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COVID-19 Update from Healthcare Provider Subcommittee Chair Dr. Mason Cobb and Andrew Meadows

New beginnings…

As the saying goes, “new beginnings are often disguised as painful endings.” Recent weeks have ushered in a new beginning here in Viet Nam, with borders opening and pandemic news receding from daily headlines. The characteristic energy, optimism, and vitality that we all love so much have returned to the streets. It certainly feels like a new beginning.

The daily accounting of COVID-19 impact continues an encouraging trend.  Reported daily cases are down 45 percent this past week, following on the heels of a 29 percent drop the week before.  Severe cases (hospitalizations) are down 43 percent this week and by more than half in two weeks. Nationwide deaths are also down another 25 percent to a 7-day average of 33.

In response to these trends, the Deputy Minister of Health Nguyen Truong Son, described dropping case counts as “a very good sign…the disease is now under control.” The government’s vaccine campaign has enjoyed great success, thanks in large part to the people’s willingness to get the jab.

Nearly all adults are fully vaccinated and over half have received a booster. Children aged 12-17 are now fully vaccinated at 94 percent. Additionally, several effective oral antiviral medications are now licensed for domestic production, paving the way for better availability and access.

The other side of the story is the pandemic’s massive cost to the community, Viet Nam, and the world in terms of life, health, connectivity, lost opportunity, and economic agony. As of today, 10 million cases of COVID-19 and nearly 43,000 deaths have been reported in Viet Nam.

These numbers represent the ‘painful ending’ as they are an aggregate representation of individual pain and suffering. We are well served to reminisce about what has unfolded over the past two years, learn lessons, and build a future with more resilient personal health, robust health systems, networks, and markets.

Undoubtedly, more viral variants will appear in the future, but the path appears well set, and systems are established to minimize any shocks. Don’t put your mask away just yet, but feel positive about work, social life, and travel.

Let It Be

As most of the world continues toward reopening with a more comfortable embrace of the new normal, the Beatles seemingly had this plan long ago, “there will be an answer, let it be.” With high vaccination rates and less dangerous – albeit more transmissible – variants taking hold, disease burdens are now more tolerable to health systems and a weary public. On the whole, this approach seems to be working.

Recently, COVID-19 counts have been dropping rapidly nationwide several months after the Omicron wave came crashing in. Reported daily cases are down 29 percent this past week. So too are severe cases (hospitalizations), down 19 percent. Deaths are also down 30 percent to a 7-day average of 44 – this represents the lowest number in more than 8 months since the current wave began.

The Omicron BA.2 variant remains the predominant cause of infection both domestically and globally. Disease surveillance shows that BA.2 accounts for 93% of cases in Viet Nam. Unlike previous variants, throat-related symptoms such as painful swallowing or voice changes are common. When combined with other common findings such as headache and fatigue, the picture looks a lot like a cold or the flu. Early and repeated testing is the only effective way to identify and manage those with illness.

A welcome development, COVID-19 travel-related obligations continue to improve. All destinations within Viet Nam are open and only a negative PCR test and minimal travel insurance are required for international arrivals. No quarantine or self-isolation is necessary. Like Viet Nam, South Korea recently loosened entry requirements for foreign travelers, much akin to other regional neighbors. Restrictions notably remain in China, Japan, and a few smaller Southeast Asian destinations.

In total, the road ahead looks positive. Individuals, institutions, communities, and science as a whole are adapting in real time as is the virus itself. Continued evolution of the virus into an endemic, but manageable, condition seems more and more likely as time progresses. Now, like always, is time to speak the words of wisdom – practice 5K to protect you and those around you.

It’s a Long, Long Road

Officially, Viet Nam has recognized the pandemic and taken decisive steps to combat it for over two years, now.  The current strategy is to return to “normal” and “live with the virus” as the economy, travel, and life generally open up.

At a superficial level, this is an easy choice given the socio-economic challenges of the last two years and the current, much milder form of the disease.  For eleven straight days the number of reported cases has been dropping: Sunday saw less than 100,000 reported cases for the first time in over a month.  There are 3347 hospitalized cases (3968 a week ago), with 282 patients on ventilators, easily manageable numbers for the healthcare system.  Deaths were 48 on Sunday with a 7-day running average of 68.

So, now that over 9 million residents of Vietnam have had this disease, most during the Omicron outbreak (4th wave), what do we know?  Some have gotten blasé about the whole Covid-19 pandemic thing.  Now it is “just the flu” and it is back to real life with socializing, laxity with the masks, distancing, and hand-washing.

However, a  friend who had been infected by Omicron was told by someone that they hoped to get Omicron and get this whole thing over with.  He replied, “no, you don’t – it doesn’t end with two days of fever, but can continue to hurt you for weeks”.

Sorry to say, this outbreak is not the flu.  Covid-19 –- and likely its Omicron variant — differs from the flu in at least one very significant way: “Long or long-haul Covid”.  These are persistent symptoms that last over 3-12 weeks.  Some will experience them for a year, based on previous Covid waves.  Most have had and gotten over the initial symptoms in a few days, mainly due to vaccination.  But some debilitating symptoms may hang on.  The virus sticks around and affects various parts of the body, although not making you acutely ill again.  Some have a slightly exaggerated immune reaction or an autoimmune component.

It is not yet scientifically proven that Omicron may produce Long Covid.  However, most clinicians in Viet Nam and world-wide have already noted this in their clinical practices, in 50-60% of cases.  Mild initial illness does not decrease your chances of contracting Long Covid – you can get it anyway.

After a patient with Omicron feels better, they typically home-test negative and return to normal life.  However, they may find great fatigue, mental fog, and a persistent cough and scratchy throat.  Other troublesome symptoms are myriad and include headache, back pain, muscle and joint aches, extreme sleepiness or sleeplessness, anxiety, and intolerance of stress.

There are many medications for sale suggesting effectiveness with Long Covid, but none are effective.  Since there is no cure for this syndrome, you must adapt your lifestyle to your own new normal until these symptoms gradually resolve over time.  This includes, pacing oneself for fatigue and building time for rest into your schedule.  Although perhaps counter-intuitive, be sure to get exercise.  Strength exercises are especially valuable.  For the muscle pains, flexibility exercises are helpful, but don’t overdo the exercise component.

For the mental fogginess, keep to-do lists and notes, reduce distractions, write down a clear plan for activities.  Since these symptoms are persistent, they can accentuate anxiety and depression.  Stay connected with people and stay active.  Keep a daily routine.  And don’t beat yourself up; this is an illness, nothing that you did, and it will pass over time.

So, even with vaccinated F1s returning to work with precautions, and the burden lightening for those infected, it is important to maintain masking, distancing, and hand-washing to prevent further spread.  Let’s stay on our path to a new normal.

Have you joined the Club yet?

For the last four days, official case numbers have been dropping, although nearly a million cases were officially added just over the last week (through 20 March), and this does not count cases diagnosed and treated at home and not reported.  But even with the onslaught of cases, life has been returning to some normality, while most of us seek to avoid unnecessary risk.     Yet more and more , the talk at get -togethers is, “have you joined the Club yet?“  You almost feel left out if you haven’t gotten that “2nd booster” yet.

There has been some confusion as we make the transition between a strong wave in the pandemic and our normal lives at work, school, and home.  The Ministry of Health (MoH) walked back a directive that seemed to cancel quarantine for those who were positive but asymptomatic.  Now it means that quarantine can be in the home but not outside.

It should be noted that these guidelines are not strictly enforced, and many businesses and individuals use variations.  This is in keeping with the motto for the pandemic: “safe, flexible adaptation and effective control of the pandemic along with economic recovery and development”.

Of note, although there were last-minute adjustments, new standards for travel were introduced this past week.  Essentially, testing before travel, full vaccination, and no quarantine are required.

The MoH now has two main criteria for monitoring the pandemic and this biggest surge.  They are serious (hospitalized) cases that overwhelm the healthcare system’s capacity, and deaths.  Although cases have increased dramatically with the Omicron BA.2 variant and its hyper-infectivity, the highly- vaccinated Vietnamese population has had no sharp increases in deaths or serious illness. Serious cases have increased somewhat (7-day average 3/20: 4135, 2/20: 2888, 12/20: 7775), but they are far below even 3 months ago.  Deaths have decreased steadily (7-day average 3/20:71, 2/20: 78, 12/20: 244).

The one stress on the healthcare system has been pediatric cases.  Although hospitalizations are unusual, the outpatient services have been overwhelmed with children with the usual symptoms.  They are being carefully evaluated and a treatment plan explained to the parents, then the child is sent home.  This week, HCMC had 30 children on ventilators (19 transferred from other provinces), and 5 on ECMO.  This is below critical numbers.

Vaccination is likely to be expanded.  Fourth booster shots have been proposed especially for those at high risk, 3–5-year-olds are being studied for vaccination, and 3rd shots will be given to 12–17-year-olds.  Boosters, including a fourth, are now recommended as immunity wanes after several months.

As the criteria are becoming more flexible for isolation of positive cases and their close contacts, when is it actually safe?  Unfortunately, it is not entirely clear.  A person who contracts Covid-19 is typically asymptomatic but infectious for one to two days before symptoms appear.  Symptoms may develop two to fourteen days after exposure.  A person is infectious for two to three days after symptoms appear.  Vaccinated people tend to spread for less time.  “Stealth infections” — those with no symptoms, but testing positive – should follow the same rules, but the count can start from the date of the positive test.

If exposed and fully vaccinated, no quarantine is needed, according to USCDC guidelines, but a mask is recommended for 10 days. Under Vietnam MoH Guidelines, a five-day quarantine is required for F1s. For those testing positive, USCDC recommends a 5-day isolation after symptoms appear and strict mask-wearing for 5 more days.  Under Vietnam’s Guidelines, a 7-day isolation period is recommended.  If Rapid Test (RT) is negative at the end of seven-days, return to normal life.  If RT positive, spend another three days at home, then return to normal.  In Vietnam, in the midst of this surge, masks are considered mandatory for everyone, as well as one to two meters social distancing.

The risk of reinfection is about 5%, if initially infected pre-Omicron.  After Omicron, it is not certain.  Vaccines do not protect against contracting Omicron Covid-19, but it is rarely serious enough for hospitalization.  However, higher risk individuals could have a worse outcome, especially those with immune system compromise.

Hopefully, the downward trend in cases will accelerate and this Omicron surge will pass as rapidly as it began.  Stay safe!

The Kids are All Right

Most of the events in our lives have several or many factors and many unknowns.  There may be several reasons for the dramatic rise in cases.  Omicron variant, so highly transmissible, and undetected for several days while infectious, is a major factor and accounts for nearly all of the new cases.  Return to school has resulted in a majority of the reported cases last week in HCMC being under 12-year-olds.

Early detection and isolation are important, so of great concern, a new peer-reviewed article in British Journal of Medicine found that false negatives occur in asymptomatic cases 20-30% of the time and among younger patients, up to 80%.  Our means of detecting cases early and reliably is misleading and the failure of our testing to diagnose early perhaps contributes to early infectious cases continuing to spread before symptoms and a positive test.

Although the Omicron variant affects children more than previous strains of the virus, it is fortunately not causing overwhelming numbers of serious cases or deaths.  In fact, over the past month, although total reported cases have risen 198%, deaths have dropped 47%, hospitalizations by 24%, and serious cases by 43%.  HCMC averages only about 4-5 new ventilator-managed cases a day.

Although the case numbers per day continue to set new records, the Ministry of Health advocates abandoning daily case numbers.  They are inaccurate, as many are diagnosed at home and do not get reported.  Each of us knows several close acquaintances who have active infections.  The key indicators in this highly vaccinated population remain deaths, serious cases, and strain on the healthcare system.

At a large assembly of government agencies, including all provinces, and most ministries, the Prime Minister urged both safely limiting the pandemic, while reopening the economy as a return to normal.  The government of Vietnam remains committed to opening the economy, including tourism.  Debate continues between the Ministry of Culture, Sports, and Tourism and other ministries over cumbersome conditions for tourists after supposed full opening next week.  Accordingly, the specific conditions of the return to normal are still not clear.

As the risk seems low for poor outcomes among vaccinated people without old age or other risk factors, many are fatalistic about catching the disease and moving on.  This is in keeping with MoH and Prime Minister statements to move Covid-19 to a common disease that does not disrupt our lives and the economy.

In the meantime, at AmCham Vietnam, our Event Rating Levels LINK encourage participants in our hybrid or in-person events to self-test with a Rapid Antigen Test on the same day of an event with a large group, and to stay home if they are feeling unwell.  So, we all continue taking what precautions while returning to live as normally as possible.

“…just can’t kill the beast”

“They stabbed it with their steely knives, but they just can’t kill the beast” (The Eagles’ “Hotel California”) could be describing Vietnam and the world trying to end this pandemic.  People are tired of two years of stress from living under a cloud of possible illness and death.  The stress and anxiety extend to job, family, social activities, schools, and travel restrictions, plus special behavior, as in the 5Ks.  But the pandemic beast is still alive and stalking us.

A key lesson is “Pandemics End Psychologically Before they End Biologically”.  From a fine article from the Washington Post, “The Hard Lessons We Learned…in Pandemic School”, by Joel Achenbach (By now we should have learned these 10 lessons from the pandemic – The Washington Post).  We are resuming our lives with a heightened risk of illness but are resolved to move on.  Today we seem to live out a strange brew of fear and nonchalance.

Game theory tells us that risk aversion increases proportionately to the direst outcomes, even with very slim odds.  The converse is also true: the much less deadly Omicron variant, in a highly vaccinated population, is not causing increased death and serious illness (hospitalization), resulting in less fear and less regard for risk.  Many are saying, “bring it on and let’s get this thing over with”.

The facts are mixed.  Case numbers have exploded, but the government and the population have learned that case numbers are not as important indicators, as death and serious illness.  Seven-day average deaths are 90: 2 months ago, over twice as many.  Serious cases, likewise, are less than half, even with reported cases four times what they were two months ago.  With a vaccination rate of 79% and serious cases manageable, the government is wisely continuing to open up and allow us to  “live safely with the virus”.

However, with the surge in cases, we are doubling down on the 5Ks, and many larger gatherings are being postposed, going back on-line, or hybrid.  Although we are living with the virus, we need to keep on keeping on with our well-known precautions.

All of us know several people with Covid-19 who, although ill, are weathering it out at home safely.  Because different authorities and locales use different criterial, the best way to manage at home is somewhat confusing.  The official Ministry of Health recommendations are included in these pointers:

  • Stay home and do not go out if testing positive, even once. MoH recommends 7 days for a positive home test, 5 days for an F1.
  • Get an SpO2 (oxygen saturation) monitor. If persistently below 95%, seek medical attention
  • Test negative twice at one week, or longer until the tests are negative. Your workplace may have specific requirements.
  • Isolate from other family members as much as possible. Always wear a mask when within the same area as another person.  Wash frequently and scrub sown all areas in direct contact with the infected person.
  • Stay well-hydrated, rest, eat healthy foods.
  • Molnupiravir from the start is the most effective medication. For high-risk people, this is an essential. There are many products on the market that are not effective. Additionally, Vitamins C and D may be helpful.
  • Panadol is sufficient for treating pain and fever. If not, seek medical attention.
  • For the F1, use saline (salt water) nasal spray frequently to decrease any virus that may be in the airway before it can cause disease. This is now a Ministry of Health recommendation.

