When the world looked to Asia for successful examples
in handling the novel coronavirus outbreak, much attention and plaudits were
paid to South Korea, Taiwan and Hong Kong.
But there's one overlooked success story -- Vietnam.
The country of 97 million people has not reported a single coronavirus-related
death and on Saturday had just 328 confirmed cases, despite its long border
with China and the millions of Chinese visitors it receives each year.
This is all the more remarkable considering Vietnam is
a low-middle income country with a much less-advanced healthcare system than
others in the region. It only has 8 doctors for every 10,000 people, a third of
the ratio in South Korea, according to the World Bank.
After a three-week nationwide lockdown, Vietnam lifted
social distancing rules in late April. It hasn't reported any local infections
for more than 40 days. Businesses and schools have reopened, and life is
gradually returning to normal.
To skeptics, Vietnam's official numbers may seem too
good to be true. But Guy Thwaites, an infectious disease doctor who works in
one of the main hospitals designated by the Vietnamese government to treat
Covid-19 patients, said the numbers matched the reality on the ground.
"I go to the wards every day, I know the cases, I
know there has been no death," said Thwaites, who also heads the Oxford
University Clinical Research Unit in Ho Chi Minh City.
"If you had unreported or uncontrolled community
transmission, then we'll be seeing cases in our hospital, people coming in with
chest infections perhaps not diagnosed -- that has never happened," he
said.
So how has Vietnam seemingly bucked the global trend
and largely escaped the scourge of the coronavirus? The answer, according to
public health experts, lies in a combination of factors, from the government's
swift, early response to prevent its spread, to rigorous contact-tracing and
quarantining and effective public communication.
Acting early
Vietnam started preparing for a coronavirus outbreak
weeks before its first case was detected.
At the time, the Chinese authorities and the World
Health Organization had both maintained that there was no "clear
evidence'' for human-to-human transmission. But Vietnam was not taking any
chances.
"We were not only waiting for guidelines from
WHO. We used the data we gathered from outside and inside (the country to)
decide to take action early," said Pham Quang Thai, deputy head of the
Infection Control Department at the National Institute of Hygiene and
Epidemiology in Hanoi.
By early January, temperature screening was already in
place for passengers arriving from Wuhan at Hanoi's international airport.
Travelers found with a fever were isolated and closely monitored, the country's
national broadcaster reported at the time.
By mid-January, Deputy Prime Minister Vu Duc Dam was
ordering government agencies to take "drastic measures" to prevent
the disease from spreading into Vietnam, strengthening medical quarantine at
border gates, airports and seaports.
On January 23, Vietnam confirmed its first two
coronavirus cases -- a Chinese national living in Vietnam and his father, who
had traveled from Wuhan to visit his son. The next day, Vietnam's aviation
authorities canceled all flights to and from Wuhan.
As the country celebrated the Lunar New Year holiday,
its Prime Minister Nguyen Xuan Phuc declared war on the coronavirus.
"Fighting this epidemic is like fighting the enemy," he said at an
urgent Communist Party meeting on January 27. Three days later, he set up a
national steering committee on controlling the outbreak -- the same day the WHO
declared the coronavirus a public health emergency of international concern.
On February 1, Vietnam declared a national epidemic --
with just six confirmed cases recorded across the country. All flights between
Vietnam and China were halted, followed by the suspension of visas to Chinese
citizens the next day.
Over the course of the month, the travel restrictions,
arrival quarantines and visa suspensions expanded in scope as the coronavirus
spread beyond China to countries like South Korea, Iran and Italy. Vietnam
eventually suspended entry to all foreigners in late March.
Vietnam was also quick to take proactive lockdown
measures. On February 12, it locked down an entire rural community of 10,000
people north of Hanoi for 20 days over seven coronavirus cases -- the first
large-scale lockdown known outside China. Schools and universities, which had
been scheduled to reopen in February after the Lunar New Year holiday, were
ordered to remain closed, and only reopened in May.
