How Vietnam, South Korea, Singapore, and New Zealand fought – and nearly defeated – COVID-19
Shortly after the pandemic started, these countries were able to limit the spread of the virus inside their borders, and experience much lower incidence, hospitalizations, and death from the disease than many other countries, including those in North America and Europe
The story of COVID-19, while not yet finalized, has become terribly familiar to all of us. But amidst the tragedy of the millions of lives lost, and the complications for millions more who have suffered from the long-term consequences of the virus, there are still stories we don’t hear enough. Stories from countries like Vietnam, South Korea, Singapore, and New Zealand, which all limited the spread of COVID-19 inside their borders and experienced much lower incidence, hospitalizations, and death from the disease than many other countries, including those in North America and Europe.
Quick and decisive action, uniform and consistent communication, and community adherence to public health guidelines and non-pharmaceutical interventions made these countries positive outliers. Their experience from past pandemics enabled them to rapidly construct an effective response plan, prioritizing uniform and equitable delivery of interventions, as well as program sustainability and flexibility. And their clear, effective, and accessible communications provided timely and consistent information, recommendations, and policies to the people they sought to protect.
In South Korea, the government formulated a COVID-19 response plan even prior to the detection of its first case. This meant that in January 2020, upon detection of South Korea’s patient zero, the country followed its new protocol: transfer the patient to a nationally designated hospital for RT-PCR testing and initiate strict self-quarantine and contact tracing through a mandated cell phone app. One week later, the government raised alert levels from yellow to orange and shortly thereafter, began restricting entry from China’s Hubei province. A national communications effort in all of Korea’s 22 provinces then kept the population informed on everything from prevention to disease mitigation.
In Singapore, the government created a centralized task force that included the departments of travel, health, transportation, finance, environment, economics, water, and education, and regularly informed its citizens with clear, science-based and non-conflicting messaging. A newly created scientific panel made up of disease modelers, virologists, and infectious disease specialists provided inputs on strategies ranging from early border control, widely available testing, and early and robust contact tracing.
In New Zealand, the country’s 2007 Influenza Pandemic Plan, updated in 2017, provided a baseline for fighting COVID, including implementing strong surveillance systems, prioritizing effective and equitable application of public health interventions, and program sustainability and flexibility to address emerging issues over time. Mandatory self-isolation after travel, limited gatherings and border closings to all non-citizens or residents then followed. Finally, the country introduced a national four-tiered alert system (with precautionary measures going up in parallel to incidence) to communicate to all regions simultaneously.
In Vietnam, initially one of the top 10 most affected countries outside China (and heavily impacted during the 2003 SARS outbreak), a formal outbreak response was implemented in January 2020, with a National Steering Committee activated shortly thereafter. A committee of scientific and government representatives advised on outbreak control strategies and committed to prioritizing health over economic growth. This led to strict mandates and enforcement of public health interventions, quick mobilization, and effective distribution of financial resources. One year later, it was among the top five countries with the lowest COVID-19 disease burden.
Testing and Surveillance Strategy
The South Korea Centers for Disease Control collaborated with at least 20 biotech companies to urgently manufacture PCR kits. By end of January 2020, PCR tests were available in the country and by April 2020, South Korea had the capacity to run an average 15,000 tests per day. The country also prioritized contact tracing with mass testing in hospitals and communities, identifying and following up with individual cases and their contacts through more than 256 public health centers nationwide.
In Singapore, testing was also widely available by mid-January 2020, when the government began screening travelers, testing symptomatic or febrile arrivals. Rigorous contact tracing was implemented with teams of contact tracers that worked 24/7. Tracers, in partnership with the country’s Criminal Investigation Department, developed activity maps to monitor people who, when tested positive, were placed under strict quarantine. To ensure compliance, GPS-enabled systems were used, with updates and messages being sent to citizens who were bound to specific locations.
In New Zealand, rapid case detection due to widespread, free testing, was followed by strict case isolation and quarantine for contacts of identified cases. To ensure compliance, quarantine was often monitored by security personnel rather than self-managed, with large fines and possible jail sentences for those who did not comply.
In Vietnam, diagnostic and management guidelines were developed in January 2020, well before the country’s first case was confirmed. The Ministry of Science and Technology developed diagnostic tests and shortly afterwards, established two testing sites. By May, 120 testing sites were in place, and since Vietnam had low case numbers, identifying clusters (vs. individuals) became possible. When even one single community transmission event occurred, community-level lockdowns and widespread local testing ensued.
Public Health and Social Measures
In South Korea, religious, recreational, and indoor sports facilities were recommended to be closed from March to May 2020. Indoor businesses could open if they were able to demonstrate adherence to strict safety measures and these were monitored over time and all businesses were advised to minimize crowding (small offices, alternate working hours). Professional sports resumed their usual schedule season, but with a limited number of spectators.
In Singapore, the government established DORSCON (Disease Outbreak Response System Condition), a color-coded framework that showed current state and informed guidelines via three types of orders in descending order of severity: a quarantine order, a stay-home-notice, or a leave of absence order. People were allowed to leave home during isolation only for necessary tasks like buying meals or household supplies.
New Zealand went into a mandatory, national lockdown for five weeks in March 2020. The country also closed its borders to incoming travel on March 19, implementing “protective sequestration.” Used in the Pacific Islands during the 1918 Influenza pandemic, this effort had shown great benefit to reducing the introduction and spread of diseases from outside travelers, especially to the Māori people, who are more at-risk due to inequities like social deprivation and house crowding.
In Vietnam, Prime Minister Nguyen Xuan Phuc mandated face masks, and encouraged hand hygiene, practicing social distancing, avoiding unnecessary gatherings, and strict quarantining for those returning from overseas. To promote adherence, the Ministry of Finance exempted tax on medical supplies and PPE. And, to alleviate the burden of isolation, individuals quarantining at health care centers and specific quarantine facilities were given around 80,000 VND (about US$3.50) per per each day, with all medical expenses paid for by the government. Social distancing and washing one’s hands were portrayed as a matter of patriotism and Vietnamese leadership used war rhetoric and called on the citizens to unite to respond to COVID-19.
From the transpiring events related to the COVID-19 outbreak that took place between December 2019 through to the present day, a comprehensive, integrated, well-coordinated preparedness plan, rapidly and decisively implemented, appears to have been a critical feature for each country’s success in responding effectively to the current pandemic.
While difficult to implement in larger countries, especially those with a cultural tradition of individual choice and multiple avenues in which information (and misinformation) can be spread and received, these countries provide a template for effective prevention and control when the next major outbreak or pandemic crises occur.
While 100 years have passed since the previous globally transforming pandemic, a panoply of factors including population growth and mobility, as well as evolving environmental conditions that increase the likelihood of animal to human pathogen spillover events, make it extremely unlikely that we will wait that long for the next one. And when the next one comes, lessons imparted by Vietnam, South Korea, Singapore, and New Zealand, might help us have a better story to tell.