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Published by Doo Fahmie, 2022-07-04 23:23:48

INLAY Covid-19 Report 010722

INLAY Covid-19 Report 010722

EDITORIAL BOARD

Advisor : Datuk Dr Hishamshah Mohd Ibrahim
Chief Editor : Dr Ahmad Faudzi bin Yusoff

EDITORS: Dr. Nor Asma Musa
Noral Elissa Ahmad Latffi
Dr. Ahmed Syahmi Syafiq Md Zamri Dr. Nor Zam Azihan Mohd Hassan
Dr. Asrul Anuar bin Zulkifli Datin Dr. Nor Haniza Zakaria
Dr. Asyraf Syahmi Mohd Noor Nursyahda Zakaria
Audrey Lim Huili Nurul Syarbani Eliana Musa
Dr. Balvinder Singh Gill Nuur Hafizah Md Iderus
Dr. Calyn Tan Jen Ai
Cik Ching Yee Ming Dr. Ooi Cheng Lee
Dr. Hanif Zailani Dr. Ravindran A/L Thayan @ Sukumaran
Dr. Jeyanthi Suppiah Ridwan Sanaudi
Kasturi a/p Manoharan Roslinda Abu Sapian
Khairulnissa Abdul Kadir Dr. Rozainanee Mohd Zain
Dr. Khayri Azizi Kamel Dr. Sarbhan Singh
Lai Chee Herng Siti Nadiah Busyra Mat Nadzir
Dr. Siti Nur Zawawi Rosli
Dr. Masita Arip Sharifah Zawani Syed Ahmad Yunus
Dr. Mohd Azahadi Omar Sumarni Mohd Ghazali
Dr. Mohd Ishtiaq Anasir Dr. Tan Cia Vei
Datin Dr. Mona Lisa Md Rasip
Dr. Muhammad Alfatih Pahrol Dr. Wan Afiqah Wan Md Sabri
Dr. Muhammad Imraan Mohd Azhar Zamtira Seman
Dr. Muhammad Nur Amir Abdul Rassip Dr. Zulkarnain Abdul Karim
Dr. Muhd Zulfadli Hafiz Ismail Zuraida Che Hassan

Dr. Nik Adilah Shahein
Nik Noor Syamimi Ismail
Dr. Norazah Ahmad

Covid-19 Technical Report 2020-2021 : The Challenging Years | 1

TABLE OF CONTENT

Foreword by the Minister of 8 Chapter 1: Epidemiology of the 25
Health Malaysia COVID-19 pandemic in Malaysia 115
133
Foreword by the Director 9 Chapter 2: COVID-19 Clusters 169
General of Health, MOH Malaysia 10 187
11 Chapter 3: Vaccination 219
Foreword by Secretary-General
of Health, MOH Malaysia Chapter 4: Development of 235
COVID-19 Vaccine in Malaysia
Foreword by the DDG of Health 259
(Research & Technical Support), Chapter 5: Hospital
MOH Malaysia Preparedness and Response 271

Foreword by the Manager of 12 Chapter 6: The Role of
National Institutes of Health Laboratory in Managing the
(NIH), MOH Malaysia COVID-19 Pandemic

Foreword by Head of Covid-19 13 Chapter 7: Genome Surveillance
Operational Room National of SARS-CoV-2 in Malaysia from
Institutes of Health (NIH), 2020-2021
MOH Malaysia
Chapter 8: Malaysia
List of Abbreviations 14 International Border Control
List of Figures 16 During COVID-19 Pandemic
List of Tables 21
Executive Summary 19 Chapter 9: COVID-19 Research
Conducted Under the Ministry
of Health Malaysia, 2020 to 2021

Appendices & References 287

The COVID-19 panic’s ramifications have
led in substantial changes in our daily lives,
changes that have usually occurred rapidly
and unexpectedly. In terms of health-care
systems, the COVID-19 outbreak put a major
strain on our systems. One of the most
significant consequences of a pandemic,
such as Covid-19, is that it interrupts care for
other illnesses by overburdening existing
under-resourced health-care institutions.

2 | Covid-19 Technical Report 2020-2021 : The Challenging Years

TABLE OF CONTENT

Chapter 1: Epidemiology of the COVID-19 pandemic in Malaysia

1.0 Introduction 27

1.1 COVID-19 case numbers, trends and distribution 27
1.1.1 Case numbers and trends 27
1.1.2 Distribution of COVID-19 cases 28
1.1.3 COVID-19 incidence rate 37
46
1.1.4 Effects of movement controls, vaccination and mass gathering events
48
1.2 Demographic characteristics of COVID-19 cases 48
1.2.1 Gender distribution of COVID-19 cases 51
1.2.2 Age distribution of COVID-19 cases 57
1.2.3 Gender and age distribution of COVID-19 cases 60

1.2.4 COVID-19 cases by local/import status 62
62
1.3 COVID-19 case categorization
63
1.3.1 Proportion of COVID-19 cases and trends 63
66
1.4 COVID-19 active cases, ICU & ventilated patients 70
1.4.1 Active case trends and distributions 73
1.4.2 ICU case trends and distributions
1.4.3 Ventilated case trends and distributions 79
79
1.4.4 Effects of movement controls, vaccination and mass gathering events 82
84
1.5 COVID-19 death numbers, trends and distribution 87
1.5.1 Death numbers and trends 89
1.5.2 Distribution COVID-19 deaths 97
1.5.3 COVID-19 death rate and case fatality rate 100
1.5.4 Gender distribution of COVID-19 deaths 102
1.5.5 Age distribution of COVID-19 deaths
1.5.6 Gender and age distribution 104
1.5.7 Effects of movement controls, vaccination and mass gathering events 104
1.5.8 COVID-19 Brought in dead (BID)
106
106
1.6 COVID-19 Testing 106
1.6.1 Cumulative COVID-19 test and cases by epidemiological weeks 109

1.7 COVID-19 Time varying reproduction number (Rt) 112
1.7.1 Estimating Time varying reproduction number (Rt) 112
1.7.2 Daily Rt trends 113
114
1.7.3 Effects of movement controls, vaccination and mass gathering events

1.8 Modelling the COVID-19 pandemic
1.8.1 Second wave
1.8.2 Third wave (first part)

1.8.3 Third wave (second part)

Covid-19 Technical Report 2020-2021 : The Challenging Years | 3

TABLE OF CONTENT

Chapter 2: COVID-19 Clusters

2.1 Introduction 117

2.2 Description Of Cluster 118
2.2.1 Number Of Clusters 118
2.2.2 New Clusters 121
122
2.2.3 Cluster-Related Cases
123
2.3 Cluster Category 123
124
2.3.1 Workplace Clusters 125
2.3.2 Community Clusters 127
2.3.3 Religious Clusters 128
2.3.4 Detention Centre Clusters 129
2.3.5 Education Institutions Clusters 131
2.3.6 High-risk Group Clusters
2.3.7 Import Clusters 135

Chapter 3: Vaccination 135
135
3.0 Introduction / Summary 140
141
3.1 National COVID-19 Immunisation Program 141
3.1.1 Chronology
3.1.2 Target group 144
3.1.3 Herd immunity 144
3.1.4 Policy related 144
147
3.2 Vaccination Registration 149
3.2.1 Introduction
3.2.2 Vaccination registration nationwide 150
3.2.3 Vaccination registration by state 150
3.2.4 Vaccination registration method 151
153
3.3 Administered vaccine doses 158
3.3.1 Introduction 161
3.3.2 Vaccination coverage nationwide & state by epid week 163
3.3.3 Total vaccination dose and average vaccine shot per day by epid week 165
3.3.4 Vaccination by demographic 167
3.3.5 Significant event related to vaccination progress
3.3.6 Vaccination by types of vaccine 168
3.3.7 Adverse effect following immunization (AEFI)
3.3.8 Vaccination centers (PPV)

3.4 Photos related to vaccine activities

4 | Covid-19 Technical Report 2020-2021 : The Challenging Years

TABLE OF CONTENT

Chapter 4: Development of COVID-19 Vaccine in Malaysia

4.1 COVID-19 Pandemic in Malaysia 171

4.2 COVID-19 Vaccine 172

4.3 Development of Inactivated COVID-19 Vaccine in Malaysia 174
4.3.1 Selection of the SARS-CoV-2 Lineage (type) suitable as viral vaccine candidate 176
4.3.2 Confirmation of the propagated passage by whole genome sequencing 176
4.3.3 Formulation and bottling of vaccine candidate 178
4.3.4 Pre-clinical Study 179

Chapter 5: Hospital Preparedness and Response 189

5.0 Hospital Preparedness and Response 189
191
5.1 Secondary and Tertiary Care Capacity 192
192
5.1.1 Facilities Preparedness 192
192
5.1.2 Types of Hospital
193
- Full COVID-19 Hospitals 193
193
- Hybrid Hospitals 194
195
- Non-COVID-19 Hospitas 195
195
5.1.3 COVID-19 Hospitals’ Bed Capacity 197
5.1.4 Hospitals for Screening
5.1.5 Intensive Care Units (ICU) 197
5.1.6 Step-down Centres/Hospital Extension/Quarantine 198
5.1.7 Malaysian Armed Forces (MAF) Field Hospitals
5.1.8 Laboratory Preparedness, Capacity and Enhancement 199
- Capability of laboratories to cater increase of COVID-19 sample 199
- Enhancement of laboratory services
201
5.1.9 Personal Protective Equipment (PPE) 202
- Strategies for an adequate supply
204
5.1.10 Clinical Management
205
- Management of Long COVID-19 205
208
5.1.11 COVID-19 Assessment Center (CAC)
- Virtual COVID-19 Assessment Center (Virtual CAC) 211
214
5.1.12 Hospital Services/Clinical Data and Surveillance

5.2 Situation Summary
5.2.1 Hospital Utilisation
5.2.2 COVID-19 Low-Risk Quarantine and Treatment Centres
(PKRC) Utilisation
5.2.3 ICU Utilisation and Ventilator Usage
5.2.4 Effects of Vaccination Program

Covid-19 Technical Report 2020-2021 : The Challenging Years | 5

TABLE OF CONTENT

Chapter 6: The Role of Laboratory in Managing the
COVID-19 Pandemic

6.1 Planning and navigation 221
6.2 Development and validation of a new diagnostic assay 221
6.3 Provision of laboratory facilities 222
6.4 Commencement of On-call task 223
6.5 In-house laboratory training 224
6.6 Training for laboratory staff from the Ministry of Health and other agencies 224
6.7 Physical Infrastructure and Equipment 226
6.8 Ministry of Health guidelines on testing protocols for Sar-Cov2 227
6.9 Laboratory inspection and audit for the Sars-Cov2 RT-PCR Test 228
6.10 Reporting of Sars-Cov2 PCR Results 229
6.11 COVID-19 in Vitro Diagnostic Test Kit Evaluation 230
6.12 Evaluation of COVID-19 Antigen kit (for professional use) 231
6.13 Evaluation of COVID-19 RT-PCR kit 232
6.14 Evaluation of COVID-19 Antibody Kit 233
6.15 Evaluation of COVID-19 Antigen Self-Test kit 233


