- Once upon a time, returning umrah pilgrims were required to observe a seven-day home quarantine. Then on Dec 25, the Ministry of Health reported 45 new Omicron cases imported from abroad, including 30 returning umrah pilgrims.
- The 45 – which were identified from 145 positive Covid-19 samples among international travellers between Dec 15 and 21 – were in addition to the three imported Omicron cases and one suspected local infection reported by the Sarawak state government on Dec 24, leading to a total of 49 new Omicron cases in Malaysia reported from December 23 to 24.
- Health Minister Khairy Jamaluddin said authorities found that a large number of these 30 umrah travellers infected with Omicron – a highly contagious virus with a reported doubling time of 1.5 to 2.5 days – violated home quarantine orders, as they did not self-isolate and instead interacted with their family members and even received visitors.
- “Maybe some want to salam and ambil berkat (receive blessings), but in the end, salam ambil Omicron,” Khairy told a virtual press conference on Dec 25.
- “So I hope people will follow (home surveillance orders). This is serious. We gave the facility of home quarantine because when we decided to manage and live with Covid-19, we wanted to make things simple. No need to send to quarantine stations or hotels that swallow a large expense. We allow home quarantine, but please follow it, self-isolate.”
- Khairy pointed out that Omicron is a highly transmissible coronavirus variant, as infected international travellers could test negative on pre-departure, but test positive for Covid-19 within 72 hours upon arrival in Malaysia.
- This is borne out by many umrah pilgrims I spoke to who said they were tested negative at the airport in Saudi Arabia before boarding the plane, but on arrival in KL Airport, just less than 24 hours later, Covid test on them turned out positive.
- Interacting with family members at home, instead of self-isolating in a room, could cause further transmission of Covid-19 as these non-quarantined family members could get infected and later spread the virus unknowingly when they go outside before testing positive.
- As a result of this development, Saudi Arabia was placed on Dec 27 on the list of high-risk countries, totalling 10 now. The remaining nine countries are the UK, the US, Denmark, Australia, France, Norway, Canada, India and Nigeria.
- Travellers returning from high-risk countries are required to undergo home quarantine for either seven days (for the fully vaccinated) or 10 days (not fully vaccinated), wear a digital tracking device during quarantine, and self-test for Covid every day.
- But despite this violation of home quarantine by the majority of umrah pilgrims, the Health Ministry was still kind enough to allow the continuation of home quarantine, and only requested they wear a digital tracker to ensure that they follow home surveillance orders.
- But enough is enough when as of Dec 30, six Omicron clusters, with index cases in returning umrah pilgrims had been reported across the country in Selangor, Kedah, Penang, Johor, Pahang and Sabah.
- One cluster with 10 Covid-19 cases so far spanned three states: Gombak district in Selangor, Yan and Kota Setar districts in Kedah, and Barat Daya district in Penang.
- Khairy said many returning pilgrims applied to quarantine at home or their residence during the seven-day quarantine period. But non-compliance to standard operating procedures (SOPs) led to positive Covid-19 cases among umrah pilgrims spreading infection among family members.
- Then on Dec 31, of the 64 confirmed Omicron cases in Malaysia, half or 32 cases, were umrah pilgrims. Besides the six Omicron clusters involving the pilgrims, three more clusters were detected in umrah pilgrims, whose index cases were not of the Omicron variant and are likely to be Delta.
- Crunch time came on Jan 1 when Khairy announced at a press conference that the government has decided on an indefinite suspension on umrah, not with immediate effect, but effective on Jan 8.
- This indefinite suspension was accompanied by a slew of other measures including:
- Booking of new umrah flight tickets was also suspended starting Jan 1.
- Pilgrims returning to the country from Jan 3 onwards would be subjected to mandatory quarantine at quarantine stations or hotels that have been identified as quarantine stations by National Disaster Management Agency (Nadma).
- Pilgrims departing for the Holy Land from Jan 1 to Jan 7 were allowed to continue with their journey but have to undergo quarantine at a designated quarantine facility or hotel when they arrive in Malaysia.
