‘The UK is a world-leader in preparing for and managing disease outbreaks and I have every confidence in our nation’s ability to respond to the threat of COVID-19,’ declared health secretary Matt Hancock on 4 March. Four months on, it seems clear that if we want a world-beating response to the virus, we should be looking elsewhere.
On 24 March, British nationals in Myanmar, including one of the writers of this piece, were urged to return home as soon as possible, because of poor health provision and imminent flight cancellations, although there were no Covid-19 cases there at the time. Imagine taking one of the last flights out of Yangon back to the UK already in lockdown, with over 8,000 cases and 42 deaths.
Since then, there has been widespread criticism of the UK government’s handling of the coronavirus crisis, including its slow response, the failure to close borders or quarantine incoming travellers, and inadequate testing and contact tracing.
In contrast, south-east Asian countries have seen far fewer cases. Why is this? The heat, lifestyle and other cultural factors have been suggested. There has also been suspicion that numbers are not as low as reported, in countries with low income, basic healthcare and long borders with China. But what is the evidence? We will look particularly at Myanmar (formerly Burma) and Vietnam, countries with similar population sizes to the UK.
Vietnam acted as early as January 2020, introducing measures which were seen as extreme at the time, but have since been proved effective and been praised worldwide. These included closing the border with China in February and mass contact tracing. Vietnam had previous experience of dealing with SARS in 2003 and avian flu in 2010.
By mid-March, the Myanmar government’s reported claims that the lack of coronavirus cases was due to ‘lifestyle and diet’ were regarded with suspicion. However, in practice, many measures were implemented from January, including temperature taking at shopping malls and schools, the banning of public gatherings such as the Thingyan water festival and the imposition of a curfew. Myanmar closed all its borders, including China, on 24 March.
Face mask wearing is commonplace in south-east Asia and is currently compulsory in both countries. Both countries closed schools after the lunar new year holiday.
In contrast, by early March in the UK, people were only being advised to wash their hands regularly and stop shaking hands.
Quarantine and lockdowns
As well as closing all borders to international travel, two weeks of mandatory quarantine for civilians returning to both countries has been strictly enforced and local transmission has been prevented or halted. In Vietnam, thousands have been quarantined in military-style facilities and the nation went into total lockdown on 1 April; local lockdowns have also been enforced.
In Myanmar, over 23,000 are in quarantine facilities set up in schools and monasteries. Although there are some local lockdowns, the civilian government is reluctant to bring in total lockdown because of its uneasy alliance with the military.
By comparison, although lockdown in the UK started on 23 March, the government only brought in quarantine on 8 June, so travellers continued to arrive from high-risk countries until then.
Contact tracing and testing
Both Vietnam and Myanmar have widespread contact tracing and this is carried out effectively at a local level. In Vietnam, this has been variously reported as due to a culture of surveillance and well-established local primary healthcare centres. There has also been widespread testing.
Far fewer tests have been carried out in Myanmar. Myanmar’s poor health infrastructure is a cause for concern and it lacks the capacity to scale up testing, although additional tests have come from Singapore and the UN. However, we can assume that not everyone in the country is included in these testing and tracing measures.
On 12 March, the UK stopped mass testing and contact tracing and the subsequent test and trace scheme has been beset with problems, to say the least.
Both Vietnam and Myanmar now face difficult choices in continuing to minimise the spread of Covid-19 whilst boosting economic recovery. Vietnam has already re-opened its borders to foreign experts and investors. Myanmar, however, is taking a more cautious approach, with only consular and UN officials allowed to re-enter the country, and restrictions set to continue for a further two or three months.
Compared to the UK’s woeful record in dealing with Covid-19, these two countries introduced impressive preventive measures at an early stage, which have enabled them to slow the spread of the coronavirus so far. Perhaps the UK government should reconsider its unwillingness to make international comparisons.
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