Chapter 7: Genome Surveillance of SARS-CoV-2 in Malaysia
from 2020-2021

7.1 Introduction 237
237
7.1.1 Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)
239
and its lifecycle 240

7.1.2 The architecture of SARS-CoV-2 spike protein 241
241
7.1.3 SARS-CoV-2 S protein interaction with its cellular receptor ACE2 242

7.2 Emerging Variants of SARS-CoV-2 243
243
7.2.1 Drivers of the emergence of variant for SARS-CoV-2 243
243
7.2.2 Variants of Interest (VOI) and Variants of Concern (VOC) 243

working definition 244
245
7.2.2.1 VOC Alpha (B.1.1.7)
245
7.2.2.2 Beta (B.1.351)
246
7.2.2.3 Gamma (P.1) 247
247
7.2.2.4 Delta (B.1.617.2)

7.2.2.5 Omicron (B.1.1.529)

7.3 Genomic surveillance in Malaysia
7.3.1 Importance of genomic surveillance in Malaysia

7.4 Methods for Genomic Surveillance utilized in the National

Institutes of Health, Malaysia

7.4.1 Metagenomics sequencing (Illumina NextSeq500 system)

7.4.2 Targeted sequencing (Oxford Nanopore technologies)

7.4.3 Variant-specific real-time RT-PCR

6 | Covid-19 Technical Report 2020-2021 : The Challenging Years

TABLE OF CONTENT

7.5 Genome sequencing consortium 249
249
7.5.1 Criteria for case/sample selection 250

7.5.2 Pipeline utilized by MOH-MOSTI-MOHE consortium for 251
251
SARS-CoV-2 genomic surveillance 0
251
7.6 Findings from genomic surveillance in Malaysia 252
252
7.6.1 Phylogenomic analysis and lineage diversity prior to the 253
0
emergence of VOC 254
255
7.6.2 Early outbreak SARS-CoV-2 lineages 255
256
7.6.2.1 Novel lineage B.1.524
0
7.6.2.2 Other notable lineages
257
7.6.3 Spread of variants of concern in Malaysia and their impact
261
on COVID-19 transmissibility and disease severity 261
268
7.6.3.1 VOC Alpha
273
7.6.3.2 VOC Beta
273
7.6.3.3 VOC Delta 276
278
7.6.3.4 VOC Omicron 279
281
7.7 Existing challenges and future plans for genomic 283
surveillance in Malaysia 283
284
Chapter 8: Malaysia International Border Control During 285
COVID-19 Pandemic

8.1 Introduction
8.2 The Sequence of International Border Control
8.3 Risk Assessment for International Travellers

Chapter 9: COVID-19 Research Conducted Under the
Ministry of Health Malaysia, 2020 to 2021

9.1 Introduction

9.2 Overview of COVID-19 Research

9.2.1 Epidemiology of COVID-19

9.2.2 Behavioural Insights of COVID-19

9.2.3 Diagnostic Insights of COVID-19

9.2.4 Therapeutic Insights of COVID-19

9.2.5 Impact of COVID-19

9.2.5.1 Impact of COVID-19 to Health Services

9.2.5.2 Impact of COVID-19 to Health Status

9.2.6 Prevention of COVID-19

Covid-19 Technical Report 2020-2021 : The Challenging Years | 7

Foreword by
MINISTER OF HEALTH
MALAYSIA

The global and fast-spreading virus has

placed unprecedented pressures on health
systems in most countries worldwide. The
COVID-19 pandemic served as a watershed
moment for the insurgency in health,
highlighting previously unnoticed issues in
the healthcare system.

We faced numerous obstacles that could be found Future pandemic prevention will require collective
at various steps of the process, be it in clinical path- social actions. For public health decision-making,
ways, patients' engagement at the point of care or the information on the projected health effects of
public health realm. Adopting a coronavirus vaccine emergencies and disasters is critical. The ability
approach has undoubtedly become a significant to address difficulties and challenges to achieve a
public health agenda for governments world-wide. collective societal response will be the tipping point
These experiences however, have allowed us a better for future pandemic prevention measures.
position to chart the progress and face challenges of The evidence from several parts of the Ministry of
the healthcare industry for the first time in the last Health's response to the pandemic is presented in
two years. this report for future reference.

While the challenge before us is significant, we KHAIRY JAMALUDDIN
have many reasons to be optimistic that we can Minister of Health Malaysia
meet our goal of improving health care by gaining
better value from our healthcare system. Some of
those enhancements are a system adaptable to
change, techno- logical advances that have resulted
in productivity gains and effectiveness of care, and
evidence-based scientific research. During this
pandemic, digital dominance was on clear display.
While it meant a break from the natural, thriving
world for some, it provided others with a new window.
In many ways, the crisis compelled us to look for
alternatives.

8 | Covid-19 Technical Report 2020-2021 : The Challenging Years

Foreword by
DIRECTOR GENERAL

OF HEALTH

There had never been a more devastating calamity other oxygen tanks, medications, and laboratory capacity.
than this global public health crisis in the recent history Beyond health system preparedness, the Ministry
of humankind. Beyond health concerns, the COVID-19 delivered consistent risk communications, which was
pandemic caused many unprecedented socio-economic instrumental in reassuring the general public and
challenges to Malaysia and the rest of the world. Hence, addressing public concerns, particularly during the
to succeed in this battle, the Government implemented uncertainty period.
effective coordination across all ministries and agencies
at the highest level, driven by the 'Whole of Government The COVID-19 pandemic has provided many critical
and Whole of Society' approach to secure the safety and lessons to mitigate and protect the nation's healthcare
health of the nation. delivery system from collapsing. Therefore, the
Ministry of Health is proud to present this 'COVID-19
The Ministry of Health assumed a pivotal role and Technical Report 2021-2022: The Challenging Years'.
responded swiftly by meticulously planning and This document is beyond historical documentation
executing to end the acute phase of the pandemic. It and aims to deliver invaluable technical insights for
was guided by robust policies and strategies reinforced future reference in preparing for global public health
by sound scientific evidence, thus allowing the Ministry crises. This report will allow future healthcare leaders
to navigate through multiple waves and eventually to leverage all critical experiences and synthesise vital
facilitate the country's transition safely into an endemic lessons to formulate health system interventions and
phase. build a resilient healthcare system for the country
against any future pandemics.
Public health measures and a nationwide vaccination
programme became the Ministry of Health's principal Tan Sri Dato’ Seri Dr Noor Hisham bin Abdullah
strategies to combat the disease and contain the Director General of Health Malaysia
COVID-19 transmission. With the emergence of more
virulent variants of concerns (VOCs), such as the Delta
and Omicron variant, the Ministry of Health had to be
agile in its strategies to secure pandemic preparedness,
including adequate hospital beds, ventilators,

Covid-19 Technical Report 2020-2021 : The Challenging Years | 9

Foreword by
SECRETARY GENERAL
OF HEALTH

The COVID-19 pandemic has seen an unprecedented Datuk Harjeet Singh a/l Hardev Singh
impact on a global level, not just on an economic scale Secretary General Ministry of Health Malaysia
but also pushing healthcare systems around the world
to their limits. Given the rapid spread of the COVID-
19 virus, countries worldwide have implemented
non-pharmaceutical measures to reduce its spread,
namely social distancing and lock-down.

Amidst the disruptions faced due to the pandemic,
the government has identified appropriate measures
and strategies to manage resources. These measures
are crucial to allow people to continue running their
operations while minimising the risks of community
spread of the virus, sustaining productivity levels, and
thus protecting the opera- tions. We have continued
to deliver key areas of our programmes to the public
throughout the pandemic. This documentation
shows a series of initiatives by the Ministry of Health
in overcoming the COVID-19 pandemic since it first
surfaced in 2020 for future references.

Finally, we will improve our ability to respond to, learn
from, and reduce the effects of crises to emerge more
resilient to handle the current situation towards a
more sustainable economy once the pandemic is
over.

10 | Covid-19 Technical Report 2020-2021 : The Challenging Years

Foreword by

DEPUTY DIRECTOR

GENERAL OF HEALTH

(RESEARCH & TECHNICAL SUPPORT)

The COVID-19 was labelled a global pandemic by the Datuk Dr. Hishamshah bin Mohd Ibrahim
World Health Organization on March 11, 2020, and the Deputy Director General of Health Malaysia
disease now impacts practically every country and (Research and Technical Support)
area. COVID-19 poses enormous problems to health
systems, public health, and economies of most, if
not all, countries. The infection induced by the virus
resulted in high morbidity and mortality in a short
span of time, and many hospitals and clinics were
immediately overwhelmed.

As the pandemic's immediate health effects were
blunted by our public health interventions, we now
need to give emphasis on evidence-based research,
address long term sequalae, build self-reliance and be
prepared for the next pandemic.

Critical levers for prompt recovery would require
inclusive participation across the breadth and depth
of government and society. Vulnerabilities changes
such as the rapid adoption of digital platforms in the
workplace and personal spheres would need to be
enhanced further.

I wish to thank the team for compiling and narrating
the details of documented evidence on how our
healthcare system responded to the crisis.

Covid-19 Technical Report 2020-2021 : The Challenging Years | 11

Foreword by
MANAGER, NATIONAL
INSTITUTES OF HEALTH

The National Institutes of Health (NIH) works as an understand the virus where researches were
interdisciplinary team of researchers to improve the conducted promptly. All these efforts should be
nation's health and well-being by overseeing and documented because they will serve as a significant
administering research in Malaysia that addresses reference in the future. The Technical Report for
national health goals. We employ scientific capabilities COVID-19 is designed to record our attempts to
and discover solutions to health requirements by address the health problem during the COVID-19
utilising expertise from interdisciplinary scientists pandemic by utilising various measures.
across six institutions during the pandemic. We applaud and thank the NIH team for coordinating
and putting together this report.
We are agile in our pursuit of evidence-based
medicine and a better knowledge of health behaviour Dr S Asmaliza binti Ismail
through continuous research in this area. In the Manager, National Institutes of Health (NIH)
event of the pandemic, when our healthcare system
was challenged, we at the NIH worked diligently to
monitor the pandemic situation while ensuring the
deliv ery of scientific data to policymakers.

