayanti Rosli ◽  
Shaharom Nor Azian Che Mat Din ◽  
Nor Zaher Ismail ◽  
...  
Keyword(s):  
Total Population ◽  
Case Fatality ◽  
Movement Control ◽  
Essential Elements ◽  
Effective Measure ◽  
Content Type ◽  
Wedding Ceremony ◽  
Control Order ◽  
Targeted Approach ◽  
Close Contacts

PurposeThe paper highlights the process-handling during the Enhanced Movement Control Order (EMCO) in combating pandemic COVID-19 in Malaysia.Design/methodology/approachMalaysia first issued an EMCO following a cluster that involved a religious gathering. The EMCO was issued to lockdown the area, undertake screening, treat positive cases and quarantine their close contacts. Active case detection and mass sampling were the main activities involving the population in both zones.FindingsOne hundred ninety-three confirmed COVID-19 cases were identified from the total population of 2,599. Of these cases, 99.5% were Malaysians, 31.7% were aged >60 years and all four deaths (Case Fatality Rate, 2.1%) were elderly people with comorbidities. One hundred and one cases (52.3%) were asymptomatic, of which 77 (77%) were detected during mass sampling. The risk factors contributing to the outbreak were contacts that had attended the religious gathering, regular mosque congregants, wedding ceremony attendees and close household contacts. Malaysia implemented an effective measure in the form of the EMCO to contain the COVID-19 outbreak, where the last cases were reported 16 days before the EMCO was lifted.Originality/valueThe residents’ compliance and inter-agency cooperation were essential elements to the success of the EMCO. A targeted approach using an EMCO should be implemented in a future pandemic.

Abstract 12259: Epidemiology of Valvular Heart Diseases: A 30-Year Retrospective of Hospitalizations and In-Hospital Mortality in New York State

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Phyllis G Supino ◽  
Ofek Y Hai ◽  
Nasimullah Khan ◽  
Jeffrey S Borer
Keyword(s):  
New York ◽  
Heart Diseases ◽  
New York State ◽  
Temporal Trends ◽  
Case Fatality ◽  
Female Gender ◽  
York State ◽  
Death Risk ◽  
Valvular Heart Diseases ◽  
Rate Of Increase

Background: Valvular heart disease (VHD) is among the most predictable causes of heart failure (HF) and an important cause of sudden death. Temporal trends of clinically significant VHD during the past three decades have not been defined. Methods: To obtain information for our region, we conducted a longitudinal analysis of all inpatient hospital records (79,689,879) obtained from the New York State (NYS) Statewide Planning and Research Cooperative System (SPARCS) database for years 1983 (first year reliable data were consistently available) through 2012 (last year data were complete). VHD cases (2,720,313) were identified from principal or secondary ICD-9 codes for aortic, mitral, tricuspid or pulmonic VHD. Linear regression was used to evaluate trends over time for VHD hospitalizations, valve surgery (VS) and in-hospital deaths. Logistic regression was used to predict mortality risk factors. Results: From 1983-2012, total hospitalizations decreased by ~500,000 cases; simultaneously, VHD hospitalizations increased markedly (34,395 in 1983 to 125,139 in 2012). Rate of increase was linear across all VHD categories = 4,248 new cases (12.4%)/yr, r 2 = 0.99, p<.0001) through 2006 (peak= 132,323 cases), and then flattened through 2012. A parallel trend was found for VS, though no appreciable flattening occurred (2,582 cases in 1983 to 7,787 in 2012, linearized increase rate=207 VS [8.0%]/yr, r 2 =0.97, p<.001). Both numbers of hospitalizations and performance of VS rose with patient age (p<.001). Over the study interval, 123,787 patients with VHD died in the hospital, including 9,272 who died after VS; avg case fatality rates were 4.6% (all VHD) and 6.4% (VS). Deaths were independently associated with advancing age, nonelective admission and presence of associated HF (p<.0001, all). Male gender predicted increased death risk among the general VHD population; female gender predicted death risk among those undergoing VS. Conclusions: The incidence of VHD hospitalization and VS in NYS has risen substantially since the early 1980s and can be expected to rise further as the population ages. Thus, intensive planning is needed to deal with public health implications of these trends as we attempt to meet the growing needs of this patient population.

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