KUALA LUMPUR: Malaysia recorded its highest daily death toll from COVID-19 on Wednesday (May 12), as the country entered another national lockdown amid a third wave of infections.
It reported a record 39 new COVID-19 fatalities, bringing the national death toll to 1,761.
Daily COVID-19 infections rose by 4,765, taking the total number of cases to date to 453,222.
The majority of the new cases were in the Klang Valley area – 2,082 in Selangor and 540 in Kuala Lumpur.
The Health Ministry reiterated its warning that the total number of new daily infections may exceed 5,000 by the middle of the month if the trend continues unabated.
A woman wearing a protective face mask passes a clothing shop at a Ramadan bazaar in Kuala Lumpur, Malaysia on Apr 19, 2021. (Photo: AP/Vincent Thian)
The victims, comprising 37 citizens and two foreigners, were aged 43 to 88, according to health director-general Noor Hisham Abdullah’s daily report. Many of them had a history of high blood pressure and diabetes.
Ten of the fatalities were in Johor and eight were in Kuala Lumpur. There were also five deaths in Selangor, three in Sabah and two each in Kedah, Sarawak, Kelantan and Pahang. The areas of Perak, Melaka, Negeri Sembilan, Terengganu and Putrajaya each recorded one death.
Since the start of the pandemic, said Dr Noor Hisham, 62 cases have been found to be of the B1351 variant from South Africa while two cases have the B16172 variant from India.
Health authorities also identified 20 new clusters, with 12 involving workplaces and five classified as "community" clusters.
To date, there have been 435 community clusters in Malaysia, with 129 of them currently active, he said.
There are 469 patients in the intensive care unit, with 244 requiring respiratory support.
"These community clusters arise from infections via family members and close contacts, celebratory events, funerals, weddings, festivities and other social activities," added Dr Noor Hisham.
Dr Noor Hisham reminded members of the public to adhere to the prevailing COVID-19 standard operating procedures, especially during the Hari Raya festivities.
An aerial view shows police manning a roadblock at the East Coast Expressway (Kuala Lumpur–Karak) during a partial lockdown set by authorities ahead of Hari Raya Puasa, in Bentong on May 11, 2021. (Photo: AFP/Mohd Rasfan)
About 78 per cent of those with COVID-19 are asymptomatic and this presents an infection risk if people go visiting during the festive season, he added.
Under the renewed lockdown, social gatherings and dining at restaurants are prohibited.
House visits and grave visits during the upcoming Hari Raya Aidilfitri celebrations are also banned, but Aidilfitri prayers are permitted subject to a cap of 20 to 50 people depending on the maximum capacity of the facility.
GENEVA: The catastrophic scale of the COVID-19 pandemic could have been prevented, an independent global panel concluded Wednesday (May 12), but a "toxic cocktail" of dithering and poor coordination meant the warning signs went unheeded.
The Independent Panel for Pandemic Preparedness and Response (IPPPR) said a series of bad decisions meant COVID-19 went on to kill at least 3.3 million people so far and devastate the global economy.
Institutions "failed to protect people" and science-denying leaders eroded public trust in health interventions, the IPPPR said in its long-awaited final report.
Early responses to the outbreak detected in Wuhan, China in December 2019 "lacked urgency", with February 2020 a costly "lost month" as countries failed to heed the alarm, said the panel.
To tackle the current pandemic, it called on the richest countries to donate a billion vaccine doses to the poorest.
And the panel also called on the world's wealthiest nations to fund new organisations dedicated to preparing for the next pandemic.
"DELAY, HESITATION AND DENIAL"
The report was requested by World Health Organization (WHO) member states last May.
The panel was jointly chaired by former New Zealand prime minister Helen Clark and former Liberian president Ellen Johnson Sirleaf, a 2011 Nobel Peace Prize laureate.
The report, COVID-19: Make It The Last Pandemic, argued that the global alarm system needed overhauling to prevent a similar catastrophe.
"The situation we find ourselves in today could have been prevented," Sirleaf told reporters.
"It is due to a myriad of failures, gaps and delays in preparedness and response."