This pandemic has taught many of us valuable lessons
in managing pandemics. The NIH has collaborated
with experts from Malaysia and worldwide to better

12 | Covid-19 Technical Report 2020-2021 : The Challenging Years

Foreword by
HEAD OF COVID-19

OPERATIONAL
ROOM NIH

The COVID-19 pandemic has presented one of the We sincerely hope that this report, which includes
biggest challenges, not only in the health sector but several chapters on how the health system in Malay-
to all Malaysians. The impact has had a huge impact sia works to address the epidemic, will make it a valu-
especially on high -risk groups. These effects include able resource to study.
in terms of the direct effects of public health crises on I would like to thank everyone involved in the prepa-
health and mortality, and indirect effects on social, ration of this report, for successfully producing it,
economic and political systems. both to the individuals who contributed and the
organizations involved.
Our team at NIH, documented the significant situa-
tion of the COVID-19 pandemic in Malaysia and the Dr Ahmad Faudzi bin Yusoff
results of interventions during the outbreak and Deputy Director
lessons that can be learned in the hope that it is a SEAMEO TROPMED NETWORK MALAYSIA
useful teaching information to be used as a guide in INSTITUTE FOR MEDICAL RESEARCH
preventing and managing future outbreaks.

Given the diverse, variable nature of information and
from diverse sources, we documented all important
documents and summarized them to show how
effectively the Ministry of Health Malaysia and various
agencies have handled the issue over the past two
years.

Covid-19 Technical Report 2020-2021 : The Challenging Years | 13

LIST OF

ABBREVIATIONS

11MP 11TH Malaysia Plan JIM Immigration Department of Malaysia
AADK National Anti-Drugs Agency JKJAV The Special Committee on COVID- 19 Vaccine
AEFI Adverse effects following immunization Supply
AGP Aerosol Generating Procedure JKM Department of Social Welfare Malaysia
APPL Approved Product Purchased List JPM Malaysian Prison Department
ATM Angkatan Tentera Malaysia KLIA Kuala Lumpur International Airport
BGI Beijing Genomics Institute MAB Malaysian Association for the Blind
BSC Biosafety Cabinet MAEPS Malaysia Agro Exposition Park, Serdang
BSI Bangunan Sultan Ismail MAF Malaysian Armed Forces
CAC COVID-19 Assessment Centre MAMPU Malaysian Administrative Modernisation and
CITF Covid-19 Immunisation Task Force Management Planning Unit
COVID-19 Coronavirus Disease MARA People’s Trust Council
CPRC Crisis Preparedness and Response Centre MCMC Malaysian Communications and Multimedia
DCA Drug Control Authority Commission
DHO District Health Office MCO Movement Control Order
eNTRI Electronic Travel Registration Ad Information MERCY Malaysia Medical Relief Society
EMA European Medicines Agency Malaysia
EMCO Enhanced Movement Control Order MGI Malaysia Genomic Institute
EQAP External Quality Assurance Program MINDEF Ministry of Defence
FDA Food and Drug Administration MKN National Security Council
FHy ICU Field Hybrid Intensive Care Unit MM2H Malaysia My Second Home
GKV STF Greater Klang Valley Special Task Force MOE Ministry of Education
GPL Langkawi Tourism Bubble MOH Ministry of Health
HAT Home Assessment Tool MOSTI Ministry of Science, Technology and Innova-
HCW Healthcare Worker tion
HQA Home Quarantine Application MOTAC Ministry of Tourism, Arts and Culture
HSO Home Surveillance Order MyVac Malaysia Vaccine Support Volunteer
HSOC Home Surveillance Order Committee NADMA National Disaster Management Agency
ICU Intensive Care Unit NGO Non-Governmental Organization
ILI Influenza-Like Illness NICU Neonatal Intensive Care Unit
ILKKM Institut Latihan Kementerian Kesihatan NIH National Institutes of Health
Malaysia (Ministry of Health Training Centre) NIP National COVID-19 Immunisation Program
IMR Institute for Medical Research NPHL National Public Health Laboratory
JAKIM Department of Islamic Development Malaysia NPRA National Pharmaceutical Regulatory Agency
NTF National Task Force
PCA Periodic Commuting Arrangement

14 | Covid-19 Technical Report 2020-2021 : The Challenging Years

PCR Polymerase Chain Reaction SARI Severe Acute Respiratory Infection
PDRM SARI Severe Acute Respiratory Infection
Pemulih Polis Di Raja Malaysia SIMKA Sistem Informasi Makmal Kesihatan Awam
(Public Health Laboratory Information
PHL Pakej Perlindungan Rakyat dan Pemulihan SOCSO System)
PhIS Ekonomi SOP Social Security Organization
PIKAS T&R Standard Operating Procedure
Public Health Laboratory UNDP Test and Release
PICK UN United Nation Development Program
PICK-B Phar¬macy Information System VLT United Nations
VOA Vaccinated Travel Lane
PICK-A Program Imunisasi Industri COVID19 Kerjasa- VOC Visa-On-Arrival
ma Awam-Swasta WHO Variant of Concern
PICU WP World Health Organization
PIKAS National COVID-19 Immunisation Program Wilayah Persekutuan (Federal Territory)

PKRC National COVID-19 Immunisation Program for
Booster
PPE
PPV National COVID-19 Immunisation Program for
PPVGP Adolescent
PPVHS
PR Paediatric Intensive Care Unit
PSA
PSV Program Imunisasi Industri COVID19 Kerjasa-
PUI ma Awam-Swasta
QC
RELA Pusat Kuarantin dan Rawatan COVID-19
RGL (COVID-19 Quarantine and Low-risk Treat-
RMAF ment Centre
RMCO
RNA Personal Protective Equipment
RTK Ag
RT-PCR Vaccination Administration Centres

RT-qPCR Private clinic PPV

Private Hospital PPV

Permanent Residents

Public Service Announcement

Vaccine Storage Centre

Person Under Investigation

Quality Control

People's Volunteers Corps

Reciprocal Green Lane

Royal Military Armed Forces

Recovery Movement Control Order

Ribonucleic Acid

Antigen Rapid Test Kit

Reverse Transcription Polymerase Chain
Reaction

Reverse Transcription Quantitative Poly-
merase Chain Reaction

Covid-19 Technical Report 2020-2021 : The Challenging Years | 15

LIST OF

FIGURES

Chapter 1:

Figure 1.1.1.1 Weekly COVID-19 cases by waves in Malaysia, 2020-2021 28
Figure 1.1.2.1 Proportion (%) of COVID-19 cases by states in Malaysia, 2020-2021 29
Figure 1.1.2.2 Spatial distribution of cumulative COVID-19 cases by states and districts Malaysia, 2020 to 2021 36
Figure 1.1.2.3 Spatial distribution of cumulative COVID-19 cases by states and districts Malaysia, 2020 to 2021 36
(cont.)
Figure 1.1.2.4 Spatial distribution of cumulative COVID-19 cases by states and districts Malaysia, 2020 to 2021 36
(cont.)
Figure 1.1.3.1 Spatial distribution of annual COVID-19 incidence rate by state/district (n=158), Malaysia 2020 to 45
2021
Figure 1.1.3.2 Spatial distribution of annual COVID-19 incidence rate by state/district (n=158), Malaysia 2020 to 45
2021 (Cont.)
Figure 1.1.3.3 Spatial distribution of annual COVID-19 incidence rate by state/district (n=158), Malaysia 2020 to 45
2021
Figure 1.1.4.1 Weekly COVID-19 cases by epidemiological weeks during the various movement control 46
measures and mass gathering events in Malaysia, 2020-2021
Figure 1.1.4.2 Percentage fully vaccinated by COVID-19 cases, Malaysia, 1 April 2021 to 31 December 2021 47
Figure 1.2.1.1 Male to female ratio of COVID-19 cases in Malaysia by state, 2020 & 2021 49
Figure 1.2.2.1 Age distribution and age-specific COVID-19 incidence rates in Malaysia (2020-2021) 51
Figure 1.2.2.2 Age-specific COVID-19 case proportions by state, 2020-2021 55
Figure 1.2.2.3 Age-specific COVID-19 incidence rate (per 1,000 population) by state, Malaysia, 2020-2021 56
Figure 1.2.3.1 Male to female ratio of COVID-19 cases by age group, national level, 2020-2021 57
Figure 1.2.4.1 Proportion of local and imported COVID-19 cases at national level 60
Figure 1.2.4.2 Weekly trend of COVID-19 cases by local/import status in Malaysia, 2020 and 2021 61
Figure 1.3.1.1 Proportion of COVID-19 cases categorization in 2021 62
Figure 1.3.1.2 Trend of COVID-19 cases categorization in 2021 63
Figure 1.4.1.1 Weekly average COVID-19 active case in Malaysia by waves, 2020 to 2021 64
Figure 1.4.2.1 Weekly average COVID-19 ICU case in Malaysia by waves, 2020 to 2021 67
Figure 1.4.3.1 Weekly average COVID-19 ventilated case in Malaysia by waves, 2020 to 2021 70
Figure 1.4.4.1 COVID-19 average active case, ICU and ventilated case during the various movement control 73
measures, vaccination and mass gathering events in Malaysia, 2020-2021
Figure 1.4.4.2 Percentage fully vaccinated by daily active case COVID19 estimates, Malaysia, 1 April 2021 to 31 76
December 2021
Figure 1.4.4.3 Percentage fully vaccinated by daily ICU case COVID-19 estimates, Malaysia, 1 April 2021 to 31 77
December 2021
Figure 1.4.4.4 Percentage fully vaccinated by daily ventilated case COVID19 estimates, Malaysia, 1 April 2021 to 31 77
December 2021
Figure 1.5.1.1 Weekly COVID-19 deaths, Malaysia 2020-2021 79
Figure 1.5.2.1 Spatial distribution of cumulative COVID-19 deaths by State, Malaysia (Second Wave) 83
Figure 1.5.2.2 Spatial distribution of cumulative COVID-19 deaths by State, Malaysia (Third Wave) 83
Figure 1.5.2.3 Spatial distribution of cumulative COVID-19 deaths by State, Malaysia (Overall) 83
Figure 1.5.3.1 Spatial distribution of COVID-19 death rate by State, Malaysia (2020) 85
Figure 1.5.3.2 Spatial distribution of COVID-19 death rate by State, Malaysia (2021) 85
Figure 1.5.3.3 Spatial distribution of COVID-19 death rate by State, Malaysia (Overall) 85
Figure 1.5.4.1 Male to female ratio of COVID-19 deaths in Malaysia by state, 2020 & 2021 89
Figure 1.5.5.1 Age trend of COVID-19 deaths in Malaysia (2020-2021) 89
Figure 1.5.5.2 Age-specific COVID-19 death proportions by state, 2020-2021 95
Figure 1.5.5.3 Age-specific COVID-19 death rate (per 100,000 population) by state, 2020-2021 96
Figure 1.5.6.1 Male to female ratio of COVID-19 deaths by age group, national level, 2020-2021 97
Figure 1.5.7.1 Weekly COVID-19 deaths by epidemiological weeks during the various movement control 100
measures and mass gathering events in Malaysia, 2020-2021
Figure 1.5.7.2 Percentage fully vaccinated by daily deaths COVID19, Malaysia, 1 April 2021 to 31 December 2021 101
Figure 1.5.8.1 Weekly COVID-19 BIDs by epidemiological weeks during the various movement control measures 103
and mass gathering events in Malaysia, 2020-2021
Figure 1.6.1.1 Cumulative COVID-19 test and cases by epidemiological weeks, Malaysia, 2020-2021 104
Figure 1.6.1.2 Weekly COVID-19 test and cases, Malaysia, 2020-2021 104
Figure 1.7.3.1 Daily COVID-19 Rt during the various movement control measures and mass gathering events in 109
Malaysia, 2020-2021
Figure 1.7.3.2 Percentage fully vaccinated by daily Rt COVID19 estimates, Malaysia, 1 April 2021 to 31 December 110
2021

