COVID-19 Malaysia

There are a few types of Coronavirus. Coronaviruses are types of virus that typically affect the respiratory tract of mammals, including humans. They are associated with the common cold, pneumonia, and severe acute respiratory syndrome (SARS) and can also affect the gut.

Different types of human coronaviruses vary in the severity of illness they cause and how far they can spread.

Rare but dangerous types include MERS-CoV, which causes Middle East Respiratory Syndrome (MERS), and severe acute respiratory syndrome (SARS-CoV), the coronavirus responsible for SARS.

In December 2019, a novel coronavirus, COVID-19 (previously named ‘2019-nCoV’) has caused an outbreak of respiratory illness. The virus was first detected in Wuhan City, Hubei Province, China. Early on, many of the patients in the outbreak area reportedly had some link to a large seafood and animal market, suggesting animal-to-person spread. However, a growing number of patients reportedly have not had exposure to animal markets, indicating person-to-person spread is occurring.

Since late 2019, the world has been battling the threat of COVID-19. The spread of the virus and the occurrence of new variants are expected.

What you need to know about COVID-19 variants

The SARS-CoV-2 virus is an RNA virus that constantly undergoes mutations, creating new variants. Some variants emerge and disappear while others persist. New variants will continue to emerge. When new variants emerge, the virus’s properties, such as how easily it spreads, the associated disease severity, or the performance of vaccines also change.

WHO and its researchers have been monitoring and designating multiple variants of concern (VOCs) and variants of interest (VOIs). These classifications are based on the variants’ assessed potential for expansion and replacement of prior variants, for causing new waves with increased circulation, and the need for adjustments to public health measures.

WHO has named variant B.1.1.529 as Omicron and designated it as a VOC on 26 November 2021. This variant has a high number of mutations between 26 and 32 in its spike protein. Since its first detection in South Africa on 24 November 2021, this variant has spread to dozens of countries globally, including the first case in Malaysia on 3 December 2021.

Since early 2022 until now, the dominant variant is Omicron. Omicron represents the most divergent VOC seen to date. Since its emergence, various new sub-variants of Omicron have been detected, including XBB, BA.4, BA.5, BA1.16 and BA2.86. So far, they have been characterised by properties of evasion of existing population immunity and a preference to infect the upper respiratory tract (versus lower respiratory tract), as compared to pre-Omicron VOCs.

Alpha, Beta, Gamma, Delta as well as the Omicron parent lineage (B.1.1.529) are considered previously circulating VOCs whereas XBB.1.5 is classified as a VOI.

As of 19 December 2023, WHO is classifying JN.1 as a separate variant of interest (VOI) from the parent lineage BA.2.86 due to its rapidly increasing spread.

What should we do?

Adhering to SOPs and getting vaccinated against COVID-19 are two effective ways to reduce risk of contracting COVID-19 or prevent long-term complications if infected with the virus. At this point, complete your primary vaccination and booster dose as immunisation remains the best way to reduce your risk of severe illness, hospitalisation, and death from COVID-19.

If you know someone who is confirmed to have COVID-19 and you have been in close contact with them, you should also get tested. Close contacts of confirmed COVID-19 cases were those as below:

• People living in the same household; colleagues working together in the same workspace; classmates in the same classroom environment with a positive COVID-19 case.
• Having face-to-face contact with a positive COVID-19 case for more than 15 minutes, less than 1 meter apart, and in an enclosed area.
• Being present in an air-conditioned room for more than 2 hours with a positive COVID-19 case although there is no face-to-face contact.
• Travelling in the same vehicle (1 or 2 seats apart) with a positive COVID-19 case for more than 15 minutes.

Types of COVID-19 tests

The worldwide pandemic has necessitated basic hygiene practices, proper usage of face masks, frequent hand washing, physical distancing, and raised the need for easily accessible COVID-19 tests in Malaysia.

COVID-19 tests in Malaysia are essential in preventing the spread of the pandemic. It can also help patients immediate care.

1. Molecular tests: Reverse transcription polymerase chain reaction (RT-PCR) tests to detect a virus’ genetic material.
2. Antigen tests: Rapid test kit (RTK-Ag) tests to detect specific proteins on the surface of the virus.

To help you understand the function of each test, here’s a helpful comparison of the tests currently available:

COVID-19 Neutralising Antibody Test

The COVID-19 Neutralising Antibody Test detects and measures the level of antibody in your body post completion of the COVID-19 vaccination or a previous COVID-19 infection.

This test is conducted two weeks post vaccination to check whether your body responds to the vaccination and how much of these antibodies are neutralising antibodies. It also helps assess potential antibody-association immunity. This test can also identify individuals with past exposure to the COVID-19 infection.

What is a close contact COVID-19?

