What pushed you to act swiftly and early against Covid-19?
We share a long border with China. We keep listening to what happens in China because what happens in China quickly affects Vietnam. For example, SARS in 2003 . Because of that, we have an event-based surveillance. Early in December, we got some information about a disease in China similar to SARS. That’s why we raised awareness about what was happening and began to have discussions about the outbreak, which might be transmitted to Vietnam. When China declared the outbreak, we set up a steering committee straight away comprising 23 ministries.
This was even before WHO’s official announcements about a pandemic?
(Laughs) Yes, long time before WHO announced the disease.
Your approach was to identify and quarantine based on risk of infection rather than symptoms. Could you explain this approach?
That was based on data. In the first outbreak of six people returning from China who had Covid19, they displayed no symptoms. They sought treatment after they returned home to their communities and began developing a fever. We also found that about 40% of our patients in hospital had no symptoms till the time they were discharged. That’s why our strategy was based on contact tracing and testing, right from early February.
What was your testing strategy and what role did the private health sector play?
All testing in Vietnam is free. Our strategy is to test everyone who is a suspected case – this means those who come back from high-risk areas even if they don’t have symptoms, all those who came in contact with confirmed patients and their contacts, if they turn positive. That’s at least two layers of contacts we test. We also inform all the contacts to stay home — the first round is quarantine at hospital, the second round at home. They (secondary contacts) have to be tested if the first round tests positive. So far, we’ve done over 300,000 tests of which we found 328 positive cases. That means tests per positive case were in the ratio of 1000:1. All the tests are real time RT PCR.
The private sector could join the network laboratory by volunteering – the government will pay for the reagent and test kit. So far, we have not allowed paid tests. If the private sector finds a positive case, they will be treated the same way as if a government centre found it. The treatment for Vietnamese people is free. Even for others, the price is very, very reasonable.
Who was directing Vietnam’s approach – was it epidemiologists?
Public health experts and epidemiologists were leading the contact tracing efforts. The team had experts from different sectors, including the media, to ensure we had accurate contact tracing while also ensuring privacy of the patients. Epidemiologists were guiding the activities. Based on data and analysis, we identified high- and low-risk areas (to formulate) different policies for different areas.
How did you go about lifting the lockdown?
On the 21st of April, we began to lift the lockdown and all activity in Vietnam returned to normal. The only activities limited now are a few like karaoke – even sports and cinema have returned to an extent. But we still ask people to protect themselves and others by wearing masks when they step outside. There are still restrictions on crossing the border, so that economic activity can continue internally.
What gave you confidence to lift the lockdown?
Two things helped us: we still have very high surveillance. We still test those with pneumonia symptoms. We have sentinel surveillance for influenza. Those with symptoms like cough and fever similar to Covid19 are compulsorily tested. Importantly, we have had no community transmission since April 15. We have not had any new cases since then, only some imported cases are in quarantine.
How did Vietnam’s decentralised model of healthcare help?
The cooperation of people was the most important thing (in our fight)– the fact that they were willing to abide by the guidelines of the government. That was a key factor in our victory. About decentralised healthcare, we have 63 provinces and provincial disease control centres in each. In the over 700 districts, we have hospitals and health centres and in the 11,000 communes, each has a health centre which have the capability to find cases and quarantine patients. We also got help from the military. Most of the quarantine centres were run by the military. People were happy because they had food and internet.
With decentralisation, the place where the case was found was where the person would be treated. They don’t need to move to the province level hospital. Only the more severe cases needed to be transferred. With all this, we managed to have zero deaths.