The report said the emergence of COVID-19 was characterised by a mixture of "some early and rapid action, but also by delay, hesitation, and denial.
"Poor strategic choices, unwillingness to tackle inequalities and an uncoordinated system created a toxic cocktail which allowed the pandemic to turn into a catastrophic human crisis."
The threat of a pandemic had been overlooked and countries were woefully unprepared to deal with one, the report found.
VACCINE ULTIMATUM
The panel did not spare the WHO, saying it could have declared the situation a Public Health Emergency of International Concern (PHEIC) - its highest level of alarm - on Jan 22, 2020.
Instead, it waited eight more days before doing so.
Nevertheless, given countries' relative inaction, "we might still have ended up in the same place", said Clark.
It was only in March after the WHO described it as a pandemic - a term that is not officially part of its alert system - that countries were jolted into action.
As for the initial outbreak, "there were clearly delays in China - but there were delays everywhere", she added.
Without the lag between the first identification in Wuhan and the PHEIC declaration - and then the "lost month" of February 2020 - "we believe we wouldn't be looking at an accelerating pandemic, as we have for the last 15 or 16 months or so. As simple as that", said Clark.
The panel made several recommendations on how to address the current pandemic.
Rich, well-vaccinated countries should provide the 92 poorest territories in the COVAX scheme with at least one billion vaccine doses by Sep 1, and more than two billion by mid-2022, it said.
The G7 industrialised nations should pay 60 per cent of the US$19 billion required to fund vaccines, diagnostics and therapeutics via the WHO's Access to COVID Tools Accelerator programme in 2021, it added.
Fellow G20 nations and others should provide the rest.
The WHO and the World Trade Organization should also get major vaccine-producing countries and manufacturers to agree voluntary licensing and technology transfers for COVID-19 vaccines, the panel said.
"If actions do not occur within three months, a waiver of ... intellectual property rights should come into force immediately."
INVEST BILLIONS, SAVE TRILLIONS
To tackle future outbreaks and pandemics, the panel called for a Global Health Threats Council made up of world leaders, plus a pandemic convention.
The G20 should also create an International Pandemic Financing Facility, able to spend US$5 billion to US$10 billion a year on preparedness, with US$50 billion to US$100 billion ready to roll in the event of a crisis.
"Ultimately, investing billions in preparedness now will save trillions in the future, as the current pandemic has so clearly illustrated," Clark told reporters.
The panel also proposed an overhaul of the WHO to give it greater control over its funding and more authority for its leadership.
Its alert system needed to be faster and it should have the authority to send expert missions to countries immediately without waiting for their green light, it added.
The panel believe their recommendations would have stopped COVID-19 from becoming a pandemic, had they been in place before the outbreak.
KUALA LUMPUR: Former Malaysian prime minister Mahathir Mohamad on Wednesday (May 12) apologised for flouting COVID-19 regulations during a Hari Raya charity event over the weekend.
In a Facebook post on Wednesday, Dr Mahathir said he had travelled back to Langkawi on May 8 to fulfil several Ramadan and Aidilfitri donation programmes in his parliamentary area.
Among the events was an aid distribution activity for residents at Surau Tsunami Batu Arang in Kuala Teriang, Kuah.
“I was informed that at the event, I violated the (standard operating procedures) by not taking body temperature when entering the surau. This was a mistake. This shouldn't happen. I'm sorry for not complying with the SOP,” he said.
The Langkawi member of parliament added that he will accept any action in accordance with the law.
He said COVID-19 is a “serious outbreak” and that everyone should obey the standard operating procedures.
“Once again, I apologise for flouting the regulations,” he added.
Last week, another former Malaysia prime minister was slapped with a RM3,000 (US$730) fine for breaking COVID-19 rules at a restaurant.
Former Malaysia prime minister Najib Razak is photographed at a government office after he arrives to pay his RM3,000 fine. (Photo: Facebook/Najib Razak)
Najib Razak had failed to register at the eatery or have his temperature taken, said the police. The restaurant owner was also fined RM10,000 for failing to ensure that Najib followed the rules.
“Myself and the man on the street will be investigated by the police and fined by the government. But I don’t know if this will happen if ministers contravene the rules," he said on Facebook.