When out and about, the best mask is a K95.  Although disposable, they can be washed and reused up to 5 times.  A K95 can be worn beneath a cloth mask that may not be as effective at preventing the highly contagious Omicron variant that is now responsible for 76% of cases.

It is likely that in one to two months, this surge will rapidly decline.  However, the experts differ on whether this Omicron surge will bring us “herd immunity” and Covid-19 will just become another annoying flu.  Others fear the BA.2 variant of Omicron.  It is known that previous infection does not confer absolute immunity to Omicron, and the newer variants may keep the pandemic going.  This open question is as elusive as the new normal.

Come Fly with Me

The good news is tomorrow (February 15th), Covid-19 travel restrictions from Vietnam will end.  There may be screening and vaccine passports will still smooth the way.

We see general opening up and life and business-as-usual are  resuming.  Kids are back in school; malls and markets are filling up again.  The only tell-tale of continuing pandemic is the occasional call for the green pass for vaccines and masks remain ubiquitous.

The government of Vietnam is embracing “living with the virus”.  Cases have exploded after the Tet socializing and over 100,000 international visitors:  the “Tet Bump”.  Official daily case numbers (7-day average) are about 25,000 and rising, with likely many more quarantining at home.  But in a population that is nearly 80% vaccinated, disease has typically been mild, and daily deaths have plummeted from about (7-day average) 250/day in late December to 89 yesterday.  Serious cases have declined from 7767 in late December to stabilizing at about 2600 now.  HCMC’s largest Covid-19 care unit, the Resuscitation Hospital in Thu Duc, is closing.  Omicron cases have remained low at 197.  So, the key metrics, deaths and serious illness that overwhelms the healthcare system, are reassuring.

With businesses open, less quarantining and checking, life is returning to a new normal and conversations now turn to the stuff of normal life and future plans, and much less about the pandemic that has threatened and transfixed us for 2 years.

As the experience of living through a pandemic begins to fade, what will the next chapter in this journey bring?  Now thoughts turn to the “new normal” frontier.

In the Home-stretch

A new lunar new year has come in, and the fears, frustrations, and losses of the departing year are happily left behind. The old year is ushering in the new with greatly diminished impact of the pandemic and high hopes for the Year of the Tiger roaring in and with it, normality. Deaths from Covid-19 are only half what they were in recent months and official case numbers in HCMC are less than half of two weeks ago and with only four deaths on February 6th. There are 2829 serious cases on a nationwide 7-day rolling average now, compared to 5988 only three weeks ago. Deaths have dropped from 195 just three weeks ago to 94 as of yesterday (February 6th).

Travel for the Tet holiday was easier, with greatly simplified paperwork for international arrivals, no more testing on arrival, options for home quarantine, and no more requirements for pre-travel rapid tests for domestic flights. Private hospitals are now invited to support home quarantine, making Vietnam a much more inviting place to visit. Limited markets and festivals still maintained holiday traditions, while fireworks and other major events were canceled to protect the population.

The Ministry of Culture, Sports, and Tourism has urged the Prime Minister to drop all pandemic-related restrictions on international travel by the end of March. AmCham and several other international business chambers, have advocated similarly.  The PM has stated that Vietnam must be prepared to safely reopen tourism, ideally at the end of March and no later than the end of April, noting the need for booster shots and appropriate immigration policies.

The low death rates and morbidity of current cases are likely due to the high rate of vaccination, with 77% of the entire population vaccinated with two shots and 30% already boosted with a third shot. The Ministry of Health has shown that 85% of Covid-19 deaths are among those who are not vaccinated.

Now supplies are being gathered to vaccinate 5–11-year-olds, thanks to a large order from Pfizer and some generous donations.  Since all schools will be open for in-person classes after Tet, vaccinating school-aged children is important to living safely with the corona virus.

Some have expressed concern over occasional deaths following the vaccination in teens and some in adults. These have occurred very quickly after injection and have been from anaphylaxis, a severe allergic reaction that shuts off the upper airway. However, prompt action with a shot of epinephrine, available in all emergency medical kits, is nearly always rapidly curative. The CDC-USA studied one week in which nearly 2 million vaccines were administered, and 21 cases of anaphylaxis were documented. All recovered with zero deaths. The vaccines are very safe and definitely are much safer than contracting Covid-19 without being vaccinated, even for a young person. Proper staff equipage and training are needed and are now widely available.

Medical workers, even with decreasing serious cases, enjoyed little time to celebrate Tet. Already short-staffed and overworked, they continue their dedication to saving lives and treating the sick. We need to respect their tremendous contribution to the overall good results that Vietnam has enjoyed during this pandemic.

Tet travel and socializing may cause another possible surge of cases, perhaps with the Omicron variant or its variants. Now that the threat of the pandemic is diminishing and we look to a time when life returns fully to normal, that could be disappointing.  But as we have faced down the other surges, we will get through this if it develops. The high vaccination rates in Vietnam make us well-prepared.

In this Case…

The Ministry of Health is developing the actual strategy for “living with the virus”, after continuing to classify risk by areas according to perhaps inaccurate case numbers.  It  will be shifting to considering healthcare capacity, vaccination rates, and compliance of an exhausted public.  The case numbers are still the big daily headline, however, and many provinces still must adapt.  So, it will not be a quick change from counting cases to actually living normally, but with the virus.

The wild card is the Omicron variant, predominant in most of the world after only six  weeks.  Omicron infections are still rare in Vietnam with no community-based cases, yet.  Yesterday (16 January) HCMC reported 18 more Omicron cases, for a total of 30.  Fortunately, all currently are imported and were promptly quarantined.

It is estimated that 140,000 overseas travelers will come to Vietnam during the Tet Holiday.  Commercial flights are steadily increasing to many countries, although re-entering Vietnam is still paperwork-heavy, expensive, and time-consuming.  The Ministry of Health has asked all nationwide healthcare authorities to prepare for an Omicron outbreak from the Tet influx.

By the numbers: 15,935 cases nationally, 7 day rolling average (for those still following official case numbers).  This has held steady, although the official case count throughout the pandemic has now topped 2 million.  With sixty of the 63 provinces with adult vaccination rates over 80%, serious (hospitalized) cases have declined from 7717 one month ago to 5865 now.  Significantly, deaths have dropped to the lowest levels since November 2020: 139 on 15 January, 129 yesterday.  The rolling average has dropped from 239 to 184 over the month.  There are 650 patients on ventilators, a decrease over a month ago.

HCMC will be closing four field hospitals because the serious caseload is dropping.  Hanoi crossed 3000 daily cases yesterday and Da Nang is also experiencing higher case numbers: 1/3 more cases per capita than Hanoi.

Since the Omicron variant is not as severe as the other varieties of Covid-19, some have advocated allowing it to sweep the population and hopefully develop “herd immunity” and become simply endemic.  However, although the surge in Omicron seems to be limited to a shorter time than previous variants, the sheer numbers have swamped healthcare systems worldwide, although deaths are down.  It has hobbled economies, with many workers infected and staying at home quarantined.  Also, Omicron variant appears to affect children more than previous versions of the virus, and children’s hospitals are overloaded in many places.  So, there are downsides of allowing Omicron to spread unabated.

Another major drawback to allowing Omicron to sweep through is “long Covid”.  Between 10% and 50% of Covid-19 cases have disabling symptoms for several months or longer after the original illness.  This can manifest as chronic fatigue, headaches, severe shortness of breath, and other disabling symptoms.  Long Covid can also occur after Omicron, although the rates and severity are not yet known.  Because of the phenomenon of “Immune escape”, one of Omicron’s attributes, the virus may stay in the body for longer periods of time and theoretically could cause high rates of long Covid.  If it is on par with earlier versions, it can affect quality of life, families, and impose an ongoing burden on the healthcare system and economy.

Vietnam, along with the rest of the world, is learning about Covid-19 as we go.  At this point, the high vaccination rate and experience are hopeful for emerging from the pandemic over the next few months, as we begin to live in a new normal.

Whither Tet?

Has there been a subtle shift in living with the pandemic? For two years, all conversations seemed to begin and end with Covid: information updates (often incomplete), concerns, responses by other countries, and personal reactions. As it wore on, the mental stress seemed more prominent. As the Year of the Tiger emerges, conversations are more about life beyond living with the pandemic, as we cautiously contemplate a more normal future.

However, even the wildest optimists do not see a quick end to Covid-19.  But it seems to be manageable now, even with tremendous inconsistencies and waffling on specifics.

The bad news, of course, is that case numbers remain persistently high, and the burden has shifted from HCMC to provinces close to Hanoi and other more rural provinces with less resources. The admirably high national vaccination rate of over 73% (exceeding the very ambitious goal of 70% by the end of 2021 from nearly zero in early July), provides assurance against huge disease burdens and deaths. The high vaccination rate has led to a crude death rate of about 1.2%, less than half at the peak of the pandemic 4th wave in summer.  It is likely lower, since many people home-test and self-quarantine with mild or no symptoms, without reporting to health authorities. Likewise, serious cases have dropped from 7775 to 6438, from December 24 to January 8 (rolling 7-day average).  Deaths are down to 214 from 244.

HCMC seems to be leaving the worst of the pandemic behind.  Deaths (20 on January 8th) are the lowest since early July.  Cases are about half what they were only 2 weeks ago.  Hanoi, on the other hand, keeps setting case records, although deaths have been very low – 13 on Friday.

There are still no community Omicron cases and only 30 total.  But given the high transmissibility, it seems to be a question of when, not if, Omicron will sweep into Vietnam.

Most studies have noted that Omicron is much less virulent and deadly than previous strains.  Death rate of those hospitalized was 2.7% as opposed to over 20% in previous waves in South Africa, and length of hospital stay decreased from 8 days previously to 3 days with Omicron.  Significantly, 66% of hospitalizations were from unvaccinated patients.  This means that even if Vietnam encounters an Omicron wave, it is likely not to overwhelm the healthcare system or cause more deaths.  Some experts believe this is the path to “herd immunity” and a significant decrease in the burden, inefficiencies, disruption, and cost of this disease.

Case detection has become a worldwide quandary. It is known that a patient might be infectious 2-3 days before becoming symptomatic, or even testing positive.  The ability to be infectious usually tails off after a week, but can persist for 10 days.  90% of cases are not infectious after 5 days, so with much criticism, the CDC-USA does not require a post-infection test, after 5 days of home quarantine for mild or asymptomatic cases.

With Omicron now the dominant strain worldwide with its reduced susceptibility to vaccination, most countries are aggressively promoting booster shots.  Vietnam aims to have this fully achieved by the end of this quarter.  Israel is already offering a 4th shot.

With Tet coming, there is confusion regarding travel recommendations, with some areas welcoming travelers from in country or abroad.  Others, such as Thanh Hoa, Thai Nguyen, and Ha Tinh advise against returning home for Tet.  In the meantime, HCMC is now officially classified as a low-risk city and is fully opening all services, such as bars and karaoke. Hanoi is reopening its inside dining and other returns to normal, even with mounting but mild cases.

Although January 1st was to be a return to commercial air travel, paperwork to return to Vietnam is still daunting and can take a month or more, as well as being expensive.  Travel agencies have had trouble deciphering government requirements, as well.  Although open, commercial flights have not fully opened.  HCMC arrivals are all rapid-tested, although previously tested a day or two before travel.  Further, it is likely that rapid-tests are not as accurate on Omicron.  In HCMC, those who test positive on arrival or at the pre-departure PCR test are currently being sent to a quarantine hospital in Thu Duc as part of an effort to prevent the spread of Omicron.  Home quarantine is now allowed, although it can be difficult to get signed district approvals that some airlines require.  Although the quarantine time on arrival is now three days for those fully-vaccinated, it can take longer while waiting for PCR results.  Families with unvaccinated children are required to quarantine for 7 days.

The government will be trying to simplify the directives for the upcoming Tet Holiday.  Stay tuned.

Are We There, Yet?

The fifth Covid-19 wave is engulfing Vietnam – and the Omicron variant hasn’t even arrived, yet.  However, the steep increase in reported cases since early November is flattening.  The new cases on December 18 were 15,883, with the 7-day average of 15,274 (excluding a day when Tay Ninh added over 18,000 previously unreported cases).   More significantly, serious cases (on oxygen, ventilators, and ECMO) nation-wide were 7893 with an average of 7798.  Increasing home quarantine for asymptomatic cases is helping to relieve the strain.  Although busy, the healthcare system has the capacity to manage the cases.  Fortunately, deaths were stable at 248 with an average of 249.

The provinces continue to document increased cases, even as the vaccines are rolling out there.  Hanoi is also experiencing record numbers of cases, now often outpacing HCMC.  HCMC’s reported cases have stabilized: 1019 on the 18th, with a 7-day average of 1089.

The vaccines are starting to saturate the population. Vietnam is in the top 3 countries world-wide for its rapid rate of vaccinating people.  About 81% of those over 14 years-old are fully vaccinated, compared to less than 200,000 at the end of June.

There is an important change in the WHO recommendation regarding booster shots. December 17th, Vietnam ‘s Ministry of Health also recommended booster shots at 3 months, not 6 months as previously.  The British Journal of Medicine just published a study showing increased susceptibility after just 90 days, following full Pfizer vaccination.

However, fear not: preliminary data suggest that a booster shot restores immunity, including against Omicron. This, and the rapid world-wide spread of the Omicron variant that is partially resistant to 2-shot vaccine programs, has prompted many countries to rapidly expand their booster programs.  Vietnam plans to complete booster shots for the entire country by mid-2022.

Omicron is spreading wildly throughout the world, although Vietnam has no cases to date.  It is much more transmissible than the Delta variant. Delta is the predominant variant in Vietnam that resulted in the huge 4th and 5thwaves that created 1.5 million cases after just a few thousand with previous SARS-CoV-2 infections. Delta has been responsible for 29,316 deaths in Vietnam.

Although hospitalization rates in UK are comparable between the 2 variants, South Africa finds a large drop in hospitalizations as Omicron replaces Delta.  Although Omicron has only been recognized for about a month, intensive research is ongoing regarding Omicron’s behavior and virulence.  At this point, it seems much less virulent with only 1 death (in UK) widely reported.  For those hospitalized, the length of stay is about 3 days with Omicron, but 8.5 with Delta.  This could also conserve healthcare resources.

There is a balancing act in Vietnam as elsewhere between the need to reopen as so many are emotionally and financially depleted on the one hand, and protecting lives on the other.  Secondary schools have reopened in HCMC.  In the face of a few cases; they are resolved to remain open.  It was proposed to drop the nonhome quarantine requirement for travelers this month.  But with the surge and variant worries, travel liberalization is delayed until next month.  And then the quarantine requirement will be at home for only 3 days (with appropriate testing).

Since Omicron can attack those who were previously infected as well as a majority of those vaccinated, the sheer number of cases is already overwhelming some healthcare systems.  This is on top of Delta infections that are still filling hospital beds in UK, USA, and much of the world.

The best-case scenario: this very transmissible but mild variant infects most of the world or is effectively vaccinated against.  Then with community immunity, new variants are much less likely, and the pandemic can wind down and no longer disrupt our world.  But for now, there are 2 quite transmissible variants sickening people and killing some, world-wide.  The people as well as the health authorities in Vietnam should be recognized for persevering and adapting to this tenacious pandemic.

Omicron is still not prevalent in SE Asia.  Most Pacific countries’ Covid pandemic is more quiescent than in Vietnam and South Korea.  But is Omicron coming to a country near you?