16 | Covid-19 Technical Report 2020-2021 : The Challenging Years

Figure 1.8.1.1 Forecast and Observed daily COVID-19 cases using the SIR Model, Malaysia, 18/3/2020- 112
Figure 1.8.2.1 18/07/2020
Figure 1.8.3.1 Forecast and Observed daily COVID-19 cases using the SEIR Model, Malaysia, 12/9/2020- 113
29/05/2021
Forecasted and observed daily COVID-19 cases using the SEIR Model, Malaysia, 1/4/2021- 114
31/12/2021
118
Chapter 2: 119
119
Figure 2.1 : Number of COVID-19 clusters in Malaysia 121
Figure 2.2 : Percentages of COVID-19 clusters by category and waves 121
Figure 2.3 : Number of COVID-19 cases by cluster category 122
Figure 2.4 : Number of new clusters by Epidemiological Week 122
Figure 2.5 : Number of new clusters by category 123
Figure 2.6 : Number of new cluster-related Covid-19 cases 123
Figure 2.7 : Percentages of cluster-related cases by Epidemiological Week 124
Figure 2.8 : Workplace sub-category 124
Figure 2.9 : Workplace cluster with the highest number of positive COVID-19 cases 125
Figure 2.10 : Community clusters sub-category 127
Figure 2.11 : Community cluster with the highest number of positive COVID-19 cases 127
Figure 2.12 : Religious cluster with the highest number of positive COVID-19 cases 128
Figure 2.13 : Detention Centre clusters sub-category 128
Figure 2.14 : Detention Centre cluster with the highest number of positive COVID-19 cases 129
Figure 2.15 : Education Institution clusters sub-category 129
Figure 2.16 : Education cluster with the highest number of positive COVID-19 cases 130
Figure 2.17 : High-risk Group clusters sub-category 131
Figure 2.18 : High-risk group cluster with the highest number of positive COVID-19 cases
Figure 2.19 : Import clusters sub-category 135
Figure 2.20 : Import cluster with the highest number of positive COVID-19 cases 143
143
Chapter 3: 144

Figure 3.1.1 First batch Pfizer- BioNTech vaccine arrival in Malaysia 145
Figure 3.1.2 Guidelines on COVID-19 vaccination in pregnancy and breastfeeding 145
Figure 3.1.3 Guidelines on COVID-19 vaccination in pregnancy and breastfeeding 146
Figure 3.2.1 Nationwide total vaccination registration and average vaccination registration per day by Epid 146
week from week 15 to week 52 (Data for week 1 to 14 not available) 148
Figure 3.2.2 Total number of vaccination registration for nationwide
Figure 3.2.3 Total cumulative number of vaccination registrations adults and adolescents by epid week 148
Figure 3.2.4 Vaccination registration amongst Malaysian adults
Figure 3.2.5 Total cumulative number of vaccination registrations adults and adolescents by epid week 149
Figure 3.2.6 Comparison of vaccination registration percentages for each state to nationwide among adult 149
group 151
Figure 3.2.7 Comparison of vaccination registration percentages for each state to nationwide among 152
adolescent group 152
Figure 3.2.8 Nationwide total vaccination registration as at 1st January 2022 according to the three methods 153
Figure 3.2.9 Vaccination registration methods by state
Figure 3.3.1 Vaccination coverage nationwide, aged more than 12 years for 1st, 2nd and booster. 153
Figure 3.3.2 Comparison of overall vaccination coverage for each state to nationwide as at 1st January 2022 155
Figure 3.3.3 Comparison of adults vaccination coverage for each state to nationwide as at 1st January 2022 156
Figure 3.3.4 Comparison of adolescents vaccination coverage for each state to nationwide as at 1st January 156
2022 157
Figure 3.3.5 Total and average vaccine shot per day nationwide by epid week 157
Figure 3.3.6 Total and average vaccine shot per day in each state by epid week 158
Figure 3.3.7 Total number of Vaccination amongst Malaysian adults, nationwide and state 158
Figure 3.3.8 Total number of Vaccination amongst Malaysian adolescents nationwide and state 159
Figure 3.3.9 Percentage of vaccine doses per total population of adult population 159
Figure 3.3.10 Percentage of vaccine doses per total adolescent population 160
Figure 3.3.11 Vaccination intake according to nationality. 160
Figure 3.3.12 Vaccination status by Malaysian ethnicity as at Epid week 52, 2021 161
Figure 3.3.13 Vaccination status amongst Non-Malaysian as at Epid week 52, 2021 162
Figure 3.3.14 Vaccination intake by gender 163
Figure 3.3.15 Vaccination status by age group in Malaysia until epid week 52, 2021
Figure 3.3.16 Vaccination intake by three most high risk groups
Figure 3.3.17 Vaccination progress in 2021 with target group timeline
Figure 3.3.18 Weekly COVID-19 cases distribution according to vaccination status group
Figure 3.3.19 Vaccination by type of vaccine used in Malaysia

Covid-19 Technical Report 2020-2021 : The Challenging Years | 17

Chapter 4:

Figure 4.1 Overview of COVID-19 mRNA vaccine 173
Figure 4.2 Inactivated COVID-19 Vaccine key investigators from IMR and UPM. A visit to the BSL-3 facility of 174
IMR (April 2021).
Figure 4.3 Experts from IMR, UPM and VRI in front of the Bio-safety Level3 Laboratory for animal in VRI 175
(September 2021). This laboratory will be the site for the vaccine efficacy study that will utilize
Figure 4.4 K18-Human ACE2 transgenic mice as the test system 175
Figure 4.5 A SARS-CoV-2 particle viewed under electron microscopy 176
Figure 4.6 Whole genome sequencing conducted on NextSeq 500 platform 177
Virus inactivation activity by investigators from IMR and UPM in BSL-3 laboratory, IMR (August
Figure 4.7 2021) 178
Figure 4.8 Vaccine formulation activity in GMP facility in UPM, Serdang (January 2022) 178
Figure 4.9 Formulated vaccine ready for safety and efficacy study (January 2022) 179
Figure 4.10 Immunization of mice to test the efficacy and safety of the vaccine candidate (February 2022) 180
Figure 4.11 Stages of mRNA vaccine development processes 180
Discussion of designing the genetic sequence of mRNA vaccine construct among researchers
Figure 4.12 from AIRC 181
Figure 4.13 Researcher performed laboratory test using cell culture for mRNA vaccine development 181
Figure 4.14 Researcher performed laboratory test using real time PCR for mRNA vaccine development 182
IMR principal investigators presented IMR COVID-19 vaccine development projects to the Prime
Figure 4.15 Minister 182
IMR principal investigators presented IMR COVID-19 vaccine development projects to the Prime
Figure 4.16 Minister 183
Shooting the special episode on IMR COVID-19 vaccine development for Majalah 3 television
Figure 4.17 show 183
Figure 4.18 IMR COVID-19 vaccine development for Majalah 3 television show 184
Figure 4.19 A visit by the Health MInister to our laboratory facility at IMR 185
IMR official visit to MVP (February 2022).
189
Chapter 5: 190
191
Figure 5.1 CPRC of Hospital Services, Ministry of Health Malaysia 192
Figure 5.2 Hospitals Treating COVID-19 by States (as of May 2020) 194
Figure 5.3 Preparations during previous waves 195
Figure 5.4 Rembau Hospital, Sungai Buloh Hospital, Kuala Krai Hospital 200
Figure 5.5 Covid-19 Quarantine and Low-Risk Treatment Centre 201
Figure 5.6 An overview of the field hospital set up outside the Penang Hospital 201
Figure 5.7 CPRC Hotline
Figure 5.8 Clinical category of Covid-19 cases 202
Figure 5.9 Different colours of wristband applied to confirmed case of Covid-19 undergo home isolation at
physical CAC 203
Figure 5.10 People waiting outside Malawati Stadium (CAC), Shah Alam waiting to be assesed their
condition 203
Figure 5.11 Digital Home surveillance Order generated by MySejahtera application for confirmed positive 204
case
Figure 5.12 Virtual CAC implementation for the Greater Klang Valley and its functions 205
Figure 5.13 Health Minister Khairy Jamaluddin speaks at a press conference during the launching of a new
website on September 2021 (https://COVIDNOW.moh.gov.my). A new website with daily data on 208
Figure 5.14 the development of Covid-19 nationwide.
COVID-19 coverage over epidemic week in Malaysia, against daily hospital admissions, 211
Figure 5.15 discharges and mean bed utilisation rate by 7-day moving averages
COVID-19 coverage over epidemic week in Malaysia, against daily PKRC admissions, discharges 214
Figure 5.16 and mean PKRC utilisation by 7-day moving averages
COVID-19 coverage over epidemic week in Malaysia, against mean ICU utilization and mean
Figure 5.17 ventilators usage by 7-day moving averages
COVID-19 coverage over epidemic week in Malaysia, against daily hospitalization and ICU
admission by 7-day moving averages. (a) Daily hospitalization; (b) daily ICU admission

18 | Covid-19 Technical Report 2020-2021 : The Challenging Years

Chapter 6:

Figure 6.1 Specimen processing under the level 2 Biosafety Cabinet 222
Figure 6.2 Analysis of Real-Time PCR test result 222
Figure 6.3 Preparation of reagents for COVID-19 for PCR testing 222
Figure 6.4 The COVID-19 laboratory at the NIH Complex 222
Figure 6.5 Laboratory staff conducting on-call duty at night 223
Figure 6.6 Laboratory staff conducting sample labeling and processing 225
Figure 6.7 Laboratory staff operating the auto RNA extractors for RNA extractions 225
Figure 6.8 Sample Receiving Counter at (a) Virology Unit, IMR Kuala Lumpur and (b) COVID-19 NIH, Setia 226
Alam
Figure 6.9 A spacious laboratory of COVID-19 NIH that can accommodate a few thermal cycler machines 226
Figure 6.10 MOH website containing all guidelines for laboratory testing of SARS-CoV-2 227
Figure 6.11 Examples of audits to a private laboratory by MOH officers as part of requirement for 229
accreditation of the laboratory
Figure 6.12(a) Specimen Management Information System (SMIS) 229
Figure 6.12(b) Integrated Laboratory Information System (ILIS) 229
Figure 6.13 (a) SIMKA OUTBREAK system 230
Figure 6.13 (b) SIMKA dashboard showing all activities with regards to specimens received in the laboratory 230
Figure 6.14 COVID-19 antigen test kit evaluation 231
Figure 6.15 COVID-19 RT-PCR test kit evaluation 232
Figure 6.16 COVID-19 antibody kit evaluation 233
Figure 6.17 COVID-19 antigen self-test kit 234
Figure 6.18 List of authorized COVID-19 evaluation at CAC Stadium Melawati antigen self-test kits on MDA 234
websites
237
Chapter 7: 238
239
Figure 7.1 Schematic representation of the SARS-CoV-2 genome and the encoded proteins 240
Figure 7.2 SARS-CoV-2 lifecycle 244
Figure 7.3 SARS-CoV-2 S protein 247
Figure 7.4 S protein-ACE2 complex 248
Figure 7.5 The number of GISAID submissions per month from 2020-2021 by laboratories in Malaysia
Figure 7.6 Whole genome sequencing conducted on NextSeq 500 (Illumina) platform 250
Figure 7.7 A) The number of presumptive omicron cases detected via SARS-CoV-2 variant-specific real-
time RT-PCR and B) the number of confirmed omicron cases detected by whole-genome 252
Figure 7.8 sequencing in December 2021
Guidelines for sample submission to IMR followed by the members of the MOH-MOSTI-MOHE 253
Figure 7.9 consortium
Major lineages circulating during the three phases of the COVID-19 outbreak in Malaysia based 254
Figure 7.10 on GISAID submissions from Jan 2020- Dec 2020 255
The three COVID-19 case surges for the periods of 1st January 2021-15th March 2021 (Epid week
Figure 7.11 1-11), 1st April-28th June 2021 (Epid week 13-26) and 29th June 2021-25th October 2021 256
Figure 7.12 Timeline of VOCs Alpha, Beta, Delta and Omicron detection in Malaysia 257
Breakdown of non-VOCs and VOCs among fatal cases (Brought-in-dead and death-in-hospital).
Figure 7.13 Data was obtained from IMR whole-genome sequencing database
Figure 7.14 Breakdown of non-VOCs and VOCs prevalence in Malaysia. Data was obtained from GISAID
Locations of the MOH-MOSTI-MOHE consortium members. The locations of consortium
members are shown in black dots while some of the locations where the samples for SARS-
CoV-2 genome sequencing were sent from are shown in green dots. Six of the consortium
members are located in Selangor/Kuala Lumpur and one member is located in Sarawak.

Covid-19 Technical Report 2020-2021 : The Challenging Years | 19

Chapter 8:

Figure 8.1 Flowchart of Screening Procedure at Point of Entry for travellers from oversea 262
Figure 8.2 Flowchart Sign-on Procedure for seafarers/off shore workers from abroad (Fully Vaccinated) 263
Figure 8.3 Flowchart Sign-on Procedure for seafarers/off shore workers resides in Malaysia 263
(Fully Vaccinated)
Figure 8.4 Flowchart Sign-off Procedure for fully vaccinated seafarers from international and domestic 263
water
Figure 8.5 Flowchart Sign-off Procedure for fully vaccinated offshore workers from international and 264
domestic platform/vessel
Figure 8.6 Flow chart management of ship with suspected/confirmed covid-19 cases onboard at 264
Malaysia Port
Figure 8.7 Portal Home Quarantine Application (HQA) for inbound international travellers 266
Figure 8.8 Criteria for home Quarantine for international travellers 266
Figure 8.9 Guidelines for Langkawi International Travel Bubble 267
Figure 8.10 Risk Assessment For International Travellers: Process And Methods 269

Chapter 9: 273
274
Figure 9.1 Distribution of COVID-19 study sites by states in Malaysia 275
Figure 9.2 Number of COVID-19 related research based on category in 2020-2021 275
Figure 9.3 Total number of COVID-19 related studies and funding allocation (RM) in 2020- 2021 277
Figure 9.4 Total duration of COVID-19 related studies in 2020- 2021
Figure 9.5 SEIR Model of COVID-19 Daily Observed and Forecast Cases

20 | Covid-19 Technical Report 2020-2021 : The Challenging Years

LIST OF

TABLES

Chapter 1:

Table 1.1.2.1 COVID-19 cases by waves in Malaysia, 2020-2021 (States) 30
Table 1.1.2.2 COVID-19 cases by waves in Malaysia, 2020-2021 (Districts) 31
Table 1.1.3.1 COVID-19 incidence rate by state and district in Malaysia, 2020 to 2021 38
Table 1.1.4.1 National COVID-19 cases by Epi Wk across various movement control events during the COVID- 47
19 pandemic, Malaysia, 2020-2021
Table 1.2.1.1 COVID-19 cases gender distribution at National/State level in 2020, 2021 and overall (2020-2021) 49
Table 1.2.2.1 Age distribution of COVID-19 cases in Malaysia, 2020 52
Table 1.2.2.2 Age distribution of COVID-19 cases in Malaysia, 2021 53
Table 1.2.2.3 Age distribution of COVID-19 cases in Malaysia, 2020-2021 54
Table 1.2.3.1 Distribution of COVID-19 cases in Malaysia by gender and age, 2020-2021 58
Table 1.2.4.1 Cumulative cases by local/import status in Malaysia, 2020 to 2021 60
Table 1.4.1.1 Weekly average and proportion of active cases by state in 65
Table 1.4.1.2 Weekly highest average active cases during the first, second and third wave by states in Malaysia 66
from 2020 to 2021
Table 1.4.2.1 Weekly average and proportion of ICU cases by state in Malaysia from 2020 to 2021 68
Table 1.4.2.2 Weekly highest average ICU cases during the first, second and third wave by states in Malaysia 69
from 2020 to 2021
Table 1.4.3.1 Weekly average and proportion of ventilated case by state in Malaysia from 2020 to 2021 71
Table 1.4.3.2 Weekly highest average ventilated cases during the first, second and third wave by states in 72
Malaysia from 2020 to 2021
Table 1.4.4.1 1 Estimated weekly average active case across various movement control events during the 75
COVID-19 pandemic, Malaysia, 2020-2021
Table 1.4.4.2 Estimated weekly average ICU case across various movement control events during the COVID- 75
19 pandemic, Malaysia, 2020-2021
Table 1.4.4.3 Estimated weekly average ventilated case across various movement control events during the 76
COVID-19 pandemic, Malaysia, 2020-2021
Table 1.5.1.1 COVID-19 deaths by states/waves in Malaysia, 2020 to 2021 80
Table 1.5.2.1 Total number of deaths by states 82
Table 1.5.3.1 Death rate by states per 100,000 populations, Malaysia 2020 to 2021 84
Table 1.5.3.2 COVID-19 case fatality rate (CFR) by state, Malaysia 86
Table 1.5.4.1 COVID-19 deaths gender distribution National/State level in 2020, 2021 and overall (2020-2021) 87
Table 1.5.5.1 Age distribution of COVID-19 deaths in Malaysia, 2020 90
Table 1.5.5.2 Age distribution of COVID-19 deaths in Malaysia, 2021 91
Table 1.5.5.3 Age distribution of COVID-19 deaths in Malaysia, 2020-2021 93
Table 1.5.6.1 Distribution of COVID-19 deaths in Malaysia by gender and age, 2020-2021 98
Table 1.5.7.1 Number of COVID-19 deaths across various movement control events during the COVID-19 101
pandemic, Malaysia, 2020-2021
Table 1.5.8.1 Distribution of BID by year and wave in Malaysia, 2020 to 2021 103
Table 1.6.1.1 COVID-19 test positivity rate Malaysia, 2020-2021 105
Table 1.7.2.1 COVID-19 Rt characterization by waves in Malaysia, 2020-2021 108
Table 1.7.3.1 Estimated Rt values across various movement control order and NRP during the COVID-19 110
pandemic, Malaysia, 2020-2021

Chapter 2:

Table 2.1 Number of COVID-19 clusters by infection waves 118
Table 2.2 Summary of COVID-19 clusters in Malaysia 120
Table 2.3 Number of COVID-19 Positive Cases of Sri Petaling Cluster by State 126
Table 2.4 Number of COVID-19 Positive Cases of Sri Petaling Cluster by Nationality 126
Table 2.5 Sub-cluster of Sri Petaling Cluster 126
Table 2.6 Summary of health-facilities sub-clusters 130

Covid-19 Technical Report 2020-2021 : The Challenging Years | 21

Chapter 3:

Table 3.1.1 National COVID-19 Immunization Program phases and timeline 141
Table 3.2.1 Vaccine registration status by state recorded as 1st January 2022 147
Table 3.3.1 List of COVID-19 vaccine that has been approved in Malaysia 150
Table 3.3.2 Vaccination coverage for Malaysian aged 12 years and above as at 1st January 2022 151
Table 3.3.3 Total and percentage of type of vaccine used in each state 164
Table 3.3.4 Vaccine side effects after Day 1 165
Table 3.3.5 Vaccine side effects after Day 2 166
Table 3.3.6 Vaccination centers in all state in Malaysia 167

Chapter 5: 197

Table 5.1 The PPE Item List 242
246
Chapter 7: 254

Table 7.1 Some of the mutations within the spike protein defining each VOC
Table 7.2 Platforms used for genomic surveillance of SARS-CoV-2 utilized in IMR
Table 7.3 VOC and Non-VOC detected from samples collected for every month from January 2020 to
December 2021 in Malaysia