- Returning pilgrims must also get tested with RT-PCR two days before departure and on arrival, self-test with antigen rapid tests if symptomatic during quarantine, and get tested with RT-PCR on Day Five of quarantine.
- They will only be released from quarantine on Day Eight if there is no extension of quarantine and if the RT-PCR test on Day Five is negative.
- Later, in a press conference on Jan 6, Khairy said the earlier announcement on the suspension of all umrah trips from Jan 8 would only be for a month.
- “However, a risk evaluation within and outside the country, especially Saudi Arabia, will be carried out from time to time before umrah trips are allowed to resume,” he added.
- According to Khairy, the health ministry and other relevant agencies would update the SOPs for umrah travellers, noting that it would be mandatory for pilgrims to have a booster dose.
- The authorities would also conduct case management and contact tracing in Saudi Arabia as well as monitor the health condition of Malaysian pilgrims, and travel agencies would be given more responsibility to ensure adherence to umrah SOPs by pilgrims.
- “They (travel agencies) will also have to report positive cases and close contacts to the health ministry.”
- Khairy is spot-on in giving additional duty to the travel agencies. In fact, they should incorporate lesson on Covid-19 protocol in their umrah syllabus which should be delivered by the mutawwifs (pilgrim guides) during the last few days of the umrah as the pilgrims are getting ready to go back home.
- These pilgrims will listen more to their mutawwifs who more often than not are an ustaz (religious teachers) than listening to MOH officials on the need not to have a feast or to salam and ambil berkat during their quarantine.
- On Jan 15, MOH announced new quarantine periods for Covid-19 cases and those with close contact to between five to seven days.
- The quarantine period for those with close contact to Covid-19 cases is now five days for those who have received their booster doses.
- However, it remains at seven days for other close contact cases who have received one to two doses of vaccines or were unvaccinated.
- If they were without symptoms (asymptomatic) throughout the quarantine period, they are required to take the antigen test at a health facility on the fifth day if under a five-day quarantine or on the seventh day if under a seven-day quarantine.
- If they become symptomatic, they will be required to undertake the RTK-Ag (antigen) test on their own or at the nearest health facility.
- Meanwhile Covid-19 positive cases, for all variants, will be quarantined for seven days for all who were fully vaccinated and did not display any symptoms.
- Those positive cases who were not fully vaccinated or unvaccinated or are displaying symptoms, will be quarantined for 10 days which means even if you are fully vaccinated or has a booster dose but you show symptoms and are positive, you’ll be quarantined for 10 days.
- The new quarantine periods will be in force from Jan 16 onwards and will also apply to those who are currently under quarantine.
- Shortly after the case of 12 unvaccinated umrah pilgrims were made known, Terengganu police arrested a 51-year-old doctor on Jan 8 at his clinic in Marang following a complaint from members of the public.
- According to police, preliminary investigations revealed a total of 1,900 individuals were found to be dealing with this clinic for vaccination purposes, and police is still investigating how many did not get injections, but got fake vaccination certificates instead.
It is understood that those who want to get this fake certificate need to pay between RM400 and RM600 compared to the actual price of RM300 for the shot.
- It is believed there are also individuals from outside the state who went to the doctor to obtain fake vaccination certificates, but most of the customers dealt with the doctor online, so police will try to get information from email in the laptop that was also confiscated from the clinic.
- The doctor was also believed to have carried out the activity alone in the treatment room without the help of other clinic staff.
- “Even though the doctor admitted to being an anti-vaxer, he has already received the vaccine shot, probably because of his work,” said Terengganu police chief Datuk Rohaimi Md Isa.
- The suspect was also believed to have used an agent who was given a commission of RM50 to promote his services and that the case was being investigated under Section 420 of the Penal Code for cheating.
- From Terengganu, Selangor was next following more than 5,600 names of people believed to have been fraudulently registered on the MySejahtera system were found in laptops confiscated by Selangor police on Jan 14 in a raid in which four men and three women were arrested.
