Background: COVID-19 emerged as a major public health outbreak in late 2019. Malaysia reported its first imported case on 25th January 2020, and adopted a policy of extensive contact tracing and hospitalising of all cases. We describe the clinical characteristics of COVID-19 cases nationwide and determine the risk factors associated with disease severity. Method: Clinical records of all RT-PCR confirmed COVID-19 cases aged ≥12 years admitted to 18 designated hospitals in Malaysia between 1st February and 30th May 2020 with complete outcomes were retrieved. Epidemiological history, co-morbidities, clinical features, investigations, management and complications were captured using REDCap database. Variables were compared between mild and severe diseases. Univariate and multivariate regression were used to identify determinants for disease severity. Findings: The sample comprised of 5889 cases (median age 34 years, male 71.7%). Majority were mild (92%), and 3.3% required intensive care, with 80% admitted within the first five days. Older age (≥51 years), underlying chronic kidney disease and chronic pulmonary disease, fever, cough, diarrhoea, breathlessness, tachypnoea, abnormal chest radiographs and high serum CRP (≥5 mg/dL) on admission were significant determinants for severity (p < 0.05). The case fatality rate was 1.2%, and the three commonest complications were liver injuries (6.7%), kidney injuries (4%), and acute respiratory distress syndrome (2.3%). Interpretations: Lower case fatality rate was possibly contributed by young cases with mild diseases and early hospitalisation. Abnormal chest radiographic findings in elderly with tachypnoea require close monitoring in the first five days to detect early deterioration.

ISARIC (International Severe Acute Respiratory and emerging Infections Consortium) partnerships and outbreak preparedness initiatives enabled the rapid launch of standardised clinical data collection on COVID-19 in Jan 2020. Extensive global uptake of this resource has resulted in a large, standardised collection of comprehensive clinical data from hundreds of sites across dozens of countries. Data are analysed regularly and reported publicly to inform patient care and public health response. This report is a part of a series and includes the results of data analysis on 8 June 2020. We thank all of the data contributors for their ongoing support. As of 8JUN20, data have been entered for 67,130 patients from 488 sites across 37 countries. For this report, we show data for 42,656 patients with confirmed disease who were enrolled >14 days prior. This update includes about 2,400 new cases from France, and we thank these collaborators for this significant addition to the dataset. Some highlights from this report The median time from onset of symptoms to hospital admission is 5 days, but a proportion of patients take longer to get to the hospital (average 14.6 days, standard deviation 8.1). COVID-19 patients tend to require prolonged hospitalisation; of the 88% with a known outcome, the median length of admission to death or discharge is 8 days and the mean 11.5. 17% of patients were admitted to ICU/HDU, about 40% of these on the very day of hospital admission. Antibiotics were given to 83% of patients, antivirals to 9%, steroids to 15%, which becomes 93%, 50% and 27%, respectively for those admitted to ICU/HDU. Attention has been called on overuse of antibiotics and need to adhere to antibiotic stewardship principles. 67% of patients received some degree of oxygen supplementation: of these 23.4% received NIV and 15% IMV. This relatively high proportion of oxygen use will have implications for oxygen surge planning in healthcare facilities. Some centres may need to plan to boost capacity to deliver oxygen therapy if this is not readily available. WHO provides operational advice on surge strategy here https://apps.who.int/iris/bitstream/handle/10665/331746/WHO-2019-nCoV-Oxygen_sources-2020.1-eng.pdf

Objective This study aims to investigate the association between smoking and the severity of COVID-19 infection during the initial wave of this pandemic in Malaysia. Methods This is a multi-centre observational study using secondary hospital data collected retrospectively from 1 st February 2020 until 30 th May 2020. Clinical records of all real-time polymerase chain reaction (RT-PCR) confirmed COVID-19 cases with smoking status, co-morbidities, clinical features and disease management were retrieved. Severity was assessed by presence of complications and outcomes of COVID-19 infection. Logistic regression was used to determine the association between COVID-19 disease severity and smoking status. Results A total of 5889 COVID-19 cases were included in the analysis. Ever smokers had higher risk of having COVID-19 complications such as acute respiratory distress syndrome (OR: 1.69, 95% CI = 1.09 - 2.55), renal injury (OR: 1.55, 95% CI = 1.10 - 2.14) and acute liver injury (OR: 1.33, 95% CI = 1.01 - 1.74) compared to never smokers. However, in term of disease outcomes, there were no differences between two groups. Conclusion Although no significant association was found in term of disease outcomes, smoking is associated with higher risk of having complications due to COVID-19 infection.

