Is COVID getting more virulent?

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The 25/5/2021 STAR paper gives the following statistics regarding the Covid epidemic

Total cases 518,600

Total Deaths 2309

New cases on 24/5/2021 6509

Deaths on 24/5/2021 61

Based on the above figures we can calculate that the overall case fatality rate (CFR) for Malaysia is 0.44% (2309/518,600). If we calculate the CFR for 24/5 using the new cases on 24/5 as denominator (61/6509) we get a figure of 0.94% – more than double the overall case fatality rate.

But we know that most deaths do not occur on the day of diagnosis. Deaths tend to occur about 10 to 14 days after the onset of symptoms, due to tissue damage and clot formation caused by over-reaction of the patient’s immune system. So using 6509 as denominator isn’t quite correct. If we wish to get a better estimate of the case fatality rate it would be more accurate to use the average number of new cases 11 to 14 days earlier as denominator – this happens to be 4113, 4855, 4765 and 3973 respectively on 11th to 14th May. This gives an average daily rate of new cases diagnosed of 4434. CFR based on 61 deaths with 4434 as denominator is 1.38% or 3 times the overall CFR.

There are some who question whether this increase in CFR is artefactual – due to the way we are identifying cases. They point out that if the increase in the number of cases has overwhelmed the capacity of the health services to trace contacts and test them, then a larger number of asymptomatic cases will not be identified. This would diminish the denominator and thus push up the CFR.

I think it is unlikely that the increase in the CFR is entirely due to “artefactual” causes. My hunch is that the most important cause of the elevated CFR, is that the variant now spreading through our population is causing over-reaction of the immune system in a larger percentage of the people infected compared to the earlier strains.

One other possible cause of the observed increase in our CFR could be inadequacy of medical care. Currently, about 25% of the patients diagnosed with Covid-19 go into stage 4 in terms of severity and they require supplementary oxygen and high quality care by an experienced team. If the medical services are overwhelmed by the sheer volume of such cases, then some of them might die because they did not receive the medical intervention they needed – oxygen, steroids, anti-coagulants and a whole lot of other things. This appears to be the case in India at present, but I do not think we have reached that stage in Malaysia just yet, though our acute beds for Covid-19 in urban centres are almost completely utilized. We are currently at about 80% occupancy of the 850 CCU beds allocated for Covid 19 cases in the public sector. If we do not reduce our incidence rates quickly we might exceed ICU capacity and our CFR will go up even more!

What all of the above means is that we are dealing with a more dangerous variant of Covid-19 now, and are dangerously close to overwhelming the capacity of our health care system to provide high quality care to all those who deteriorate to Stage 4 or 5. This underlines the importance of staying in, reducing trips out to a minimum and strict adherence to the SOPs when we do go out. We need to work together to disrupt transmission of Covid-19. We also need to combat vaccine hesitancy, counter the paranoia spread by anti-vaxxers and encourage our family members and friends to sign up for the vaccine so that we can build herd immunity and escape from this cycle of lock-down, partial relaxation and lock-down again.

Dr. Jeyakumar Devaraj
Parti Sosialis Malaysia

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