The Beat Goes On

Another week with increasing cases, moderate deaths and numbers of serious cases, and steps toward opening. HCMC average case numbers were steady as were serious cases and deaths.  Hanoi’s numbers have gone up and some of their hospitals are bumping up against capacity.  Da Nang has seen steadily rising cases as well.  To put this in perspective, Vietnam ranks 35th among 223 nations in case numbers, but 149th in cases per million population.

Ho Chi Minh City already developed healthcare capacity during the massive outbreak of July and August.  It is again increasing capacity back up in the HCMC Covid-19 Resuscitation Hospital: beds will increase again to 300-500, and the Department of Health is urging all major hospitals, including private, to allow for increasing Covid-19 cases.

As the HCMC homecare program develops, more minor cases will be treated at home.  At last count, 66,000 were under homecare, about 3,000 in hospital on oxygen, 370 on ventilators in the city.  In the entire country, there are 6,778 in serious condition, with 665 on ventilators and 14 on ECMO.   Although cases are increasing, there is still capacity within the system overall.

Dr. Le Minh Khoi, Deputy Director of the HCMC Medicine and Pharmacy University Hospital’s Covid-19 treatment center, noted that, even with a 94% vaccination rate in HCMC, 50% of serious cases are unvaccinated.  93.5% of deaths are in people with serious underlying health problems and average age of 72 years.

Another 4.4 million doses of Pfizer arrived from USA over the weekend.  The final contracted 1.5 million Astra Zeneca vaccines have also arrived.  The cities are already highly vaccinated, but as cases and deaths increase most dramatically in the outlying provinces, vaccines are welcome.  Vietnam now has 59% of the total population vaccinated or about 76% of those over age 14.

It looks like Vietnam may be opening up to more international air travel on January 1, but details are still pending.  Deputy Prime Minister Pham Binh Minh announced Thursday that commercial flights among designated countries, including the USA, will reopen on January 1, to speed up economic and tourism recovery and enable overseas Vietnamese to return home for the Tet holidays.  Deputy Prime Minister Vu Duc Dam on Wednesday had instructed the Ministry of Health to move the required 7-day quarantine from a quarantine hotel to home quarantine, after arrival of fully-vaccinated individuals from overseas.  The Ministry of Health now has been instructed to issue new guidelines to implement this change, with the Ministries of Public Security and Information and Communications to develop new monitoring  and tracing software, and the Ministry of Foreign Affairs to focus on negotiating more mutual recognition of “vaccine passports”.

Focus on the Omnicron variant has dominated the globe recently.  While this variant thankfully appears to be marginally less lethal than other variants, it certainly spreads rapidly and shows more resistance to vaccines. Accordingly, booster shots are now being recommended in most countries, including Vietnam.  Initial work by Pfizer and a study from UK show that a 3rd shot brings about 75% immunity.  Of 40 patients with Omicron studied in USA, most have been vaccinated, although most over four months ago.  Significantly, there were no deaths and only one 2-day hospitalization.  Omicron has not been reported yet in Vietnam.

The keys for living safely with the virus in Vietnam are the capacity of the healthcare system as case numbers increase and continued progress in vaccinating the entire country.  In the meantime, steps are cautiously being taken to fully open lives and the economy, including travel.  So, keep those masks on and stay distanced.  Follow the guidelines as they are announced.  And get that booster when available, ideally six months after your last shot.

“It’s Déjà vu all Over Again”

It doesn’t seem that long ago that case numbers and deaths in Vietnam had dropped steeply.  We were preparing to live with the virus, open up the economy, and people’s lives.  Now we are seeing case numbers increase, but still not so many serious cases in HCMC and Hanoi, while new cases, serious illnesses, and deaths are increasing more significantly in provinces with lower vaccination rates, where the medical facilities are not yet ready for many serious cases.

Globally, we are facing a new, very transmissible variant, Omicron.  There are many more questions than answers, but in just two weeks, Omicron has spread to most major countries and is stressing the healthcare system in South Africa, where it was first identified.  What will this mean to Vietnam, while we are in the midst of a fifth wave of Delta infections?

The rate of infections has gone up in most places, especially in the Southern and Central provinces.  Although the cases have gone up, as well as deaths and serious illness, the deaths are still far below their national peak in early September: a weekly average of 377 deaths per day.  This week ended with an average of 196 deaths per day. Healthcare resources were stressed and inadequate at the beginning of the fourth wave in July.  Between July and October, over 1000 healthcare workers quit, likely due to burn-out from that period.

Now, nation-wide, the resources are adequate and healthcare workers are no longer overwhelmed.  There are 6778 patients in serious condition (requiring oxygen), 665 are on ventilators, and 14 on ECMO.  In HCMC, 3000 are serious and 370 are on ventilators.  There is still capacity in the hospitals.  There is finally a movement to more home-based care, with 66,862 with mild or no symptoms being treated at home in HCMC.  The private sector hospitals and clinics now have been formally asked to participate in the mobile care program.

Of note, even with HCMC’s highly-vaccinated population, 50% of hospitalizations are unvaccinated.  There have been 126.8 million total doses given nationwide, with 56% of the population now vaccinated, or nearly 80% of adults.  This was accomplished in about four months, a massive effort that is now showing its impact in greatly decreased serious cases and deaths.

However, this week in Thanh Hoa, there were a few deaths following vaccination, and 120 high school students were hospitalized for severe reactions to vaccination.  Since this was confined to limited regions, the cases are being studied and the vaccine batches analyzed.  Although shocking, it is a very small number compared to the 126.8 million vaccines given, with very few severe reactions.

With high school children widely vaccinated, the question is whether and how fast schools should reopen?  Hanoi and HCMC are piloting programs to reopen this month.  To live with the virus means that our children must continue their education.  However, children can contract Covid-19 and can spread it at least half as much as adults.  It is very unusual for children to suffer serious illness. Several countries saw no impact on the pandemic with schools open, but a few experienced an uptick in cases.  With the highly-vaccinated Vietnamese population in most places, and potent, oral, antivus medications soon to be available, the risks of opening schools have decreased.

The American Academy of Pediatrics is advising schools to reopen.  There is strong evidence that learning and social maturity are adversely affected by prolonged on-line learning.  Balancing risks, schools are advised to reopen.  In light of the risks, masks, hand sanitation, and proper distancing need to be enforced, as well as careful attention to cleaning and properly disinfecting the schools.veryone worldwide is concerned about the rapidly-spreading Omicron variant identified less than four weeks ago.  Many investigations and studies are underway.  It is clearly very transmissible.  However, there is no excessive demand for hospitalizations among the many cases now seen in South Africa.   Deaths, if they have occurred, are rare.  Most cases so far have been quite mild, with symptoms limited to only a few days.

It does appear that reinfection is more common with Omicron and vaccine effectiveness against it is still being studied.  The vaccine makers are working intensively on determining the efficacy of their current vaccines.  Modified vaccines to address Omicron can be ready within 100 days.  In the meantime, booster shots are strongly recommended, now, for all who have completed their two vaccinations.  The current standard is a six-month wait after the second shot.  Omicron may move that timeframe up a bit.

The world is acting preemptively by banning travel from many African countries and otherwise tightening borders.  Vietnam continues to cooperate with WHO and USCDC for policy recommendations.

In the meantime, with a fifth wave of Delta and a new variant still to be characterized, the pandemic is not over.  We are living with it, but it is not fully predictable.  It is important to keep our guard up and protect ourselves in order to “live safely with the virus”.

Keep on Keeping On

Every battle has changes in momentum, from favorable to unfavorable and back again.  This week, two new issues about “living with the virus” have developed.  This is the time to persevere.

Although there is still movement toward opening up, cases per 100,000 population have increased, triggering upgrades in risk assessment.  However, there is a strong likelihood that cases are grossly undercounted.  Many people test at home and may test positive, but feel well and do not want to risk centralized quarantine, occasionally arbitrarily applied by authorities.

Dr. Nguyen Truong Son, Deputy Minister of Health, states that case counts per population are unimportant.  Important, instead, are the numbers of serious cases, deaths, and hospitalizations.  Since hospitalization now is overused in nonserious cases, even this number could be inaccurate.  Dr. Son also strongly supports treating mild Covid-19 illness at home, especially with Molnupiravir which has been very effective at preventing hospitalization and death here in Vietnam.

As of two days ago, 95,932 total cases were under treatment, with 52% being treated at home, 42% of cases are being treated in hospitals, and the remaining 4% in quarantine facilities.  Serious cases, however, only constitute about 3.6% of total cases under treatment, indicating current trends of over-hospitalization.

By the numbers: Vietnam’s weekly case average on October 27 was 3544; it was 16,096 on November 27, an increase of 450%.  Serious cases went from 2938 to 5301, an increase of 182%.  Deaths went from 63 to 144, an increase of 230%.  So, the rate of increase of serious illness and death is about half or less of the increase in known cases (with probably many uncounted cases, decreasing the risk of serious disease and death even further).  Hospital resources were expanded for the large numbers of serious cases from July to September before there was widespread vaccination.  Most hospitals in major cities  are not at capacity, although there are some personnel shortages, but with cases growing, some outlying provinces are reaching capacity.

HCMC continues to establish criteria for reopening.  Some “nonessential services,” like karaoke and massage parlors, can reopen in safer areas with some restrictions.  But travel between zones and entries to HCMC from outside will be more stringently patrolled.  Other Southern and Central provinces are experiencing large increases in case numbers and some are placing more severe restrictions.

As tourism and business travel has impacted the economy so severely, there are proposals to eliminate quarantine for fully-vaccinated travelers.  Routine international flights have also been proposed.  Both could take effect as early as next month.  If we are living with the virus, even the occasional infected but vaccinated traveler is unlikely to change anything on the ground in Vietnam.  However, this is dependent on the virus situation in the rest of the world.

Meanwhile, the vaccination rate continues to climb.  Now, over 50% of the adult population of Vietnam is fully vaccinated, and over 90% in HCMC and Hanoi.  More vaccines continue to arrive, with a recent delivery from USA of 4.1 million doses of Pfizer vaccine.  Totally, USA has contributed over 20 million doses, more than any other country.  The daily average of vaccine administration is 371,801.  Unfortunately, four workers who received Vero Cell vaccines at a Thanh Hoa shoe factory died of severe reactions after their injections.  These cases are being investigated to determine the cause, since vaccines have been very safe through 112 million doses given, including millions of doses of Vero Cell.

The dark clouds are gathering over the Omicron variant, just named by WHO and designated a variant of concern.  It was first gene-sequenced November 11th.  As of this writing, only a few cases have been detected world-wide, after originating in South Africa.  The Omicron variant is thought to be even more transmissible than the Delta variant that continues to wreak havoc on Vietnam and the world.  Already, 90% of the new cases in the province of South Africa containing Johannesburg, are the Omicron variant.  In the lab, it is known to have several unusual mutations in the spike protein.  The impact of this is not yet known.

Additionally, its virulence is not yet known, nor its susceptibility to current vaccines.  However, four cases were found in vaccinated people in Botswana.  There have been no reported deaths to date.  A South African doctor has observed that the patients she has seen have not been very ill, but they have been younger people.

There is a bold and fast reaction to this variant since the response to Delta was delayed.  Whether this will prove helpful or specious remains to be seen; not enough is known about this very recent variant.  Scientists worldwide are intensively studying Omicron and should have some answers in 1-2 weeks.

Many countries, including some in ASEAN, have restricted travel from South Africa and other affected African countries.  The threat of Omicron could further delay liberalization of international travel to Vietnam, particularly since Omicron already has been discovered in Europe and Hong Kong, too

So, the new normal is uncertainty.  We need to keep up our guard and continue a more cautious lifestyle, while questions are answered and pathways are forged

On-Again, Off-Again

There is always some question about which way to go with this pandemic that has stubbornly high rates of new cases, but generally stable rates of serious cases and deaths.  Worldwide it has also varied from China’s heavy-handed attempt to achieve zero cases to UK’s laissez-faire approach since the population is highly vaccinated.  And everything in between.

In Vietnam, there is opening up and then closures in reaction to new case numbers.  And reversals the other way due to the impact of restriction s on the economy. The bars, clubs, karaoke, and massage parlors were open for two  days this past week, then closed again.  This meant more economic pain, as businesses rehired, restocked inventory, then were closed for an indefinite period.  Hanoi was shocked by the explosion of cases in the South and reinstituted a quarantine which was also rescinded later in the week, as it was damaging the economy and domestic tourism and hospitality sector just as it was starting to recover.

Nationally, case numbers are as high now as back in late September.   However, deaths and serious illness are dropping, comparing mid-month October to November vs. September to October.  This is a result of a highly vaccinated public in the cities, with the more rural areas and smaller cities catching up (57% of all adults in country fully-vaccinated and 95% with one shot).  As of two days ago, there were only 426 patients on ventilators and 9 on ECMO in the entire country.

As oral antivirals and mobile units promoting home care for asymptomatic cases increase, the importance of the case numbers decreases even more.  Many vaccinated people are contracting very mild cases of Covid-19.  This enhances their immunity to subsequent infection, as well as moving the country closer to “herd immunity”, through spread without serious illness.  The seasonal flu shot also increases resistance to serious illness from Covid-19: get yours soon.

The way forward on reopening is uncertain.  Although Thailand and other countries are making travel easier and dispensing with quarantines for fully-vaccinated travelers, only well-organized tour groups to isolated resorts are allowed so far in Vietnam.  Plans to open further wend into next year.  Because the 4th wave became severe after an open spring holiday, there is speculation that travel will only open more fully after the Tet holidays in February.

One positive result of the entire pandemic is how rapidly scientific research and development has progressed.  Vaccines in less than a year, effective oral medications in less than two years. Medical digital technology and generally enhanced digital communication have come into their own.

The mRNA vaccines (as well as Astra-Zeneca) have been shown to be the most effective vaccines.  This emerging technology may have applications for difficult vaccines for conditions like HIV/AIDS and malaria, as well as possibly cancer and other diseases.  There has been rapid development of the vaccines, so if the predicted and feared resistant variants arise, more effective vaccines could be only a few months behind.

Effective antiviral oral medications are game-changers.  Molnupiravir from MSD and Paxnovid from Pfizer can be taken at home and can effectively stave off severe disease and death in most cases.  HCMC has requested 100,000 more doses of Molnupiravir, having already used it on a trial basis even before its release in UK and USA.  Paxnovid, also an oral antiviral, from Pfizer has just been approved in the USA.

As the global policy landscape continues to evolve regarding lockdowns, restrictions, and quarantines, so too does the scientific advancement required to oppose this dread disease. A manageable equilibrium will likely emerge at some point in the future as history has shown with other viral and bacterial pandemics. What remains unclear is the exact duration and direction of that journey.

The Greater Good

As life gets back toward normal, with gathering and socializing, cases are rising.  However, deaths and healthcare system capacity remain manageable. Serious cases are increasing, albeit not as rapidly as known cases.

However, slippage away from the cautious 5Ks, with larger gatherings of people not distanced, forgetting masks, interacting at close range, and not being careful of hand hygiene may be spiraling us in the wrong direction.  Many establishments are not careful about green (vaccination record) passes and Covid QR registration, also potentially contributing to a rise in spread of this highly contagious disease.

Dr. Nguyen Van Vinh Chau, Deputy Director, Department of Health, HCMC, warned, “We are very worried. In the past few days, the number of deaths has increased more than in previous days…if the epidemic situation is so complicated that it is uncontrollable, the city is forced to tighten up, even return to implementing social distancing measures”.  HCMC has resolved to bear down and enforce national Resolution 128 and local Decree 18 which offer guidance on behavior while living with the virus.

