SINGAPORE – Malaysia’s health crisis is taking a turn for the worst as new Covid-19 cases rise exponentially, a viral surge that as a percentage of the population is now higher than India’s daily infection rate.

With a record number of critically ill patients occupying almost 1,200 intensive care unit (ICU) beds, the healthcare system is at a breaking point amid reports of doctors giving priority care to patients with higher chances of recovery.

The Muslim-majority nation has seen a dramatic five-fold rise in cases since the beginning of the year and consecutive days of record-high daily caseloads in the thousands following the Eid al-Fitr holiday.

Recent infections are being traced to gatherings held in violation of social distancing and movement restrictions during the end of the month-long Ramadan fasting period.

Daily transmissions have far outpaced Ministry of Health (MoH) forecasts, which were projected to cross the 8,000-case threshold by around June 5 if safety guidelines, or what Malaysia calls standard operating procedures (SOPs), were not complied with.

But by May 29, the country had already logged a record 9,020 cases and 98 deaths. A monthly high of 1,289 cumulative deaths was recorded in May, exceeding total casualties recorded by Malaysia during the first year of the pandemic.

As cases and deaths climb, so too does anger and frustration with Prime Minister Muhyiddin Yassin’s government. After being criticized for not imposing tougher curbs as infections spiraled, the premier on May 28 announced a “total lockdown” nationwide starting from June, during which only essential services and sectors will remain in operation.

Muhyiddin’s government declared a state of emergency in January on public health grounds, which suspended Parliament and gave the premier enhanced powers to enact legislation. Emergency rule, consented to by Malaysia’s king, is set to expire on August 1. But the worsening pandemic could see the premier seek an extension.

Malaysia’s Prime Minister Muhyiddin Yassin arriving at a quarantine facility for people with the Covid-19 coronavirus at the Malaysia Agro Exposition Park (MAEPS) in Serdang, outside Kuala Lumpur, January 19, 2021. Photo: AFP via Malaysia Department of Information / Aqilah Mazlan

With active cases nearly tripling since the emergency was imposed, lawmakers from both political aisles have called for an urgent parliamentary sitting to deliberate Covid-19 prevention measures and related matters.

However, it’s not clear if Muhyiddin, who is wary of losing his razor-thin governing majority, will permit Parliament to reconvene.  

The first of a three-phase lockdown is set to go into effect from June 1-14, with the MoH to determine when the restrictions should be eased and economic sectors reopened.

Authorities have said the decision to reimpose the lockdown was influenced by the emergence of several highly contagious Covid-19 variants. Malaysia detected its first case linked to India’s B1617 variant earlier this month.

Two other strains from the United Kingdom and South Africa, deemed “variants of concern” by the World Health Organization (WHO), have also spread into the community. Meanwhile, a rising number of patients, including younger people, are exhibiting more severe symptoms.

Total cases since the start of the pandemic now stand at 572,357 with 2,796 deaths. Malaysia has Southeast Asia’s worst outbreak relative to its population size, though its overall caseload is lower than more populous Indonesia and the Philippines.

Official data shows Malaysia’s daily infection rate per million people now exceeds India, which in early May reported a global record of over 414,000 new daily infections.

“We have a current situation that is quite serious. Cases are happening everywhere around the country and we have needed a strict lockdown to recalibrate and reorganize our actions toward Covid-19,” said Zainal Ariffin Omar, a former WHO consultant for non-communicable disease prevention.

Muhyiddin announced a third movement control order (MCO) from May 12 that prohibited social gatherings and limited movement but allowed businesses to operate with reduced hours.

A man walks along an empty China Town street in locked down Kuala Lumpur, Malaysia, May 28, 2021. Photo: AFP via EyePress News

In a May 23 television interview, the premier said he was reluctant to reimpose a full lockdown, which was enforced between March and May last year, over concerns that the economy could “collapse.”    

Zainal, president of the Public Health Physicians Association of Malaysia, said that Selangor, the country’s wealthiest state where the number of infections is more than triple those of the next worst-hit state, and the Klang Valley, which is conterminous with greater Kuala Lumpur, should undergo at least three weeks of total lockdown.

“We also need strict enforcement on inter-state and inter-district movement, because people haven’t always followed the SOPs and have spread the disease,” he said.

Thousands reportedly tried to cross state borders during Eid, known as Hari Raya Aidilfitri in Malaysia, to visit friends and relatives despite rules explicitly banning such gatherings.

“The reality is SOPs have been totally ignored,” said Nor Azimi Yunus, the top health official for Terengganu state, in a Facebook post. Experts and observers have pointed to a laxer adherence to health protocols among rural communities where vaccine registration rates are lower compared to the urban-based, non-Malay population.

As Malaysia attempts to ramp up a sluggish immunization campaign, vaccine hesitancy also appears to be spreading, evidenced by lower take-up in some areas and missed immunization appointments, perhaps due to fears of side effects.

“There are some instances of vaccine hesitancy, especially for appointments during the fasting month. People were reluctant to get their vaccination during this period,” said Zainal. “Others have issues with a lack of transport to vaccination centers.”  

In Kedah state, over a third of the 30,100 people registered to be immunized reportedly failed to show for their appointments. Around 45.6% of the adult population has registered for vaccination nationwide.