Malaysian authorities have come under fire in recent months for what many have criticised as inconsistent or ineffective application of regulations to stem the spread of COVID-19.
Malaysia’s latest national lockdown, which was announced on Monday evening, also added to public confusion.
The capital Kuala Lumpur and three districts in Johor were added to the movement control order (MCO) list less than a week ago.
Senior Minister Ismail Sabri Yaakob also announced on Saturday that the government had no plans to implement a nationwide MCO and that it would instead proceed with targeted movement restrictions.
JAKARTA: China's Sinovac Biotech COVID-19 vaccine was 98 per cent effective at preventing death and 96 per cent effective at preventing hospitalisation among a group of inoculated Indonesian medical staff, a study conducted by the country's health ministry has found.
The findings were based on data from 120,000 healthcare workers in Jakarta who had received the vaccine between January and March this year, lead researcher and health official Pandji Dhewantara told a briefing on Wednesday.
Phase 3 trials of the vaccine, called CoronaVac, have produced varying results globally, but Pandji said the study found it also prevented symptomatic COVID-19 in 94 per cent of the group.
"We see data from the taskforce that the incidence of morbidity and mortality for health workers tends to decrease," health ministry official Siti Nadia Tarmizi said at the news conference.
Separately, data from the Indonesian Medical Association showed the number of doctors dying from COVID-19 has dropped significantly since Indonesia’s vaccine rollout began this year.
In January, 64 doctors died due to the respiratory disease, the highest rate since the start of the pandemic, but that figure halved in February, and dropped to eight last month.
The promising findings come after Indonesia's phase 3 trials showed the vaccine was 65 per cent effective. Trials in Turkey showed it was 91.25 per cent effective, while researchers in Brazil said it was 50.4 per cent effective at preventing symptomatic infections.
CoronaVac is efficacious in preventing COVID-19 in adults under 60, but some quality data on the risk of serious adverse effects was lacking, World Health Organization experts found.
Indonesia has pushed hard to shore up vaccine deals to inoculate its large population but so far has largely relied on the Chinese vaccine due to global supply issues.
Almost 9 million people have been fully inoculated so far, according to the health ministry, with Indonesia aiming to vaccinate 181 million people by January, 2022.
Indonesia has suffered the highest number of cases and deaths from Sars-CoV-2 in Southeast Asia, with more than 1.7 million confirmed infections and 45,090 deaths, with the nation’s healthcare workers hard hit by the virus.
As of Apr 22, at least 900 Indonesian healthcare workers had died from COVID-19, according to Lapor-COVID-19, an independent coronavirus data initiative.
JAKARTA (BLOOMBERG) - Sinovac Biotech Ltd's vaccine is wiping out Covid-19 among health workers in Indonesia, an encouraging sign for the dozens of developing countries reliant on the controversial Chinese shot, which performed far worse than western vaccines in clinical trials.
Indonesia tracked 25,374 health workers in capital city Jakarta for 28 days after they received their second dose and found that the vaccine protected 100 per cent of them from death and 96 per cent from hospitalisation as soon as seven days after, said Health Minister Budi Gunadi Sadikin in an interview on Tuesday (May 11). The workers were tracked until late February.
Sadikin also said that 94 per cent of the workers had been protected against infection - an extraordinary result that goes beyond what was measured in the shot's numerous clinical trials - though it's unclear if the workers were uniformly screened to detect asymptomatic carriers.
"We see a very, very drastic drop," in hospitalisations and deaths among medical workers, Sadikin said.
It's not known what strain of the coronavirus Sinovac's shot worked against in Indonesia, but the country has not flagged any major outbreaks driven by variants of concern.
The data adds to signs out of Brazil that the Sinovac shot is more effective than it proved in the testing phase, which was beset by divergent efficacy rates and questions over data transparency. Results from its biggest Phase III trial in Brazil put the shot known as CoronaVac's efficacy at just above 50 per cent, the lowest among all first-generation Covid-19 vaccines.
A spokesman for Sinovac in Beijing said the company cannot comment on the Indonesian study until it acquires more details.
