Prepare For Delta Wave Of Covid 19 Outside Klang Valley

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Much of the recent focus of the nation for Covid-19 has been on the Klang Valley, including Negeri Sembilan, and rightly so. 
The outbreak there continues to rage and the multi-sectoral task force set up to deal with the region, the Greater Klang Valley Special Task Force (GKVSTF), is working hard to make a difference.
We however may not be aware that other states outside the Klang Valley are gradually slipping into a crisis. 
If you track the intensive care unit (ICU) bed use by Covid-19 patients for Perak, Kedah and Pulau Pinang, as examples, you can see this steep rise in the past 3-4 weeks (see chart below). 
Remember that this data does not show the full picture as for every one Covid-19 patient documented in an ICU bed. There are perhaps 1-2 times as many Category 4 and 5 patients in a non-ICU bed, often in casualty departments.
Much of the rapid change in the situation is due to the Delta variant which is most likely the predominant strain spreading in the nation. 
The Delta variant is highly infectious as it has a very high viral load and infects more persons faster. 
In addition, the full vaccination rates for many states outside the Klang Valley are lower due to limited vaccine supply. 
Data for July 25, 2021, shows that completed vaccination rates (two doses) for the states (percentage of the total population) was 14.4 percent for Perak, 11.5 percent for Kedah and 14.5 percent for Penang. 
With the Delta variant, two-dose protection is important.



What can we do to prevent a Klang Valley-like disaster?
We need to act now to prevent the situation in many states from getting worse. We possibly have a narrow three to four-week window to act. Some summary suggestions are:
Advocate for more vaccine supply and ramp up vaccination to the maximum possible. Leave no vaccine vials in storage. Avoid using large PPVs and instead, do drive-by vaccination and use the existing vaccination infrastructure (maternal and child health clinics, school health teams, GPs, private hospitals). We want to reduce the risk of mega PPVs being a location for Covid-19 transmission.Reduce all non-critical social interaction to cut community spread of the virus. Avoid social, travel and religious activities. Avoid the use of vaccination passports at this time for travel, especially avoid interstate movement.Use RT-PCR only for hospital admissions and expand dramatically RTK-Ag testing for all contacts, whether symptomatic or well. Enable the public to self-test with the availability of reliable, cheap saliva-based RTK-Ag tests at pharmacies and health centres/GP clinics. The state government should consider investing in subsidising these tests. Anyone who is RTK-Ag test positive should be considered a case and be isolated and monitored.Activate a state-level multi-sectoral disaster team, not unlike the GKVSTF. Get the plans in place, teams activated and resources on standby as quickly as possible, so that when the Delta wave hits, we will be better prepared. This includes increasing the number of hospital beds, oxygen delivery capacity and electrical power supply.The state-level disaster management teams must be empowered to act immediately (decentralised decision making) and supported by state governments. Remember that the federal government have invested significant resources to support the Klang valley and may have limited funds for other states. Hence state governments must come together with wealthy business leaders to act now for their state.We need to give a clear message that vaccination alone will not stem the Delta wave; we need all public health measures as well (masks, ventilation, physical distancing, etc). We need to encourage the public to be vigilant and maintain their SOPs even if vaccinated.Finally, transparent data sharing with the public to comprehensively explain the true situation is crucial. We cannot say "everything is under control" when we know it is not. Granular, down to district level, will encourage an all-of-society involvement to reduce the impact of the Delta wave. A concerned public is one that acts.We have an opportunity to avoid the anguish that the greater Klang Valley residents are going through. 
If we have good, strong regional leadership stepping up now, we just may avoid the worst of the crisis that is impending. - Mkini

DR AMAR-SINGH HSS is a consultant paediatrician.

The views expressed here are those of the author/contributor and do not necessarily represent the views of MMKtT.

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