22 | Covid-19 Technical Report 2020-2021 : The Challenging Years

EXECUTIVE

SUMMARY

COVID-19 named by the World Health Organization SARS-CoV-2 was first identified in Malaysia on 25
(WHO) was discovered and act as an agent of the January 2020; three cases were notified, all of which
outbreak of the respiratory tract infection that began were imported from Wuhan, China. On 30 January
at the beginning of December 2019 near in Wuhan 2020, WHO declared COVID-19 a public health emer-
City, Hubei Province, China . COVID-19 (coronavirus gency of international concern. On 6 February, the
disease 2019) is a disease cause by pathogenic virus first local transmission was reported in Malaysia in a
named severe acute respiratory syndrome coronavi- close contact of a confirmed COVID-19 case who had
rus 2 (SARS-CoV-2) and it is very contagious and has returned from Singapore. The first case in Malaysia
quickly spread around the world. COVID-19 most often with neither a history of contact with a confirmed
causes respiratory symptoms that can feel much like case nor travel to an affected area was reported
a cold, a flu, or pneumonia to more severe diseases on 12 March 2020. By 31 December 2021; or end of
like severe acute respiratory syndrome (SARS) and epid week 52/2021, Malaysia had reported 2,761,472
Middle East respiratory syndrome (MERS). Most confirmed cases and 31,514 fatalities.
people with COVID-19 have mild symptoms, but some
people become severely ill. Some people including This report provides a comprehensive result of the
those with minor or no symptoms may suffer from pandemic Covid-19 situation in Malaysia from 2020
post-COVID conditions — or “long COVID”. Older until 2021. Our intension is to give a comprehensive
adults and people who have certain underlying medi- overview of our approaches, results from intervention
cal conditions are at increased risk of severe illness and some discussion on related results. We describe
from COVID-19 and millions of people have died from mostly technical related events, activities, results
COVID-19 globally. Vaccines against COVID-19 are and issues which covers epidemiology of the cases
available, safe and effective in reducing the morbidity, during the pandemic in Malaysia, cluster of cases,
severity and mortality due to the illness. vaccination activities and programmes, vaccine
development in Malaysia, Hospital preparedness
During the week 20-26 December 2021, the global and response, Malaysia International border control
number of new COVID-19 cases increased by 11% during pandemic, laboratory activities, genomic
as compared to the previous week of that month; sequencing and Covid-19 research related activities
while the number of new deaths remained similar to conducted under the Ministry of Health Malaysia.
numbers reported during the previous week of that
month. This corresponds to just under 5 million new
cases and over 44 000 new deaths being recorded. As
of 26 December, over 278 million cases and just under
5.4 million deaths have been reported globally.

Covid-19 Technical Report 2020-2021 : The Challenging Years | 23



COVID-19 TECHNICAL REPORT

2020-2021: The Challenging Years

Chapter 1:

Epidemiology of the COVID-19
pandemic in Malaysia



Chapter 1: Epidemiology of the COVID-19 pandemic in Malaysia

CHAPTER 1:

EPIDEMIOLOGY OF THE COVID-19
PANDEMIC IN MALAYSIA

1.0 INTRODUCTION Data was obtained from the Ministry of Health, Malay-
sia (MOH) official web portal and the Github repos-
Chapter 1 presents the epidemiology of the COVID- itory, which were all open source data. The analysis
19 pandemic in Malaysia form the beginning of the performed were descriptive and analytical in nature
pandemic in the year 2020 to the year 2021. The find- which included frequencies, distributions, trends
ings of this chapter is presented in relation to the analysis, rates, ratios and mathematical models for
various COVID-19 waves in Malaysia beginning from estimating the disease transmission and forecasting.
the first wave which was from 25 January 2020 to 26 There are eight sub chapters in Chapter 1 which begins
February 2020, followed by the second wave which with the description of the COVID-19 case numbers,
was from 27 February 2020 to 19 September 2020 and trends and distribution in Chapter 1.1, followed by
finally the third wave which was from 20 September the Demographic characteristics of COVID-19 cases
2020 to 31 December 2021. In addition, the epidemi- (Chapter 1.2), COVID-19 case categorization (Chapter
ology of COVID-19 was also presented annually for 1.3), COVID-19 active cases, ICU & ventilated patients
the years 2020 and 2021 as well as the overall period (Chapter 1.4), COVID-19 death numbers, trends and
between 2020 to 2021. Also this chapter presents the distribution (Chapter 1.5), testing (Chapter 1.6),COVID-
effect of various events such as the movement control 19 Time varying reproduction number (Rt) (Chapter
measures, vaccination program and mass gathering 1.7) and finally Modelling the COVID-19 pandemic
events on the epidemiology of COVID-19 in Malay- (Chapter 1.8). The following sections presents the sub
sia. Appendix 1 shows the time periods of the various chapters in Chapter 1.
COVID-19 waves and events in Malaysia.

1.1 COVID-19 CASE NUMBERS, TRENDS
AND DISTRIBUTION

This section describes the COVID-19 case number, RMCO), National Recovery Plan (NRP), COVID-19
trends and incidence rate at the National, state and vaccination program and mass gathering events on
district levels. In addition, the effects of various COVID- COVID-19 case at the National level are also described.
19 movement control measures (i.e MCO, CMCO,

1.1.1 Case numbers and trends

A) NATIONAL
OVERALL (2020-2021)

• A total of 2,761,472 cases were reported from 2020 1,163 cases). Subsequently the case trends started
(Epi Wk 1-53) to 2021 (Epi Wk 1-52), where in 22 to decrease from Epi Wk 15/2021 (n=1,045 cases) to
(0.0008%), 10,145 (0.37%) and 31,357 (99.6%) cases Epi Wk 36/2020 (74 cases), following this the case
were reported during the first, second and third trends started to once again increase from Epi Wk
waves respectively 37/2021 (n=477 cases) and peaked in Epi WK 4/2021
(n=29,206 cases). A downward trend of cases has
• The first case was reported on 25 January 2020, been observed from Epi Wk 5/2021 (n=29,060 cases)
the highest daily (n=24,599) and weekly cases (n till Epi Wk 14/2021 (9,507 cases). Subsequently, case
= 150,933) was reported on 26 August 2021 and in trends started to increase from Epi Wk 15/2021
Epidemiological week (Epi Wk) 33/2021 respectively (n=13,742 cases) and peaked in Epi Wk 33/2021
(n=150,933 cases) and this corresponded to the
• Since the outbreak began in Malaysia, the number longest increasing case trends which was 18 weeks.
of cases started to increase from Epi Wk 10/2020 A downward trend of cases has been observed from
(n= 68 cases) and peaked in Epi WK 14/2020 (n= Epi Wk 34/2021 (n=150,224 cases) till Epi Wk 52/2021

Covid-19 Technical Report 2020-2021 : The Challenging Years | 27

Chapter 1: Epidemiology of the COVID-19 pandemic in Malaysia

(n=23,071 cases) which corresponds to the longest • The weekly COVID-19 cases in Malaysia is shown in
decreasing case trends which was 18 weeks. Figure 1.1.1.1

WAVE • For the third wave, a total of 2,751,305 (99.63%) of
cases was reported, the highest daily (n= 24,599)
• During the first wave, a total of 22 (0.0008%) cases and weekly (n=150,933) cases was reported on 26
was reported, the highest daily (n=4) and weekly (n August 2021 and in Epi Wk 33/2021 respectively
= 8) cases was reported on 25 January 2020 and in
Epi Wk 6/2020 respectively

• In the second wave, a total of 10,145 (0.37%) cases
was reported, the highest daily (n=277) and weekly
(n = 1,163) cases was reported on 4 June 2020 and in
Epi Wk 14/2020 respectively

Figure 1.1.1.1 Weekly COVID-19 cases by waves in Malaysia, 2020-2021

B) STATE
• Weekly COVID-19 cases by states in Malaysia from 2020 to 2021 are shown in Appendix 2

1.1.2 Distribution of COVID-19 cases

OVERALL (2020-2021) Selangor state and Kuala Lumpur (n=211,024). The
spatial distribution of cumulative COVID-19 cases
• The highest cumulative cases were reported in the by states and districts Malaysia for the year 2020,
states of Selangor (n= 787,416, 28.51%) followed by 2021 and overall (2020 – 2021) are shown in Figure
Sarawak (n=252,324, 9.14%) and Johor (n=245,366, 1.1.2.2- 1.1.2.4.
8.89%) as shown in Figure 1.1.2.1. While the highest
cumulative cases were reported in the districts of
Petaling (n=226,721) and Hulu Langat (n=165,916) in

28 | Covid-19 Technical Report 2020-2021 : The Challenging Years

Chapter 1: Epidemiology of the COVID-19 pandemic in Malaysia

Figure 1.1.2.1 Proportion (%) of COVID-19 cases by states in Malaysia, 2020-2021

WAVE

• During the first wave, the highest cumulative cases of Petaling (n=511) and Hulu Langat (n=668) in
were reported in the states of Johor (n=8, 36.4%), Selangor state and Kuala Lumpur (n=2,623) (Table
Selangor (n=5, 22.7%) and WP Kuala Lumpur (n=4, 1.1.2.2)
18.2%) (Table 1.1.2.1). While the highest cumulative
cases were reported in the districts of Johor Bahru • For the third wave, the highest cumulative cases
(n=8) in Johor state, Petaling (n=3) in Selangor state were reported in the states of Selangor (n=787,416,
and Kuala Lumpur (n=4) (Table 1.1.2.2) 28.5%), Sarawak (n=252,324, 9.1%) and Johor
(n=244,614 8.9%) (Table 1.1.2.1). While the highest
• In the second wave, the highest cumulative cases cumulative cases were reported in the districts of
were reported in the states of WP Kuala Lumpur Petaling (n=226,207) and Hulu Langat (n=165,248)
(n=2,624, 25.9%), Selangor (n=2,200, 21.7%) and in Selangor state and Kuala Lumpur (n=208,397)
Sabah (n=1,044, 10.3%) (Table 1.1.2.1). While the high- (Table 1.1.2.2)
est cumulative cases were reported in the districts

Covid-19 Technical Report 2020-2021 : The Challenging Years | 29

Chapter 1: Epidemiology of the COVID-19 pandemic in Malaysia

Date of the
highest cases

Daily highest
cases

Epid week
with the high-

est cases

Highest cases

Cumulative
case

Date of the
highest cases

Daily highest
cases

Epid week
with the high-

est cases

Highest cases
Cumulative
case

Date of the
highest cases

Daily highest
cases

Epid week
with the high-

est cases
Weekly High-

est cases
Cumulative

case

Date of highest
cases

Daily highest cases

Epid week wth the
highest cases

Weekly Highest
case

Cumulative cases
in 2020-2021

30 | Covid-19 Technical Report 2020-2021 : The Challenging Years
Table 1.1.2.1 COVID-19 cases by waves in Malaysia, 2020-2021 (States)