Malfunctions of the government’s MySejahtera mobile application, used for contact tracing and scheduling vaccination appointments, have also been widely reported, with glitches causing people to miss or forfeit their appointments.

People queue for the Pfizer/BioNTech Covid-19 coronavirus vaccine during the first mega Covid-19 vaccination at the Malaysia International Trade and Exhibition Centre in Kuala Lumpur on May 31, 2021. Photo: AFP / Mohd Rasfan

The government aims to immunize 80% of the population, or close to 27 million people, by the first quarter of 2022. But the national vaccination drive has proceeded more slowly than anticipated due to procurement delays.

Although the pace of vaccination is accelerating, only 3.1% of the population has been fully vaccinated while 5.3% of Malaysians have received at least one dose.

Malaysia began its inoculation rollout in late February and has so far approved the use of the Pfizer-BioNTech, Oxford University-AstraZeneca and Chinese biotech firm Sinovac Covid-19 vaccines. Official data shows that government-run vaccination centers have administered 66,158 doses per day on average over the last two weeks.

“There has to be 250,000 vaccinations a day going forward in order to complete the vaccination in accordance with the government’s timeline,” said opposition lawmaker Wong Chen. “There has been a vaccine shortage, and the government is banking on a high volume of vaccines arriving from mid-June and early July to salvage its position.”

While the government cannot be fully blamed for delivery delays, inadequate levels of testing and contact tracing are to blame for the ballooning outbreak, Wong said.

“They have had so long to do this, they just never improved on it. When there’s a surge, they realize that they don’t have the infrastructure to trace and track. That’s really the bottom line.”

A Covid-19 patient in an intensive care unit at a Malaysian hospital, May 2021. Image: Twitter

The deteriorating health crisis and alarming rise in cases threaten to weaken Muhyiddin’s political standing, particularly if the situation sharply deteriorates and leads to a prolonged economic shutdown. But analysts believe the premier will still have an upper hand against opposition challengers as long as emergency rule is in place.

One key reason for Muhyiddin’s emergency declaration was to ensure political certainty amid threats of no-confidence motions brought against the government in Parliament. His ruling Perikatan Nasional (PN) coalition appeared to be hanging by a thread after lawmaker defections from its biggest party, the United Malays National Organization (UMNO).

Though Muhyiddin was largely given the benefit of the doubt for invoking emergency powers earlier this year, the measures have by now manifestly failed to halt a runaway rise in cases and deaths.

Any extension of the emergency without parliamentary debate would thus likely spark accusations that the premier is leveraging the health crisis to ensure his political survival.

“If the situation remains dire into late June or beyond, then it is probable that the state of emergency, approved by the king in January after Muhyiddin’s second request, will also be extended beyond the current end-date of 1 August,” said Peter Mumford, a Southeast Asia analyst with the Eurasia Group consultancy.

Doing so could put Sultan Abdullah Sultan Ahmad Shah, known as the Yang di-Pertuan Agong, in an uncomfortable position, say analysts.

The monarch, who under Malaysia’s constitution has the power to declare an emergency based on threats to security, economy or public order, has been petitioned by opposition politicians to suspend the measures and recall Parliament.

The country’s king initially rejected a request from Muhyiddin to declare an emergency last October, which opposition parties had then criticized as a bald bid to cling to power.

If the Agong refuses to endorse an extension of the current emergency, Parliament could then debate how to proceed so that the palace remains above the political fray.

Malaysia’s King Sultan Abdullah Sultan Ahmad Shah approved Muhyiddin’s declaration of a state of emergency. Photo: AFP / Nazri Rapaai

Despite rising criticism of the government’s pandemic handling, Mumford said Muhyiddin “appears safe for now” with the power of incumbency and apparent support of the king.

But if the outbreak worsens considerably, figures like opposition leader Anwar Ibrahim could plausibly garner majority support to become prime minister and topple Muhyiddin’s coalition.

Political camps are, at least for the moment, offering bipartisan assurances that they will not support no-confidence motions against the government if Parliament is reconvened. Observers say the severity of the pandemic has also given pause to would-be defectors seen previously as maneuvering to bring about early elections.

Deputy Speaker of Parliament Azalina Othman Said proposed in an open letter on May 27 that Putrajaya enact an ordinance allowing the legislature to reconvene without any motions of confidence being heard and with no general election allowed “until and unless the pandemic is controlled and herd immunity of at least 50% is achieved.”

Prior to the current Covid-19 surge, an early election had been expected by the third quarter of this year, which now appears to be off the table until at least 2022.

Azalina, an UMNO lawmaker in the ruling coalition, has proposed the formation of an interim “emergency government” with representation from all political parties, which some opposition figures have welcomed.

Political scientist Chandra Muzaffar said “both the severe health crisis and the concomitant economic crisis” would justify an extension of the emergency, but the country’s long political stalemate demands that Putrajaya go beyond merely extending emergency measures.

The circumstances “should prompt the prime minister and the king to initiate a genuine national unity government that will not only include the opposition, but also a couple of respected figures from the health sector who have expressed some independent views on how to handle the current pandemic,” opined Muzaffar.

“The management of the twin crises should be seen by the people as a sincere national effort that transcends political affiliations,” he told Asia Times.

As things stand, the premier has given no clear indication that he sees a broader unity government as a way out of the crisis of a generation, meaning the wait to reconvene Parliament looks set to continue.