In a separate interview with Bloomberg on Tuesday, Sinovac's chief executive officer Yin Weidong defended the disparity in clinical data around the shot, and said there was growing evidence CoronaVac is performing better when applied in the real world.
But the real-world examples also show that the Sinovac shot's ability to quell outbreaks requires the vast majority of people to be vaccinated, a scenario that developing countries with poor health infrastructure and limited access to shots cannot reach quickly.
In the Indonesian health worker study, and another in a Brazilian town of 45,000 people called Serrana, nearly 100 per cent of people studied were fully vaccinated, with serious illness and deaths dropping after they were inoculated.
In contrast, Chile saw a resurgent outbreak after vaccinating over a third of the population of 19 million - one of the fastest rates in the world, but not fast enough to stop the spread of the aggressive variant sweeping Latin America.
"The earliest group of people vaccinated in Chile are old people. Less than 15 million of doses given to Chile means only 7 million people can get our shots. That equals to only 36 per cent of a population of 19 million," said Yin.
"It's normal that the country sees a resurgence of infections as social activities increase among the younger people who are mainly not inoculated."
The vaccine's protection is likely to vary from place to place due to virus variants, but Sinovac's shot appears to be holding up well against the new mutations of concern, he said.
A key question for all Covid-19 vaccines is whether they can prevent or deter actual transmission of the virus. Yin said on Tuesday that Sinovac does not yet know if its shot - a traditional inactivated vaccine - can stop or reduce the virus from being contracted in the first place, but the fact it is preventing serious illness and death is more important.
While non-mRNA vaccines are unlikely to be that effective in preventing transmission, the growing body of evidence that Sinovac's shot works is a boon to China's mission of supplying the developing world in a bid to increase its influence and standing.
It's also somewhat of a vindication amid criticism that Chinese vaccine developers disclosed less data and were less transparent about severe adverse events compared with western companies.
"The results from real world application and the scientific data we have from clinical trials will allow the world to judge our vaccine comprehensively," said Yin.
"We encourage our partners and governments in countries where our vaccine is being used to release such data as soon as possible."
Indonesia was one of the earliest countries to place its bets on a Chinese vaccine. In January, President Joko Widodo became the first major world leader to receive the Sinovac shot in a bid to quell scepticism at home and abroad. Since then, Southeast Asia's largest economy has administered more than 22 million doses, mostly Sinovac, as it seeks to reach herd immunity for its 270-million strong population by year-end.
"The minimum efficacy rate should be above 50 per cent, so beyond that, the best vaccine is the one you can get as soon as possible, as every shot given can prevent deaths," Health Minister Sadikin said.
"It isn't only about getting the highest efficacy rate, but inoculating people quickly."
While neighbouring Malaysia and Thailand are seeing a resurgence in cases, Indonesia's rate of new infections and deaths has stabilised since a January peak. But with its massive population still mostly unprotected, the upcoming Eid holiday could cause cases to rebound by as much as 60% as people gather with family and travel home despite government restrictions, Sadikin warned.
Helen Petousis-Harris, a vaccinologist at the University of Auckland, said that the ability of vaccines to control a disease can be higher in the real world than when measured in clinical trials.
“In my experience, we often fail to predict the overall impact of vaccines, something that can only be seen in the real world after widespread use,” she said. “Reducing the bulk of disease is not only essential to save lives but also to reduce the chances of problematic variants appearing.”
JOHOR BAHRU: In a surprise move at about 7.30pm on Monday (May 10), Prime Minister Muhyiddin Yassin announced that a Movement Control Order would be imposed on Malaysia effective from Wednesday (May 12).
He posted a series of photographs of a Prime Minister’s Office (PMO) press statement on his Facebook page.
In it were details of activities banned, with festive activities like house and grave visits singled out, along with cross-district and interstate travel, though Aidilfitri prayers are allowed if caps are adhered to.
The news caught everyone off-guard. Coming about an hour after the Malaysian government’s daily COVID-19 press release which gave no inkling of a nationwide MCO, many Malaysians had a rude shock.
The national news agency, Bernama, posted information only an hour after the Facebook post. The Ministry of Defence, placed in charge of national COVID-19 management, only released the list of SOPs at 9.30pm.
