Policies to prevent infection of SARS-CoV-2 and spread of COVID-19 casesThu, Nov 12, 2020
Country studies of Vietnam, Thailand and Belgium
Professor Yasushi Katsuma
Graduate School of Asia-Pacific Studies (GSAPS), Faculty of International Research and Education, Waseda University
Background and the objectives of this article
At the end of 2019, there was an outbreak of an emerging infectious disease (EID) in Wuhan, in China’s Hubei Province. Following that, the World Health Organization (WHO) announced the discovery of the novel coronavirus “SARS-CoV-2” on January 12, 2020. Infection by this virus is called COVID-19. It has become a global pandemic, and there is as yet no end in sight. What makes COVID-19 different from other infectious diseases? What public policy options are there to prevent infection and spread? Going forward, what should we do in the mid- to long term to combat COVID-19 and other EIDs?
I spent time in Vietnam in December 2019 and February 2020, in Thailand in January 2020, and in Belgium in March 2020. Although my purpose was not directly related, I was able to observe and experience some COVID-19-related developments in those three countries. Through such observation and experiences, I became interested in exploring the issues listed above.
Below, I will first lay out the major features of COVID-19. Second, I will compare the policies, especially mobility restrictions, taken in Vietnam and Belgium, to prevent its nationwide spread. Then, I will look at how behavior changes were promoted among citizens to prevent infection and spread. Finally, referring especially to the example of Thailand, I will examine future prospects for the mid- to long term measures against EIDs.
What makes COVID-19 different?
First, COVID-19 is a global pandemic, with an extremely high number of infections in general, as well as higher death rates among vulnerable groups. One reason could be that asymptomatic or undiagnosed people are spreading the virus. Second, in the combat against COVID-19, international cooperation on the development of testing kits to prevent in-hospital infection and the acquisition of N95 masks, face shields, caps, gowns, gloves and other personal protective equipment (PPE) has been insufficient.
COVID-19 is the seventh coronavirus known to infect humans. Of the seven, four have spread globally, but most have mild symptoms like the common cold. The other three, including COVID-19, can cause more serious symptoms. The severe acute respiratory syndrome (SARS-CoV), a coronavirus infection discovered in China’s Guangdong Province in 2002, is thought to have spilled over to humans from greater horseshoe bats. By July 2003, it had spread to over 30 countries and regions, with confirmation of around 8,000 people infected and over 700 deaths. The Middle East respiratory syndrome (MERS-CoV), another coronavirus infection discovered in Saudi Arabia in 2012, is thought to have spilled over to humans from the Arabian camel. By the end of 2019, it had spread to 27 countries, with confirmation of about 2,500 people and over 800 deaths.
Since the first report in December 2019, COVID-19 has become a global pandemic across 219 countries and territories, with over 47 million confirmed infections and over 1.2 million confirmed deaths (as of December 5, 2020). Much is still unknown about this virus, and there is no end in sight to the pandemic. Although the world now is much different than it was 100 years ago, the scale of its spread invites comparison to the 1918-20 Spanish flu (H1N1 type-A influenza virus). That virus is said to have infected 600 million and killed 20 to 40 million around the world.
The actual number of people infected by COVID-19 is estimated to be several times more than the confirmed number. First, many are thought to become infected and recover with only mild or no symptoms, going about their daily lives without ever being aware of the virus. Further, some researchers point out that asymptomatic people can spread the infection to others. Second, there are many cases in which people with symptoms resembling COVID-19 go undiagnosed because Polymerase Chain Reaction (PCR) tests are not conducted quickly enough. Either way, infected people who are unaware or unconfirmed may be causing spread of the disease in ways that make contact tracing difficult.
WHO’s International Health Regulations (IHR), agreed upon by member nations, allow WHO to declare a “public health emergency of international concern.” Such an emergency was declared for COVID-19 on January 30, 2020. Following the H1N1 flu (2009), wild poliovirus (2014), Ebola virus (2014), Zika virus (2016) and Ebola virus (2019), COVID-19 is the sixth declaration under the IHR. International cooperation on development of testing kits and acquisition of PPE, as well as research and development of treatments and vaccines is important. However, because of WHO’s lack of global leadership, along with the “my country first” stance of many member nations, including America’s stop of monetary contributions, international cooperation has been insufficient. Nevertheless, the WHO and other partners was able to launch the Access to COVID-19 Tools (ACT) in April 2020 in order to promote global public-private partnerships in development, production and equitable access to new COVID-19 diagnostics, therapeutics and vaccines, while strengthening health system. For the vaccines pilar of the ACT, the COVAX Facility was also launched as a global risk-sharing mechanism for pooled procurement and equitable distribution of eventual COVID-19 vaccines.
