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PETALING JAYA: Health experts have warned of the risk of community transmission of Covid-19, especially in the Klang Valley, as sporadic cases now show an upward trend.
University of Malaya Professor of Epidemiology and Public Health, Dr. Sanjay Rampal, defined community transmissions as newly diagnosed cases that cannot be linked to a previous group.
“Based on new case reporting methods, these are cases that were identified through symptom screening, surveillance systems, or preoperative screening.
Community transmission, he said, could represent the tip of the iceberg in terms of undiagnosed cases.
The Covid-19 cases involving healthcare workers in the Klang Valley illustrate the possibility of community transmission, where the source of many of the infections could not be identified and spread before being detected.
On Thursday, Selangor Health Director Datuk Dr. Sha’ari Ngadiman said that some 50 staff at Tengku Ampuan Rahimah Hospital (HTAR) were infected, noting that the increase in cases of severe acute respiratory infection that sought treatment at HTAR could have been the cause.
The following day, Health Director General Tan Sri Dr. Noor Hisham Abdullah revealed that 1,359 healthcare workers had been infected since the third wave began on September 20, as he associated the increase in the number of cases between health workers in the Klang Valley with the increase in Covid-19 cases in the community.
Of the total number of infected health workers, 587 (33.1%) were attributed to community transmission, while 409 (23.1%) cases are still under investigation and 58 (3.3%) infections are from unknown causes .
An analysis by The Star of Covid-19 case reports in the Klang Valley between October 16 and December 20 found that 18.9% of the total 21,489 cases were not linked to any group or close contact. .
Most of the positive cases that were not linked were detected by work-related screening in 68.9% or 2796 positive cases, followed by symptomatic screening in 19.5% (792 cases), private screening in the 2.7% (110 cases), healthcare-related screening including both healthcare workers and patients in 1.6% (65 cases), SARI screening (66 cases) in 1.6% and travel-related screening at 1.5%.
Other examinations, such as community examinations, detainee, prisoner and foreigner examinations, as well as post-mortem examinations, contributed to 4.3% of all sporadic cases during the 66-day period.
Sanjay, who acknowledged the increasing trend of sporadic cases in the community in recent weeks, explained that the Ministry of Health has not classified the cases affecting the staff of the Tengku Ampuan Rahimah Hospital (HTAR) and all other cases as “non-cases. linked “.
He clarified that cases can later be identified as first-generation or multigenerational community transmission.
“The problem of linkage occurs during the management of an individual outbreak after contact tracing and subsequent analysis.
“A simple and crude method is to define cases that are not linked in the incident reporting as unrelated,” he said, noting that there may be more reports completed after the outbreak investigation.
Dr Rafdzah Ahmad Zaki, a specialist in public health medicine at the Department of Social and Preventive Medicine at the University of Malaya, said it will be difficult to contain community transmission as those infected may be only experiencing mild or asymptomatic symptoms.
“Community transmissions pose a greater threat because we don’t know who is infected or spreading the disease.
“This also means that there are more cases that go undetected,” he said, warning that Covid-19 testing should be done on as many people as possible, especially among high-risk groups.
Universiti Malaya epidemiologist Professor Datuk Dr. Awang Bulgiba Awang Mahmud said the level of unrelated cases in Selangor indicates that the infections are entrenched in the community.
He cited the example of cases of foreign workers in Malaysia as a possible source of community transmission.
A large portion of Malaysia’s Covid-19 cases in the past month have been contributed by foreign workers. The Teratai group, which involves workers from glove maker Top Glove, is currently the largest and most active infection group in the country, registering a total of 5,746 positive cases as of November 7.
“The evaluations of workers that have been carried out include those who do not show symptoms, so when there is a significant number of unrelated asymptomatic cases, it is of great concern,” said Professor Awang Bulgiba, noting a similar trend observed. in Sabah in September. .
As an example, Singapore’s Straits Times reported on Tuesday (December 15) that nearly half of the republic’s 323,000 migrant workers living in dormitories have had a Covid-19 infection.
The report said that while 54,505 workers tested positive for the virus through a polymerase chain reaction or PCR test, another 98,289 had a positive result from a serological test, which verifies a previous infection.
This meant that 152,794 dormitory workers in the neighboring country tested positive for PCR, serology, or both.
Professor Awang Bulgiba suggested increasing efforts to improve the living conditions of foreign workers in Malaysia as it can help reduce the risk of community transmission in the long term.
In the meantime, he said repeated workplace checks with large concentrations of migrant workers should be considered.
Awang proposed that antibody tests be performed randomly in Selangor to identify the seroprevalence rate in the community.
“A seroprevalence survey looks for antibodies against a disease, which is evidence of a past infection.
“A high proportion of people with antibodies to Covid-19 will indicate that the disease is ingrained in the community,” he noted, adding that a decision can then be made on whether to change the strategy from containment to mitigation.
Dr. Awang suggested the creation of an extensive real-time syndromic surveillance system in the community, making use of government and private clinics with Internet access.
“This could give us an early warning and maybe we can get some of those infections before it gets to this stage,” he said.
Malaysian Medical Association President Professor Datuk Dr. Subramaniam Muniandy said that the level of public compliance with Covid-19 standard operating procedures was crucial since the lifting of most inter-district and interstate travel restrictions. from December 7.
Malina Osman, a medical epidemiologist at Putra Malaysia University, advised everyone to stay home, avoid crowds and unnecessary travel, as active Covid-19 cases have reached a worrying level, with two-thirds of those cases found in Selangor and Kuala Lumpur.
“If awareness is translated into proper compliance, the potentially serious consequences will always be under control,” he said.
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