The declaration of a nationwide MCO came after many official statements to the contrary. Senior Minister and Minister for Defence Ismail Sabri Yaakob had just reassured the public on Saturday that the government had no plans to impose one.
The change is more symbolic and declaratory than in substance and so should in theory be publicly palatable.
With several districts and states already declared MCO areas from May 6, a surprise nationwide ban on inter-district travel anywhere in the country on May 9 was widely perceived to be effectively imposing a national MCO. Hence, the actual declaration of an MCO should not have been unexpected.
Kelantan and two areas in Pahang were already under MCO, with a few areas in Kelantan under Enhanced MCO. Malaysians in other states exhaled a little, thinking they’d been spared.
The intention was to use targeted MCOs in response to rising numbers in specific locations. But the incremental declarations and lack of clarity only served to heighten uncertainty and exasperation.
A medical worker collects a swab sample from a woman at a COVID-19 testing center in Kajang, outskirts of Kuala Lumpur, Malaysia, May 8, 2021. (Photo: AP/Vincent Thian)
Mr Ismail Sabri announced that Kuala Lumpur and three districts in Johor would be added to the MCO list barely a week ago. Swiftly after came the addition of Penang Island, a few more areas in Pahang and Perak, and an additional district in Johor.
INCONSISTENCIES, U-TURNS AND CONFUSION
U-turns in the rules compounded public confusion as people struggled to keep track of what the latest changes were.
In this latest MCO, for example, the Ministry of Youth and Sports had earlier announced that individual exercise outside the home would not be allowed, a change from the last MCO. But the ban was retracted two days later after a public outcry.
Take another example: Ramadhan bazaars and night markets, initially allowed to proceed for ostensibly economic reasons, subject to local government rules, were ordered to be shut a few days later.
Often, the trouble isn’t just the changing rules, but the short warning businesses, traders and the general public have. Many in F&B and retail have to scramble to clear stock, while households and small businesses have to stockpile to get through the lockdown period.
Mixed messaging from different ministries and ministers adds to the befuddlement.
When Minister of Science, Technology and Innovation Khairy Jamaluddin, released a list of “potential cluster locations” identified by the national Hotspots Identification for Dynamic Engagement (HIDE) system as an early warning last Thursday, he stressed the move was geared towards enabling better individual decision-making.
Yet, on the same day, Mr Ismail Sabri then announced that these listed premises would be placed under immediate lockdown for three days. This had huge implications for many Malaysians as the list also included public transport hubs.
It often feels like the rules can change at no notice, and businesses and people have to be constantly alert for updates. No announcement can be taken at face value.
For example, while Mr Ismail Sabri said employees needed police permits to travel for work or health purposes as an exception to the ban on inter-district travel, the Ministry of International Trade and Industry Malaysia later clarified that an employment pass and employer’s letter would suffice.
Malaysia Senior Minister Ismail Sabri Yaakob. (File photo: Bernama)
The police also had to highlight that police permits were not necessary for medical appointments and COVID-19 vaccinations.
Most of the anger is directed at the lack of holistic, carefully thought-through measures. Authorities fixate on numbers in each car but not the passengers in densely packed public transportation.
While dining al fresco with safe distancing is not allowed, close-contact, high-density, closed-environment work in factories continue. This despite factory clusters being rife.
NEW LEVELS OF FATIGUE AND FRUSTRATION
All around the world, long lockdowns and changing rules have left people with fatigue and frustration.
This is especially true in Malaysia, when daily-wage earners, small businesses and families have been financially battered with each lockdown.
All this is fueling a sense of hopelessness in escaping the pandemic and the accompanying hardships, with the spotlight turned on government rules.
The policy u-turns are not seen as a willingness on the government’s part to listen to public feedback, but instead are taken as a sign that many restrictions are knee-jerk reactions and guesswork than considered decisions based on science and data.
FILE PHOTO: Medical workers collect swab samples from people at a coronavirus disease (COVID-19) testing centre in Petaling Jaya, Malaysia January 25, 2021. REUTERS/Lim Huey Teng
At the same time, detailed and timely SOPs are lacking and enforcement is selective.
