With the exception of Singapore, Southeast Asian countries have recorded unprecedented spikes in daily case numbers and deaths during the last several weeks.
In April 2021, Thailand recorded an eight-fold increase in 7-day average daily new cases. The trend in the last few weeks have been worse. Malaysia’s seven-day average daily new cases per million population more than doubled between May 1 (94.2 per million population) and July 11 (254.43 per million).
With a population nearly ten times that of Malaysia, Indonesia has recorded an almost seven-fold increase for the same parameter from May 1 (18.85 new cases per million) to July 11 (126.98 new cases per million).
Indonesia’ daily case numbers for the last few days is breaking records, without a significant increase in test numbers. On July 14 2021, Indonesia broke another record of 54,517 new COVID-19 cases.
Indonesia is now considered Asia’s new COVID-19 epicentre, overtaking India. What has prevented Indonesia from showing a similar spike with India during its worst days in terms of incidence rate per million population was simply the country’s low test coverage.
The increase in case numbers has been followed by spikes in deaths as well.
Why cases are increasing
Two things contribute to increased COVID-19 cases in several countries in Southeast Asia: human mobility and activities and the spreading of new coronavirus variants.
The drastic rise of COVID-19 cases in Thailand during April 2021 was preceded by increased activities in workplaces that peaked in March.
In Malaysia and Indonesia, being Muslim countries, most people celebrated Eid in May. Despite government restrictions, people travelled to meet their families (“mudik” in Indonesia or “balik kampong” in Malaysia). We can easily relate the current spikes with the increase in mobility.
Additionally, the government’s effort for economic recovery following the 2020 economic downturn has also been attributed to an increase in cases.
In Malaysia, for instance, more than 50% of about 9.300 new cases between February and April 2021 were found in workplaces, among construction and factory workers.
It’s also clear that the new SARS-CoV-2 variants of concern are significant factors in the unprecedented spike. The Delta variant, for example, has shown transmission capacity and immune evasiveness that was never seen before for a coronavirus. This means there is increasing risk for the delta variant to wreak havoc an otherwise healthy immune system. What happened in India was a clear sign of this.
All four variants of concern (Alpha, Beta, Gamma and Delta) have been found in Southeast Asia, mainly in Malaysia, Thailand, Philippines, Singapore and Indonesia. The COVID cases are increasing in those countries, although Singapore tough measures have managed to control it.
The death also increase
A sharp increase in the death toll has accompanied the rising COVID-19 cases.
The weekly average of daily new deaths in Thailand recorded over a 100-fold increase over the period from April 1, 2021 (< 0.01 deaths per million population) to July 13, 2021 (1.05 deaths per million population).
Malaysia recorded a 24-fold increase (0.13 deaths per million population on April 1 compared to 3.13 deaths per million population on July 13) for the same parameters and period. Although Indonesia has recorded “only” 6.5-fold increase for the same period (0.51 vs 3.32), the country’s death toll is now the worst in the region.
As of July 13, Indonesia’s case fatality rate with 2.61 deaths for every 100 confirmed cases of COVID-19 remains the highest in Southeast Asia (Malaysia 0.75%; Thailand 0.81%).
When we published the Indonesian version of this article last month, Malaysians showed an 11-fold higher risk of being infected with COVID-19 than Indonesians (21.32 -Indonesia- vs 236.46 -Malaysia- new cases per million population).
In a mere one month, this gap is closing only 2-fold as of July 11 (126.98 -Indonesia- vs 254.43 -Malaysia-). This has happened amidst sterling efforts to increase testing capacity in Indonesia.
Vaccination as a solution
The United Kingdom and United States experience shows that vaccination is the most effective strategy in stopping the pandemic.
Even though both countries saw a recent spike in cases, with Delta being the dominant variant there, we do not see a corresponding spike in hospitalisations and deaths, as seen in Southeast Asia with lower vaccination coverage.
The United Kingdom and the United States experienced a surge of cases, hospitalisations and deaths in early 2021. Now in almost all of the parameters their numbers have significantly lowered. As of July 12, 51.55% of the UK’s population and 47.69% of the US’s population have been fully vaccinated.
On May 28, 2021, the US Center for Disease Control (CDC) issued bold recommendations for those who have been fully vaccinated. The agency has decided to remove the obligation to wear masks, social distancing and post-international-travel quarantine to those with complete vaccinations.
Test-Trace-Isolate
Test-Trace-Isolate (TTI) remains the key strategy to controlling the pandemic.
The principle of this effort is to detect as many cases as possible as quickly as possible, preventing them from becoming sources of virus spread. Upon detection, patients must be separated from the general public and be given medical care if necessary.
The government also has to meet WHO’s 5% maximum positivity rate standard, used as a marker of adequacy in test coverage. If the positivity rate is still above 5%, the number of tests must be increased.
And until the majority of the population gets vaccinated, we should continue to wash hands, wear masks, maintain distance, avoid crowds and limit travel to control the pandemic.