Estimating the infection burden of COVID-19 in Malaysia.

Malaysia has reported 2.75 million cases and 31,485 deaths as of 30 December 2021. Underestimation remains an issue due to the underdiagnosis of mild and asymptomatic cases. We aimed to estimate the burden of COVID-19 cases in Malaysia based on an adjusted case fatality rate (aCFR). Data on reported cases and mortalities were collated from the Ministry of Health official GitHub between 1 March 2020 and 30 December 2021. We estimated the total and age-stratified monthly incidence rates, mortality rates, and aCFR. Estimated new infections were inferred from the age-stratified aCFR. The total estimated infections between 1 March 2020 and 30 December 2021 was 9,955,000-cases (95% CI: 6,626,000-18,985,000). The proportion of COVID-19 infections in ages 0-11, 12-17, 18-50, 51-65, and above 65 years were 19.9% (n = 1,982,000), 2.4% (n = 236,000), 66.1% (n = 6,577,000), 9.1% (n = 901,000), 2.6% (n = 256,000), respectively. Approximately 32.8% of the total population in Malaysia was estimated to have been infected with COVID-19 by the end of December 2021. These estimations highlight a more accurate infection burden in Malaysia. It provides the first national-level prevalence estimates in Malaysia that adjusted for underdiagnosis. Naturally acquired community immunity has increased, but approximately 68.1% of the population remains susceptible. Population estimates of the infection burden are critical to determine the need for booster doses and calibration of public health measures

Monthly COVID-19 reported deaths between March 2020 and December 2021 in Malaysia

Monthly COVID-19 reported deaths between March 2020 and December 2021 in Malaysia</p

Comparison of reported aCFR of COVID-19 in Malaysia by age categories from 1 March 2020–30 December 2021 in Malaysia compared to assumed IFR and literature-derived IFR

Comparison of reported aCFR of COVID-19 in Malaysia by age categories from 1 March 2020–30 December 2021 in Malaysia compared to assumed IFR and literature-derived IFR</p

Comparison of reported COVID-19 cases with estimated COVID-19 cases based on reported mortality and excess counts between March 2020 and October 2021 in Malaysia

Comparison of reported COVID-19 cases with estimated COVID-19 cases based on reported mortality and excess counts between March 2020 and October 2021 in Malaysia</p

Monthly reported COVID-19 cases and estimated COVID-19 cases between March 2020 and December 2021 in Malaysia

Monthly reported COVID-19 cases and estimated COVID-19 cases between March 2020 and December 2021 in Malaysia</p

Comparison of reported COVID-19 cases to estimated COVID-19 infections.

a) cumulatively and b) by age categories from 1 March 2020–30 December 2021 in Malaysia.</p

Deaths in Malaysia between 1^st October 2020-30^th December 2021 in Malaysia.

a) Daily deaths by age categories across time, b) Heatmap of daily mortality rate by age categories across time (Data before 1 September 2020 were removed as deaths were relatively lower to increase visualization quality).</p

Cases in Malaysia between 1 October 2020–30 December 2021 in Malaysia.

a) Daily incidence rate by age categories across time, b) Heatmap of daily incidence rate by age categories across time (Data before 1 September 2020 were removed as deaths were relatively lower to increase visualization quality)</p

Adjudication of deaths in Malaysia.

(DOCX)</p

Spatial Dynamics and Multiscale Regression Modelling of Population Level Indicators for COVID-19 Spread in Malaysia

As COVID-19 dispersion occurs at different levels of gradients across geographies, the application of spatiotemporal science via computational methods can provide valuable insights to direct available resources and targeted interventions for transmission control. This ecological-correlation study evaluates the spatial dispersion of COVID-19 and its temporal relationships with crucial demographic and socioeconomic determinants in Malaysia, utilizing secondary data sources from public domains. By aggregating 51,476 real-time active COVID-19 case-data between 22 January 2021 and 4 February 2021 to district-level administrative units, the incidence, global and local Moran indexes were calculated. Spatial autoregressive models (SAR) complemented with geographical weighted regression (GWR) analyses were executed to determine potential demographic and socioeconomic indicators for COVID-19 spread in Malaysia. Highest active case counts were based in the Central, Southern and parts of East Malaysia regions of Malaysia. Countrywide global Moran index was 0.431 (p = 0.001), indicated a positive spatial autocorrelation of high standards within districts. The local Moran index identified spatial clusters of the main high&ndash;high patterns in the Central and Southern regions, and the main low&ndash;low clusters in the East Coast and East Malaysia regions. The GWR model, the best fit model, affirmed that COVID-19 spread in Malaysia was likely to be caused by population density (&beta; coefficient weights = 0.269), followed by average household income per capita (&beta; coefficient weights = 0.254) and GINI coefficient (&beta; coefficient weights = 0.207). The current study concluded that the spread of COVID-19 was concentrated mostly in the Central and Southern regions of Malaysia. Population&rsquo;s average household income per capita, GINI coefficient and population density were important indicators likely to cause the spread amongst communities