After the long lockdown, people are longing for their former, more carefree lives to restart.  The vaccine does largely fend off severe disease in healthy individuals (only about 12% catch it and become severe cases).  This, along with the desire to return to the old normal, leads to a false sense of security.  Those vaccinated are not bullet-proof and lack of continuing precautions can lead to bad outcomes.  Now, 86% of hospitalizations in HCMC are vaccinated individuals.  A study from the Hospital for Tropical Diseases in HCMC found that although vaccination reduced severe disease from 74% to 40% among those hospitalized, that is still a significant risk.

Alarmingly, vaccinated people can still spread the disease as easily as the unvaccinated:  About 38% within a household are likely to contract it from an infected, although vaccinated, family member.  Even if an entire household is vaccinated, the spread is still 25% from this easily contracted but frequently asymptomatic infection.  Worse, a vaccinated person who contracts a severe case of Covid-19 can develop long-haul Covid with debilitating symptoms that can last for months or years.

So, as we return to more normal social and work lives, this is not the old normal.  Although we have some protection from the vaccine, it is not a free pass to disregard our tried-and-true 5Ks.

Another concern as the pandemic drags on: underreporting of cases. Even with known case numbers rising dramatically, this may be significantly undercounted.  Anecdotally, many people are self-testing positive for Covid-19.  They may have not been reporting, however, because the decision of where to treat seems to vary, depending on the ward and responding health official.  Asymptomatic F0s may find themselves arbitrarily treated at home or incarcerated in a very crowded, poor standard field hospital.  But these unknown cases also may mean further spread, especially if these asymptomatic carriers do not self-isolate.  So, case numbers may be artificially low and the spread of the disease not under full control or even recognition.

Mobile units are being developed in the provinces where the rate of increase is much greater than the major cities (which are also reinforcing their mobile units).  These units are essential to home monitoring and treatment of mild cases.  However, there are now fewer mobile units in HCMC than previously and these are understaffed. The Ministry of Health recommends staffing of 10 medical personnel per 30,000 population but is falling far short.  Steps are being taken to increase staffing.  When mobile units can reliably be used for homecare of minimally-ill patients, reporting and control may become more accurate.  This may make self-reporting to health authorities more reliable, if people are secure that they will not be arbitrarily treated, counter to the decrees that allow care in the home.

Vaccination efforts are rolling forward amazingly well.  Fully 92.8% of teens in HCMC have been vaccinated one time (statistically, 35% immunity and less serious illness).  Now, 66% of the adult population of Vietnam has had one dose, and nearly 32% are fully vaccinated, with over 1,200,000 doses administered on November 12th alone.  HCMC has transferred 900,000 doses to other locales, where the vaccination effort needs to catch up as their cases rise.

The silver lining of high case rates on a highly-vaccinated population is the likely development of “herd immunity”: ultimately, living with the virus with fewer cases, severity, and deaths.  However, Dr. Nguyen Minh Tien, Deputy Director of the Municipal Children’s Hospital, said, ” Vaccine coverage and adaptation with safety are inevitable approaches. To live alongside the virus, people must follow prevention measures and form new habits.”  The new normal is one of continuing caution and “attention to prevention”.

The challenges as we move to a new normal still need to be confronted.  These challenges include a tendency toward loosening discipline of the 5Ks, over-reliance on vaccines to totally guard against disease, and underreporting of cases, due to fear of incarceration.  Stay safe: keep those masks on; stay properly distanced; clean your hands, and report symptoms for the greater good.

Links:

HCM City tightens COVID preventive measures as cases increase – Society – Vietnam News | Politics, Business, Economy, Society, Life, Sports – VietNam News

Ho Chi Minh City Department of Health: May be separated if COVID-19 gets out of control – Tien Phong Newspaper (baomoi.com)

HCMC resolved to prevent Covid from breaking out again (appfast.me)

86 percent of Covid patients in HCMC hospitals are vaccinated: survey – VnExpress International

Fully vaccinated people can spread COVID at home, scientists say – Deseret News

Saigonese drop their guard despite threat of Covid resurgence – VnExpress International

HCMC needs 18 mln vaccine doses next year – VnExpress International

HCM City vaccinates 92.8 per cent of kids aged 12 to 17 against COVID – Society – Vietnam News | Politics, Business, Economy, Society, Life, Sports – VietNam News

Covid-19 in Vietnam: New wave tally tops 1,012,000 (vnexpress.net)

https://vnexpress.net/covid-19/vaccine

Afternoon 13/11: The whole country has received nearly 98 million doses of COVID-19 vaccine; many provinces record F0 in the community – Health & Life Newspaper (baomoi.com)

Covid infection surge without deaths can facilitate herd immunity: expert – VnExpress International

PM instructs intensification of measures to fight COVID-19 – Society – Vietnam News | Politics, Business, Economy, Society, Life, Sports – VietNam News

Rising Freedom, Rising Cases

As our cities have opened, people mix and normalize their work and lives.  However, cases and hospitalizations are now on an upward trend that could be worrisome.  This is “living with the virus”, as work resumes, restaurants, and bars open, crowds gather, and people mingle.

Cases have gone from 3027 on October 19, to 7480 on November 6.  Cases under treatment have also gone up from 36,911 on 10 October to 98,556 on 6 November.  One reaction is panic that the outbreak is breaking bad.  Fortunately, the authorities and most of us understand that this is part of “living safely with the virus”. The cases and those statistically under treatment, include a majority of asymptomatic cases in our increasingly vaccinated population.  Serious cases have only gone from 2840 on October 31 to 3235 on November 6.  Deaths are very steady and relatively low at 53 on October 31  to 58 on November 6. This is consistent with a well-vaccinated population with the epicenter, HCMC, now with over 84% pf adults fully vaccinated.

The most recent information on hospital utilization in HCMC, showed 240 on ventilators and 15 on ECMO, easily manageable.  Thus, high vaccination rates and available healthcare resources plus continuing careful 5Ks mean that even with rising case numbers, we are living safely and successfully with the virus and the cautious steps in opening can continue.

The Mekong Delta Provinces are seeing more cases, but although rates of vaccination are lower, there have so far not been many deaths.  Facilities are not totally prepared, and the medical teams not as experienced as in HCMC or Hanoi.  Several major hospitals in HCMC have contributed staff, equipment, and supplies to help in their meeting their needs.

There remain many questions about the disease itself.

Clearly, vaccination leads to better outcomes but does not guarantee not getting Covid-19. In highly vaccinated HCMC, 86% of hospital admissions this week were vaccinated, one or two doses.   However, a study of 349 patients from the HCMC Hospital for Tropical Diseases showed that 45% of cases were mild.  Of the severe cases, only 12% of fully vaccinated patients were severe, but 49% of those with only one shot were severe.  This compared to 74% of those unvaccinated being severe.

Other studies have shown a 35% risk of contracting the disease after only one shot, but about 85% protection if fully vaccinated.  Booster shots at 6 months, especially for those with higher risk or exposure is recommended and will be offered.  Viet Nam is now vaccinating 12–17-year-olds as rapidly as possible.  Based upon recent CDC (USA) approval, 3–12-year-olds will be vaccinated after other groups are more completely vaccinated.

A sad and frightening feature of the disease that has not been highly publicized in Viet Nam, is “post-Covid conditions”, or “long” or “long haul Covid”.  Dr. Nguyen Thanh Sang, Director of Centre for Rehabilitation and Psychiatry at Le Van Thinh Hospital says that 30-50% of cases have persistent symptoms that are often debilitating.  These can include severe shortness of breath, fatigue, headache, “brain fog,” and even psychiatric disorders (some teens who have had Covid-19 develop antibodies in their brains that are associated with psychosis).  These symptoms are most common in severe cases, most often unvaccinated.  Receiving the vaccine with long haul Covid often improves or eliminates it.  Otherwise, these patients do need to be under careful medical care.

The end game for Covid-19 us unpredictable.  However, many specialists believe that it will become less severe, but may persist.  New variants that are more transmissible or more virulent could prolong it as a very serious disorder.  Otherwise, as the population develops immunity, the disease, itself, will become less severe, more like a cold or seasonal flu.  However, the “natural immunity” from contracting the disease still leads to a 5 times greater risk of recurrent infection than those vaccinated.

Since Viet Nam and the world are still fighting the pandemic, this week has brought much hopeful news.  Viet Nam provided a Phase 3 site for Molnupiravir, MSD’s pill that drastically decreases the risk of hospitalization and severity of the disease.  Only 0.02-0.06% of cases became severe and there were no deaths.  Pfizer also rolled out its Paxlovid pill in USA, about 89% effective.  There are two other new treatment agents finishing trials.  One is a French medication that will begin trials in Viet Nam and plans are being made to produce it here.  Effective pills taken early in the course of illness’s  that prevent severity and death will be game-changers: Viet Nam has significantly contributed to their development already.

Living safely with the virus does not mean complacency.  It is important to continue masking, distancing, frequent hand sanitization, avoiding large crowds, and keeping your Covid data up to date.  Otherwise, enjoy our progress toward the new normal.

A “New Normal” Awaits

As the gates of the “new normal” are slowly opening, there is a reacquaintance with old times and familiar places.  We have been locked down for about 4 months, and it is liberating to resume something like normalcy.

Deaths and serious cases are declining.  There are several effects of the new normal as Vietnam and its cities reopen.  Restaurants, shops, malls, and businesses are open, and crowds are beginning to venture out.  Plans are underway to restore public transportation to previous levels, and once again open to international travel.

The carefully watched trends in the pandemic have been consistent with “living safely with the virus”.  Although the last few days have seen an upward trend in total cases under treatment, this has not been reflected in serious cases or deaths.  As of mid-October, there were about 37,866 total cases under treatment, but this has now gone up to 75,240 yesterday (30 October).   New cases per day have gone from 3159 (3411 weekly average) in mid-October to 5224 yesterday (weekly average 4376).  However, serious cases, in hospitals, have actually decreased from 3522 (weekly average 3757) in mid-October to 2831 yesterday (weekly average 2855).  Deaths have also decreased to 64 yesterday (weekly average 59) from 75 deaths (86 weekly average) in mid-October.

This is consistent with more mingling, with consequently more cases, albeit in a highly-vaccinated population.  About 80% of adults in the epicenter, HCMC, have been vaccinated.  Although there is a risk of contracting the disease even if vaccinated, it is not usually serious or deadly, as reflected in these figures.  Thus, as we open up, we see more cases, but the worst aspects have been dramatically decreased.

As workers have returned by the thousands to their homes outside HCMC, there have been rapidly-increasing numbers in outlying areas.  There has also been some increase in deaths, mainly in the South and Central provinces.  Nearly 1/3 of the deaths remain in the HCMC and Binh Duong areas, with the remainder scattered throughout the country, especially in areas where the HCMC outmigration sent the most people.  This will require stepped-up vaccination programs where the rates are still low, continued quarantining of returnees, and augmentation of healthcare system capacity there.

To increase safety, especially in children returning to school, the government is moving swiftly to vaccinate 12 to 17-year-olds.  Vulnerable and front line fully-vaccinated adults are advised to receive a booster shot six months after the second jab.

Fully opening, including karaoke, bars, and massage, is proposed by HCMC Department of Health, often the most cautious authority.  Also, resuming foreign travel without quarantine for vaccinated individuals is under consideration, with tentative plans for submission to the Prime Minister by 5 November, for action as soon as reasonable.

It is well recognized that there is much anxiety in returning to “normal” work and life. Many people experience apprehension and stress, and everyone’s experience is different. This has been true of children as well, with school and normal social growth disrupted.  Attitudes toward work and family are changing.  Many do not want to return to regular work-sites, when their school-aged children are home, and/or leave their family homes in the provinces.  Companies in HCMC and surrounding industrial zones are offering incentives to return.  What this will mean to labor supply, working and living conditions, and productivity is not known.

This effect on workers has been seen in pandemics before. The Bubonic Plague in Europe and England in the 14thCentury killed nearly 1/3 of the population. The remaining workers were in short supply, and many surviving workers chose not to return to poor conditions or pay and demanded better wages.  Because of the disruption, King Edward III of England issued The Statute of Labourers in 1351, keeping workers in place and at pre-plague wages.

The government of Vietnam has a 6-pillar program to revive the economy while keeping the public safe.  This, like King Edward’s Decree, is favorable to business and investors, but also encouraging for workers.

The “new Normal” is fast arriving.  What this will mean and how it will alter our lives and our society are being written day by day.

Venturing Out

There is an air of normality creeping into HCMC and perhaps Vietnam as a whole.  It is rampant in Hanoi where food and beverage outlets have reopened to large crowds of customers yearning for the joys of times past. Although cases have been steady (but less than half of a month ago), deaths and serious cases continue to decline.  People are venturing out to stores and malls.

The Saturday (October 23) case count was 3977, well over the 7-day average of 3400.  However, as of Saturday, deaths were only 56, with a 7-day average of 77.  Total serious cases were 3073, considerably less than the 7-day average of 3428 cases.  The disconnect between case numbers and serious cases and deaths is a product of vaccination and personal responsibility to stay masked, clean, and distanced.

The world leader in this disconnect between case numbers and serious outcomes is Singapore, with the highest per capita case rate in Asia, but a low incidence of serious illness and death.  In fact, the risk of contracting COVID-19 is 11 times less with full vaccination, and the rate of serious illness is 1% of those vaccinated but infected, while the risk of death is 1 in a thousand.

However, the out-migration of at least 1.3 million people from HCMC to their homes, mostly in southern or central provinces, has led to increased cases outside the three major cities.  Nonetheless, only 14 deaths were recorded Saturday in the entire country, outside of HCMC, Binh Duong, and Dong Nai.  HCMC had 33 deaths, far below its peak at nearly 250 just over a month ago.

This drastic drop in deaths and serious illness is largely due to control in the epicenter of the outbreak: HCMC: Binh Duong: and Dong Nai.  Their full vaccination rates are 80%, 75%, and 54%, respectively.  The country has now fully vaccinated 21% of the entire population, and continues to increase vaccinations, while expanding to children, 12-17 years-old.  The push for vaccinating is now for children in urban areas, particularly those at greater risk due to obesity or underlying illness, and in the more rural areas where clusters are arising as immigrants from HCMC return home.

This has led some experts to question whether further local quarantines and possible localized lockdowns based on case numbers will do anything other than prolong the economic slowdown and mental health burdens.

The question for the people, as well as the government, is what will open and when?  When will we return to unrestricted access to services and when will travel be fully open?  There may be plans to open some additional sit-down food and beverage outlets this week in HCMC, (beyond District 7), but details are pending.  When Hanoi opened bars, restaurants, and coffee shops last week, they were deluged with eager customers longing for “return to normalcy”, as the campaign slogan for USA President Harding urged in 1920, as the world was recovering from the last pandemic.

Travel is starting to normalize in-country with local airlines beginning normal schedules.  Fully-vaccinated passengers may avoid testing to many destinations.  However, fully-vaccinated travelers from HCMC still are required to test and isolate for seven days if they travel to Hanoi.  HCMC and other provinces are focusing on domestic tourism for the remainder of 2021, with an eye to opening to foreign tourists in Q1 2022.  Five localities, including Kien Giang, Khanh Hoa, Quang Nam, Da Nang, and Quang Ninh, have been approved for limited opening in November to foreign tourists who can quarantine on the beach at plush resorts.  Vietnam will accept vaccinated tourists from 72 countries with an additional 80 countries being negotiated.  However, a 7-day quarantine is still required.  With both Thailand and Singapore now having eliminated quarantine for fully vaccinated tourists, pressure will be on Vietnam to do likewise.