Thwaites, the infectious disease expert in Ho Chi Minh
City, said the speed of Vietnam's response was the main reason behind its
success.
"Their actions in late January and early February
were very much in advance of many other countries. And that was enormously
helpful ... for them to be able to retain control," he said.
Meticulous contact-tracing
The decisive early actions effectively curbed
community transmission and kept Vietnam's confirmed cases at just 16 by
February 13. For three weeks, there were no new infections -- until the second
wave hit in March, brought by Vietnamese returning from abroad.
Authorities rigorously traced down the contacts of
confirmed coronavirus patients and placed them in a mandatory two-week
quarantine.
"We have a very strong system: 63 provincial CDCs
(centers for disease control), more than 700 district-level CDCs, and more than
11,000 commune health centers. All of them attribute to contact tracing,"
said doctor Pham with the National Institute of Hygiene and Epidemiology.
A confirmed coronavirus patient has to give health
authorities an exhaustive list of all the people he or she has met in the past
14 days. Announcements are placed in newspapers and aired on television to
inform the public of where and when a coronavirus patient has been, calling on
people to go to health authorities for testing if they have also been there at
the same time, Pham said.
When the Bach Mai hospital in Hanoi, one of the
biggest hospitals in Vietnam, became a coronavirus hotspot with dozens of cases
in March, authorities imposed a lockdown on the facility and tracked down
nearly 100,000 people related to the hospital, including medics, patients,
visitors and their close contacts, according to Pham.
"Using contact-tracing, we located almost
everyone, and asked them to stay home and self quarantine, (and that) if they
have any symptoms, they can visit the health centers for free testing," he
said.
Authorities also tested more than 15,000 people linked
to the hospitals, including 1,000 health care workers.
Vietnam's contact-tracing effort was so meticulous
that it goes after not only the direct contacts of an infected person, but also
indirect contacts. "That's one of the unique parts of their response. I
don't think any country has done quarantine to that level," Thwaites said.
All direct contacts were placed in government
quarantine in health centers, hotels or military camps. Some indirect contacts
were ordered to self isolate at home, according to a study of Vietnam's
Covid-19 control measures by about 20 public health experts in the country.
As of May 1, about 70,000 people had been quarantined
in Vietnam's government facilities, while about 140,000 had undergone isolation
at home or in hotels, the study said.
The study also found that of the country's first 270
Covid-19 patients, 43 percent were asymptomatic cases -- which it said
highlighted the value of strict contact-tracing and quarantine. If authorities
had not proactively sought out people with infection risks, the virus could
have quietly spread in communities days before being detected.
Public communication and propaganda
From the start, the Vietnamese government has communicated
clearly with the public about the outbreak.
Dedicated websites, telephone hotlines and phone apps
were set up to update the public on the latest situations of the outbreak and
medical advisories. The ministry of health also regularly sent out reminders to
citizens via SMS messages.
Pham said on a busy day, the national hotlines alone
could receive 20,000 calls, not to count the hundreds of provincial and
district-level hotlines.
The country's massive propaganda apparatus was also
mobilized, raising awareness of the outbreak through loudspeakers, street
posters, the press and social media. In late February, the health ministry
released a catchy music video based on a Vietnamese pop hit to teach people how
to properly wash their hands and other hygiene measures during the outbreak.
Known as the "hand-washing song," it immediately went viral, so far
attracting more than 48 million views on Youtube.
Thwaites said Vietnam's rich experience in dealing
with infectious disease outbreaks, such as the SARS epidemic from 2002 to 2003
and the following avian influenza, had helped the government and the public to
better prepare for the Covid-19 pandemic.
"The population is much more respectful of
infectious diseases than many perhaps more affluent countries or countries that
don't see as much infectious disease -- Europe, the UK and the US for
example," he said.
"The country understands that these things need
to be taken seriously and complies with guidance from the government on how to
prevent the infection from spreading."
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