First wave Second wave Third wave

MALAY- 2761472 150933 33(2021) 24599 26/8/2021 22 8 6(2020) 4 25/1/2020 10145 1163 14(2020) 277 4/6/2020 2751305 150933 33(2021) 24599 26/8/2021
SIA
787416 51031 31(2021) 3009 26/8/2021 5 4 7(2020) 2 15/2/2020 2200 308 14(2020) 60 26/3/2020 785211 51031 31(2021) 3009 26/8/2021
Selangor 252324 25574 37(2021) 1866 15/9/2021 0 -- -
245366 14918 36(2021) 1288 26/8/2021 8 4 4(2020) 4 701 128 14(2020) 31 1/4/2020 251623 25574 37(2021) 1866 15/9/2021
Sarawak 240796 21043 34(2021) 883 22/8/2021 0 -- -
211041 15494 31(2021) 2880 28/7/2021 4 3 6(2020) 1 25/1/2020 744 157 13(2020) 29 26/3/2020 244614 14918 36(2021) 1288 26/8/2021
Johor
-- - 1044 375 37(2020) 167 11/9/2020 239752 21043 34(2021) 883 22/8/2021
Sabah 1 5,6 and 1
4/2/2020, 2624 369 23(2020) 271 4/6/2020 208413 15494 31(2021) 2880 28/7/2021
W.P. 7(2020) 6/2/2020,
Kuala -- - 8/2/2020
Lumpur &14/2/2020
-- -
Kelantan 169393 9644 35(2021) 689 2/10/2021 0 160 58 12(2020) 11 19/3/2020 169233 9644 35(2021) 689 2/10/2021
2 6(2020) 2
Kedah 168640 13373 34(2021) 803 25/8/2021 3 29/1/2020, 318 65 37(2020) 20 8/9/2020 168319 13373 34(2021) 803 25/8/2021
-- - 6/2/2020 &
-- -
15/2/2020
-- -
Pulau 161310 13816 36(2021) 834 24/8/2021 0 -- - - 141 43 12(2020) 6 21/3/2020 161169 13816 36(2021) 834 24/8/2021
Pinang
129203 8716 36(2021) 1041 21/2/2021 0 -- - - 269 109 13(2020) 15 25/3/2020 128934 8716 36(2021) 1041 21/2/2021
Perak 5/2/2020 1042 160 19(2020) &
-- -
Negeri 113661 8407 28(2021) 1371 14/7/2021 2 26/3/2020
Sembilan 95614 0
82810 0 72 29/4/2020 112617 8407 28(2021) 1371 14/7/2021
Pahang 76472 0
10826 5169 37(2021) 486 29/8/2021 0 - 371 67 14(2020) 23 11/4/2020 95243 5169 37(2021) 486 29/8/2021
Tereng- 9409 5749 36(2021) 340 15/9/2021 0
ganu 7191 0 - 114 29 14(2020) 9 3/4/2020 82696 5749 36(2021) 340 15/9/2021

Melaka 5182 33(2021) 843 16/8/2021 - 262 66 15(2020) 37 19/4/2020 76210 5182 33 (2021) 843 16/8/2021
1344 23(2021) 253 29/5/2021 - 23 5 13(2020) 5 28/3/2020 10803 1344 23(2021) 253 29/5/2021
W.P.
Labuan 634 30(2021) 122 27/7/2021 - 99 23 17(2020) 13 20/4/2020 9310 634 30(2021) 122 27/7/2021

W.P. & 6/8/2021
Putrajaya
551 40(2021) 200 7/10/2021 - 33 11 32(2020) 10 7/8/2020 7158 551 40(2021) 200 7/10/2021
Perlis

Table 1.1.2.2 COVID-19 cases by waves in Malaysia, 2020-2021 (Districts) Chapter 1: Epidemiology of the COVID-19 pandemic in Malaysia
Covid-19 Technical Report 2020-2021 : The Challenging Years | 31

Chapter 1: Epidemiology of the COVID-19 pandemic in MalaysiaTable 1.1.2.2 COVID-19 cases by waves in Malaysia, 2020-2021 (Districts)
32 | Covid-19 Technical Report 2020-2021 : The Challenging Years

Table 1.1.2.2 COVID-19 cases by waves in Malaysia, 2020-2021 (Districts) Chapter 1: Epidemiology of the COVID-19 pandemic in Malaysia
Covid-19 Technical Report 2020-2021 : The Challenging Years | 33

Chapter 1: Epidemiology of the COVID-19 pandemic in MalaysiaTable 1.1.2.2 COVID-19 cases by waves in Malaysia, 2020-2021 (Districts)
34 | Covid-19 Technical Report 2020-2021 : The Challenging Years

Table 1.1.2.2 COVID-19 cases by waves in Malaysia, 2020-2021 (Districts) Chapter 1: Epidemiology of the COVID-19 pandemic in Malaysia
Note *Undefined: Cases with unknown district.Covid-19 Technical Report 2020-2021 : The Challenging Years | 35

Chapter 1: Epidemiology of the COVID-19 pandemic in Malaysia

STATES DISTRICTS

YEAR 2020

Figure 1.1.2.2 Spatial distribution of cumulative COVID-19 cases by states and districts Malaysia, 2020 YEAR 2021
Figure 1.1.2.3 Spatial distribution of cumulative COVID-19 cases by states and districts Malaysia, 2021

OVERALL 2020-2021

Figure 1.1.2.4 Spatial distribution of cumulative COVID-19 cases by states and districts Malaysia, 2020 to 2021
36 | Covid-19 Technical Report 2020-2021 : The Challenging Years

Chapter 1: Epidemiology of the COVID-19 pandemic in Malaysia

1.1.3 COVID-19 incidence rate

2020 2021

• Annual incidence rate was defined as the number • The annual incidence rate of COVID-19 in Malay-
of COVID-19 cases over the total population in the sia for the year 2021 was 77.2 per 1,000 population
respective year (Table 1.1.3.1)

• The annual incidence rate of COVID-19 in Malaysia • The highest annual incidence rate was reported
for the year 2020 was 3.5 per 1,000 population (Table in the states of Selangor (110.6), W.P Kuala Lumpur
1.1.3.1) (102.3) and W.P Putrajaya (95.0)

• The highest annual incidence rate was reported in • The highest annual incidence rate was reported
the states of W.P Labuan (16.5), Sabah (9.3) and W.P in the districts of Kinta (211.3), Manjung (172.2) and
Kuala Lumpur (7.4) Serian (164.7)

• The highest annual incidence rate was reported in
the districts of Tuaran (17.3), Kota Kinabalu (16.6) and
Lahad Datu (15.1)

OVERALL (2020-2021)

• The overall incidence rate was defined as the total (55.0) and W.P Labuan (52.2)
number of COVID-19 cases over the total popula-
tion for the year 2020 and 2021 • The highest overall incidence rate was reported
in the districts of Kinta (109.1), Manjung (86.9) and
• The overall incidence rate of COVID-19 in Malaysia Sepang (86.0)
(2020 to 2021) was 40.6 per 1,000 population (Table
1.1.3.1) • The spatial distribution of COVID-19 incidence rate
by states and districts Malaysia for the year 2020,
• The highest overall incidence rate was reported in 2021 and overall (2020 – 2021) are shown in Figure
the states of Selangor (58.2), W.P Kuala Lumpur 1.1.3.1- 1.1.3.3

Covid-19 Technical Report 2020-2021 : The Challenging Years | 37

Chapter 1: Epidemiology of the COVID-19 pandemic in MalaysiaTable 1.1.3.1 COVID-19 incidence rate by state and district in Malaysia, 2020 to 2021
38 | Covid-19 Technical Report 2020-2021 : The Challenging Years

Table 1.1.3.1 COVID-19 incidence rate by state and district in Malaysia, 2020 to 2021 Chapter 1: Epidemiology of the COVID-19 pandemic in Malaysia
Covid-19 Technical Report 2020-2021 : The Challenging Years | 39

Chapter 1: Epidemiology of the COVID-19 pandemic in MalaysiaTable 1.1.3.1 COVID-19 incidence rate by state and district in Malaysia, 2020 to 2021
40 | Covid-19 Technical Report 2020-2021 : The Challenging Years

Table 1.1.3.1 COVID-19 incidence rate by state and district in Malaysia, 2020 to 2021 Chapter 1: Epidemiology of the COVID-19 pandemic in Malaysia
Covid-19 Technical Report 2020-2021 : The Challenging Years | 41

Chapter 1: Epidemiology of the COVID-19 pandemic in MalaysiaTable 1.1.3.1 COVID-19 incidence rate by state and district in Malaysia, 2020 to 2021
42 | Covid-19 Technical Report 2020-2021 : The Challenging Years

Table 1.1.3.1 COVID-19 incidence rate by state and district in Malaysia, 2020 to 2021 Chapter 1: Epidemiology of the COVID-19 pandemic in Malaysia
Covid-19 Technical Report 2020-2021 : The Challenging Years | 43

Chapter 1: Epidemiology of the COVID-19 pandemic in Malaysia
44 | Covid-19 Technical Report 2020-2021 : The Challenging Years
Table 1.1.3.1 COVID-19 incidence rate by state and district in Malaysia, 2020 to 2021

Note. *Undefined indicates that the district data was not provide for the particular case (but state data is provided)
Population data (data in 2022) sourced from Department of Statistics Malaysia website (http://pqi.stats.gov.my/,poplation

Chapter 1: Epidemiology of the COVID-19 pandemic in Malaysia

STATES DISTRICTS

YEAR 2020

Figure 1.1.3.1 Spatial distribution of annual COVID-19 incidence rate by state and district (n=158), Malaysia in 2020 YEAR 2021
Figure 1.1.3.2 Spatial distribution of annual COVID-19 incidence rate by state and district (n=158), Malaysia 2021

OVERALL 2020-2021

Figure 1.1.3.3 Spatial distribution of annual COVID-19 incidence rate by state and district (n=158), Malaysia in 2020-2021
Covid-19 Technical Report 2020-2021 : The Challenging Years | 45

Chapter 1: Epidemiology of the COVID-19 pandemic in Malaysia

1.1.4 Effects of movement controls, vaccination
and mass gathering events

• The various movement control measures, vaccina- mass gathering events in Malaysia, 2020-2021. The
tion and mass gathering events during the period following sections describes the effects of move-
from 2020 to 2021 are described in Appendix 1. ment control measures, vaccination and mass
Figure 1.1.4.1 shows the case trends during the vari- gathering on the COVID-19 case trends.
ous movement control measures, vaccination and

Figure 1.1.4.1 Weekly COVID-19 cases by epidemiological weeks during the various movement control measures
and mass gathering events in Malaysia, 2020-2021

A) MOVEMENT CONTROL MEASURES AND NATIONAL RECOVERY PLAN (NRP)

• For the MCO phase, a total of 6,351 cases were • For the MCO by states phase, a total of 477,015 cases
reported with the highest and lowest cases being were reported with the highest and lowest cases
1,163 and 413 in Epi Wk 14/2020 and Epi Wk 19/2020 being 53,419 and 8,929 in Epi Wk 21/2021 and 12/2021.
respectively. The difference of cases between these The difference of cases between these weeks was
weeks was 750 cases, with a mean of 794 cases. A 44,490 cases, with a mean of 22,715 cases. An increase
reduction of cases was observed during this period. of cases was observed during this period.