Vietnam’s policies to prevent infection and spread of the virus
Vietnam’s first COVID-19 case, a Chinese who traveled from Wuhan to visit his son living in Hanoi, was confirmed on January 23. The following day, on January 24, the acting health minister ordered the establishment of an emergency infectious disease prevention center. On February 1, four Vietnamese were found to be infected from the Chinese traveler, the first confirmed cases of domestic transmission and totaling six cases including two Chinese. On the same day, Prime Minister Nguyen Xuan Phuc signed Decision No. 173.QD-TTg, declaring COVID-19 an epidemic in Vietnam. Border measures begun the same day, with the Civil Aviation Authority of Vietnam suspending approval of flights between Vietnam and China. Movement of people and things across the 1,400 km border with China was also restricted.
Even after the holidays of the Vietnamese lunar new year (Tet) on January 25, the Ministry of Education & Training kept primary and secondary schools closed. In mid-February, universities and other tertiary institutions were closed. The Ministry of Culture, Sports & Tourism advised that traditional events scheduled across the country during the new year holidays on February 8 be scaled down, postponed or canceled. With the restrictions on so many activities, construction work stopped and road traffic significantly reduced.
Social distancing, or physical distancing as WHO has been calling it recently, has faced several delicate issues. During February 27 to March 1, approximately 16,000 (including around 1,500 non-Malaysians) attended a Tablighi Jamaat religious gathering held at a mosque in Sri Petaling, a suburb of Kuala Lumpur in Malaysia. Some Vietnamese Muslims who attended the event but did not observe self-quarantine after returning home and continued to attend services at mosques in Vietnam have been criticized.
Among behavior changes promoted to the public, efforts to establish the custom of handwashing are especially notable. The National Institute of Occupational and Environmental Health, an agency of the health ministry, hired musicians to rearrange a hit song to promote proper handwashing to the public. The song with illustrative animation can be seen on YouTube.
As of April 24, a total of 270 people have been confirmed to be infected with COVID-19 in Vietnam, with no confirmed deaths. No new infections have been confirmed since April 17. Along with South Korea, Singapore, Taiwan and Hong Kong, it is receiving attention for being relatively successful among Asian countries and regions at containing the spread of the virus.
Belgium’s policies to prevent infection and spread of the virus
A Belgian returning from Wuhan was confirmed positive on February 4. An advisory was issued on January 29 against non-urgent travels to China, but at the time, COVID-19 was only acknowledged as a problem in Asia.
Beginning February 22, there were carnivals in towns of Binche, Aalst and Malmedy, and schools were closed for about a week in Belgium. At that time, some Belgian tourists returned from skiing in northern Italy, and on March 2, six were confirmed to be infected. Beginning in March, people began to realize the risk of infection from neighboring European countries.
On March 10, indoor events of 1,000 or more participants were ordered to be canceled. After that, Belgium’s National Security Council declared a state of emergency, closing schools, discos, cafes and restaurants, as well as canceling sports and culture events from March 13. Many cafes and restaurants did not allow indoor dining, selling only for takeout. Next, on March 17, non-urgent travels were prohibited, nonessential stores were closed and gatherings were banned. Further, on March 20, the national borders were closed to nonessential travel.
To encourage behavior changes, a message to maintain 1.5 meters distance from others was repeatedly promoted to citizens, using pictograms. This was a major change for a culture where shaking hands, hugging and kissing are part of everyday greetings.
As of April 26, Belgium had over 46,000 confirmed cases and over 7,000 confirmed deaths. Around 40% of deaths were reportedly happening at nursing homes.
The future of EID control in the medium to long term
The first issue is border control. Being an island nation, it is also literally called “waterside measures” in Japan. Judging from the outcomes, the early and strict border control measures imposed by Vietnam seem to have succeeded in containing COVID-19 so far. As its level of medical care is not the highest, preventing an influx of the virus is a high priority, and Vietnam seems to have learned from its experience with SARS-CoV. South Korea also seems to have learned from in-hospital transmission of MERS-CoV, and the system built then for PCR testing was effective, allowing widespread testing and quarantine of the infected.
