THE PANDEMIC –  What Canada Should Have Done and Should Be Doing

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By Peter Chow

Vietnam shares a 1,300-km border with China, where Covid-19 first emerged.

Vietnam is a lower-middle income country of 97.3 million people.
Canada has a population of 37.6 million.

Per capita, Vietnam’s GDP in 2019 was US$2,715.
Canada’s was US$46,195.

Vietnam spends US$152 per person per year on healthcare.
Canada spends US$5,418.

Yet, Vietnam has experienced only two peaks of community transmission (March–April and July–August) and reported a total of only 2,626 cases with 35 deaths as of April 3, 2021.

In contrast, Canada has had almost 1 million (999,555) cases and 23,050 deaths.

The experience Vietnam gained from previous epidemics, such as SARS-CoV-1 in 2003 and bird flu (H5N1) in 2004, was critical to its rapid response to COVID-19.

But Canada also had experience with SARS in 2003 and several cases of H5N1 bird flu in 2004.  Canada had 251 cases of SARS with 38 deaths, while Vietnam had 63 cases and 5 deaths.

Vietnam has a history of successfully managing pandemics.

It was the second country after China to face SARS and, after 63 cases and 5 deaths, it was the first country declared SARS-free by the World Health Organization (WHO).

Many public health interventions pioneered by Vietnam during the SARS epidemic have been and are being used to respond to COVID-19.

Similarly, its experience with epidemic preparedness and response measures has led to a greater willingness among the Vietnamese people to comply with a central unified public health response.

On January 3, 2020, even before the first cases in the country were confirmed, with news of increasing numbers of “severe atypical pneumonia” in Wuhan, Vietnam took early steps to tighten and monitor the border with China, implement closures, mandate masks, and limit mobility for citizens and international travellers.

On January 16, 2020, well in advance of the first case of Covid-19 in the country, the Vietnamese Government issued the first diagnostic and management guidelines for COVID-19.

The Vietnamese government basically adopted an immediate urgent policy of “zero tolerance” toward Covid-19.

In contrast, the response in Canada was too late, too slow, too incremental and too inconsistently communicated.

The guidelines in Vietnam provided instructions on intensive contact tracing and mandated 14-day isolation of all direct contacts (F1) of a confirmed case, regardless whether those contacts had symptoms or tested positive or not.

Vietnam diagnosed their first 2 COVID-19 cases (a father and son) on January 23.   The father arrived from Wuhan, China, to visit his son in Vietnam, representing the first case of human-to-human transmission of SARS-CoV-2 outside of China.

Their contacts were traced, isolated and tested;  one was positive for SARS-CoV-2.  Thus, the first community transmission chain in the country was quickly identified and contained.

Health Canada did not officially report that local community transmission had become a “primary source” of cases in the country until March 24 (at which point there were already 2,792 confirmed cases). But there is evidence of community transmission going on much earlier.

Immediately following the detection of these first cases, on January 24, Vietnam suspended all flights from Wuhan.  At that time, the WHO and Health Canada were advising against travel restrictions.

On January 25, a Toronto man who returned from the Chinese city of Wuhan became the first case of Covid-19 in Canada.

On January 29, the Vietnamese Ministry of Health established 40 mobile emergency response teams, on stand-by to assist affected locations, for quarantining, disinfecting, and transporting patients or suspected patients.

On January 30,, Vietnam formed a national steering committee that initially met every 2 days to coordinate the country’s “whole of government” strategy.  Each meeting was followed by communication to the entire Vietnamese population.

On February 1, Vietnam closed its border with China.   All flights to and from China were suspended and all arrivals to Vietnam from countries with COVID-19 were quarantined for two weeks.

On Feb. 26, Dr. Tam told CTV that “as more countries are infected, the less effective and feasible it is to close our borders.”  Dr. Tam  resisted calls for more aggressive screening at borders and airports.  Canadian research, in which Dr. Tam was personally involved, had suggested such measures weren’t effective.

