With the latent surge coming to the fore in South East Asia, are there significant learnings that India can adopt?
Learning from the Past
South East Asia represents a kaleidoscope of diversity, in the type of governance with both democratic and autocratic systems coexisting, different levels of economic and social indices and the approach to life in general. Perhaps it is this diversity which has been reflected in their varying strategies to cope with COVID-19. Singapore, South Korea, Taiwan, and Vietnam have emerged as models of efficiency for early action and containment, while Indonesia, Malaysia and the Philippines stand out for their laggard and chaotic response. After their initial efforts to prevent the spread of COVID without lockdowns, there is now a second surge affecting that has caused them to change their route. Some have taken to enforcing a partial lockdown as well.
It will be pertinent for us to learn from the strategies that each of the SE Asian countries followed to improve India’s chances of combating the pandemic.
Singapore was known for its controlled, meticulous and focussed approach, which indicates their degree of preparedness. However, in the first week of April, the number of confirmed cases increased in Singapore. Most of them have been reported from dense migrant worker accommodations. The country is now under a partial lockdown. Schools and non-essential businesses are closed. This second surge has been suggested to have started in homes of travellers who returned to Singapore who could have been asymptomatic carriers, having infected their family - who went about their days and weren’t in quarantine.
Singapore commenced its preparations the moment the Wuhan Fever was revealed back in December last year. It immediately began research, increased border control and surveillance, and started screening inbound flights. Its efficient healthcare system, wisely well equipped with Personal Protective Equipment (PPE) and ventilators, enabled it to save the lives of patients severely suffering from SARS 2 keeping its morbidity low. The government also established an online application called TraceTogether (akin to our own Aarogya Setu) to enable tracing and tracking through the Bluetooth of smartphones.
Lisa Ng, the senior principal investigator of the Agency for Science, Technology and Research (A*Star)’s Singapore Immunology Network, stated that the 2003 SARS epidemic served as a “wake-up call,” based on which they increased R&D and were better equipped to adopt a more stringent approach to COVID-19.
Vietnam launched an aggressive response that has resulted in zero reported deaths according to government data, and so far, Vietnam hasn’t reported any cases in this second surge. The communications, so critical to ensure public order when faced with a threat of such magnitude, were fully transparent through clear public messaging and real-time sharing of data. The response was equally prompt and specific, isolating and tracking individuals and their second- and third-hand contacts, quarantining travellers, and enlisting services of all available medical professionals - be it students, retired doctors or nurses. The outbreak has been contained to a large degree, without resorting to mass testing as Vietnam does not have the capacity. They too enforced an effective lockdown in places as needed, instead of a blanket ban on everything.
South Korea’s model of "trace, test and treat” has been unique and allowed it to control the infection rate without resorting to lockdown. Yet, in April, there have been cases of viral reactivation - close to 100 people who were fully recovered have since tested positive again. Since most of its new cases have been imported cases, South Korea has enforced stricter measures. All Koreans and foreigners with residence in Korea from all countries are to self-quarantine for 14 days upon entry. Short-term travellers without a place of residence to self-quarantine will be allowed to use the quarantine facility provided by the government for a certain fee. Routine updates are still in place, with the Korea Centres for Disease Control and Prevention issuing daily briefings on infection status and measures being taken. They also send smartphone alerts about infected people’s movements.
What makes South Korea stand out is their previous success is their adherence to the World Health Organisation (WHO) mantra of “test, test. Test.” The strong point in their fight against COVID-19 has been mass testing. As of March 19th, the country had carried out more than 307,000 tests, the highest per capita in the world, and that too for free. Results of this were swift as well. Those infected were quarantined and treated in hospitals stocked sufficiently.
As per current indicators, China has managed to contain the contagion, yet also sees a rising second wave of infections, with 108 cases reported on April 12th, its highest since March 5th. Nearly all of these cases have been found to be imported cases - 98 of them were from Chinese nationals returning from Russia’s Far Eastern Federal District, who re-entered China through border crossings in Heilongjiang province.
China previously bore the brunt of not being forthcoming about the onset of a pandemic, perhaps seriously delaying its disclosure as it did in 2002 during the SARS outbreak. Faced with the immensity of the threat, China moved swiftly to cap the spread. Prefab Hospitals were set up almost overnight to deal with COVID-19 patients. There were many gaps in their strategy, both in their sharing of correct and timely data and ensuring an adequate supply of even basic items like masks and sanitisers. However, the mammoth manufacturing complex soon got cranking out PPEs and other essentials in huge numbers, and today China is supplying to other countries.
Taiwan has had better results when it comes to dealing with COVID-19, although it also sees a rise in infections after seven new imported cases, bringing the total number of cases up to 329. No closing of borders has taken place yet, although quarantining travels is still taking place. After SARS, they were better prepared to deal with this pandemic, due to having a national health command centre, moving to stockpile supplies and PPE, and restricting the price of masks. To ease the process of screening, Taiwan merged peoples’ international travel history with their digital health-insurance files, allowing doctors and pharmacists to access it all. They also heavily fined those who violated quarantine.
During the early phases of the epidemic, Japan appeared to have a grip on things, and the infection and mortality rates were low. This encouraged them not to go for complete lockdown like other countries. While people were advised to work from home and not go out, this was not strictly enforced by any means. Businesses were also kept open. Then in the first week of April, a second wave hit, spiking infections. Flights in and out of the country were only completely banned on April 3rd. A lockdown was finally issued to the country on the 7th April Japan after cases rose to roughly 4,500 from 2000 on March 31st. This lockdown would be in place until May 6th, 2020. Officials have reported 166 new cases in Tokyo on April 12th, bringing the total there to more than 2,000.
- Every country has a lesson for India, which needs to be carefully studied while evolving our strategy for initial infections and the second surge. In the absence of mass testing like South Korea, India opted for a total lockdown to flatten the curve and gain time to build up its medical defences against COVID 19. This effort can be lauded as it would also prevent the second surge. It does, however, need to increase its testing capacity, along with increasing imports of PPE and ventilators, as India enters its Stage 3 in community transmission.
- Public health care systems have withstood the challenge well, especially in countries which had invested wisely upon them. Even Italy, while it may have suffered huge fatalities due to being slow in imposing lockdown and social distancing, it was able to fight a gallant fight against COVID due to its world-class public health system. In India, we have seen that the private health care system, so much in demand by foreign health care tourists, has near-zero capacity to handle an epidemic of this nature.
- India can adopt the best practice of establishing a national command centre for disease control, ensuring better testing procedures, and employing stricter rules to those who violate quarantine measures. It should also brace for cases increasing. National Disaster Management Authority in the present context has proved to be ineffective, and perhaps there is a need to create a separate entity to deal with pandemics, which will visit mankind again.