Wednesday, December 2, 2020

A Covid-19 Study in Malaysia

Two weeks ago, a cohort of eight Malaysian medical professionals wrote and published Southeast Asia’s first national study on Covid-19 cases. 

It represents an entire country’s experience – and it was deemed good enough to appear in The Lancet, arguably the most prestigious and influential medical journal in the world. 

Titled “Clinical characteristics and risk factors for severe Covid-19 infections in Malaysia: A nationwide observational study”, it paints a detailed picture of the disease’s spread in Malaysia from February 01 till May 30, 2020. The authors were Benedict Lim Heng Sim, Suresh Kumar Chidambaram, Xin Ci Wong, Mohan Dass Pathmanathan, Kalaiarasu M Peariasamy, Chee Peng Hor, Hiu Jian Chua, and Pik Pin Goh. 

The Malaysian study shows conclusively that we had a Case Fatality Rate of 1.2%. This is almost an order of magnitude less severe, translating to slightly more than 1 in a 100 people who contract the disease eventually succumbing to it. 

As at today, 00:00 GMT, Malaysia’s CFR is only at 0.5%!


The said study shows that Covid-19 overwhelmingly affects men compared with women in Malaysia (71.7%). Men are also proportionally more likely to have a severe case of the disease (71.5%). 

This could partly be due to the large male foreign worker population we have here. They are often subjected to unsafe, non-socially distanced workspaces that cause the disease to run riot – as the Top Glove situation illustrates so well. 

It could also be due to women having a stronger immune system thanks to the double helping they have of the X chromosome, which has about 60 genes involved in immune function. 

According to Akiko Iwasaki (right), professor of immunobiology at Yale University, T-cell response in men is also weaker. 

T-cells play an integral role in a person’s immune system, detecting and killing infected cells and helping direct antibody response. She has shown that unlike the female immune system that declines gradually, the male immune system takes a nosedive after they hit their 30s. Most starkly, the T-cell response of men in their 30s and 40s is similar to that of a woman in her 90s. Supposedly. 

Pertaining to ethnicity, Malays account for 58.4% of all cases and 70.0% of all severe cases, while the Chinese account for 6.7% of all cases and 12.1% of severe cases and Indians account for 2.3% of all cases and 4.5% of severe cases. The ratio of severe cases to all cases of almost 2 to 1 for Chinese and Indians might be due to their slightly older-skewing population. 

Other nationalities account for 23.8% of all cases but only 4.9% of all severe cases – a ratio of almost 5 to 1. This, again, could be due to the foreign worker population which generally skews younger and so has a reduced chance of developing a severe instance of the disease. 

Another piece of vital information provided is the presence of comorbidities in those who developed a severe infection. Those with hypertension are the most at risk at 48.6%, followed by diabetes mellitus at 39.1% and chronic cardiac disease at 14.0%.

Surprisingly enough, being an active smoker does not indicate an elevated risk of developing a severe infection. Smokers account for 9% of all cases and 7% of severe cases. 

Note that this doesn’t mean smoking is a good idea as it still is a leading cause of cancer, heart disease, bronchitis and a host of other ailments. 

The study also confirms the importance of early detection and treatment of Covid-19. Those admitted when the disease has progressed to stage 4, i.e. pneumonia with hypoxia are the likeliest to develop a severe case of the disease (44.6%), compared with those at stage 1, i.e. asymptomatic (6.4%). 

Additionally, the study shows: Acute liver (6.7%) and kidney (4%) injuries, and acute respiratory distress syndrome (2.3%) were the three most common complications seen in our Covid-19 cases. 

Kudos to the Malaysian team of researchers!

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