Social media is rife with posts criticising the government and its management of the pandemic. Many cite MCO-induced inconveniences, the negative impacts past MCOs have had on businesses and incomes, and the climbing trend of infection numbers.
DENIAL, DOUBT AND DIVISIONS
The frustration with the government and its lack of clarity and consistency has serious consequences on citizens’ grasp of the dangers of COVID-19 and Malaysia’s recent spike in cases in some areas.
COVID-19 daily infection rates have soared above 4,000 several times in the past two weeks. The number of patients in ICU, intubated and dying are at record highs.
Yet, while some are calling for a return to the tight restrictions of MCO 1.0 to properly stem the rise in infections, not everyone believes that this is the solution.
In the rural outskirts, many yet untouched by the virus struggle to believe that it is dangerous. Most also do not understand how new variants of concern, now circulating in Malaysia, could pose new challenges for the country and necessitate a rapid response when numbers spike.
Nowhere is this clearer than in Kelantan, which saw a sudden spike in numbers leading to its early MCO. Prior to that, there were many instances of the SOPs being ignored, of people not wearing masks and regular large gatherings. Reports now indicate that the COVID-19 variant originating from South Africa has been found in infection cases there.
Many Malaysians living in the rural outskirts receive news of the desperation in India by Whatsapp, yet struggle to believe that it could happen in their own neighbourhoods.
I have also heard of people denying reported infection numbers and harbouring views that they know of people who were infected but were fine because it is “nothing more than the flu”.
The danger in Malaysia’s current situation is not the steady rise in infection numbers, but the increasing denial, doubt and divisions brewing on the ground.
The Malaysian government needs a unified communication strategy that focuses on the dangers of the virus, with a sole voice speaking with authority.
The Ministry of Health needs to create and disseminate accessible COVID-19 updates in local languages via Whatsapp and TikTok.
Muslim wearing protective masks waiting for customer outside a scarf shop at a Ramadan bazaar, amid the outbreak of the coronavirus disease (COVID-19) in Kuala Lumpur, Malaysia, Monday, April 19, 2021. (Photo: AP/Vincent Thian)
They need to underscore the severity of the situation, of the struggles medical personnel undergo, that COVID-19 and ICU beds are full, and that the number of deaths are steadily increasing.
Because death rituals are so important to rural communities, these videos need to demonstrate how death by COVID-19 entails dying alone and being buried only by medical staff in PPEs. Perhaps this might motivate them to take the virus threat more seriously.
They also need to disseminate information on policy changes and details through similar social media channels.
Complete enforcement is difficult given Malaysia’s size and sprawl. If Malaysia cannot keep such doubts and divisions under control to launch a unified national response, new daily infections breaching 5,000 may come sooner rather than later.
TEL AVIV: Palestinian militants Hamas fired a barrage of rockets at Israel's economic hub Tel Aviv on Tuesday (May 11) in retaliation for an Israeli strike that destroyed a tower block in Gaza, as the foes traded their heaviest fire for several years.
The sharp escalation, triggered by violence in Jerusalem, has killed at least 30 Palestinians in the blockaded Gaza Strip and three Israelis, and wounded hundreds more.
"This is just the beginning" of Israel's strikes, Defence Minister Benny Gantz warned.
Hamas leader Ismail Haniyeh vowed that "if Israel wants to escalate, we are ready for it".
The UN envoy for Middle East Peace, Tor Wennesland, warned that Israel and Hamas were heading towards "full scale war".
In the crowded, Israeli-blockaded enclave of Gaza, 10 children and one woman were among those killed since Monday night.
A further 203 people were reported wounded from the ongoing Israeli air strikes, many rescued from the smouldering ruins of buildings.
In Israel, sirens sounded as Hamas rockets rained down, and some of those unable to make it to underground shelters took cover under bridges.
A Israeli soldier takes cover as an Iron Dome air defence system launches to intercept a rocket from the Gaza Strip, in Ashkelon, southern Israel on May 11, 2021. (Photo: AP/Ariel Schalit)
"It was scary," said Haim Roy Ben Shlomo, 38, resident of Ramat Gan near Tel Aviv, adding he had heard "several loud shots, or booms, above our heads".