- Police are investigating the case under Section 269 of the Penal Code for a negligent act that could spread an infectious disease and Section 22 (d) of the Prevention and Control of Infectious Diseases Act 1988.
- Next, it’s Kelantan when four suspects, including the operator of a private clinic, have been arrested in relation to falsifying Covid-19 vaccination cards.
- But this time around, it was different because according to Kelantan police the suspects, aged between mid-30s and early 60s, were the seller and buyers.
- Investigations showed the clinic offered such service at a charge of RM180 per record. Further checks had shown that four individuals who were said to have received the vaccine shots did not have records on their MySejahtera app. During the raid, police also seized vaccination cards along with other documents.
- So far, these are the only three clinics involved in fake vaccination cards/certificates – a small number – but the number of clients involved is a whopping 7,500 people whom we can say are certainly the anti-vaxers in the sense that they will go out of their way even through illegal means to get a fake vaccination certificate without being vaccinated.
- Since it takes two to tango, it’s time for the authorities to go hard not only on the wayward doctors and clinics but also the unvaccinated clients before this “pandemic” of the unvaccinated spirals out of control.
- The unvaccinated should take this “hard” approach towards them for their own good and the good of the community and the nation, as evidence worldwide showed it is the unvaccinated that forms the majority of Covid deaths.
- It is said the unvaccinated people are about six times more likely to test positive than vaccinated people, nine times more likely to be hospitalized, and 14 times more likely to die from Covid-related complications.
- Although the Malaysian government has not released the data on the number of unvaccinated deaths due to Covid-19, a study on Covid-19 deaths in Malaysia found that unvaccinated individuals had a mortality rate of 43.2 times higher than people fully vaccinated with Pfizer, and 12.5 times higher than people who obtained Sinovac.
- The study by Nur Asheila Abdul Taib et al – which analysed Covid-19 deaths by vaccination types and status in the country between February and September 2021 – also showed that the total Covid-19 age-standardised mortality rate (ASMR) was 47.5 per 100,000 population for the unvaccinated group. ASMR adjusts for differences in the age distribution of the population.
- Among fully vaccinated individuals, the total Covid-19 ASMR of those who received Sinovac’s inactivated vaccine (non-mRNA) was 3.8 per 100,000 population, higher than recipients of Pfizer’s mRNA vaccine (1.1 per 100,000 population) and AstraZeneca’s viral vector vaccine.
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Umrah trips suspended from Jan 8
Temporary suspension of umrah travel from Jan 8 over Omicron concerns
Khairy lists non-compliance with SOPs, home quarantine rules among reasons for umrah suspension
Suspension of all umrah trips only for a month, says Khairy
Read more on measures to contain Omicron, R0 and Hari Raya Puasa:
Quarantine period for Covid-19 close contacts who’ve received booster dose now five days
Well prepared for an Omicron surge
- The firm measures in suspending umrah indefinitely and giving additional duties to travel agents to check and report on the health status of their pilgrims are all preventative measures aimed at dealing with the possible surge of Covid-19 cases especially the Omicron variant.
- This is a proactive move on the part of the Health Ministry to prevent a surge in the Omicron variant before it rears its ugly head like what is happening in Europe presently.
- For now, the saving grace in Malaysia is that there was a reduced risk of hospitalization from Omicron compared with the Delta when it first made its appearance, along with a reduced risk of severity in both younger and older people.
- Almost 99% of Covid-19 patients infected with the Omicron variant are in categories 1 and 2 (no symptoms and mild symptoms). And about 98% of total daily cases of Covid-19 are also in categories 1 and 2.
- But as pointed out by Health Minister Khairy Jamaluddin, the number of Covid-19 cases in Malaysia could rise to more than 30,000 per day by the end of March, if measures were not taken to control the spread of the Omicron variant of the virus, which include the temporary suspension of Umrah travels to Saudi Arabia and the revision of quarantine standard operating procedures (SOPs).