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Different neurological manifestations of COVID-19 in adults and children and their impact have not been well characterized. We aimed to determine the prevalence of neurological manifestations and in-hospital complications among hospitalized COVID-19 patients and ascertain differences between adults and children. We conducted a prospective multicenter observational study using the International Severe Acute Respiratory and emerging Infection Consortium cohort across 1507 sites worldwide from January/30th/2020 to May/25th/2021. Analyses of neurological manifestations and neurological complications considered unadjusted prevalence estimates for predefined patient subgroups, and adjusted estimates as a function of patient age and time of hospitalization using generalized linear models. Overall, 161,239 patients (158,267 adults; 2,972 children) hospitalized with COVID-19 and assessed for neurological manifestations and complications were included. In adults and children, the most frequent neurological manifestations at admission were fatigue (adults: 37.4%; children: 20.4%), altered consciousness (20.9%; 6.8%), myalgia (16.9%; 7.6%), dysgeusia (7.4%; 1.9%), anosmia (6.0%; 2.2%), and seizure (1.1%; 5.2%). In adults, the most frequent in-hospital neurological complications were stroke (1.5%), seizure (1%), and central nervous system (CNS) infection (0.2%). Each occurred more frequently in ICU than in non-ICU patients. In children, seizure was the only neurological complication to occur more frequently in ICU vs. non-ICU (7.1% vs. 2.3%, P &lt; .001). Stroke prevalence increased with increasing age, while CNS infection and seizure steadily decreased with age. There was a dramatic decrease in stroke over time during the pandemic. Hypertension, chronic neurological disease, and the use of extracorporeal membrane oxygenation were associated with increased risk of stroke. Altered consciousness was associated with CNS infection, seizure, and stroke. All in-hospital neurological complications were associated with increased odds of death. The likelihood of death rose with increasing age, especially after 25 years of age. In conclusion, adults and children have different neurological manifestations and in-hospital complications associated with COVID-19. Stroke risk increased with increasing age, while CNS infection and seizure risk decreased with age.

The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 dataset is one of the largest international databases of prospectively collected clinical data on people hospitalized with COVID-19. This dataset was compiled during the COVID-19 pandemic by a network of hospitals that collect data using the ISARIC-World Health Organization Clinical Characterization Protocol and data tools. The database includes data from more than 705,000 patients, collected in more than 60 countries and 1,500 centres worldwide. Patient data are available from acute hospital admissions with COVID-19 and outpatient follow-ups. The data include signs and symptoms, pre-existing comorbidities, vital signs, chronic and acute treatments, complications, dates of hospitalization and discharge, mortality, viral strains, vaccination status, and other data. Here, we present the dataset characteristics, explain its architecture and how to gain access, and provide tools to facilitate its use.

Background We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world's largest international, standardized data sets concerning hospitalized patients. Methods The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV). Results Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and male sex [1.23 (1.21, 1.24)] were associated with a higher risk of death. Rates of admission to an ICU and use of IMV increased with age up to age 60 years then dropped. Symptoms, co-morbidities and treatments varied by age and had varied associations with clinical outcomes. The case-fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients and was on average 21.5%. Conclusions Age was the strongest determinant of risk of death, with a ∼30-fold difference between the oldest and youngest groups; each of the co-morbidities included was associated with up to an almost 2-fold increase in risk. Smoking and obesity were also associated with a higher risk of death. The size of our international database and the standardized data collection method make this study a comprehensive international description of COVID-19 clinical features. Our findings may inform strategies that involve prioritization of patients hospitalized with COVID-19 who have a higher risk of death.

The Food Safety and Quality Division (FSQD) in Malaysia is the competent authority tasked with ensuring food safety throughout the food supply chain within the country. Despite implementing various regulations toward improving food hygiene standards in Malaysia, outbreaks of food poisoning cases continued to occur in Malaysia. This cross-sectional study was designed to explore the occurrence of food poisoning incidents in Malaysia, within the Pahang state, from 2013 to 2018 via both reported passive case detection (PCD) and active case detection (ACD) food poisoning incidents. Upon detecting all the food poisoning cases using both PCD and ACD, the people identified to have suffered from food poisoning underwent a structured interview for investigators to elicit all relevant information about the food poisoning incident. Results showed that in Pahang, the number of reported episodes fluctuated from 2013 until 2018, with an average of 21 food poisoning episodes occurring yearly, reaching a maximum in August and a minimum in May. Furthermore, Kuantan, being the state capital, had reported an exceptionally high total number of reported incidents of food poisoning with a total of 48 episodes over six years from 2013 to 2018, while Kuala Lipis had only one incident reported during the same period (which was reported in 2016). Finally, this study concluded that adequate measures must always be taken to minimise the occurrence of food poisoning, especially when preparing foods in large quantities.