Canadian leaders, into March, continued to resist calls to shut down borders as some other countries had already done.  Federal health minister Patty Hajdu said travel bans would be ineffective, pointing out on March 11, that Italy had closed its borders to China, well before it experienced one of the worst outbreaks outside of China.

In Canada, it was not until March 16, that Canada announced its closing of its borders to non-Canadians, apart from Americans.

On March 18, Canada and the United States closed the border to non-essential traffic.

Vietnam mandated masking for everyone, everywhere, on January 3.

In contrast, Transport Canada made masks mandatory for airplane passengers starting on April 17, 2020.

On May 20, Canada’s chief public health officer, Dr. Tam, “encouraged” Canadians to wear a mask as an “added layer of protection” whenever physical distancing wss not possible.  Asked if the federal government could issue a directive to make mask-wearing mandatory, Dr. Tam said that it remained a voluntary “recommendation” at the federal level.

A Montreal suburb that had hundreds of confirmed COVID-19 cases and dozens of deaths by the beginning of June, started making face masks mandatory (only in indoor public spaces) starting July 1.

Toronto passed a bylaw to make mask wearing indoors mandatory on July 7.  Mayor John Tory said the bylaw would not rely on “aggressive enforcement.”

Quebec was one of the only provinces to enact province-wide mask regulations, on July 13, making masks mandatory on all public transit in the province.

Schools in Vietnam were closed early, initially for the Lunar New Year, from  January 25 to early February, but closures were extended to early May, by which time the first wave was successfully controlled.

Ontario cancelled in-person learning on May 19 until at least September.

In Vietnam, physical distancing, wearing a face mask in public and in-country travel restrictions were applied with increasing stringency, with strong public support and adherence.

Suspected transmission hotspots (for example, a city or a community) were locked down to stop community transmission.

On March 31, when community transmission was escalating and the total reported cases in Vietnam exceeded 200, the prime minister enacted a strict nationwide lockdown for 15 days, which was extended to April 30 in hotspotss.

Accordingly, non-essential businesses and public transport were shut down, and only essential travel between cities and provinces was allowed.

Gatherings of >2 people in public places were prohibited.

People were asked to not leave their houses unless it was for essential activities (for example, seeking medical care or buying food).

Nasal and throat swab testing by PCR was done to all F1s (direct contacts), regardless of lack of symptoms, and all travellers entering Vietnam.

Confirmed cases, their F1s (regardless of the PCR results) and travellers were all subjected to a minimum quarantine of 14 days at one of the government-run isolation centers (free of charge), deployed across the country.

Meanwhile, home quarantine for a maximum of 14 days was mandatory for anyone in contact with an F1, whether that F1 tested positive or not.

From January 23 to May 1, 2020, over 200,000 people spent time in a quarantine facility.

By the end of 2020, 730,000 individuals had been quarantined in isolation centers across Vietnam, and 2.7 million people had been tested for SARS-CoV-2.

Mass testing, coupled with a creative sample-pooling strategy, whereby nasal and throat swabs from 5–7 individuals were placed in one tube at collection, was key to the success of suppressing the second wave between July and August.

In Vietnam, 1,000 tests were done for every confirmed case of Covid-19 in 2020.   In Canada, it was 31.2 tests for every case of Covid.

An innovative communication strategy was developed to keep the public informed and safe.

From the start of the pandemic, the government sent regular updates on COVID-19-preventive responses and the national situation via SMS texts.

Mobile apps, especially those developed locally, such as Bluezone, helped users to identify whether they were in contact with a confirmed case.

In February, “Ghen Co Vy” (Jealous Coronavirus), a well-known pop song given new lyrics and turned into a hand-washing public service announcement to raise public awareness of the disease and to promote good hygiene habits, was released as a video . To date, the video has attracted 9 billion views on Tik Tok.

On July 25, when the second wave started, Vietnam had gone 99 days without a single case of community transmission.  The second wave ended by September 10.

The government has also sought to mitigate the socioeconomic impacts of COVID-19.