Medically, Molnupiravir, a promising oral antiviral medication, is nearing approval in the USA.  It is official: boosters can be mixed and matched in USA to strong effect.  Boosters are recommended for certain age groups or medical conditions and offer excellent enhanced protection.   The “Delta Plus” variant, recognized in Israel and UK, does not appear to be a gamechanger, as the Delta variant is, but it is very early.

Mental health issues may continue in Vietnam, given the many deaths, financial hardship, and recognition that the new normal at least initially will not be the old normal.  Some people may recover their mental health with perhaps their priorities rearranged.  Also, mental health issues are becoming more evident in children, as their normal socialization at school has been interrupted for so long.

Living safely with the virus and enabling a safe reopening and economic recovery is the common goal. That includes a desire to return to some sort of normalcy for society.  Increasing the vaccinations in outlying areas as rapidly as possible and adhering to the tried-and-true personal responsibilities, while healthcare facilities remain vigilant, is the path.

Vietnam is opening up.  Shops are mostly open, although not always offering full-service.  Although the streets are not as crowded as the “old normal”, people are out and about with the promise of further opening.  Many sectors remain closed, and businesses still face difficulties and uncertainty from the slow and only partial reopening.

Nobody alive remembers the last worldwide pandemic, over a century ago.  We are all experiencing an international learning curve, adjusting as we go and as more information becomes available.  WHO gives general guidelines, but each country applies its own specific policies to this strange new world.

Many other countries are returning to a new normal.  This approach is a “mindset change” to a world that must live with COVID-19.  This new mindset de-emphasizes case rates, while assuring vaccination, healthcare system capacity, and individual responsibility.  With high vaccination rates, serious cases and death rates are low, also the trend in HCMC.  Home testing has been effective in detecting and, when needed, treating cases.  Those who contract the disease self-report to the health authorities and receive care.  The true case rates are not known in many countries because in this setting of few serious cases or deaths due to wide-spread vaccination, case rates do not matter.

Although all but three districts in HCMC have been designated under control, HCMC is still considered “Orange”, or “High Risk”.  Department of Health Director Dr. Tang Chi Thuong said, ” has yet to enter the ‘new normal’ phase after basically putting the outbreak under control, moving from ‘very high risk’ to ‘high risk’ level”.

Under the new Resolution 128, there are now only two criteria for evaluating progress against the pandemic.  The criteria are (1) a high vaccination level, district by district; and (2) weekly new case numbers per 100,000 population. That number in HCMC is currently 150/100,000, or high risk.

However, other numbers suggest that if evaluated as other countries are doing, the risk could be assessed as more moderate.  Total cases in Vietnam on October 16th were 3211, well under the 7-day average of 3525.  This is compared to 8665 average, on October 1st, the reopening date.  Deaths (7-day average) have gone from 174 to 98 over that period.  HCMC, the epicenter of the outbreak, has gone from 4262 to 1086 7-day average cases in 15 days.  This is consistent with the experience in other countries as vaccination and public health measures control the pandemic.  Similarly, although HCMC has much less social-distancing after reopening, results continue to improve, as they did in Hanoi after the large crowds at the Mid-Autumn Festival.

The vaccination rate is key, as is ability to manage the decreased number of serious cases.  The fully -vaccinated rate in HCMC is 77%.  Dr. Thuong also stressed that the city continues to build capacity, so that every health outlet has oxygen available.  Mobile units continue to operate to provide home care.  Most significantly, there are only about 500 cases on ventilators, compared to 1000 previously, and discharges outnumber admissions, as hospitalization rates plummet.  Thus, HCMC meets key criteria used globally for full reopening, but could be held back in Vietnam by criteria reliying on case numbers.

Chasing case rates may believe not shifting from a zero strategy to living with COVID-19, as other countries are doing as they move their citizens and economies to the new normal.

Dr. Thuong notes that continuing to be personally responsible, observing the 5Ks, remains crucial in Vietnam as in other countries adjusting to living safely with the virus.  This is important for all of us in HCMC and throughout Vietnam as we move forward with reopening.

Will the Last One to Leave Please Turn off the Lights?

A week into the gradual reopening of HCMC and environs, there has not been a spike in cases – only in outmigration. According to media reports, as many as 2.1 million of 3.5 million migrant workers in HCMC and nearby provinces of Binh Duong, Dong Nai, and Long An want to return to home provinces. This motivation is caused by a fear of COVID-19, combined with extreme hardship in many cases as many migrant workers are still unemployed and are struggling to make ends meet.  Receiving provinces are concerned that the in-migration may result in unknown F0s spreading the disease to less-vaccinated home provinces in the Mekong and Central Highlands. This outflow of migrant workers decreases the uncounted population numbers in HCMC, however, and makes the reported vaccination rate in HCMC more accurate and effective. AmCham and our member companies have urged clear reopening plans now to enable safe reopening and economic recovery, and encourage migrant workers to stay in place and return to the workforce.

On the medical front, there remain differences between districts and wards as to what can open and on what terms. The timing of further reopening is unclear but obviously conditional on limited spikes in the outbreak. From three “controlled” HCMC districts a week ago, now all but two are considered under control.  Nationally, the 7-day running average of cases is now 4700, compared to 12,750 only one month ago. Most significantly, the 7-day average of deaths is 114 (only 105 on 9 October), compared to 333 one month ago. In HCMC, the 7-day running average of cases was 2001, compared to 6588 a month ago. Deaths were 74 on 9 October.

As the world and Vietnam learn to live safely with the virus and vaccination rates increase, the risk of serious disease and death are declining. Now 72% of eligible Saigonese have been fully vaccinated, surpassing the goal of 70% (although public health authorities maintain that 80-90% is required for the ultra-transmissible Delta variant). In fact, there are less than ¼ as many cases under treatment nationally than one month ago, so reopening has not adversely impacted healthcare capacity to date.

A note for those vaccinated. Antibody testing has become a fad and the one-upmanship of “my antibodies are higher than yours” has become the bragging right of the day. In fact, nearly 100% of vaccinated healthy people will have an adequate immune response from any of the vaccines available in Vietnam.  Additionally, antibodies are only one of several immune functions, so the test is not a complete answer to the risk question. Although members of the AmCham Healthcare Committee provide the test, we do not recommend it as a routine practice, since the information it provides is, at best, of limited value.

Everyone is psychologically ready for full opening, while still fearing COVID-19. There is some lack of clarity on what and when will we see full reopening. For example, it is proposed that some select tourist destinations can reopen in December, but full travel reopening may not be until June 2022. When can businesses dispense with the expensive and disruptive testing and allow their workers to leave the factories with less restrictions? When can factories actually reopen? How can recruiting of workers be enhanced with the extreme labor shortages due to the exodus?

WHO has recommended that VN continue to vaccinate fully, keep up individual responsibility (5Ks), and assure that the healthcare facilities can meet the challenge of reopening in the face of continuing COVID-19 cases.  These are the “Big 3”: vaccinate; continue individual responsibility; and assure healthcare capacity. The Ministry of Health will continue extensive testing for positive cases and continue to isolate localities based on case numbers, as well as isolating F1s.

Other countries that have successfully reopened in the face of continuing high case numbers have followed the Big 3 without resorting to case numbers as an indicator to change policy. Vaccination decreases risk of hospitalization and death 96%, making the critical criteria deaths and healthcare capacity. An AmCham epidemiological advisor suggests home testing that obviates armies of testers and trackers as well as the disruptions of isolating localities. It places the responsibility solely on the individual, sometimes a difficult pill to swallow in Vietnam.

Moving forward, the advice remains constant. Get vaccinated, if you haven’t been already, and continue wearing that mask, use good hand hygiene, stay distanced, avoid crowds, and register.

What do we do now?

That fine day finally arrived as the full lockdown has ended.  Directive 18 is now in effect –  a reopening with some restrictions.  There are many questions about the rules both generally and individually.  Opening up amid thousands of cases has led to anxiety among all parties.  Will we return to semi-normal or see a new rise in cases?

The trend of the Delta pandemic, although impossible to eliminate, is consistently downward.  Vaccinated numbers rise and extending care to patients at home has dented the death rate.  Now 56% of the eligible population are fully vaccinated and the Green card system to allow entrance to open businesses and areas is becoming reliable.   The 7-day national running average is now 8065 cases, and deaths at 166.  HCMC is at 4073 7-day average and deaths are ½ the levels of of 2 weeks ago.  Significantly, hospital discharges outnumber admissions and recoveries outnumber new cases.  Thu Duc City (including District 2) and District 1 have been declared under control.  Officially, COVID-19 is deemed under control, so the long-planned reopening is proceeding.

COVID-19 cannot be eliminated, and fuur months of lock-downs of varying severity have not come close to eliminating the virus, while lives and livelihood have been adversely impacted.  The “mental health vaccine” is sorely needed for the people who have been mostly homebound or in 3-in-place one road/ two stps schemes whereby they could not leave their places of work or hotels for months.

Everyone knows someone who died of this disease.  We know how transmissible it is and we also now know that the vaccine is not 100% effective at totally preventing the disease.  We are still at some risk of contracting COVID-19, even if fully vaccinated, but the chance of having serious disease is very small, about 1.8%, as opposed to 15-20% if unvaccinated.  This produces anxiety for many as we venture out.

Recent statistics from Singapore are telling.  Singapore is about 80% vaccinated and in “living with the virus”,  has opened up with some restrictions, accepting higher case numbers.  Some project up to 10,000 cases per day.  Friday, Singapore had 2356 cases (equivalent to about 5000 cases in HCMC, per capita).  That day there were four deaths, bringing Singapore’s total since the beginning of the pandemic to 107.  All four deaths were unvaccinated and over 50 years old.  The previous day there were six deaths, all elderly, but two had been fully vaccinated.  Of 1422 cases in hospitals, 543 were serious, of whom 533 were over the age of 60.  This indicates that serious cases will likely be minimal and deaths unlikely, but still a danger to those over 50 years of age or with pre-existing conditions.  But although cases are high, overstraining the healthcare system and large numbers of very ill or dead seem extremely unlikely in Singapore, given the high vaccination rates.

Regardless of risk category or country of residence, the “5Ks” remain vitally important in protecting oneself as well as the community.  That is, masking, distancing, frequent hand-washing, avoiding crowds, and being registered.  If not yet vaccinated, that is vitally important.  This disease is very transmissible, so it good to review the way it spreads.   The main route is through aerosol spread, very tiny droplets literally float in the air and can remain there for some time.  Singing, laughing, and talking put more virus into the air.  Thus, masks are essential when venturing out.  The virus can also spread by contact, so continuing frequent hand sanitizing is essential.  Since the aerosol multiplies with the number of people, avoiding crowds is important, especially indoors where a stodgy ventilation system can accumulate virus in the air.  Staying two meters away from others also decreases the viral load exposure.

So, as we open, what is safe?  How worried should you be?   Although the Delta variant affects twice as many younger people as  previous versions of SARS-CoV-2, they are still relatively likely to have minor disease.  The risk goes up with age.  Beyond 50 years-old, the risk increases.  74% of cases that break through the vaccine with serious or fatal result are over 65 years of age.

Diabetes, high blood pressure, kidney disease, immune disorders, and obesity are further risk factors to consider before engaging with the reopening.  If any of these factors describes you, consider avoiding situations where you cannot practice minimal exposure.

All of these risks are decreased with vaccination.  Overall, consider your risks and comfort level before engaging.  Get vaccinated and practice 5Ks whenever possible!

A New Day Dawns

The magic day, September 30, is getting close.  The Vietnamese government is expected to issue new directives regarding a reopening early this week.  Drafts already are circulating.  This is in the face of a pandemic that is not fully controlled, although trending the right way.  The thinking among many is that we must pursue restarting lives and livelihoods, while living with COVID-19, and reopening effectively and as quickly as can be done safely.

As the lock-down with “stay in place” drags on, the economic costs are mounting. There is also a high human toll.  Food security, housing, and jobs were most impacted.  Some children were orphaned.  Although the Government has allocated funds for relief, there have been bureaucratic delays in distributing benefits, driving some to attempt to sneak back to their home provinces.

The “new normal” is very speculative as to changes being wrought. Until the pandemic, mental health was very much undercover, because of its stigma.  One telehealth service was heavily weighted to mental health services because of the anonymity.  A recent study at Cho Ray Hospital showed that 67% of COVID patients requested mental health services.  A startling 73% of patients suffered from anxiety disorder or depression.  The lock-downs also have had a human cost, with recognition that a “Vaccine for Mental Health” is needed, as the VN government has recommended.

There have been some welcome signs of reopening in HCMC.  More restaurants have reopened and delivery services are allowed cross-district.  Exercising in some parks is permitted.

An opening soon in HCMC may be possible, but will require caution and close cooperation of businesses and residents.  Case numbers and deaths have been trending downward, although these numbers have been variable and still in the thousands.  Most notably, the HCMC death rate is nearly 100 less/day than 2 weeks ago.  Further, some field expansion hospitals will be closing, although they will keep their facilities in case there is another wave or a rise in cases after reopening.  Hospital admissions and critically ill have dropped dramatically, with ICU patients at one hospital dropping from 25 to 6, and those reliant on oxygen from 170 to 40.

These dramatic improvements may be due to vaccines, now with 98% of HCMC adults having received one shot and 33% with two.  666,000 doses of AstraZeneca and Pfizer arrived Friday and will be rapidly administered.  SinoPharm delivered 500,000 doses last week, as well.  Totally 6 million more vaccines are need by the end of October to finish vaccinating the 7.2 million HCMC adults.

The stage is set for reopening both in HCMC and throughout Vietnam with announcements expected this week.  The old metrics may not be applicable, including case numbers and positive tests.  To live safely with COVID-19, keys are high vaccination rates to decrease serious illness, and adequacy of hospital resources.  Both are strong currently.  Additionally, as Deputy Prime Minister Vu Duc Dam has recommended, there will be a need for strict adherence to the 5Ks discipline (masks, distancing, avoiding crowds, frequent hand-washing, and registry with government COVID-19 tracking sites).

Furthermore, vaccination status will become the ticket for freedom.  The proposed “Green Card“ system will allow greater access for those vaccinated, including for interprovincial travel.

This is an exciting time of expectation over how and how rapidly we can regain our normal lives and livelihoods.

Many Cures for the Same Malady

Anton Chekhov, the physician who was a famous Russian playwright, said, “when there are many treatments for the same malady, you can be sure that none work”.  Although the pandemic is beginning to slow in the south of Viet Nam, the best that can be said is that, of the many measures, some have worked.  Finally, the disease and death curves seem to be flattening.

The 7-day average of daily cases in VN is now 11,168, down from 12,712 7 days ago, 12,712.  Deaths nationwide have gone from 315 to 270, daily 7-day average.  In HCMC, 7-day average cases have gone from 6669 to 5793, and deaths have dropped more dramatically, with only 166, after 6 weeks of over 237.  Saturday’s numbers are down even more for both the country and HCMC, with 2000 and 1000 decreases below weekly averages, respectively.

Hospitals are still stressed, although some are at capacity, but no longer overwhelmed.  Currently, there are 40,888 patients under treatment (including over half as outpatients), 2514 seriously ill, on ventilators, and 23 on ECMO.  The number of children in hospitals has increased to 3145.

