Get smart, not strict about social distancing, HCMC advised

On July 9, HCMC began its second 15-day citywide social distancing order under Directive 16 as the nation’s current Covid-19 epicenter seeks to curb the spread of the novel coronavirus.

The order requires people to stay home and only go out to buy food, medicines or work in essential factories and businesses allowed to remain open.

Andrei Akhmetzhanov, Assistant Professor, College of Public Health, National Taiwan University, said the introduction of stricter control measures is mainly guided by how much the healthcare system is stretched, therefore he assumed that the healthcare system in HCMC has been under significant pressure recently.

A recent mobilization of 10,000 medical personnel for the city is evidence, he said.

Recently, HCMC has been recording several hundred new cases daily, accounting for the most cases in Vietnam since new wave hit the country late April. On July 14, the city’s and nation's total numbers topped over 17,200 and 31,000 respectively.

Akhmetzhanov predicted that the city could see a rise in case numbers in the first or the second week after announcing social distancing. He explained that there was some delay in reporting of new cases, not all cases are confirmed right away, there is an incubation period of about five days from their day of infection plus another five days or more will go before the person would seek healthcare and get tested. It means that case numbers people see today in HCMC were infected about two weeks ago.

As a result, if the healthcare system was already stretched, there will be much more pressure for one more week. Moreover, the higher counts of severe cases can't be avoided, unfortunately.

Nonetheless, it is proven that with social distancing, the cases will go down sooner or later. In other words, if people comply with the regulations by staying home and restricting their social activities, HCMC will see the numbers go down.

"At this moment, people need to understand and try to help the government by following the rules," Akhmetzhanov said.

Associate Professor Alex Cook, Vice Dean of the Saw Swee Hock School of Public Health, Singapore, said it was a good time for HCMC authorities to apply social distancing because the number of cases was growing, indicating additional infections that the local government did not know about. One of the problems is there is a greater percentage of cases which are unlinked, suggesting the virus is widespread in the community.

Cook said that looking at the number of cases, the situation in HCMC is quite similar to that of Singapore in April last year when the city state enforced its own social distancing called circuit breaker. That measure helped Singapore to bring down the number of community cases to a manageable level. If that can be replicated, "it may not be too late for HCMC."

With the Delta variant, which is about twice as transmissible as the original Wuhan strain, control is challenging, highlighting the urgency to get vaccines into bodies as fast as possible, Cook said.

In Singapore, the authorities had a small scale of social distancing a couple of months ago, because they were getting concerned that there were too many community cases. Covid-19 vaccination in Singapore has been acting like a car brake on the transmission of the Delta variant, cooling down the transmission ability, he added.

In the longer term, Cook said Singapore aimed to stop counting new cases on a daily basis and focus on counting severe cases. This can happen when the disease has become endemic, something that people live with, once herd immunity is achieved with vaccination.

Social distancing risks

On July 9, HCMC authorities announced that they will continue with the mass testing that began June 26 and target collecting 1.3 million samples a day.

Assessing the risk in mass testing, considered a measure that could help Vietnam to "find all positive cases," Cook said the authorities may not know if positive cases found are current or recovered (from previous periods) or a combination.

In fact, when Singapore carried out mass PCR testing, it found that there were people who had Covid-19 a month before testing and had antibodies in their blood. In other words, they recovered from mild infections but they still tested positive by PCR testing because there were still fragments of the virus in their noses and respiratory tracts.

On balance, Cook said, mass testing was valuable but some thought would be needed on what to do with the positive test results, since not all of them will be infectious. What Singapore did in such cases was to carry out serology tests afterwards and assumed that seropositives were those who had recovered. That is not a completely fool-proof solution though, because of the (small) risk of reinfections.

"If there is sufficient capacity, follow up serology testing might be valuable in making isolation and contact tracing easier."

In reality, Cook said, Singapore is doing regular mass testing for some high risk groups such as healthcare workers and foreign workers working on construction sites. Tests are done once a week or every two weeks.

Moreover, Singapore is looking at using new technologies like breathalyzers to try and detect the virus in people's breaths.

Sharing similar concerns about the risks in mass testing, Professor Juhwan Oh with the Seoul National University College of Medicine, South Korea, said it could lead to a huge loss of resources because there are people who have been negative for a long time, and healthcare workers have to "do the same job" during this period. For example, among 1,000 people, there may be just one positive case.

Moreover, there is a high risk of infection spreading from long queues waiting for mass testing if someone is positive, Oh said, adding that it had happened in Wuhan, China last year.

He recommended that instead of doing mass testing, Vietnam may consider increasing personnel to test at isolation and quarantine facilities, which will work well. He said high risk groups could be the possible target of more extensive testing compared to previous weeks, with more number of tests per person, instead of doing it for everyone regardless of risk.

Oh also said he strongly supported Vietnam’s zero Covid strategy.

"However, mass testing will outgrow a situation or prove unhelpful for implementing that strategy by wasting testing capacity and the time of the officers."

Pointing to another risk in the new social distancing in HCMC, Oh said Vietnam should notice that poor people carry a higher risk of being infected if one family member tests positive because they share a room together. At the same time, the rich are safe during social distancing. This happened in India last year as the country had a lockdown to contain Covid-19.

To reduce the risks of infection in families, Oh said Vietnam may need to increase the number of quarantine facilities in every community.

"Increasing quarantine centers may help reduce the number of intensive care units (ICU) in the future."

Emphasizing the importance of "speed" in the new wave, Oh said authorities should increase human resources for contact tracing, testing, and quarantining in order to facilitate early detection and preventive monitoring. Otherwise, actions are delayed, leading to people circulating in the community during even one day delay. In fact, Vietnam had done these tasks quite well until March 2021, he said.

Akhmetzhanov, meanwhile, said that some people escaping from quarantine facilities in Vietnam showed they did not have much faith in them.

Health and the economy

Several experts said HCMC could have been late in applying social distancing because it was trying to implement the nation’s strategy of containing the pandemic alongside economic development.

On July 7, the Vietnamese government asked the public to be understanding in case social distancing or lockdowns were imposed on a large scale to contain the coronavirus.

The Government Office, citing Prime Minister Pham Minh Chinh, said the coronavirus situation in HCMC remained dire, posing a serious infection threat to nearby areas. This called for stricter, more aggressive measures.

Oh said the trade-off concept of health and economy has no room in a Covid-19 situation. If a country contains the pandemic well, the economic loss can be small, but if it does not reduce the scale of the pandemic, the economic loss could be high.

"If you let the number of deaths increase, your economic loss will increase too. You will lose both. That's the worst situation."

He recalled that this was the situation in the U.S. and U.K. last year before vaccination.

Oh emphasized that other countries, Vietnam in particular, can resort to "smart, not strict social distancing," by increasing people's awareness of Covid-19 transmission mechanisms between two persons. People would, on their own volition, wear masks, keep physical distance of two meters, and ensure interpersonal hygiene. In closed spaces, ventilation must work well.

According to Akhmetzhanov, the rising number of new cases in Vietnam, South Korea and Japan are connected to the so-called economic opening.

In Taiwan, authorities adopted a careful approach. For example, if the number of new cases per day not linked to previous infections is below 10 for seven days, the local government would open up carefully, he said.

Akhmetzhanov hoped that the relief package announced by the Vietnamese government about a month ago will support small businesses to adjust operations and survive the pandemic.

Cook said vaccination was realistically the only means out in the long term, because the virus is set to become endemic on a global level.

"Any other interventions like social distancing are stop-gap measures to delay things until the vaccine becomes available."