The fight against the COVID-19 crisis: What are core factors of a successful low-cost model?

Dear editor,

Vietnam shares the border with China which was known as the originated place of SARS-CoV-2 virus; however, the country has kept low numbers of infections with 1063 cases and 35 deaths (updated on 13^th September 2020, Vietnam Ministry of Health). The fight against COVID-19 in Vietnam would be divided into two following phases: The first phase from 23rd January (the day of the first cases confirmed with SARS-CoV-2) to 16^th April 2020 with 267 confirmed cases and zero deaths, while second phase started from 25^th July to 3^rd September 2020 with 1046 cases and 35 deaths (Vietnam Ministry of Health). No locally transmitted cases had been reported within 100 days before the phase 2 started. Although the second wave of COVID-19 caught Vietnam by surprise from an unknown source, the country has still successfully controlled the crisis using the same series of the following decisive and cost-effective actions as the phase 1.

Social distancing

Social distancing had been practiced immediately when there were just a small number of cases confirmed with the virus in Wuhan, China. In addition, this measure was taken in various models in both phase 1 and phase 2 of the pandemic. Since the first case confirmed on 23rd January 2020 (2 days before the Lunar New year’s Eve), social distancing in the whole country was immediately implemented (Ha et al., 2020). To encourage people to stay at home, the national holiday had been extended to following months instead of 7 days as usual, except essential works, such as food industry, pharmacy, or governmental office work. In the meantime, all schools were closed, except for medical and nursing schools. At phase 2 of COVID-19, to mitigate the impacts of the pandemic on the national economy and avoid national lockdown, social distancing was imposed as soon as the latest cases detected from local transmission, which effectively reduced the chances of the virus spread to other parts of the country. Specifically, the resurgence of COVID-19 started on 25^th July when the first case was detected in Da Nang from mysterious sources; social distancing was implemented on the whole Da Nang 3 days after (Da Nang today, 2020). Thanks to that swift action, Da Nang, the epicenter of resurgence of COVID-19 cases, had been under control, and the restrictions in Da Nang were lifted on 4^th September 2020, just more than 1 month from the start of the outbreak.

Strategic tests taken

Testing plays a crucial role in controlling COVID-19 pandemic. Vietnam was considered as one of the first countries in the world that had successfully designed test-kit packages based on real-time PCR method (RT-PCR) with high sensitivity and specificity to the COVID-19, which benefited to detect new cases timely. As being a low-middle-income country with a limited budget, Vietnam has chosen a targeted strategy, in which tests are allocated strategically and effectively. Strategic tests have been conducted on all people who have close contacts with infected people, who in quarantine stations, and who with suspected symptoms such as cough, fever, and sore throat. In addition, large-scale testing is conducted once evidence of major community transmission is identified. In the recent outbreak in Da Nang with unknown sources and major local transmission, ideally, all residents should be tested as regular and large population testing can enable identify asymptomatic infected patients—known as hidden carriers, which can significantly contribute to eliminate community-infected transmission from silent spreaders. This ideal method is, however, hard to do in a country with limited resources, like Vietnam. To save budget while ensuring that hidden clusters of COVID-19 would be detected timely and accurately, one representative from each family living in Da Nang was required to get test. Chosen family’s representatives must have the highest risks of catching COVID-19 virus compared to others or they must be in vulnerable groups, such as people with chronic diseases. Additionally, testing for COVID-19 in Vietnam has been free of charge for all citizens, which encouraged people to take tests.

Quarantines

Quarantines have been taken in different models. To prevent transmission from exported cases, all individuals entering the country from abroad were required to undergo a 14-day community quarantine. Then, quarantine of an entire area was implemented promptly when the first locally transmitted cases were confirmed. The two cities, Da Nang and Hai Duong, were put in quarantine when community infections had been determined from unknown sources, for instance (Da Nang today, 2020) (Tienphong News, 2020). By implementing early quarantine, the outbreaks had been zoned, which contributed to reduce the possibility of the local spread of the virus, preventing the full lockdown of the country, saving the “COVID-19 budget,” and keeping the economy less affected.

Wearing mask

Wearing face masks in public places in Vietnam has been compulsory for all citizens as well as foreign visitors since 16^th March 2020 when the number of cases was relatively small and when WHO just recommended wearing medical masks for only positive-confirmed patients (Huynh, 2020). Those who broke the law of masking got a fine. In fact, almost Vietnamese people had worn face masks since the beginning of COVID-19 outbreak, earlier than the government’s requirement. Since 91.5% of COVID-19 cases in Vietnam were mild and/or asymptomatic (World Health Organization, Representative office for Vietnam, 2020), face-covering would be an effective measure to break the chains of human-to-human transmission via droplets or airborne.

It is a fact that those mentioned measures undertaken in Vietnam have been not new and applied by many countries. However, the combination of those actions put in place timely and swiftly would be the key element, especially in a low-income country. Thus, Vietnam has been setting a good example in successfully containing the virus in the circumstances of limited resources.