Vaccinations have been aggressively rolled out for the last 2 weeks with over 600,000 daily doses administered nationally.  In HCMC, 6.7M (97% of eligible in official 9M population) have received one vaccination, and 1.9M (27%) have received the full, 2-dose vaccination status.  More money was allotted for 20M Pfizer vaccines, expected as early as later this month.  1.4M AstraZeneca vaccines have been delivered recently, and several million SinoPharm Vero Cell vaccines have arrived.  Several vaccine donations from other countries have arrived, so every effort is under way to vaccinate the population as rapidly as possible.  Additionally, NanoCovax, the home-grown vaccine, is again being considered for use and new vaccines from Cuba and United Arab Emirates have been approved.

There has been limited opening of 3 HCMC districts that have “controlled the outbreak”.  Passes through different apps for the right to travel from green (low risk) zones, and green cards for personally completed vaccinations have suddenly appeared, within days of announcing the prolonged “stay at home” measures.  The official documentation has been slow and with errors, so the green card accuracy and availability may improve.  In essence, there is a Phase 1-Lite quietly coming into play.

Experts and leaders with different opinions and outlooks on the current situation differ on how to measure and how to proceed.  The Ministry of Health  has proposed rigid criteria for the pandemic being “under control”, which focus on rates of disease through extensive testing.  However, the Prime Minister has acknowledged the pandemic is here to stay and we need to adjust to “living with the virus safely”.  Some experts say that testing is wasteful and not productive, and that the extreme social distancing is unsustainable both for lives and livelihoods.  While the curve is flattening, it is unclear whether the severe distancing and locking down for 6 weeks has been as effective in achieving those results as vaccinations.

Although the HCMC government admitted not controlling the outbreak by  September 15 and therefore extended the extreme “stay at home” restrictions less than a week later, more travel is allowed, opening to at least some residents shopping at food markets, and other essential outlets with limits.  Restaurants and stores may now deliver across districts.  The new travel app and travel pass is in effect.  Green cards will allow fully-vaccinated people access to some stores.

“When old-fashioned thinking and traditional solutions do not manage to contain the Covid-19 pandemic, innovate…We need independent thinkers and innovators who are willing to break new ground and clear new paths instead of relying on old-fashioned, traditional thinking and methods”, according to Nguyen Thanh My, in VN Express.  So, there is a trend among some to look beyond rigid criteria, including case numbers, to metrics that allow rebuilding of the economy and lives.  Mr. Vu Duc Dam, Deputy Prime Minister, looks to 3 criteria: vaccination rates over 80%; enough oxygen and medications;  and suitable behaviors (continuing masks and social distancing).

HCMC has already reached this standard on first-dose vaccination rates, and will likely achieve 80% for second doses soon if vaccine supplies remain steady.  Regarding DPM Dam’s second point, there are 12,500 oxygen-equipped hospital beds, 9500 oxygen canisters and 117 tanks, so by this criterion, opening should be imminent.

There has already been a mild opening, facilitated by apps and technology.  Vaccines keep rolling out.  But massive testing and “stay at home” continues, as well as the disruptive and unsustainable 3 in place or 1 road, 2 destinations industrial policies.  Businesses have made clear a reopening plan and date certain is needed now.  Other views and solutions are emerging.

A Ticking Clock or a Light at End of the Tunnel?

The dueling demands of opening lives and the economy vs. controlling massive spread are colliding on 15 September.  This was the date mandated in HCMC to “control the pandemic”.

The economy has been locked down and a significant number of Saigonese have lost their jobs.  A recent VN Express survey (not clear geographic are) found 62% had lost jobs.  There is food deprivation in HCMC, and the vaccination rollout had slowed down for several weeks, until the last few days.  Yet cases and deaths remain high, and several international media outlets have revealed Viet Nam’s struggles and failures in the 4th outbreak.  The need to control Covid-19 is colliding with economic and human disaster.

The numbers of cases and hospitalizations have remained stubbornly high, although deaths in HCMC are dropping somewhat.  The death rate per 100,000 people in HCMC remains twice as high as any other area in Vietnam.  Keeping F0s at home has allowed better focus and more prompt detection of deteriorating cases in hospital.  The grossly overworked but stalwart doctors and nurses have been the true heroes, although their pay has been cut and they are threatened to lose their licenses to practice if they totally burn-out and quit.

The Central government, although changing goals and methods frequently, has positively decided twogame-changers.  First, there is recognition that there is no scenario for zero cases, so “control” of case numbers, hospitalizations, and deaths is the goal.  Second, the economy must be reopened, but in a way that still assures control of the pandemic. That balance is critical.

All parties recognize that with desperately needed reopening and failure of a tight lockdown to adequately control the outbreak, a high rate of vaccination is necessary.  The vaccine rollout is picking up steam again, mainly through VeroCell, the vaccine from Sinopharm in China.  This is the one that is available to Ministry of Health (MoH) and Department of Health (DoH).  Most other vaccines are scheduled for arrival later this month or next quarter, even into next year, while the need to reopen is urgent.

San Francisco, with a 90% vaccination rate, has opened its schools and economy without serious outbreaks, a guide to the pivotal role of vaccines.  As of September 9th, HCMC had given a single vaccination to over 7.3 million adults.  This is over 100% of adults in the official 9 million population or 87% of the likely 12 million population.  Only about 600,000 (6.38%) have received the 2nd dose.  This is the highest priority and the scramble for vaccines is to address this.  Vaccine supply is tenuous, but millions of doses are promised and anticipated this month and next.

A single vaccination in the face of the Delta variant only offers 33% protection against contracting the disease.  However, it may be much less severe, easing the personal misery and burden on the healthcare system in facing serious and fatal cases.  Nonetheless, getting a high rate of a fully-vaccinated population is crucial to opening up safely.

Recognizing this, the HCMC People’s Committee’s proposed a three-phase “Return to Normalcy Plan” hingingon “Green Cards”, issued to those who are fully vaccinated (See infographic below).  Non-fully vaccinated people will get ”Yellow Cards” and will continue to be restricted.  Although a gradual reopening has merit,given the health risks involved, danger remains until the population in HCMC and elsewhere in Vietnam gets vaccinated to avert a new upsurge in cases that can endanger people’s lives and economic recovery.

Finally, there is an end in sight, a strategy for reopening.  At least there was, until HCMC Party Secretary Nenannounced Sunday afternoon that the deadline might slip to late September to reach COVID control targets…

The Storm Before the Calm?

Covid-19 is tightening its grip on Vietnam, HCMC in particular with over half the cases and ¾ of the deaths. HCMC’s 7-day case average is nearly 6000 new cases per day. The death rate in HCMC is 4.1%, nearly double the current WHO world rate and 60% higher than the national rate outside of HCMC.  41,470 patients are under treatment as of Saturday, September 4th. As of September 3rd, 6491 patients were in serious condition, with 1046 on ventilators and 28 on ECMO.

Although the case numbers spiked over the past 2 weeks, part may be due to the Department of Health’s massive testing program. Detection of all F0s is essential to control.

A bright spot is D7 declaring that it has controlled Covid-19! It had only 2 deaths on a recent day. Of note, 94% of its population is vaccinated. D7 authorities also anticipated the need for isolation hospital beds and immediately had adequate hospital care. Their 34 mobile units with 2-3 nurses each, served over 1000 home cases.

Prime Minister Chinh has stated that each locality must assume responsibility for its own success in controlling the pandemic. Da Nang is doing just that with opening up slowly by zones, based on successful control by location and number of cases.

According to the Nikkei Recovery Index – how well countries have managed the pandemic and how their economies and societies are returning to normal, out of 125 countries, Vietnam placed 125th.

The high death rate in HCMC may be related to both artificially low case numbers until the last 2 weeks, and the need for urgent detection of symptomatic cases that deteriorate rapidly. Such cases require prompt recognition, immediate oxygen, and perhaps mechanical ventilation in an ICU. The stretched resources and heavy case loads in HCMC may be contributing factors, as well as the limited availability of rapid oxygen. This past week, a Navy ship from India delivered 300 oxygen concentration tanks and 300 tons of oxygen tanks.

There is a shift to treating mildly or asymptomatic cases at home, utilizing 411 mobile units. They are to deliver a total of 150,000 bags of medications to the roughly 28,000 F0 cases at home. However, there have been delays in delivering the bags. By comparison, the mobile units in D7 successfully served an average of 29 patients each, while the mobile teams for the rest of the city must average 68 patients each. Additionally, there is no mention of the essential oxygen saturation monitors, so at any time the patient feels short of breath, the oxygen in their body can be measured and rapidly reported. This case overload and difficulty in knowing the patient’s oxygenation status, could contribute to the vulnerability of the rapidly deteriorating home patient. This could be a factor in HCMC having so many of the nation’s Covid-19 deaths.

Several private clinics in HCMC were fined and forced to halt their programs to serve this population at home. They have adequate supplies of oxygen and oxygen saturation monitors. Enlisting private clinics would free much needed resources for seriously ill patients and decrease the large numbers of patients for the mobile units. With case numbers 30% increased over the past week, this is more urgent than ever.

The clock is ticking on the September 15th goal of controlling the pandemic. Across HCMC, there has been some shifting of the goals, but most recently, Ministry of Health (MoH) seeks a 20% reduction in the death rate, 50% reduction from peak cases, and no new clusters. Most significantly, hospital admissions should be under 2000/day and discharges greater than admissions.

PM Chinh and the National Steering Committee that he chairs recognizes that complete eradication of Covid-19 is not possible, so we must control the disease and live with it while we open up our lives and the economy. An announcement and re-opening strategy is eagerly anticipated soon.

As in D7, an essential factor is fully vaccinating at least 80% of the population. To date, there are over 21 million vaccinated in Vietnam with one shot, but only about 3.2 million with 2 shots. HCMC is awaiting more vaccines to complete its vaccination program, needing some 6.2M more doses to give over 70% of its population both doses. There is the expectation of adequate supplies of vaccine by year’s end. In the current situation, with the desire to open up soon but still protect the population, there is an immediate need. Hopefully, the supplies will arrive soon, and the vaccine rollout and control of this scourge can improve the situation soon.

Darkness Before Dawn?

The persistent pandemic worsened with more cases and deaths, until the total “stay where you are” effort to lock-down this city of 13 million this week.  This all-out effort in this densely-packed population must still provide essential services and basics like food and medications.   With deaths averaging over 350 per day, military enforcement and aid, plus mobilization of most local facilities, has been driven from the national level.  This has also involved replacements of the Former Chairman of HCMC People’s Committee Nguyen Thanh Phong and of  Director of the Department of Health Nguyen Tan Binh, now Chairman Phan Van Mai and Director Tang Chi Tuong, respectively.

Eerily like the “hungry ghosts” who legendarily roam loose at this time of the lunar year, silently and invisibly creating mayhem, “mystery cases” may silently spread disease to unsuspecting people. In addition to lack of full vaccination, the leakage from previous attempts to socially-distance has propelled the pandemic, so that most cases are now community-based.  One reason for this is that 37-50% of F0s may be “mystery cases”: asymptomatic and undiscovered carriers, spreading disease through the community.

So, testing of 100% of red and orange (most heavily-infected) areas, and larger numbers throughout, with a goal of testing 100% of the population, is being undertaken.  Predictably, increased testing has driven case numbers up, but may help detect and control these “hungry ghosts”.

Low vaccination totals and leakage from social distancing has driven the overload of local healthcare facilities.  36,000 patients are in hospitals, 2563 are on ventilators, and 20 on ECMO, as of earlier this week.  Still, recruiting the private sector to join the fight in a major way has been delayed.

Most of us are semi-resigned toward the restrictions of the pandemic.  However, more vaccines continue to arrive, including last week, another 1 million doses of Pfizer donated by the U.S. government, announced during Vice President Kamala Harris’ visit, and 200,000 of Sinopharm by the Chinese Ambassador, with pledges of 1.1 million doses of AsraZeneca by the Italian and Ro. manian governments, another delivery of 1.4 million doses of AZ already contracted arriving, and a contract for an additional 20 million doses of Pfizer finalized , bringing the total doses of Pfizer to arrive this year to 51 million.  Another ray of hope is in a potential gamechanger that may be about to break.  The locally- developed Nano Covax vaccine may be approved for emergency conditional use by the end of the month.  8-10 million does per month can be produced and ramped up to 20-25 million.  This will dramatically hasten the real endgame for the pandemic here and perhaps regionally.

Because children are more affected by the Delta variant and may be transmission vectors, the Prime Minister has advised that children from 12-17 years may now be vaccinated.  Which vaccine has not been revealed.

On the treatment side, clinical trials will be done broadly in the HCMC population among the lightly symptomatic or asymptomatic 28,000 F0s at home.  The trial is of a new antiviral medication, Molnupiravir.  This is part of a government program for caring for these Covid-19 patients at home, this having been largely removed from the private sector.

The endgame for the pandemic is currently a loud silence. September 15th is the goal for “ending the pandemic”, according to the Central Government.  Very clearly, this will be far from zero cases.   The criteria for a measure of control over the viral spread has not been fully elucidated and may change with facts on the ground.  The Ministry of Health specified that continuous decrease from the past two weeks, and 50% below-peak daily numbers, continuous drop in number of PCR positives over 14 days, and absence of new clusters will mark control of this Delta outbreak.

After the endgame criteria are achieved, the method of loosening of Directives 10 and 16 and the curfew to unchain lives and the economy, have not yet been stated.

The Delta variant was the wild card and totally unanticipated, world-wide.  Delta has some defining characteristics, beyond its (literally) breathtaking hyper-infectivity.  The high transmissibility is worse than seasonal flu or even the common cold.  On average, a case infects 5-8 others, raising the number for herd immunity to about 80-90% of a population.  HCMC claims 70% rate for a single shot, but this is based on the official census, not the 13-million total population.

Symptoms of the Delta variant are like previous varieties.  Loss of sense of smell and taste is not as common, so symptoms are less distinctive and when mild, more like seasonal flu or the common cold.  Vaccination does not stop reinfection completely, although the vast majority of cases are among those who are not vaccinated.  Hospitalizations and deaths among those vaccinated are only about 0.3% of the total.  However, it is becoming clearer that the viral load in the upper airway is about the same for vaccinated reinfected and new cases, meaning that vaccinated cases can still spread disease, although for much less time.

Children and young adults are more prone to infection, with pediatric hospitalizations in USA up 36% with Delta, and 2243 pediatric cases in hospitals in HCMC.  Some feel that children are now the main vector of infection.  Because of large numbers of hospitalizations of younger people, more deaths are seen, but rates seem to be about the same as with previous versions of Covid-19.

In the old normal, this scenario was unimaginable. Now people’s lives, livelihoods, and many businesses are existentially impacted.  We need to give and give generously to those in greater need and join in the fight however we can.  The city and country are doing everything possible to contain this plague that is so disruptive to normal life.  Continuing to cooperate with public health directives and staying on top of the developments is essential.

Now the pandemic is hitting hard, and case numbers and deaths are increasing, even with enhanced social-distancing measures.  Although very strict, “social-distancing leakage” and vaccine shortage has undermined efforts to reverse the trend.

As the personal and economic devastation mounts, the Central government is taking a more prominent role with the reassignment of the Chairman of the HCMC People’s Committee, bringing in the army for support and increased resources, plus implementing an even stricter “stay in place” program.