• During the CMCO phase, a total of 2,269 cases were • During the NRP phase, a total of 2,202,938 cases were
reported with the highest and lowest cases being reported with the highest and lowest cases being
577 and 142 in Epi Wk 22/2020 and 24/2020 respec- 150,933 and 22,554 in Epi Wk 33/2021 and 51/2021. The
tively. The difference of cases between these weeks difference of cases between these weeks was 128,379
was 435 cases, with a mean of 378 cases. A reduc- cases, with a mean of 71,063 cases. A reduction of
tion of cases was observed during this period. cases was observed during this period.

• In the RMCO phase, a total of 146,792 cases were • Table 1.1.4.1 shows the National COVID-19 cases by
reported with the highest and lowest cases being Epi Wk across various movement control measures
21,536 and 42 in Epi Wk 2/2021 and 27/2020 respec- during the COVID-19 pandemic, Malaysia, 2020-2021.
tively. The difference of cases between these weeks
was 21,494 cases, with a mean of 4,587 cases. An
increase of cases was observed during this period.

46 | Covid-19 Technical Report 2020-2021 : The Challenging Years

Chapter 1: Epidemiology of the COVID-19 pandemic in Malaysia

Table 1.1.4.1 National COVID-19 cases by Epi Wk across various movement control events during the
COVID-19 pandemic, Malaysia, 2020-2021

Time period MCO CMCO RMCO MCO by NRP
Duration states
Epi Wk 18/3/2020 to 4/5/2020 to 10/6/2020 to 1/6/2021 to
3/5/2020 9/6/2020 10/1/2021 11/1/2021 to 31/12/2021
Highest cases 47 days 37 days 215 days 31/5/2021
Lowest cases 12/2020 to 19/2020 to
Differences 19/2020 24/2020 24/2020 to 141 days 214 days
Ranges 2/2021
Mean cases 1,163 577 2/2021 to 22/2021 to
413 142 21,536 22/2021 52/2021
750 435 42
53,419 150,933
413 to 1,163 142 to 577 21,494 8,929 22,554
44,490 128,379
794 378 42 to 21,536
8,929 to 53,419 22,554 to 150,933
4,587
22,715 71,063

B) VACCINATION

• Total population fully vaccinated (completed second dose) is 78.4% as of 31 December 2021. Decreasing daily
cases trends are observed since 29 August 2021 at 45.82% fully vaccinated Figure 1.1.4.2.

Figure 1.1.4.2 Percentage fully vaccinated by COVID-19 cases, Malaysia, 1 April 2021 to 31 December 2021
Covid-19 Technical Report 2020-2021 : The Challenging Years | 47

Chapter 1: Epidemiology of the COVID-19 pandemic in Malaysia

C) MASS GATHERING • During the electoral event in Melaka, the high-
est and lowest cases reported were 6,144 and
• For the Sri Petaling mass gathering event, the 4,087 on 25 November 2021 and 29 November
highest reported case was 190 on 15 March 2020, 2021 respectively, with a mean of 5,264 cases. A
with a mean of 23 cases during this period. An decrease of cases was observed during this period
increase of cases was observed during this period
• For the electoral event in Sarawak, the highest and
• During the electoral event in Sabah, the high- lowest cases reported were 4,083 and 2,589 on 18
est and lowest cases reported were 691 and December 2021 and 20 December 2021 respective-
82 on 6 October 2020 and 26 September 2020 ly, with a mean of 3,309 cases. An increase of cases
respectively, with a mean of 288 cases. An was observed during this period
increase of cases was observed during this period

1.2 DEMOGRAPHIC CHARACTERISTICS
OF COVID-19 CASES

This section describes the demographics characteristics of COVID-19 cases in Malaysia in terms of gender, age,
local and import status for the duration from 2020 to 2021.

1.2.1 Gender distribution of COVID-19 cases

A) NATIONAL • COVID-19 gender-specific incidence rates:
• Incidence rate in males: 23.3 per 1,000 male
• Male outnumbered female COVID-19 cases population
• Percentage of male cases: 56.5% (n=1,559,098) • Incidence rate in males overall: 19.0 per 1,000 female
• Percentage of female cases: 43.5% population
(n=1,202,374)
• Ratio of male to female cases: 1.3 (13 male • COVID-19 cases gender distribution at National/
cases for every 10 female cases) State level in 2020, 2021 and overall (2020-2021) is
shown in Table 1.2.1.1


B) STATE • State with lowest incidence rate in males: Perlis (7.0
per 1,000)
• Male to female ratios ranged from: 0.9-2.5 (Figure
1.2.1.1) • State with lowest incidence rate in females: Perlis
• States with more male compared to female cases (7.1 per 1,000)
(M:F ratios range from 1.18-2.52) are WP Labuan,
Pahang, Pulau Pinang, Melaka, Negeri Sembilan, • State with highest incidence rate in males: WP
Selangor, Johor, WP Kuala Lumpur and Perak Kuala Lumpur (34.8 per 1,000)
• States with equal proportions of male and female
cases (M:F ratio between 0.99-1.06) are Perlis, Tereng- • State with highest incidence rate in females: Selan-
ganu, W.P. Putrajaya, Sarawak, Kedah, Sabah gor (25.3 per 1,000)
• States with the lowest proportion of male cases is
Kelantan (M:F ratio=0.9).

48 | Covid-19 Technical Report 2020-2021 : The Challenging Years

Chapter 1: Epidemiology of the COVID-19 pandemic in Malaysia

Figure 1.2.1.1 Male to female ratio of COVID-19 cases in Malaysia by state, 2020 & 2021

Table 1.2.1.1 COVID-19 cases gender distribution at National/State level
in 2020, 2021 and overall (2020-2021)

2020 2021 2020-2021

Male Female M:F Male Female M:F Male Female M:F
ratio ratio ratio
n 79,429 33,581 1,477,938 1,167,138 1,557,367 1,200,719
70.3 29.7 2.4 55.9 44.1 1.3 56.5 43.5 1.3
National % 4.7 2.1 88.1 73.5 46.4 37.9
3,934 1,800 2.2 1.5 99,320 0.9
IR 68.6 31.4 141,686 97,520 145,620 40.5
2.0 1.0 3.2 59.2 40.8 1.0 59.5 27.5 1.0
n 2,304 720 71.6 53.7 36.9 81,660
76.2 23.8 1.1 80,940 0.9 48.5 1.0
Johor % 2.1 0.7 84,422 48.9 86,726 37.7
402 356 6.2 51.1 74.6 1.4 51.5 88,814 1.0
IR 53.0 47.0 76.2 88,458 39.2 52.5
0.4 0.4 5.2 52.6 1.3 46.8 1.0
n 1,055 170 79,827 92.8 80,229 32,112
86.1 13.9 5.5 47.4 31,942 1.2 47.5 42.1 1.1
Kedah % 2.3 0.4 81.9 42.6 41.4 34.4
6,560 1,268 43,123 68.1 44,178 46,581
IR 83.8 16.2 57.4 45,313 57.9 41.0
11.3 2.3 92.0 42.9 47.2 42.4
n 1,155 210 82.2
84.6 15.4 60,423 43,233 66,983 43,443
Kelantan % 1.3 0.3 57.1 46.0 59.0 45.6
104.5 54.2 57.9 27.4
IR 51,903
50,748 54.4
n 54.0 29.3
57.2
Melaka %

IR

n

Negeri Sembilan %

IR

n

Pahang %

IR

Covid-19 Technical Report 2020-2021 : The Challenging Years | 49

Chapter 1: Epidemiology of the COVID-19 pandemic in Malaysia

Table 1.2.1.1 COVID-19 cases gender distribution at National/State level
in 2020, 2021 and overall (2020-2021)

2020 2021 2020-2021

Male Female M:F Male Female M:F Male Female M:F
ratio ratio ratio
Pulau Pinang n 2,481 1,007 90,271 35,573 92,379 36,660
% 71.1 28.9 2.5 71.7 28.3 2.5 71.6 28.4 1.1
Perak IR 2.8 71.4 28.6 36.5 14.7
n 2,108 1.1 1.9 3,530 3,593 1.0 3,560 3,609 1.2
Perlis % 66.0 1,087 49.6 50.4 49.7 50.3
IR 1.7 34.0 1.9 27.8 28.0 1.2 14.0 14.1 1.2
Selangor n 30 0.9 72,127 73,134
Terengganu % 65.2 3.3 85,489 45.8 1.0 87,970 45.4 1.2
IR 0.2 16 1.9 54.2 81.6 1.0 54.6 41.4 1.4
Sabah n 24,918 34.8 96.0 49.4 116,623
n% 72614.9 0.1 1.3 100,360 1.4 123,909 12438,8.500 1.4
Sarawak %IR 675.4.8 7,477 103,132 12439,3.317 12581,5.500 4319.5.1
W.P. Kuala IR 0.3 21311.1 1.3 12570,8.766 1.0 3500..98 45.6 1.5
n 20,777 324.4.2 5449..61 44.0 319,026
Lumpur % 56.1 0.2 6.8 5501..79 90.7 1.4 467,604 40.6 1.5
W.P. Labuan IR 10.3 16,263 87.4 311,549 59.4 50.5
n 634 43.9 1.2 442,686 41.3 1.2 69.1 40,967 1.5
W.P. Putrajaya % 0.0 8.7 58.7 98.4 41,713 49.5
IR 0.4 483 1.4 130.6 40,856 1.0 50.5 32.8 2.5
n 11,757 43.2 41,499 49.6 32.4 85,399
% 87.2 0.4 50.4 65.0 125,451 40.5
IR 13.0 1730 64.2 83,669 59.5 49.9
n 935 12.8 113,694 42.4 69.6 4,959
% 55.0 2.0 57.6 98.3 5,865 45.8
IR 18.7 766 126.9 4,193 54.2 50.0
n 165 45.0 4,930 46.0 58.5 4,612
% 58.5 15.5 54.0 84.2 4,777 49.1
IR 3.2 117 98.2 4,495 50.9 38.2
41.5 4,612 49.4 45.4
2.0 50.6 72.4
85.4

M:F, Male:Female; IR, gender-specific incidence per 100,000 population
* Incidence of COVID-19 in 2020-2021 per 1,000 population
Denominators are total of 2020 and 2021 populations
Population data sourced from the Department of Statistics Malaysia website (http://pqi.stats.gov.my)

50 | Covid-19 Technical Report 2020-2021 : The Challenging Years


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