Objectives Chronic hepatitis C virus (HCV) infection is often asymptomatic until the occurrence of severe liver disease such as liver cirrhosis and liver cancer. These HCV-related clinical sequalae can cause significant clinical and financial implication. This study aims to describe the clinical characteristics of HCV-infected patients during initial presentation to tertiary care in Malaysia, a middle-income Asian country, to inform the development of a national guideline. Methods A descriptive cross-sectional study of a hospital-based case-series on consecutive HCV patients who presented in 2014 at the national referral centre was conducted. All patients with active viremia (detectable HCV RNA) during initial presentation were included. Results There were 741 HCV patients treated by the hepatology specialty in 2014 (n=741/5865). Mean age at initial presentation was 48 years (SD=11.5; median=49) with 541 (73%) being male. Prior known exposure to various HCV risk factors included: intravenous drug use (n=271/737), blood or blood products transfusion (n=237/737), multiple sexual partners (n=123/737), high-risk practices such as tattooing, cupping therapy, acupuncture and sharing of personal items with infected individuals (n=68/737), dialysis (n=38/737) and organ transplantation (n=13/737). Based on histology, fibroscan findings or aspartate aminotransferase-to-platelet ratio index (APRI), 327 (44.1%) patients had cirrhosis at initial presentation, with mean age 52 years (SD=8.86) compared to 44 years (SD=12.0) for non-cirrhotic patients. Decompensated cirrhosis was seen in 118 (36%) and HCC in 45 (13%) of the 327 cirrhotic patients. Only 262 (44%) of 595 patients who were clinically eligible for interferon-based therapy (patients with no cirrhosis or with compensated cirrhosis) received interferon-based HCV treatment. Conclusions HCV-infected patients at initial presentation to tertiary care in Malaysia reflected delayed presentation to clinical care with disproportionately high number of cirrhotic patients. The low proportion of clinically eligible patients receiving HCV treatment need to be investigated further and addressed accordingly in future guidelines.

The World Health Organization (WHO) has initially categorised COVID-19 infection as a Public Health Emergency of International Concern (PHEIC) in late January 2020 and later on declared the outbreak as a pandemic on March 11, 2020. On February 4, 2020 the first Malaysian positive COVID-19 patients was detected. It was estimated through a thorough decision tree technique, cumulatively 22,000 positive patients were expected to be infected nationwide. At the current rate of disease detection, screening yield and clinical capacity in Malaysia, the identification of the positive patients will have to be continuously done until middle of May 2020. In addition, a prediction with the forecasted testing capacity was also conducted. In contrast with the earlier estimation, massive testing causes the number of positive patients to be saturated earlier, by the end of April 2020. Based on the projection, 346, 307 cumulative tests will be conducted with 225,100 cumulative positive cases will be identified. Of the numbers, the cumulative number of patients in care would be 17,631 with 705 cumulative number of admission to intensive care unit and 353 cumulative patients required for ventilator. The cumulative death and cumulative discharge are expected to be 394 and 6008 respectively. Currently, it is challenging for Malaysia to flatten the epidemic curve due to the constraints of healthcare resources. These challenges potentially highlight the need for realistic strategies with regard to the country’s capacity.