Complacency, non-compliance compound Vietnam's new Covid woes

After going for more than a month without any Covid-19 community transmission, the streak snapped on April 27 with a hotel employee infected by a group of Indian experts quarantined at the hotel in the northern province of Yen Bai.

Two days later, six more local cases were recorded in the northern province of Ha Nam. The cases stemmed from one man who finished his mandatory 14-day quarantine period after returning from Japan, but neglected post-quarantine self-isolation protocols and ended up passing the virus to others.

In the following days, the outbreak spread to several localities, especially following a four-day Reunification Day holiday that saw tourism sites jam-packed with people. As of Saturday, the spark of infection has ballooned into 176 community cases recorded in 19 cities and provinces, forcing lockdowns on several places across the country.

In the latest outbreak, even a frontline hospital in the Covid-19 fight has not been spared. Hanoi’s National Hospital for Tropical Diseases, the main facility for Covid-19 treatment not only for the capital city, but the northern region in general, has been locked down after becoming a novel coronavirus hotspot, triggering dozens of infections in at least 14 localities.

Commenting on this development, Health Minister Nguyen Thanh Long said: "That stronghold has now been breached."

Vietnam’s fourth Covid-19 outbreak has shown marked differences compared with the earlier ones in Da Nang City last year or Hai Duong Province earlier this year: multiple hotspots; the existence of different variants; the difficulties in tracking down "patient zeros;" and infections detected after completion of mandatory quarantining.

Multiple hotspots

Nguyen Van Kinh, chairman of the specialists’ council for Covid-19 treatment, said previous Covid-19 waves had spread from one hotspot to different locations. For example, the Da Nang outbreak last year had the Da Nang Hospital as its epicenter, and the one in Hai Duong outbreak earlier this year the Poyun industrial area.

But this time, things have been different: multiple outbreaks have been observed across different locations within a short time frame – one at Ha Nam Province, stemming from the man returning from Japan who tested positive after completing the mandated quarantining in a centralized facility, but tested positive later and passed the infection to people in localities like Hanoi, HCMC and Hung Yen; another in Vinh Phuc Province, associated with a group of Chinese experts who'd tested negative three times during their quarantine, but were found positive later; yet another in Yen Bai Province where a group of Indian experts staying in a local hotel tested positive; and even one at the National Hospital for Tropical Diseases, which has proved highly contagious, spreading to many other localities.

"This coronavirus wave is much more complex with so many outbreaks involved, forcing all provinces to ramp up their prevention measures," said Kinh.

Variants of concern

Genetic sequencing has revealed the existence of several variants among cases in the new wave, most notably one carrying double mutations – B.1.617 – that originated in India.

This variant, making its first appearance in Vietnam, contains two key mutations called E484Q and L452R, which have been found separately in other variants but not together in a single strain. These mutations have been seen to make the virus more transmissible and less susceptible to neutralizing antibodies, experts said. This variant has been found among patients in the outbreak at Vinh Phuc, Hanoi and Hai Duong.

Another variant with origins in the U.K., called B.1.1.7, which had already appeared in Vietnam previously, have been found among cases at Ha Nam, Hung Yen and Ha Tinh. The U.K. variant is believed to be more transmissible, but not more deadly, experts said.

Le Quoc Hung, head of the Tropical Diseases Department of HCMC’s Cho Ray Hospital, said the presence of multiple outbreaks and variants at the same time means these are independent of each other and have come from different sources.

"The virus is ever-changing. The recently observed variants would increase infection risks and incubation periods so they could go from one person to another in a shorter time frame," he said.

While isolation and lockdowns might be very effective against local outbreaks, multiple variants and infection sources mean the virus has spread on a much wider scale, requiring much greater containment efforts, he added.

Missing Patient Zeros

In previous Covid-19 outbreaks, the first patients to be infected with the virus were relatively quickly identified, which was especially helpful for contact tracing and quarantining. But things changed with the Hai Duong outbreak earlier this year. The virus had already spread far and wide by the time it was detected, making it very difficult to track down the original source of infection, Hung said.

The same thing is happening with the current wave, he added.

"We have totally lost track of F0 cases," said Hung, referring to patients who were infected first and placed in the first chain of transmission. The fact that most patients were largely asymptomatic also means they did not know they had the virus and still continued to travel, silently allowing the virus to fester within the community.

"They are like time bombs," Hung said.

The inability to track down Patient Zeros has made contact tracing much harder. Combined with the fact that authorities have been detecting a high influx of illegal entrants trying to enter Vietnam, meaning there could be people who have slipped through the border undetected and the chance of the virus silently infiltrating society is high, he added.

Negative three times, but positive again

The 28-year-old man who sparked the coronavirus outbreak in Ha Nam had already finished his 14-day quarantine after returning from Japan and tested negative three times, but he still managed to contract the virus later. The same thing happened with the group of Chinese experts in the Vinh Phuc outbreak and other cases.

Tran Dac Phu, a senior advisor for the Public Health Emergency Operations Center (PHEOC), said there must have been breaches in quarantine procedures at hotels for the virus to get out.

Truong Huu Khanh, head of the Neuro-infectious Disease Department of HCMC’s Children’s Hospital 1, said novel coronavirus positive results after 14-day quarantining may indicate problems with either the quarantining or testing procedures.

"In general, the problem lies with human carelessness, not the disease," he said.

The Ministry of Health recently extended the Covid-19 quarantine period from 14 to 21 days.

Letting their guard down

People used to be much more fearful and careful about Covid-19, said Hung, with streets becoming empty and crowds not gathering anywhere during previous outbreaks.

But in this wave, citizens have decided to go out and party despite frequent reports of new Covid-19 cases popping up everywhere.

Authorities have found numerous instances of people going to karaoke parlors despite existing bans. Some people have neglected self-isolation protocols and endangered public health in the process, Hung said.

He said Vietnam’s earlier successes and high trust in the government may have made people complacent and not follow protocols strictly.

He warned: "This is especially alarming. People play a vital role in the Covid-19 fight. If outbreaks are not quickly contained, the virus will spread on a large scale and have unexpected impacts."