Sarawak’s Fight Against the Covid-19 Pandemic: A Cautionary Tale?

Malaysia appears to be seeing some light at the end of the tunnel in the long battle against the Covid-19 pandemic. From the just over 20,000 new Covid-19 infections reported on 24 August, the number fell to just under 15,000 on 20 September. Since early September, new Covid-19 infections have been on a gradual but consistent decline (Chart 1). The number of ‘actual deaths’ — measured in terms of Covid-19 casualties each day – have also fallen significantly, although ‘reported deaths’ each day has remained high due to a severe backlog in the documentation of Covid-19 casualties which occurred in the past months. The same optimism, however, cannot be said of the Borneo state of Sarawak — so much so that there could be instructive lessons here on how to fight the coronavirus.

On the vaccination front, there are similarities between Sarawak and the entire country. In both the Borneo state and at the national level, vaccination levels have been trending upward, hitting 63 per cent and 47 per cent respectively as of 1 September. The decline in daily national infection numbers is likely to be attributed to Malaysia crossing the 50 per cent fully vaccinated threshold in early September.

Digging deeper into the daily new infection data, however, Sarawak appears to be in a more precarious state. In the same period from 24 August to 20 September, the numbers of new infections in Sarawak more than doubled, from 1,543 to 3,611 (Chart 2).

At this, Sarawak could serve as a cautionary tale that double-dose vaccination alone may not be the panacea in the fight against Covid-19.

The situation in Sarawak looks puzzling when one compares the eastern state with two other states with similarly high vaccination rates. Excluding the Federal Territory of Labuan, Sarawak is the state with the third-highest level of vaccinations. As of 19 September, 64 per cent of the state’s total population were fully vaccinated. This puts Sarawak in the same ballpark as Negeri Sembilan (67 per cent) and the Klang Valley (78 per cent). Intriguingly, the trajectory of Sarawak’s daily infections has diverged from the other two states. In the case of Negeri Sembilan and the Klang Valley, new infections began to fall after they crossed the 40 per cent fully vaccinated threshold. For Sarawak, however, the number of daily infections rose since early August despite the state crossing the 50 per cent (of total population) fully vaccinated threshold on 2 August. In fact, the number of daily infections continued to defy gravity, and in the past week, Sarawak has consistently surpassed cases in the Klang Valley, which until very recently was the epicentre of Malaysia’s Covid-19 outbreak. Cases have only started to fall in the past few days, and incidentally, after the Sarawak health authority announced on 13 September that asymptomatic close contacts of Covid-19 patients would no longer be tested. The reduced testing may have accounted for the declining cases. At this, Sarawak could serve as a cautionary tale that double-dose vaccination alone may not be the panacea in the fight against Covid-19.

The surge in daily infections in Sarawak has resulted in a steady rise in occupancy rate for patients on ventilators and in intensive care units (ICUs) (Chart 3), though fortunately, the medical system remains able to cope with the situation at present.

There are several possible reasons as to why Sarawak has its hands full fighting the pandemic. One possible reason for the surge in daily infections — coupled with the steady rise in severe Covid-19 cases — could be due to the prevalence of the highly infectious Delta variant which is the dominant Covid-19 strain within Sarawak. Incidentally, Sarawak has the highest utilisation of the Sinovac vaccine among all Malaysian states; more than three-quarters of total administered vaccines were of that Chinese variety (Chart 4). In contrast, Pfizer and AstraZeneca vaccines were more widely administered in Negeri Sembilan, Selangor and Kuala Lumpur (the latter two being within Klang Valley).

Malaysian health minister Khairy Jamaluddin has suggested that the rise in daily infections in Sarawak could be caused by the ‘waning effectiveness of the vaccines over time’.

Dr Sim Kui Hian, Sarawak’s housing and local government minister announced on 17 September that Sarawak would soon start to administer third jabs as boosters to combat the surge in Delta variant. While the details for booster jabs have yet to be announced, some epidemiologists have suggested that Malaysia adopt a ‘mix and match’ strategy for booster shots, where the third dose is a different type of vaccine compared to the first two doses. That said, other medical groups, including the Malaysian Health Coalition, has called the government to release more granular data before implementing the booster shots.

The reopening up of Sarawak could be another cause. Since early August, large swathes of economic activity in Sarawak resumed operations under the Phase 3 of National Recovery Plan (with the exception of the eight districts in the southern region which remained under the more restrictive Phase 2). Phase 3 saw the physical resumption of most business sectors and dine-in at eating establishments with safe distancing measures and a cap on group sizes. The loosening of restrictions may have been implemented too early before the pandemic was brought under total control.

The difficulty of enforcing safe distancing in rural areas could be another factor that could have resulted in the recent surge in Covid-19 infections. Future research could analyse how the present wave of Covid-19 was transmitted in Sarawak, and whether the surge occurred in rural areas where residents were in communal living arrangements. Sarawak has one of the country’s highest percentages of rural residents. Sarawak is not out of the woods yet in the fight against Covid-19. Nonetheless, the experience of Sarawak would be a valuable lesson for Malaysia and other states on the transition to an endemic Covid-19 phase.

2021/239