As of midnight August 23rd, through September 6th, all HCMC residents will be expected to rigorously stay in their homes.  Only the most essential workers may leave their homes.  A mission of the army, besides enforcing checkpoints, will be to work with each ward to deliver food or medical supplies, to homes in need.  Priority will be given to those impoverished or otherwise in special need.  There will be some allowances for safety-risk zone classification, but the entire city will be strictly confined.

Social media is filled with videos (some inauthentic, including from Myanmar) of the army taking to the streets of HCMC.  More credible, though unfortunate, are the photos and videos of massive crowding at markets, as 13 million people prepare to be self-sustaining for the next 2 weeks.  The extreme crowding at food outlets, as the populace prepares for stricter lock-down, is itself worrisome as super-spreader events.

As the weekend progressed, more information became available, through local media, that those in green and yellow zones would still be allowed out for limited shopping opportunities, with those in green zones able to still have within district delivery, and that supermarkets would remain open.

During this stricter “stay in place” time, Red (unsafe) Areas will strive for 100% rapid testing to root out F0s, also to bring better control.  Currently, there are too many community-based cases to trace, and many may be missed, as at least 35% of cases are totally asymptomatic.

Another challenge is that many of HCMC’s residents are now without incomes to pay for food and housing, another reason for the military, both to provide emergency support and prevent workers fleeing to return to home provinces, where they could inadvertently cause additional outbreaks. Thus, ending the pandemic is of utmost urgency, in the face of ever-increasing cases.

Vaccines are still an essential.  As more vaccines arrive, the vaccination effort will move forward.  The ongoing role of the private sector is not known, although so many AmCham members actively supported the government’s vaccination sites and efforts.  The goal is still 70% vaccination rate over the next week.  A question is whether that is 70% of 8.8 million, the official population, or 13 million, the actual population.  If the latter, about 3 million will still need to be vaccinated this week, assuming availability of vaccines.  More vaccine to HCMC, Binh Duong, and the southern region, is critical, both to protect lives and livelihoods., as AmCham advocates.

Healthcare resources are far over-capacity in caring for the exploding numbers of Covid-19 cases.  The private sector had been treating asymptomatic F0s at home to free up resources for the sicker patients in government hospitals and expanded sites.  The Ministry of Health (MoH) was concerned about potential  profiteering as we joined together to fight this pandemic, with its worsening grip.  Some private, international facilities were charging 12-36 million dong for 10 days of home care via telemedicine.  A clinic member of AmCham, by comparison, charged 4.2 million for a similar package.  Because of the reported profiteering, MoH did a surprise inspection of these facilities, fined them, and interrupted their operations.  MoH now has said such services will require special licensing in an environment where all DoH resources are too busy with the pandemic to do licensing that takes up to 3 months during normal times.

The HCMC death rate is a full percent higher than the national average, due to grossly over-burdened healthcare resources, and likely under-reported positive cases.  There are reports of deaths at home because no hospital can take more critically-ill patients.  With the private sector now sidelined, and unable to provide telemedicine or other support for FOs at home, this is a further burden on the public sector .  Going forward, enlisting all healthcare resources, public and private, will be required to bring this devastating pandemic to heel.

Links:

Discovery of private clinic consulting F0 treatment package at million-dollar house in Ho Chi Minh City (tienphong.vn)

Covid-19 in Vietnam: New wave tally tops 332,000 (vnexpress.net)

Vietnam’s daily Covid infection reaches new peak – VnExpress International

More than 15 million doses of the vaccine have been given, experts recommend vaccination timeline – Tien Phong Newspaper (baomoi.com)

American business group wants southern industrial hubs vaccinated – VnExpress International

HCMC streets bustle despite social distancing restrictions – VnExpress International

Man dies at home after being rejected by five healthcare facilities in southern Vietnam | Tuoi Tre News

Give Vietnam more vaccine, American CEOs tell Biden – VnExpress International

HCMC to ban people from going out starting August 23 – VnExpress International

HCMC FDI could suffer from prolonged social distancing – VnExpress International

Việt Nam sees second day with daily increase surpassing 10,000 cases – Society – Vietnam News | Politics, Business, Economy, Society, Life, Sports – VietNam News

HCM City firms forced to close down due to lack of workers – Economy – Vietnam News | Politics, Business, Economy, Society, Life, Sports – VietNam News

A change in the strategy to deal with the pandemic required – Society – Vietnam News | Politics, Business, Economy, Society, Life, Sports – VietNam News

A change in the strategy to deal with the pandemic required – Society – Vietnam News | Politics, Business, Economy, Society, Life, Sports – VietNam News

Ministry of Health issues new criteria for pandemic control – Society – Vietnam News | Politics, Business, Economy, Society, Life, Sports – VietNam News

Groundhog Day, All Over Again

“Groundhog Day” is a 1993 movie about a man who wakes up each morning to the very same day, to repeat it endlessly.  The current severe outbreak with very strict social distancing will be extended until at least 15 September, as cases and deaths remain stubbornly high.  The monotony of being mostly confined to home each day continues.

The Delta variant has slammed the USA and the world, as well as Vietnam.  We all know that it is not the same as the original SARS-CoV-2 virus that Vietnamese authorities handled so adroitly through three previous surges.  On the dark side, children and young adults contract the disease at higher rates than in previous COVID-19 outbreaks.  Due to its extreme infectivity, it has filled the hospitals as daily cases approach 10,000, with nearly 4000 new cases in HCMC daily.  Because of the large numbers infected, deaths have also been on the rise, with 4300+ deaths in HCMC alone.  About 2.9% of known cases have died in HCMC, 2% nationally.

On the brighter side, about 35% of cases are totally asymptomatic.  They do not need hospitalization, where the resources are stretched, and the hospitals are overloaded.  There are currently about 10,000 patients being monitored at home, with some 312 quick response teams to rescue any home patients who deteriorate rapidly.  DoH’s highest priority is to protect and save lives.

Several clinics and hospitals offer telehealth services to home patients, who are then outfitted with thermometers, blood pressure cuffs, and oxygen saturation monitors (SpO2).  SpO2 measures the amount of oxygen your lungs can deliver into your blood. When SpO2 drops below 95%, hospital help with supplemental oxygen is needed.  Thus, careful monitoring at home with proper professional expertise is safe, can keep you at home, and may save your life.

The extreme transmissibility of the Delta variant makes even the strictest social distancing difficult for the high-density 13 million population.  The only alternative is vaccination.  The goal is to vaccinate 70% of the HCMC population by the end of August.  With over 3.5 million already vaccinated, and roughly 2/3 of the population being adults, about 2.5 million still need to be vaccinated for at least one dose.  Nearly half will be ready for the second dose by the end of the month or by September 15th.

AmCham’s Healthcare Committee Hospitals and Clinics Subcommittee members have joined the DoH and HCMC to vaccinate as many as possible.  Now the means of vaccinating is outstripping the supply of vaccines, although more continually arrive.

Nearly all of us yearn for the “good old days” when lunches, Connect and Cocktails, face-to-face meetings, and going out with friends was taken for granted.  We all need social connections which are disrupted with the strict social distancing requirements.  In the USA, substance abuse has exploded, with 34% more overdose deaths.  31% of subjects in another study reported low well-being and all of us are impacted.  Anxiety, fear, and depression are common risks.  And in our own AmCham August 3-5th survey, more than half of our respondents said mental health concerns – stress, depression, and anxiety, were among the top concerns of them and their family members.

Keep schedules and lists, keep moving and active, are the best tips.  Also, the knowledge that this is temporary, even though now it feels like Groundhog Day.  In the movie, the repetition finally ended, normal days returned, and life went on.  So will it be here with our Groundhog Day.

This week, the vaccination drive intensified and nearly 1 million more people in HCMC were vaccinated.  From about 24,000 on 22 July to 1.8 million as of today (Saturday, August 7), progress has been rapid and consistent.  Over 85,000 have completed two doses, doubling in a week.

This progression has been the work of many.  The private hospitals and clinics in the AmCham Healthcare Committee Hospitals and Clinics SubCommittee have devoted much time and resources to this effort.  Some devote 80% of their staff, all at their own expense, to vaccinate where directed by the HCMC Department of Health (DoH) or the district-level health authorities.

In the past week, 1200 vaccination sites have been opened.  Vaccinating is more mobile, now setting up sites at apartment complexes, factories, etc. Respect is now paid to social-distancing at the sites.  Although the 16 priority groups are still used, many local sites will take all adults from 18 years-old on up.  Very few serious reactions have been seen and no deaths.  Please note that clinics and hospitals are not permitted to vaccinate at their own sites yet, using their own protocols and pricing.  Vaccination is free through the government at its selected sites and under its guidance, although private clinics and hospitals are staffing and running these sites for DoH.

There is still a shortage of vaccines, but they continue to arrive.  31-51 million doses of Pfizer vaccines are expected by the end of the year, as well as millions more doses of Moderna and AstraZeneca vaccines.  Health authorities may recommend mixing vaccines for dose #1 and #2.  Dr. Kidong Park, WHO Representative in VN, recommends taking whichever vaccine is available when you can obtain a vaccination.

NanoCovax, the home-grown vaccine, is being rigorously tested and near the end of trials.  Its efficacy is promising and it appears safe.  Approval will be expedited, as data is nearly ready for submission.  It should be available in the 4th quarter.

The number of cases in HCMC is leveling off at less than 4,000/day, down from over 6,000 on July. 27th  However, hospitalizations are still overtaxing the available resources, and deaths are mounting.  There are totally 131,000 hospitalized nationally, at all levels of severity.  There are about 33,000 symptomatic patients in HCMC.  There are over 1,200 on ventilators, and 17 on ECMO, reported earlier this week.  Unfortunately, Vietnam reached a new record daily high of new cases Sunday of nearly 9700 cases.

Many young doctors are spending all waking hours away from their regular jobs and garnering equipment for their colleagues caring for critically ill Covid-19 patients.  300 doctors plus other staff, and much equipment arrived Thursday from Hanoi.  In two days, three field hospitals and ICUs were set-up and opened.  AmCham member FV Hospital has requested the Ministry of Health for permission to establish the “split hospital” model to care for critical COVID-19 patients.  FV is also requesting permission to vaccinate 10,000 patients per day on-site.

Fortunately, the cases are leveling off, and resources are rapidly rising to meet the need.  The vaccination program is expanding rapidly.  A good site to follow nearly real-time progress is Covid-19 in Vietnam: New wave tally nears 197,000 (vnexpress.net).

The unknown is how long the severe restrictions must persist, with constriction of lives and commerce.  The situation will be re-evaluated at the end of next week.  In the meantime, stay home or stay socially-distanced, wear those masks, follow the guidance, and get vaccinated when called, or queue safely at an open site.

“The War Has Changed”

The “war” against Covid-19 has intensified with most major Vietnamese cities facing mounting case numbers and imposing severe forms of social-distancing.  HCMC imposed a 6 pm to 6am strict curfew. Its first since the war.  This is in response to the ever-increasing numbers of new cases of the SARS-CoV-2 Delta variant.  The massive surge of Delta variant is world-wide, including a vertical curve of new Delta cases in the USA.  Dr. Rochelle Walensky, Director of CDC (USA), acknowledged an internal document that stated, ” should ‘acknowledge the war has changed'”.

Wars are fought on battlefields and depend on logistics and supplies.  As cases multiply rapidly, resources for care are stretched.  Many private clinics and hospitals, some from the Hospitals and Clinics SubCommittee of AmCham’s Healthcare Committee, are joining the frontlines.  Some 80% of their staff are over-busy running parts of the vaccination programs, as well as mass rapid-testing.  The private sector units also devote their own resources to getting enough PPE and oxygen tanks for this surge, as hospitals creak under the strain.  Many young doctors are volunteering to locate equipment and supplies and distribute them.

For example, the Tropical Diseases Hospital in HCMC is a frontline hospital along with several others.  It alone has seen 880 severe cases, and discharged 378, with 46 deaths: a low rate among severe cases.  There are plans for 80,000 new beds in HCMC through several new field hospitals.  This includes the Resuscitation Hospital in Thu Duc City, with 1000 beds dedicated to care for the most severe cases.  50,000 new beds in several new hospitals are being readied in Hanoi.  30,000 new ICU beds will be implemented across the country.

As in total war, the population is also stepping up.  There is generally compliance with the curfew which includes only leaving home with vouchers for food shopping twice a week, medical emergencies, and pervasive testing.  This is in addition to the Directive 16 regulations from earlier in July, and closure of many businesses from early May.  Many private citizens and companies are contributing their resources to the effort.

The Enemy:  the Delta variant is extremely infectious (50x as infectious as the UK’s Alpha variant, which was 50x more infectious than the original.  Younger people can get it more frequently and it likely causes more severe illness than the other forms.  Those vaccinated can still acquire it at 1/3 the rate of unvaccinated and can spread it as much as those unvaccinated.  However, the vaccinated are 90% protected against severe illness, and death is extremely rare.

Epidemiology Class 101:  R0 measures the number of cases one infected individual spreads it to, on average.  The original C19 virus was about R2.5 (one case infects 2.5 others, who then propagate it exponentially).  The world quickly learned that R2.5 is very infectious.  The Delta, however, is R8-9.  The formula for herd immunity is 1-1/R0.  That means for herd immunity, whereby the virus can no longer spread and therefore cannot mutate into something even more transmissible and lethal, is at least 87.5%, a very high bar for any country.  With Delta, the war has changed.

Thanks to this massive, combined effort between the government, private healthcare, businesses, and people, vaccines reached about a million and a half arms just this week, and 2nd vaxxes are up by over 100,000.  There are massive vaccination programs in Hanoi and HCMC.  As vaccines arrive, preparations are in place for rapid, massive vaxxing.

As President Phuc states, “fighting the pandemic is like fighting the enemy.”  The war continues and we continue to engage in battle against this potent enemy to our health and livelihoods.

Cases surge with nearly vertical increase. Thankfully, more vaccines arrive, including a U.S. donation of 3 million doses of Moderna on Saturday, nearly 1.5 million direct to HCMC.

Although very restrictive measures have been in place for nearly a month, the curve of new cases is nearly vertical.  New records of new cases seem to be set daily.  Deaths and critically ill patients have also increased dramatically.

As of July 24th, there are 37,407 Covid-19 patients in city hospitals.  Over 150 patients are on ventilators, and at least 12 on ECMO (heart-lung machine used when even a ventilator is inadequate).  HCMC established a new Resuscitation Hospital with 1000 ICU beds in Thu Duc City and is already very busy with its staff of over 500, overworked.  The MoH is preparing for as many as 50,000 hospitalized patients and the oxygen supply can be doubled.  Oxygen tanks for home use can be purchased, but if this takes away from those  needed in hospitals, it is not helpful.  Hanoi and Da Nang also have similar new hospitals dedicated to the sickest Covid-19 patients.

Hanoi has reinstituted more stringent social distancing under Directive 16 as its cases have increased, as did Da Nang on Wednesday.  HCMC extended Directive 16 at least through August 1, and now has imposed a curfew from 6PM-6AM for all residents, effective Monday, July 26th at 6PM.  It also put in place additional restrictions, with those in high risk areas strictly confined to their homes except for emergencies.  High risks are confined to their homes but may leave twice a week with issued vouchers for food, or to go to work.  Even essential businesses are restricted, and any nonessential business is now closed.  New positive cases without symptoms now can be sent home for isolation after medical evaluation, so doctors in hospitals can focus on more severe cases.

