Beware the 5th wave of

COVID-19
By Contributor 3:57 pm, 25 June 2021 Leave a
Comment

On 8th May 2021 I wrote about how to “Avoid a COVID-19

Disaster in Malaysia”. This crisis has washed over us and
the toll in deaths and loss of livelihood has been and
continues to be significant.

I am now writing about the impending, massive fifth wave.

This wave may be so big as to make the current one look
pale in contrast. In a sense, we have, in the fourth wave,
experienced what Italy did last year. Now the fear is that
we may experience what India, Peru and some other
countries in South America are experiencing.

Some of our leaders seem to live in denial of the reality;

one even saying that the pandemic in Malaysia is under
control. Others have set a value of ‘4000 cases‘ as a
benchmark to use, but in the face of a high positivity and
limited testing this is fraught with problems. A good look
at the data and trends suggests that the worst may be yet
to come.

When will a 5th wave potentially hit

us?
The figure below shows the growth of the COVID-19
outbreak in Malaysia in relation to the population (seven-
day averaged data to offer a more accurate picture).
You can see that the 4th wave came very quickly after the
3rd wave; as fast as four weeks after the 3rd wave. Some
may argue that the 4th wave was due to considerable
movement of individuals related to the puasa and Hari
Raya period; that this encouraged spread. But the real
issue is that, even now, we fail to understand that there is
no safe number to meet. All social interactions at work,
education, religious or otherwise are easily exploited by
this virus. The current high baseline community infections,
predominantly unlinked, makes another surge very likely.

Why will a 5th wave come?

The fifth wave will come for a number of reasons.

Firstly, we cannot continue lockdowns indefinitely; the

suffering of the poor and middle class is enormous. It has
been estimated that an additional 2-3 million Malaysians
have been pushed below the poverty line income during
the COVID-19 crisis thus far. The Small and Medium
Enterprises (SME) Association of Malaysia is quoted as
saying that approximately 100,000 companies have
ceased operations since the first MCO and an additional
50,000 may lose their business with any extended
lockdown. So we will have to reopen the economy or face
worsening poverty, malnutrition of children, rising suicide
rates, etc. It should be noted that we have provided
inadequate support for the poorer segments of the
population and those struggling in terms of financial and
mask assistance.

Secondly, we have yet to make significant changes to our

work, business and education environments to reduce
COVID-19 spread. We have continued to focus on surface
decontamination instead of the more important ventilation
to reduce airborne transmission. The lack of a national
directive to do this hampers local initiatives.

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Thirdly, our social responsibility remains limited. This

applies to the leaders as much as to the people. Blaming
the people without stern action against errant leaders and
the rich does not promote collective community social
responsibility in addressing this pandemic.
Finally, and perhaps a critical reason, is the Delta variant.
Dr. Mike Ryan, executive director of the World Health
Organization (WHO) said, during a news conference on
21st June 2021, that the Delta variant has the potential “to
be more lethal because it’s more efficient in the way it
transmits between humans and it will eventually find those
vulnerable individuals who will become severely ill, have to
be hospitalized and potentially die”. Data is just coming in,
but the Delta variant appears to be more contagious and
vaccines to be less effective against it.

The limited genome testing done locally shows that the

Delta variant is present in many states but we need more
data to track its spread. Data from some nations show
that Delta variant rapidly becomes the dominant infective
strain and reverses some of the progress that has already
been made.

Won’t our COVID-19 vaccination

programme save us?
Vaccinations are a key component to bringing the COVID-
19 pandemic under control. While we have had a slow
start to vaccination, we are now vaccinating at an
accelerated pace. However, the impact of our vaccination
may not ‘kick in’ fast enough. Many hope our vaccination
will save us, but we still require about 3 months to get
50% of our population vaccinated with 2 doses. There is
also an unacceptable disparity in vaccination supply
between states which may leave some regions less well
protected.

Note also that many vulnerable people have yet to be

vaccinated. As of June 20 we have
937,078 registered senior citizens who are still waiting for
appointments. Only 19,000 (6.8%) out of 280,000 adults
with disabilities who registered have received a first dose.
We have no idea of vaccination rates among adults with
comorbidities like diabetes, hypertension and heart
disease; they comprise ~30% of the adult population with
many under 60 years of age. Note that there are many
more of these three vulnerable groups who are either not
able to register or hesitant. They will be the ones hard hit
by a 5th wave.

Note that even nations with high vaccination rates are

beginning to see a rise in cases and hospitalisations due
to the Delta variant. Current data from Scotland (see
figure below) from Dr Gabriel Scally (@GabrielScally),
former Regional Director of Public Health England and a
member of Independent Sage, shows that despite 48% of
the population fully vaccinated, the Delta variant has
caused a rise in cases and hospital admissions. While the
majority who get infected are not yet vaccinated
(showing good vaccine benefit), some vaccinated
individuals also do get infected.