From August 2020,  Vietnam slowly opened its borders to allow highly skilled workers and experts to enter the country.  Everyone entering underwent a compulsory 14-day isolation period in designated government facilities, with PCR screening on days 1 and 14.

The government arranged >200 flights to repatriate >60,000 citizens stuck abroad and issued financial assistance packages to support businesses and employees affected by COVID-19.

Because of the success of Vietnam’s Covid strategy, its economy was able to re-open much earlier than almost any other country.  Ho Chi Minh City (formerly Saigon) re-opened fully on April 23, 2020, the rest of the country by May 1.

Vietnam’s GDP grew by 2.91% in 2020 — one of the highest rates in the world.

Statistics Canada says real GDP shrank by 5.4% in 2020, the steepest annual decline since comparable data was first recorded in 1961.

Collectively, early preparedness, contact tracing, isolation and mass PCR screening, coupled with timely border closure, physical distancing and community adherence, have been the key components that have determined the success of Vietnam’s control of COVID-19.

Heading into the second year of the pandemic, clinical trials of locally developed vaccine candidates are ongoing in Vietnam, and 90 million doses of the Oxford–AstraZeneca vaccine have been ordered for 2021.

Until then, the Government will continue to enforce the measures that gave it such exemplary control of COVID-19 in 2020.

Many lessons from Vietnam are widely applicable:

1)  Investment in public health infrastructure (e.g., emergency operations centers and surveillance systems) enables countries to have a critical head start in managing the pandemic effectively.

2)  Early drastic action, ranging from border closures and masks to testing, quarantining and lockdowns, can curb community spread before it gets out of control.

3)  Thorough extensive contact tracing enables a targeted containment strategy.

4)  Quarantines based on possible exposure, rather than symptoms or positive tests only, reduce asymptomatic and pre-symptomatic transmission.

5)  Mandatory testing and quarantining of all international travellers is an effective policy.

6)  Clear, consistent communication is crucial.  No politician or public figure in Vietnam called Covid-19 a hoax or ranted against lockdowns or masking.

7)  A strong whole-of-society collective approach engages citizens in decision-making processes and encourages cohesive participation in appropriate measures.   When people trust the government, people do what the government says.

8)  A sharper, harder, earlier, more intensive, more urgent response paid huge long-term benefits of a much earlier, much more complete economic recovery.  Short term pain pays off in huge long term gain, economically, monetarily, big-time.

Vietnam shows what Canada should have done and what Canada should be doing today.

Covid-19 should be a learning experience for Canada to prepare for the next pandemic.

4 COMMENTS

  1. Trudeau must go! He’s managed Canada horribly pre-pandemic and peri-pandemic. We simply can’t afford any more time with him at the helm as be steers Canada to ruin.
    Unfortunately too many Sault residents are singing Sheehan’s praise and will likely vote him in again (even though a look at his voting record shows him voting with the party and against what would have been good for the Soo).
    Terry & his party simply put our community and Canadians last.

  2. Well written, very informative.

    With respect to Italy, I felt that the Minister of Health’s conclusions that Italy’s border measures didn’t work (so why should Canada do it?) was, shall we say, perplexing.

    It is not so much that Italy’s measures were ineffective, it is that they were implemented too late in the game, through no fault of their own. Italy had no warning; Canada did.

    The Health of Minister of Taiwan said in an interview that he was confident that the virus was circulating in Europe in December of 2019.

    Italy is claimed to have a large population of Chinese persons living in the northern regions and who in all likelihood travel to and from China to visit family.

    Italy also has a large number of seniors and a large number of persons who smoke.

    By that time the virus was in Italy (spreading asymptomatically), border closure, although probably somewhat helpful, was overall too little too late.

    There is no reason why Canada, who was at very low risk for spread at the time, couldn’t have learned from Italy, and protected her borders before we were in the same predicament as Italy. Again, Canada had a warning, Italy did not.

  3. The buck stops at Mr. Trudeau’s desk. He did a very poor job. Mr. Ford started out well but is a dismal disaster now.

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