1. Shared spaces
   • People living in the same household with a positive COVID-19 case.
   • Colleagues working together in the same workspace with a positive COVID-19 case.
   • Classmates in the same classroom environment with a positive COVID-19 case.
2. Close proximity
   • Having face-to-face contact with a positive COVID-19 case for more than 15 minutes, less than 1 meter apart, and in an enclosed area.
3. Long exposure
   • Being present in an air-conditioned room for more than 2 hours with a positive COVID-19 case although there is no face-to-face contact.
4. Travelling together
   • Travelling in the same vehicle (1 or 2 seats apart) with a positive COVID-19 case for more than 15 minutes.

What to do if you are a positive COVID-19 case?

Updated as of 19 December 2023:

1. Self-isolate at home with digital Home Surveillance Order (HSO) for 5 days from the date of onset of symptoms.
2. Home Surveillance Order (HSO) will be given via the MySejahtera application.
3. Update and complete the Home Assessment Tool (HAT) in the MySejahtera application.

Upon completing five (5) days of isolation period, daily activities can be resumed. However, it is necessary to take the following preventive measures until the 10th day to avoid the risk of spreading COVID-19 infection to others.

• Wear a face mask when leaving the house.
• Avoid being in crowded places.
• Avoid visiting high-risk groups / individuals.
• Make only necessary / essential trips.
• Always wash your hands with soap or use hand sanitizer.

What to do if you are a close contact to a positive COVID-19 case?

Updated as of 19 December 2023:

Preventive measures:

• Wear a face mask when leaving the house.
• Avoid being in crowded places.
• Avoid visiting high-risk groups / individuals.
• Make only necessary / essential trips.
• Always wash your hands with soap or use hand sanitizer.
• Ensure good ventilation.

What are the symptoms of COVID-19?

For confirmed COVID-19 infections, reported illnesses have ranged from people with little to no symptoms to people being severely ill. COVID-19 symptoms may appear 2-14 days after exposure:

Category 1: Asymptomatic

• Sore throat / cold
• Cough
• Loss of sense of taste (but still have appetite)
• Loss of sense of smell
• No fever
• No difficulty breathing
• Diarrhoea twice in 24 hours
• Nausea & vomiting
• Fatigue (but can still do daily activities)
• Muscle aches & pains (but can still do daily activities)

• Fever / onset of fever for more than two days
• Shortness of breath when exerting yourself
• Chest pain
• Loss of appetite
• Fatigue while doing daily activities or after waking up
• Requires walking assistance
• Increasing severity of other symptoms (e.g., persistent cough, nausea, diarrhoea, etc.)
• Decreased level of consciousness
• Gradual decrease in urine output over 24 hours

Category 3: Some breathing issues

Category 4: Requires oxygen support

Category 5: Needs intubation / ventilator

Close contacts of positive COVID-19 cases are allowed to quarantine at home (Home Surveillance Order) if you are:

• Below 60 years old
• Have mild or no symptoms (Category 1 and 2A)
• Low-risk individuals (free of co-morbidities and other factors which are likely to worsen the effects of COVID-19 infection)

SOPs for home quarantine

• Dedicated space for isolation: Have a dedicated room to isolate in, preferably with an attached bathroom, especially if you are living with others. Keep the door closed and windows open for ventilation. If the bathroom is shared, it should be cleaned and disinfected after each use.
• Dedicated caregiver: Have a dedicated person to help you get your meals and other necessities sorted out.
• Rest & hydrate: Have plenty of rest, drink lots of fluids, and eat nutritious food to strengthen the weakened immune system.
• Personal hygiene: Frequently wash your hands with soap and water and use hand sanitizer. Wear a face mask and observe physical distancing if you need to open your room door to get your meals, packages, or garbage disposal. Avoid sharing meals and utensils with others.
• Monitor symptoms: Keep a close eye on your symptoms and report your daily status on MySejahtera. Use a thermometer and oximeter to monitor your temperature and oxygen levels. Contact CAC or hospital immediately if symptoms worsen.

What to avoid during home quarantine

• Have visitors over: Avoid inviting or allowing visitors to your house.
• Go out: Do stay in your room and avoid leaving our house to buy food, medication, etc. Do get your dedicated caregiver to help you with the necessary tasks.
• Self-medicate: Avoid taking advice from social media, always contact a healthcare professional.

The home quarantine SOPs are also relevant to those who are:

• Waiting to take a COVID-19 test
• Waiting for COVID-19 test result
• Waiting to be admitted to hospital
• Waiting for further instructions from health authorities
• Unwell and living in a shared space

The COVID-19 virus can incubate in humans from 5 to 14 days, but the result of having COVID-19 can have longer term consequences than most people realise. Where symptoms last beyond the 4-to-12-week time frame, it is referred to as ‘long COVID’, ‘long-haul COVID’, or ‘post-COVID syndrome’.

