Post-vaccination era: Debunking the myths of Covid-19 vaccination

Sarawak and its vaccination drive.

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By Lian Cheng

UNDOUBTEDLY, Sarawak has achieved a high rate of Covid-19 vaccination within a very short period of time, despite its huge geographical size and sparse rural population. Due to this achievement, the Sarawak Disaster Management Committee (SDMC) has been spared substantial criticism which could be much worse, as all governments in the world are suffering, in the face of an unprecedented pandemic.

When Sarawak first launched its vaccination plan, SDMC aimed its efforts at those over 18 years of age, resulting in the claim of a high vaccination rate of over 90 per cent, higher than most developed countries which started their vaccination efforts much earlier.

As of Sept 4, 2021, 1,883,698 individuals or 91.2 per cent of those eligible for vaccination in Sarawak had received at least one dose while 1,832,445 individuals or 88.7 per cent had been fully vaccinated. This constituted approximately 65 per cent of the total Sarawak population.

Vaccination rate in Sarawak. Credit: Sarawak Public Communications Unit (Ukas)

In the initial stages of its vaccination rollout, Sarawak was using the benchmark of vaccinating 70 per cent and above of the population for herd immunity, to decide on the next course of action, while gradually opening up economic sectors with new measures in place.

Like many countries, however, this was brought to an abrupt halt by the emergence of the Delta variant. Things changed overnight.

Coming into August 2021, Sarawak found itself facing an exponential increase in Covid-19 positive cases. The Delta variant which is far more infectious that the original Covid-19 virus, is taking Southern Sarawak by storm.

The Delta variant, according to Sarawak Health Director Dato Dr Mohamed Sapian Mohamed, is five to eight times more contagious and spreads faster than earlier forms of SARS-CoV-2, the virus that causes Covid-19. It has driven up case counts in countries all over the world, even those with high vaccination coverage.

SDMC advisor Dato Sri Dr Sim Kui Hian went one step further as to explain that the Delta variant has higher chances of being transmitted by infected individuals through breathing, singing, and even talking. Even breathing quietly carries a risk of infecting others with the virus, while conducting heavy activities which require breathing through the mouth has seven times’ higher chance of infection.

“This includes talking normally (8 times), singing normally or talking loudly (11 times) and singing loudly (90 times),” said Dr Sim, who is also Local Government and Housing Minister.

Number of Covid-19 cases reported in Sarawak between Aug 8 to Sept 4, 2021.

According to the Sarawak Health Ministry, as of Monday (Sept 6, 2021), a total of 696 samples in Sarawak have tested positive for the Delta variant.

Sarawak reported its first Delta variant case on July 8, 2021 and since then, cases have been on the rise, initially predominantly in the districts in the Southern Zone namely Kuching, Samarahan and Serian, but now, across the whole Sarawak after it was detected in 10 divisions.

Unfortunately, data shows that the unvaccinated who are infected with this variant may likely exhibit more severe illness than if they were infected with other variants, while the fully vaccinated carrying the Delta variant may develop breakthrough infections (medical term referring to infections among those fully vaccinated) and spread the virus.

Graph showing the number of daily new Covid-19 cases vs vaccination coverage. Credit: Sarawak Health Department.

A higher transmission rate is not the only noticeable trait of the Covid-19 Delta variant. What is worse is it is also spreading among youngsters below the age of 18 and causing fatalities. According to the Sarawak Health Department, 27.6 per cent of the positive cases in Sarawak comprised children and teenagers aged 17 years and below.

Yesterday, Sarawakians witnessed yet another record-breaking figure of 3,714 new Covid-19 infections, adding fuel to the general public concern over the severity of the situation in Sarawak. If we were to apply the earlier average of 27.6 per cent to this figure, it means slightly more than 1,000 of yesterday’s cases involved children below the age of 18.

In fact, the Delta variant was already raising red flags in more developed countries such as the United Kingdom (UK) and the United States of America (USA) even before it reached Sarawak’s shores.

As early as June and early July, the Delta variant was already the dominant variant in the UK, with scientists predicting it would to be responsible for a potential new wave of infections in the country, despite the country having vaccinated two-thirds of its adult population.

CNN, in an article titled ‘Britain thinks it can out-vaccinate the Delta variant. The world isn’t so sure’ on July 2, stated that nearly 120,000 new cases were reported in the week before, an increase of 48,000 compared to the previous seven days, attributing the source of infections to the Delta variant.

Schools were reported to be breeding grounds for the new variant, as it was more prevalent among younger age groups, unlike the Alpha variant.

“This variant (Delta) has the potential to change the shape of the pandemic in your country,” said CNN, quoting Deepti Gurdasani, a senior epidemiology lecturer at Queen Mary University of London who was further quoted as saying “once this variant enters a population, it’s easy to lose control of it”.

Covid-19 vaccines however, have been noted to have played their expected part with lower rate of hospitalisation and deaths so far, even in the face of this new threat, said the article.

In the same period of time, besides the UK, the Delta variant was found to be responsible for one in every five infections in the USA.

Quoting the Center for Disease Control and Prevention, Scientific American in an article titled “How dangerous is the Delta variant, and will it cause a Covid Surge in the US?’ described the Delta variant as a “variant of concern”.

“It is the most hyper-transmissible, contagious version of the virus we’ve seen to date, for sure — it’s a super spreader strain if there ever was one,” said Scientific American, quoting Eric Topol, a professor of molecular medicine as well as an executive Vice President of the Scripps Research Institution.

According to Topol, vaccines remains the best tool for combating a Delta surge.

For anyone following international Covid-19 developments closely, one would have noticed that it is inevitable that Malaysia, including Sarawak will finally have to face off against the Delta variant.