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volunteers, internal inquiry will be conducted
So vaccination will help but they need to reach a large
segment of the population before outbreaks can be
reduced.

Why will a 5th wave be more severe?

If we have a 5th wave very soon after the 4th we may not
do as well. Our intensive care services (ICUs) are
overstretched and still struggling with COVID-19 cases,
with some having adults who have been dependent on
ventilators for a long time. The health system has chronic
fatigue, not just in hospitals but also in the public health
sector and vaccination centres. If we have a fresh surge
due to the Delta variant the system has little reserve to
cope.

How can we work together to minimise

a 5th wave to come?
COVID-19 has been dubbed the “unforgiving virus”. Any
failure on our part will be exploited to infect us or spread
the disease. The key is to avoid getting infected. This
requires a shared responsibility that is built on trust and
discipline (routines) between everyone – especially if you
are working or studying outside the home; what we like to
call ‘Trust Bubbles’. As always remember to improve the
quality and fit of your mask.

We need to follow the data and science when working to

minimise COVID-19. Sharing all our COVID-19 data will
help the public make better informed decisions. Some
suggestions to minimise a 5th wave include:

1. The Only Good Vaccine is the One in the Arm of a

Person

We need to administer all our vaccine supply to the public

as quickly as possible. There should not be any vaccines
in the storehouse and all PPVs (Pusat Pemberian Vaksin)
in the country should be supplied according to their
population numbers. The second dose should be given at
the minimum duration possible (shortest data-based
interval possible). Ramping up daily vaccinations to the
highest possible (based on supply) is critical; 300-
400,000 doses a day are necessary.

2. Speed up the Vaccination of the Vulnerable

In the next 4 weeks we should focus on completing the
vaccination for all registered senior citizens, adults with
disabilities and adults with comorbidities. In addition, we
should proactively search for these vulnerable groups
who have not been able to register or are hesitant and
offer them vaccination appointments. Parents of children
with disabilities should also be prioritised for vaccination
to protect their vulnerable children; as should all those
involved in child care and pre-school services.

3. Test, Test, Test

We need to test widely and not allow 60-80% of cases to

be unlinked. We have to test asymptomatic contacts of
identified cases and not just those who present with signs
of an infection. Using reliable antigen rapid test kits (RTK-
Ag) for community testing and polymerase chain reaction
(PCR) tests for admissions will be the best utilisation of
resources and offer quicker results. 200-300,000 tests a
day should be our minimum.

SEE ALSO: Khairy tells World Bank to speak out

against vaccine inequity, calls COVAX a 'massive
failure'

We need an effective contact tracing and isolation

mechanism. Digital contact tracing and alerts must occur
in real time for this to happen.

If possible we should offer cheap, weekly RTK-Ag tests for

all those going to work in any sector to limit clusters from
developing. We need to work towards developing and
maintaining Work Safety Bubbles.

4. Home Safety Bubbles, even for the Vaccinated

For all of us, we need to limit all unnecessary contact with

others to maintain a Home Safety Bubble. Don’t visit your
extended family or grandparents and don’t stop to talk to
your neighbours when doing your morning walk – speak to
them via a video call. Stop all family and religious
gathering, even in small groups – there is no safe number.

Those who are vaccinated should continue to maintain the

normal COVID-19 prevention measures like everyone else.
It is important not to relax our vigilance at this time.

We are concerned this pandemic has damaged our

children, especially with the loss of schooling. But in the
current crisis, keeping children at home and continuing
their education there is the right move. Many children
(40%) have no digital devices or internet connections. We
need to work together as a community to ensure they are
supported.

5. National Ventilation Mandate and Streamline SOPs

We now know that the COVID-19 virus is primarily spread

by airborne mechanisms, especially indoors. Keeping a 1-
2 meters’ distance in a room is of little value unless you
improve ventilation. We need a national initiative to
improve ventilation in all buildings and maximise the intake
of outdoor air. This means encouraging fresh air to come
in all the time and stopping recirculation of air by air-
conditioning units.

Current standard operating policies (SOPs) are not all

science based. Many are burdensome to the public. Even
temperature scanning has little value and should be
stopped. Time to revise all the SOPs, remove many and
streamline them to include only the meaningful ones. This
will improve compliance and effectiveness.

We must not be complacent about the threat of the 5th

Wave in Malaysia, especially due to the Delta variant. Our
pandemic is barely under any control despite 4 weeks of a
lockdown. We need to support each other and see the
nation through these next few difficult months.

This opinion piece was contributed by Dato’ Dr Amar-

Singh HSS, Senior Consultant Paediatrician. If you have
an article or opinion that you would like to contribute for
the benefit everyone, share it with us here.

[ IMAGE SOURCE ]

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