Common Signs and Symptoms

Ear, Nose, and Throat (ENT)

ENT symptoms have always been a hallmark of the COVID-19 virus. This remains the case, and while the symptoms tend to overlap with the common flu, they tend to be more pronounced and chronic in how they affect the individual. Those afflicted can expect to experience a range of symptoms including tinnitus (ringing in the ear), earache, sore throat, loss of taste and/or smell.

Respiratory

The respiratory element of the COVID-19 virus is a common occurrence in patients. This often results in breathing difficulties and is often coupled with a persistent cough that does not abate. In severe cases, regular oxygen use may be necessary.

Cardiovascular

As respiratory factors influence the cardiovascular system, long haul patients can expect to experience chest tightness, chest pain, and palpitations (the sensation of your heart pounding or racing). These are often more prevalent in patients with pre-existing conditions which are diabetic, respiratory, or cardiovascular in nature.

Gastrointestinal

While nausea and diarrhoea are common symptoms present at the onset of the COVID-19 infection, they may carry on in a mild to severe combination of abdominal pain, reduced appetite, and/or resulting anorexia.

Neurological

As the long-haul symptoms take their toll on the body, neurological symptoms (associated with the brain) may set in as well. This may be mild or severe and include cognitive impairment (brain fog, loss of concentration, memory loss), headache, sleep disturbance, peripheral neuropathy symptoms (loss of feeling in extremities), dizziness, and/or delirium.

Muscular

Further associated with long-term illness, patients may experience muscular symptoms such as joint pain, muscle pain, or a general feeling of lethargy for the duration of the illness, and post-recovery. This may occur in specific parts of the body or affect the body in a more generalised manner.

Dermatological

Long haul COVID-19 may result in chronic or permanent skin problems such as skin rashes and hives. There may also be swelling in the fingers and toes which is tender to the touch and appears like bruising. Other uncomfortable symptoms include sores on the lips and mouth. Both latter conditions often heal over time once the patient recovers.

Managing Your Symptoms

Should you suffer from ‘long-haul COVID’, ensure that you eat well and drink plenty of water during this time to aid in your recovery. Paracetamol (up to 1000 mg every 6 hours), antihistamines (up to 3 times a day), and cough syrup (up to 3 times a day) are possible methods of treating the symptoms to ease your discomfort. However, do consult with your doctor prior to consuming any new medication.

What is Multi-System Inflammatory Syndrome in Children (MIS-C)?

MIS-C is a life-threatening complication caused by COVID-19 infection in children. This condition causes organs to become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, and gastrointestinal organs.

What are the symptoms of MIS-C?

How to prevent MIS-C?

Parents and guardians should get the COVID-19 vaccines for their children aged 5-11 years old to protect them from COVID-19 and its related medical complications including MIS-C. The Cominarty for children vaccine uses a new and safe formulation and dosage that is appropriate for children in that age range.

It is important to protect yourself and those around you by taking the right precautionary measures to reduce the risk of coronavirus infection.

1. Get tested if unwell: If you are showing COVID-19 symptoms such as fever, cough, sore throat, etc., do a self-test immediately.
2. Always wear protective face mask: When you are going out of your house and meeting with others, always wear a face mask properly.
3. Keep your hands clean: Wash your hands often with water and soap or clean them with 60% - 70% alcohol-based gel, foam, or liquid sanitizer.
4. Physical distancing: Practice adequate physical distancing (1-2 meters apart).
5. Avoid the 3Cs: Stay away from Closed areas, Crowded places, and Close interactions.
6. Test before gathering: Do an RTK test before attending gatherings with other people.
7. Get vaccinated: Studies show that vaccination provides the best protection against COVID-19 infections, in particular severe illness, and death. Ensure that you and your family are fully vaccinated. Take your booster doses and consider enrolling your children for vaccination. Unvaccinated people are 9x more likely to be infected and 62x more likely to die from COVID-19 infection.

Improve Your COVID-19 Self-Assessment With TRIIS

• Test (T): Get tested with a self-test kit as soon as possible if you are experiencing any infection symptoms such as runny nose, fever, or cough.
• Report (R): Report the test result (negative, positive, or invalid) in your MySejahtera app as soon as possible.
• Isolate (I): Isolate yourself or self-quarantine immediately with discipline if you have been tested positive for COVID-19. Adhere to the HSO and self-isolation procedures.
• Inform (I): Inform all your close contacts if your test result is positive so that they can monitor their health status and do a COVID-19 self-test if they are having symptoms.
• Seek (S): Seek immediate assessment or treatment if you are experiencing worsening symptoms. High risk individuals are advised to undergo a health assessment at the CAC or a nearby healthcare facility, even if they only experience mild symptoms, to determine their suitability for antiviral treatment.