In contrast, Belgium advised that travels to China be postponed, but tourists brought the virus home from neighboring countries such as northern Italy. The headquarters of EU, which works to integrate Europe, happens to be located in Brussels, and at the beginning, Belgium was not keen to impose border control measures on Schengen countries that have signed a treaty to remove border controls. There is a tendency to simplify procedures required for international mobility in globalism, but this will likely be re-examined in the future.
The second issue is physical distancing. We may not revert to previous greeting customs, even after COVID-19 is gone. It may be an opportunity to conceive of a new “greeting culture.” A more sensitive issue is how to deal with religious gatherings. The actions of some Muslims were seen as problematic in Vietnam, and there have been cluster outbreaks from worship services of new-established Christian groups in South Korea. There is a chance of similar outbreaks in other religious groups as well, making this an issue for religious leaders to consider.
The third issue is “leaving no one behind,” one of the principles of the Sustainable Development Goals (SDGs). Many of the confirmed COVID-19 deaths in Belgium were people under care in nursing homes. Though there is a lack of information, the health of those who are incarcerated in prison may also be at stake. In Thailand, many initiatives are being implemented with support from the Thai royal family to improve the quality of life of inmates, which includes monitoring their health. For instance, in cooperation with the nearby Bang Bo General Hospital, an onsite clinic has been set to treat inmates at the Samutprakan Central Prison in Bang Bo District of the Samutprakan Province. As such, a collaboration between government agencies are required so that those who are in environments vulnerable to infection will not be left behind.
The fourth issue is the apparent increase in zoonotic diseases, such as the avian influenza virus and henipavirus, as well as coronavirus, which can infect humans and animals. It is thought that the increasing contact between humans and animals is one factor. Steps to protect animals’ health and their habitat will also be needed to ensure the world’s health and safety. The Food and Agriculture Organization of the United Nations, the World Organisation for Animal Health and WHO already signed an agreement in 2010 to look at the interaction of animals, humans and their habitats, under the idea of “One Health.”
In Thailand, the Lyle’s flying fox is now seen gathering in towns in search of food, such as in Phanat Nikhom, Chonburi province, where huge numbers of the bats have taken up residence in a temple. As villagers were not well aware, a public education program is teaching them about the risk of infections to humans from excrement and partially eaten fruit dropped by the bats. In the long term, we must work to preserve the environment, since deforestation and other habitat changes are behind the bats coming to the towns in search of food.
Professor, Graduate School of Asia-Pacific Studies (GSAPS), Faculty of International Research and Education, Waseda University; Director, Global Health Affairs & Governance, the Institute for Global Health Policy Research (iGHP), National Center for Global Health & Medicine (NCGM); Co-Director, Master’s Program in Global Leadership, Vietnam-Japan University; Visiting Professor, United Nations University Institute for the Advanced Study of Sustainability (UNU-IAS)
Other current activities include: International Advisory Board member, the BMJ (London); Councilor, Japan Association for International Health; Director, Japan Society for International Development; Board member, Japanese Organization for International Cooperation in Family Planning (JOICFP); and Board member, GLM Institute.
Before his current position, Professor Yasushi Katsuma worked as a volunteer for a British project in Honduras, as a development consultant in Southeast Asia, Far-Eastern Russia and South America at Japan’s Engineering & Consulting Firms Association, and for UNICEF in Mexico, Pakistan, Afghanistan and Tokyo.
Professor Katsuma graduated from high school in Pennsylvania, U.S.A., on the International Fellowship program from Kwansei Gakuin Senior High School. After studying at the University of California, San Diego, he received a B.A. from International Christian University, LL.M. & LL.B. from Osaka University, and Ph.D. (Development) from the College of Agricultural and Life Sciences, the University of Wisconsin at Madison.
Professor Katsuma’s recent areas of interest include sustainable development, human development, global health affairs and governance, and security of children.
Recent publications include: Leave No One Behind: Time for Specifics on the Sustainable Development Goals (Brookings Institution Press, 2019; co-authored); “Next steps towards universal health coverage call for global leadership,” BMJ (2019; 365: l2107; co-authored); and “Challenges in achieving the Sustainable Development Goal on good health and well-being: Global health governance as an issue for the means of implementation,” Asia-Pacific Development Journal (Vol.23, No.2, 2016; co-authored).