The daily cases of Brazil and Malaysia. Credit: John Hopkins Coronavirus Resource Centre.

The Covid-19 trend in the UK and Iran. Credit: John Hopkins Coronavirus Resource Centre.

Does vaccination work? 

It does and it doesn’t.

From day one, pharmaceutical companies, world leaders and scientists, local politicians and medical experts have been stressing that vaccination is not effective in preventing recipients from contracting Covid-19, whether Delta or other variants.

It does, however, reduce the severity of Covid-19 symptoms (including in cases caused by the Delta variant), and is proven to be effective in reducing death and hospitalisation.

In Sarawak’s experience, despite the recent huge surge of Covid-19 cases, statistics show that more than 99 per cent of the infected fall into the Category 1 and 2 due to the State’s high vaccination rate.

What exactly is Category 1, 2, 3, 4 and 5?

According to the Ministry of Health, confirmed Covid-19 patients in Malaysia are classified into five categories as stated below. The clinical management of patient is based on these categories.

Clinical staging of syndrome associated with Covid-19.

Post-vaccination era vs pre-vaccination era

According to Dr Mohamed Sapian, following the mutation of the coronavirus, policies and strategies to counter it must also change to stay relevant and effective. Before vaccination was available and widespread, lockdown was an effective measure to curb Covid-19 spreading but it comes at the expense of Sarawak’s economy. Many people bore with the inconveniences and the loss of income readily, believing that it was just a one-time temporary measure and that it would soon be over.

Is daily number of confirmed cases still relevant?

Before the emergence of the Delta variant, daily updates on the number of new infections became a yardstick by which to measure the severity of the pandemic or the success of keeping Covid-19 under control. The announcement of this daily figure was an announcement all Sarawakians awaited eagerly on a daily basis, to get a glimpse of the current Covid-19 situation in Sarawak.

As we move into the post-vaccination era, is the daily Covid-19 infection figure still relevant when Covid-19 has become endemic? Taking a closer look at the daily statistics recently unveiled by SDMC, we will notice that the majority of new cases are classified as Category 1 or 2, which means no or only mild symptoms in patients.

Let us take a look at the number of cases from Aug 12, 2021 when Sarawak first broke its 1,000-case mark to Sept 6, 2021. (Tabulated by DayakDaily)

Comparing total number of new Covid-19 cases and those classified as Category 1 and 2. Tabulation by DayakDaily.

From Aug 12 to Sept 6, the average percentage overall constituted by patients in Categories 1 and 2 is 99.79 per cent with the lowest at 99.51 per cent on Sept 3 and the highest of 100 per cent on the next day.

When plotting these figures in graph charts, it is difficult to tell apart the number of infected cases and the number of cases under Category 1 and 2 (see graph below).

Despite the high number of confirmed daily cases, patients in Category 1 and 2 take up an average of 99.79 per cent of total cases. DayakDaily graph based on information from SDMC.

The red line shows the total number of Covid-19 cases and the orange line denotes the total number of cases in Categories 1 and 2. One can hardly detect difference between the two scenarios.

This is to say, after full vaccination, people still will get infected. However, 99.79 per cent of them will show no symptoms or adverse effects, or if they exhibit any symptoms, it would be very mild.

This also shows that the total number of daily confirmed cases, at this stage, has ceased to bear any significance. What the public needs to take note then perhaps is not the daily new infection figure but rather the death rate and hospitalisation rate.

Sarawak’s death rate and hospital capacity

Despite having a high number of cases, Sarawak also has one of the lowest death rates compared with other states in Malaysia, as shown in the table below.

Covid-19 cases and death rate in Malaysia between Aug 29 to Sept 4, 2021. Credit: Ministry of Health.

Knowing fully that we will need to live with Covid-19 one day as part of our daily life, it is not too much for both Local Government and Housing Minister Dato Sri Prof Dr Sim Kui Hui and the new Health Minister Khairy Jamaluddin to say that Covid-19 is endemic in Sarawak.

Khairy in response to Democratic Action Party (DAP) adviser Lim Kit Siang urging the former to address the increasing number of cases in Malaysia despite the national vaccination rate at 44.5 per cent of the population, said those who questioned the effectiveness of vaccination should take a look at the Covid-19 hospitalisation numbers.

“Hospital admissions in states where many people were fully vaccinated, such as in Klang Valley, Negeri Sembilan, Labuan and Sarawak, have declined,” said Khairy.

Left: Bed capacity for Covid-19 patients in all states/regions in Malaysia as of Sept 3, 2021, 5 pm. Right: Number of new cases in different states/regions in Malaysia, as of Sept 4, 2021, 12 noon.

Living with the virus

In January, Nature.com asked more than 100 immunologists, infectious-disease researchers and virologists working on the coronavirus whether it could be eradicated.

“Almost 90 per cent of respondents thought that the coronavirus will become endemic – meaning that it will continue to circulate in pockets of the global population for years to come,” said Nature in its news feature titled “The coronavirus is here to stay – here’s what that means” published on Feb 16, 2021.

The following is Nature poll. (Credit: Nature.com)

In the Nature poll, 89 per cent of scientists felt that Covid-19 was either very likely or likely to become an endemic virus.

To State Health Director Dr Mohamed Sapian, though we know that virus is likely to continue to mutate into more efficient and infectious or pathogenic variants, we need to live with it and adapt.

“More economic sectors and social actives are gradually allowed to operate as Sarawak enters into the third phase of the NRP (National Recovery Plan). The gradual opening of economic sectors and social activities is vital to allow livelihoods to continue and for the economic recovery of the country.

“While we recognise that the local transmission is still high, with most of the community fully vaccinated, the risk of serious ill or hospitalisation and deaths due to Covid-19 will remain at levels where the health department will still be able to cope,” he said. — DayakDaily