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Doctors prepare to ration care as covid surge leaves Malaysia in ‘total lockdown’

Malaysia is putting in place a strict lockdown as coronavirus cases continue to soar. (Vincent Thian/AP)

Coronavirus cases are soaring. Hospitals are growing crowded. And officials are warning that doctors may soon have to decide who lives.

While India’s covid-19 crisis is far from over, the number of new coronavirus infections per million people in Malaysia has overtaken that of the more populous South Asian country. Malaysia, with its roughly 32 million people, now registers more new cases per capita than any medium- or large-sized country in Asia, according to Our World in Data, which tracks publicly available figures.

Facing a record number of new cases, Malaysia’s prime minister announced a two-week “total lockdown” starting Tuesday.

“There is no time to lose,” wrote one local columnist. “We are staring at the abyss.”

On Saturday, Malaysia reported 9,020 new coronavirus cases — a national record for the fifth day running. Although the number fell slightly the next day, it is registering almost as many new cases as the United States — a country with 10 times its population.

At least 98 covid-19 deaths were reported Saturday, setting another daily record.

The outbreak is bad enough that a top health official warned over the weekend that doctors may have to allocate scarce intensive-care beds to patients with higher chances of recovery.

“The number of ICU beds at covid hospitals, quarantine and treatment centers is declining and may be inadequate,” Health Director General Noor Hisham Abdullah said, according to Bloomberg News. The Health Ministry “has warned of possible situations where doctors will have to make difficult choices to prioritize ICU beds for patients with higher recovery potential.”

For much of last year, Malaysia handled the pandemic relatively well. The Southeast Asian nation was quick to tighten and then shut its borders. When a large religious gathering threatened to become a superspreader event, officials launched a swift and effective lockdown.

“We prided ourselves in acting very, very quickly when the news of the [virus] came out,” said Adeeba Kamarulzaman, professor of medicine and infectious diseases at the University of Malaya, adding that the previous SARS and H1N1 outbreaks had primed Malaysia to take action. “For months, we only saw imported cases. Everything was hunky-dory.”

That changed in September, when cases began to rise sharply following outbreaks in detention centers and a state election that saw large gatherings.

“We kind of let our guard down,” Kamarulzaman said. “From there, it seeded multiple mini clusters.”

In January, she was one of almost 50 health professionals to sign a letter calling on the government to increase testing and contact tracing, among other measures. Days later, Prime Minister Muhyiddin Yassin announced a partial lockdown.

Cases fell but then began to rise again in April, as families in the Muslim-majority country gathered for Ramadan and new variants of the virus spread. Malaysia has vaccinated about 3.5 percent of its population, far behind neighboring Singapore.

Malaysia’s per million rate of confirmed daily coronavirus infections is nearly twice that of India, according to Our World in Data, although experts have warned that the number of cases in India is probably far higher than recorded.

“While the situation is dire, we are not quite at the level of running out of oxygen and the type of scenes we have seen in India,” Kamarulzaman said.

Hospitals have begun to fill up, especially outside of major cities, she said, raising fears that the health system could crash. But Kamarulzaman said she was hopeful the latest lockdown would ease the pressure.

The 14-day lockdown could shave as much as two percentage points off economic growth this year, analysts predicted.

But critics say it may not go far, or long, enough.

“Without a doubt, we need this lockdown, but it needs to be really strict,” said Kamarulzaman, adding that a longer lockdown would give the country a chance to ramp up its testing, contact tracing and vaccination programs. “Otherwise, we are really going to escalate into a point of no return.”

On Sunday, two days after the new restrictions were announced, the government said a dozen manufacturing sectors — including some hard-hit by the pandemic — would be allowed to continue operating at 60 percent capacity.

The surge in cases has led some to call for the creation of a national unity government and an end to the state of emergency in place since January that suspended parliament.

“This is not the time for political calculation, party or personality,” wrote Munir Majid, a former top banking executive, in a column with a title — “Be afraid, be very afraid” — that captured its tone. “This is a matter of national survival at so many levels.”