Abstract
The rapid transmission of highly contagious infectious diseases within communities can yield potential hotspots or clusters across geographies. For COVID-19, the impact of population density on transmission models demonstrates mixed findings. This study aims to determine the correlations between population density, clusters, and COVID-19 incidence across districts and regions in Malaysia. This countrywide ecological study was conducted between 22 January 2021 and 4 February 2021 involving 51,476 active COVID-19 cases during Malaysia’s third wave of the pandemic, prior to the reimplementation of lockdowns. Population data from multiple sources was aggregated and spatial analytics were performed to visualize distributional choropleths of COVID-19 cases in relation to population density. Hierarchical cluster analysis was used to synthesize dendrograms to demarcate potential clusters against population density. Region-wise correlations and simple linear regression models were deduced to observe the strength of the correlations and the propagation effects of COVID-19 infections relative to population density. Distributional heats in choropleths and cluster analysis showed that districts with a high number of inhabitants and a high population density had a greater number of cases in proportion to the population in that area. The Central region had the strongest correlation between COVID-19 cases and population density (r = 0.912; 95% CI 0.911, 0.913; p < 0.001). The propagation effect and the spread of disease was greater in urbanized districts or cities. Population density is an important factor for the spread of COVID-19 in Malaysia.
Highlights
Humans are known to spread infectious diseases, such as the ancient bubonic plague, the human immunodeficiency virus (HIV), and the current ongoing coronavirus disease (COVID-19) [1,2]
To be coherent with the emerging epidemiological landscape, this study aims to determine the correlations between population density, clusters, and COVID-19 incidence across districts and regions in Malaysia
We found that in districts with more than 250,000 inhabitants (Figure 2A) and with a density of more than 500 inhabitants/km2 (Figure 3A), approximately 1.5 people or more per km2 were infected with COVID-19 (Figure 3B)
Summary
Humans are known to spread infectious diseases, such as the ancient bubonic plague, the human immunodeficiency virus (HIV), and the current ongoing coronavirus disease (COVID-19) [1,2]. Microbial experts and immunologists are consistently postulating heterogenous plausible theories, including genomic expression, cell structure, and the biological environment of microorganisms that are capable of altering the host’s immune responses, making people vulnerable to infections [3,4,5]. These systemic theories at the molecular and microscopic levels do not answer the fundamental question as to why geometric progressions or the chaotic spread of diseases are sustained at the population level.
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