An Israeli woman was killed as rockets hit Rishon Letzion on the coastal city's southern edge, while in nearby Holon, AFP footage showed a burnt-out bus as rescue workers cleaned up debris.
The rocket fire forced Israel to suspend flights at its main airport of Ben Gurion, near Tel Aviv.
'HELL'
In Gaza, people sifted through debris after an Israeli air strike destroyed a 12-storey building.
Hamas, which controls the Palestinian territory, said the tower block had been a residential building. AFP reporters said it also houses offices of several Hamas officials.
Hamas threatened to turn the nearby Israeli city of Ashkelon into "hell", and rockets fired by militants in Gaza killed two women there.
At one stage the group claimed to have fired more than 100 rockets in under five minutes to overwhelm air defences.
Israeli firefighters take cover as a siren sounds a warning of incoming rockets fired from the Gaza strip, in the southern Israeli town of Ashkelon, on May 11, 2021. (Photo: AP/Ariel Schalit)
At least 100 Israelis were injured in Tuesday's escalation.
Israel's army said more than 600 rockets had been fired since Monday from Gaza towards Israel mainly by Hamas, which rules Gaza, and the Islamic Jihad group.
Many landed inside Gaza or were taken out by Israel's Iron Dome air defence system.
'FIGHTING WILL INTENSIFY'
Army spokesman Jonathan Conricus said Israel estimated it had killed 20 Islamist militants in Gaza, warning that "our expectation is the fighting will intensify".
Asked about unconfirmed reports that Hamas was seeking a ceasefire, Conricus said: "I don't think my commanders are aware, or particularly interested."
A Palestinian was also killed and another wounded Tuesday by Israeli army gunfire in the north of the occupied West Bank, a Palestinian security source told AFP.
The Israeli army reported an attempted drive-by shooting, saying "two assailants were neutralised at the scene".
The United States on Tuesday urged both sides to avoid "deeply lamentable" civilian deaths.
"Israel does have a right to defend itself," State Department spokesman Ned Price said, adding: "We don't want to see provocations."
'YOU ESCALATE, WE ESCALATE'
Weeks of tensions boiled over when Israeli riot police clashed with crowds of Palestinians at Jerusalem's Al-Aqsa mosque, on the last Friday of the MuslimIsraeli police clash with Palestinians at Al-Aqsa mosque 1 holy month of Ramadan.
Nightly clashes since then at the compound, which is holy to both Muslims and Jews, and elsewhere in east Jerusalem have left at least 700 Palestinians injured.
Hamas had warned Israel on Monday to withdraw all its forces from the mosque compound and the Jerusalem district of Sheikh Jarrah, where looming evictions of Palestinian families have fuelled protests.
Sirens wailed across Jerusalem just after the deadline as people in the city, including lawmakers in the Knesset legislature, fled to bunkers for the first time since the 2014 Gaza conflict.
Hamas' Qassam Brigades warned Israel: "If you respond we will respond, and if you escalate we will escalate."
Palestinians begin to clear rubble following Israeli airstrikes that destroyed a building belonging to the Hamas movement's, Al-Salah Charitable Association, in Deir Al Balah, central Gaza Strip, on May 11, 2021. (Photo: AP/Khalil Hamra)
Diplomatic sources told AFP that Egypt and Qatar, who have mediated past Israeli-Hamas conflicts, were attempting to calm tensions.
But Egypt's Foreign Minister Sameh Shoukry told an emergency Arab League meeting that although Cairo had "extensively reached out" to Israel and other countries, "we did not get the necessary response".
The UN Security Council was set to discuss the violence at an emergency meeting on Wednesday.
'TAKING OFF GLOVES'
Large protests were held in solidarity with Palestinians around the world, including in London, as well as in Muslim-majority countries including Kuwait, Oman, Pakistan, Tunisia and Turkey.
In Jordan, protesters gathered outside the Israeli embassy, burning Israeli flags and chanting "Shame, shame the embassy is still there" and "Death to Israel!"