- “If the basic reproduction number (R-naught or R0) of Covid-19 infections increases to 1.2, daily Covid-19 cases will increase to 10,000 per day, and if R0 is 1.6, we will see an increase in daily cases to more than 30,000,” Khairy cited the Susceptible, Exposed, Infectious and Removed (SEIR) model of daily observed and forecasts Covid-19 cases prepared by his Ministry.
- So the key lies in managing the R0, which must be kept at below 1 (See Sustaining endemicity in pre-endemic time). A figure above 1 means the number of new Covid-19 cases is rising.
- And to keep it at below 1 would entail introducing preventative measures such as the temporary suspension of Umrah travels to Saudi Arabia, the revision of quarantine SOPs and SOPs for celebrating any festivals with public holidays such as Thaipusam or Chinese New Year.
- As of Jan 18, R0 for Malaysia is at 0.99, not a comfortable figure as any lapses in preventative measures will bring it to 1 or above. But if we break it down based on states, there are seven that have an R0 of above 1 – Kuala Lumpur (R0 of 1.08), Negri Sembilan (1.06), Melaka (1.04), Kedah and Johor (1.03 each), and Selangor and Sabah (1.01 each)
- Just to underscore the importance of R0, let’s take the case of Singapore. On Sunday (Jan 16), with an R0 of 1.49, total daily case was 863.
- Then the next day (Jan 17), there was a big jump in R0 to 1.60 with total daily case of 1,165 – the first time daily cases was in the four-digit in the republic since Dec 2.
- Health director-general Tan Sri Dr Noor Hisham Abdullah was spot on when he said on Jan 17 even though the Omicron variant is considered to be less severe than the Delta variant, the higher transmission rate could cause an increase in hospitalisation.
- Hence, the Health Ministry has put several measures in place to prepare for the possibility of a surge in Covid-19 cases due to the Omicron variant.
- “They may be an increase in patients that require a short stay in the hospital particularly among high-risk groups such as senior citizens, individuals with comorbidity and children, which will pressure the healthcare system in the country,” he added.
- As such, said Dr Noor Hisham, the ministry has turned district hospitals into hybrid hospitals to treat Category 1, 2 and 3 patients.
- While patients under Category 4 and 5 will be referred to specialist hospitals, stable cases will be isolated at home, monitored by Covid-19 Assessment Centres (CAC) till the isolation period ends.
- Moreover, patients will be treated with identified antiviral medicine at early stage at CAC and Covid-19 quarantine and treatment centres.
- Dr Noor Hisham also stressed that the whole-of-government, whole-of- society approach is vital in ensuring there is no surge in Covid-19 cases caused by new variant.
- “Hence, continue to adopt and strengthen self-control, continue to comply with the SOPs and get vaccinated so that Covid-19 cases can be under control in the country,” he added.
- Meanwhile through his tweet, he gave rays of hope that this year Hari Raya celebrations might just be different from the last two years if only the public continues to get booster jab as protection for themselves and their family.
- As Hari Raya Puasa is more than three months away, there is hope that it could be different this time around if preparations for a relatively stable Covid situation is made now by consistently observing SOPs, getting a booster jab, and making the R0 as low as possible, say 0.8 or below.
- Social visits were not allowed during the last two years of Aidilfitri celebrations.
Read more on measures to contain Omicron, R0 and Hari Raya Puasa:99 per cent of Covid-19 Omicron patients are in categories 1 and 2
Khairy: Omicron could drive Malaysia’s Covid-19 daily cases past 30,000 by end-March if unchecked
- Vol 1 No 4: Handling Omicron: Back to basics of preventive measures, vaccination and booster jab [PDF]
- Vol 1 No 5: Delinking the appeal process from the disqualification of an MP [PDF]
- Vol 1 No 6: Novel, creative ways of flood mitigation by respecting the natural need of water [PDF]
- Vol 2 No 7: Year in Review 2021: Cautious optimism on all fronts faded as the months went by [PDF]
- Vol 2 No 8: A whole-of-world approach is crucial in the fight against Covid-19 [PDF]