It is understood that vaccinating 70% of the population will be the solution to bring about a “new normal”, end the lockdowns, and reboot the economy.  The Delta variant is spreading wildly in Vietnam as in most other countries.  It is highly transmissible and can spread up to 50% faster than the Alpha strain.  The vaccines are not quite as effective against Delta, and breakthrough infections can occur after vaccination.  Fortunately, after two doses of the vaccines available in Vietnam, the risk of serious disease is reduced by about 91%.  Nearly all hospitalizations and deaths are among the unvaccinated.

Several million Astra Zeneca and Moderna doses arrived this week and more are expected over the coming month as well as Pfizer and Sputnik V (the latter now beginning to be produced locally).  More Moderna is also anticipated.  Vietnam’s own innovative NanoCovax vaccine has completed much of Phase 3 trials and will apply for emergency use soon.  It is estimated that vaccines will be much more abundant by September, with the hope of vaccinating ½ the adult population by year’s end.

Astra Zeneca (AZ), Pfizer-BioNTech (PB), and Moderna (Mo) will be used and already 8.6 million doses of AZ have been delivered, as well as 5 million Mo, and nearly a million PB with more to come soon.  30 million Sputnik V are also reportedly available soon and Vietnam will produce and distribute it locally.

MoH has given the green light to mix AZ and PB vaccines.  Although not formally approved by WHO or fully endorsed by the manufacturers, several observational trials suggest that mixing is as safe and equally or more effective as two doses of either.  Whether mixed or not, the 2nd dose is recommended at 3-12 weeks after the first: the wide range is from different studies and national experiences.

The government vaccine registry is open to all residing in VN and is the recommended way of assuring a vaccine: register online for COVID-19 vaccines via the COVID-19 vaccination portal: https://tiemchungcovid19.gov.vn/portal/register-person or via the E-health app for phones using Android and iOS that can be downloaded at: https://hssk.kcb.vn/#/sskdt.

The long period of lockdown and drastically decreased face-to-face contact has been a difficult time for most of us.  Do your best to maintain contact with friends and family, keep fit and move.  Eat a healthy diet.  Stay informed, register for the vaccine, and join in following the guidelines.  This will be the means to the end.

As Cases Spiral Upward, Lockdown and Vaccines Try to Flatten the Curve

New cases and deaths set records in both the nation and in Ho Chi Minh City this week.  The Directive 16 lockdown has been in place for 8 days, but more time is needed for its true effectiveness to be known.  National cases have topped 43,000, and HCMC cases at the epicenter have topped 26,000.  There have been 190 deaths and hospitals are busy with cases.  The Directive 16 lockdown is being extended an additional 2 weeks in HCMC, and expanded to include 16 southern provinces to control the outbreaks.

VN secured several million more vaccine doses this week, as well as 1.5 million promised from Australia and an additional 3 Million Moderna vaccines from USA, to add to the 2 Million received earlier in the week.  AstraZeneca has delivered 2 million doses in a week, so the supply is ramping up.  So far, at least 105 million doses of various vaccines have been committed to VN.  Additionally, MoH has granted T&T corporation authority to negotiate for 40 million doses of Sputnik V vaccine from Russia, and has approved Johnson & Johnson’s one-dose COVID-19 vaccine for emergency use, enabling another possible vaccine supply.  And on Wednesday, MOH announced another potential 20 million doses of Pfizer vaccine, in addition to the 31 already committed, to be used for 12-18 yr-olds; negotiations are being finalized.  MOH also announced it was negotiating for a possible 15 million doses of India’s Covaxin.  However, Minister of Health, Nguyen Thanh Long, cautions that vaccine arrivals may be slow until September.

Although some private clinics have registration lists for vaccine, there is no indication that they will receive vaccines to administer.  The government has a registration site in English that is highly recommended, as that will be the definitive list: register online for COVID-19 vaccines via the COVID-19 vaccination portal: https://tiemchungcovid19.gov.vn/portal/register-person or via the E-health app for phones using Android and iOS that can be downloaded at: https://hssk.kcb.vn/#/sskdt.

This week saw over 1800 cases in industrial zones as the government and the industries attempt to stay open and curb to spread.  Although exports have remained strong, the local economies and consequently the people, have suffered.  The lockdown with its closures of all but essentials, and the severe restrictions on the population’s mobility hit nearly everyone hard.  220,000 day workers received relief aid; banks dropped interest rates on business loans to help ease the burden.  President Phuc told an APAC conference that only access to vaccines can lead to economic recovery, through international cooperation.  The national strategy is to first provide safety, but also to preserve jobs and the economy.  MOH Minister Dr. Long attributes this surge’s severity and length with consequent personal and economic pain not only to the infectiousness of the Delta variant, but also incomplete adherence to the restrictions designed to control the surge.

The Delta variant is about 5 times more transmissible than other variants and perhaps 50 times more than the original SARS-Cov-2 virus.  The R0 value (average number of cases one F0 can infect) is R5.  It becomes contagious after only 2 days after infection and can take 5 days to show symptoms.  The infectious period is about 10 days.  Since up to 80% of cases are asymptomatic or mild, the period of spread can be long, with many contacts.

Because of the large numbers, the minority of cases that are serious can still overload hospitals.  Ventilators are being manufactured in Vietnam, now, and Dr. Long reassures us that there is enough oxygen, which ran out in India and Indonesia in their massive outbreaks.  There are arrangements for 50,000 beds in HCMC.

The government is using all resources, methods, and resolve to meet this crisis and vaccines are in the offing.   Following the rules, being patient, and registering for the vaccine are our best ways of dealing with this.

Vietnam and HCMC’s healthcare systems are under stress. Please contribute now to support AmCham donations of critically-needed medical equipment and supplies to support the Vietnamese government’s response. We are committed to partnering with Vietnamese, HCMC, and potentially other provincial authorities to support the dual goals of controlling the COVID-19 pandemic and promoting sustainable economic growth. We want to partner to protect the health and safety of those of us living and working in HCMC and neighboring provinces, and do all we can to maintain business operations and supply chains. AmCham and our Healthcare Committee currently are working with DOH to finalize top priority needs of PPE and equipment. We will conduct due diligence to obtain the best value and a transparent process for your donations. If you are able to contribute to this important cause, please contact Office Manager Cindy Tran at cindy.tran@amchamvietnam.com for additional information. Contribute Now to demonstrate AmCham Cares!

We also are happy to highlight any COVID-related contributions from our member companies on our social media. Please email details, including photos, to Cindy Tran.

HCMC Locks Down as COVID-19 Cases Explode, and Millions of Vaccines Arrive

It was déjà vu all over again as a near-lockdown under drastic Directive 16 went into place Friday.  This is a repeat of the April 2020 lockdown which extinguished the COVID-19 outbreak of that time.   With the more transmissible Delta variant being predominant, Vietnam experienced a new daily high, with 1844 cases, 1300 of which were in HCMC, with 140 in neighboring Binh Duong, 33 in Long An, and 19 in Dong Nai.  On Saturday morning alone, there were 76 cases of unknown origin that require tracking of perhaps hundreds of F1s.  Since an asymptomatic person may be contagious for 10 days after contracting this disease, its spread can be rapid and far-reaching.

This outbreak has affected the entire city and most of the country with over 24,000 cases nationally, nearly half in HCMC.  23% of HCMC cases of this assiduous disease have been discovered through routine testing, another 12% at clinics or hospitals on check-ups.  25% were detected in mass testing of locked down areas.  This outbreak has spread widely, and it is likely that many F0s are still not detected.

That means that new cases may continue to appear until near the end of the current lockdown.  It may take until near the end of this lockdown to see the impact on numbers of new cases and whether further lockdowns are needed.

Although there have been social distancing restrictions since May31, Directive 16 rigidly enforces a virtual lockdown, with people allowed to venture out only for necessities.  Others found outside their homes or necessary jobs may be fined.

The good news is that 8 million doses of vaccines will arrive in July.  Already, Pfizer has delivered nearly 100,000 doses and the U.S. donation of 2 million doses of Moderna vaccines arrived Saturday morning.  Astra Zeneca will deliver 1 million more doses yet this month.  There are solid orders for enough supply to fully vaccinate ½ of all adults by the end of the year.  70% should be fully vaccinated by April 2022.

As with any remedy that is in short supply, there are dangers of scams, frauds, and counterfeits for vaccines.  Rightly, the VN government is keeping tight control of vaccine supply, receiving all shipments, even through private sources.  It is then tightly overseeing distribution and administration.  The government plans to distribute the vaccine at no cost to recipients, according to stated priority recipient groups.

There are some private, international clinics offering sign-up lists for vaccination.  However, there is currently no government plan to release vaccines for distribution to private clinics.  Also, there is no control over use of these lists or their privacy.  So be very thoughtful before giving your information to those who say that they may offer vaccines to you.

Please join our free-for-members Tuesday, July 13 830AM Flash Briefing on COVID-19 Outbreaks – HCMC and Beyond to hear from a panel of medical experts more about Vietnam’s and especially HCMC’s current COVID-19 outbreaks, vaccine availability and rollout plans, and how to protect yourselves, your families, and your employees.

This is a time of emotional depletion for many, after over 1½ years of pandemic and several months of restrictions, culminating in this lockdown.  You may have concerns over your family and business, leading to overall stress.  It is important to have routines and a mind-set of caring for yourself and making it through.  AmCham’s Healthcare Committee is hosting a Virtual Lunch and Learn on Wednesday, July 14, from noon-1:30PM., When the Going Gets Tough:  Wellness and Selfcare for Body, Mind, and Workplace.  This may be of interest to help you navigate these times – and beyond.

Shoe on the other foot: USA returns to normalcy as Vietnam suffers worst outbreak yet.

As a return toward normal marks the July 4th holiday in the USA, pandemic outbreak #4 grinds on and escalates in Vietnam.  The total case numbers in HCMC went from just over 4000 on Thursday to over 5000, 48 hours later. A new VN record of 914 cases was set Saturday (3 July: date of this report). The death toll is now 84 from the beginning of the pandemic: 49 in the new outbreak.  There have been over 15,000 cases since April 27th.

Part of the large recent numeric increase is mass rapid testing in HCMC; 5 million tests are planned in 10 days. Plans are underway to increase testing to 1 million per day.  Since 67-80% of cases are nearly asymptomatic, there are many cases which have not yet been identified, thus spreading the disease faster than they can be tracked. Also, there is grave concern that the crowding of F0s and F1s together at the quarantine camps is causing some spreading, as well, since most new cases are detected there. The Ministry of Health has given permission for F1s to self-isolate at home, but this had not yet been fully implemented.

As cases multiply, the HCMC healthcare system is becoming overloaded.  Although not exceptionally virulent, the sheer numbers of positive cases may result in overburdening and some deaths.

A worry with both the excellent rapid testing and rapid vaccine roll-out has been crowding with loss of distancing at the designated sites, thus perhaps themselves enhancing spread. This violates the “5Ks” (masks, social distancing of 1.5 meters, medical declaration, no gathering in crowds, frequent hand hygiene and clean surfaces in house). Nguyen Truong Son, Deputy Minister of Health, visiting HCMC, advised testing and vaccine administration at workplaces rather than centers, using extended hours to decrease crowding. He also advised pooling samples together. If positive, then individual testing can be performed.

The vaccine roll-out has been successful in HCMC.  3.6 million people have been vaccinated with at least one shot nationally. Eight million doses are anticipated in July, and 145 million total after September. Negotiations are underway for timing of delivery of 61 million doses of Astra Zeneca (AZ) and Pfizer BioNTech (PBT) that are already on order.

In the meantime, with case numbers accelerating, Directive 10, defining “social distancing”, continues and is even more stringent.  Most businesses are delivery-only or customers not allowed inside. All who can are working from home. People are instructed to go straight to work from home and return with outside stops only for necessities.

About 64% of workers have had financial setbacks or have lost jobs or businesses. Plans are being made for relief for those most severely affected.  The IFC is working with SeABank for a loan program for SME businesses.

Besides obtaining enough vaccine rapidly, there are timing concerns. It is recommended to space the two AZ shots 8-12 weeks apart.  But one shot does not offer sufficient protection, although it may lessen the severity of the disease. The current vaccines are effective against the Delta variant, the predominant strain in this outbreak. Some encouraging data from the UK and Spain suggest that mixing the PBT and AZ vaccines is even more potent than either with two doses.  Not enough data has been collected yet, to know for sure.

This is a time of concern and also pandemic fatigue. Consult the AmCham Facebook page for pointers on how to beat the harmful effects on us individually, and how to maintain a healthy life-style.

The war with Covid-19 is a running, constant battle. The battle zone has become Ho Chi Minh City, as well as continuing at a lower level nationwide. On Friday, June 25th, HCMC recorded 667 cases. Although all but 30 were contained in quarantine areas, at least 10 were dispersed and had no known source of infection: potentially, at least 10 unknown sources are continuing to spread infection. This treacherous Delta variant is able to stay ahead of tracking of points of origin, despite current lockdown and social distancing measures.

However, the good news is that 400,000 doses of vaccine were given in just six days, of the 840,000 granted HCMC from 1 million Astra Zeneca vaccines donated by Japan. Another 1 million has been promised. Although the HCMC Department of Health (DoH) had hoped to administer all doses within a week, this was a major breakthrough. In this battle where the enemy is advancing, vaccines are our key to victory.

This effort to deliver 840,000 vaccines into arms in record time requires the combined efforts of DoH working hand-in-hand with private hospitals and clinics. The cooperation has resulted in getting this immense task done in record time, even as cases mount. Private doctors and nurses, taking time away from their regular busy care duties, went to industrial parks, district hospitals, and other sites to administer this lifesaving vaccine. In many cases, it was dawn to dusk, outside in the heat, wearing the hot PPE gear. Our hats are off to these hard-working teams of government and private caregivers.

What happens when this supply runs out? MoH says that 8 million more doses will arrive in July, so there will be steady supply. Vaccines will continue to arrive in Vietnam for the remainder of the year and into 2022, with the largest supplies expected in late Q3 and Q4. The indigenous NanoCovax vaccine may complete Phase 3 trials in August and be ready for emergency use as early as September. Although timelines and distribution are not certain, more vaccines will be available over the coming months. Additionally, 30 countries have been authorized to import vaccines for their nationals.

As vaccines rush to catch the virus, there is a new impediment. There is a distressing reluctance to take the vaccine because of safety concerns. The bottom line, which should be spread farther and wider than the virus, itself: the vaccine is many times safer than the disease. Some fear dying from the vaccine: the 3 deaths that have occurred out of some 2.777 million vaccinated Vietnamese, have sent a shock-wave through the country. However, while 74 have died in VN from the 15,000+ cases here: vaccinated have 0.0001% deaths, but those with disease had 0.5% deaths. In the USA, over 178 million vaccine doses have been given, and now only 1 in every 250 Covid-19 deaths are in those vaccinated: deaths nearly all occur in the unvaccinated.

During the current outbreak, many are in hospitals and 31 are in critical condition. Breakthrough infections can occur in those vaccinated but are much less likely to be severe or require hospitalization. These breakthrough patients are much less likely to spread it to others – especially important since the current Delta variant spreads so fast and easily. So, the risk of the vaccine is so much less than the risk of the disease – and especially the risk that the unvaccinated present to others. Even when you are vaccinated, those not vaccinated remain a risk to your family and the country generally, as the disease can continue and mutate. It makes sense to continue to wear masks in public places and practice the 5 K’s.

The other piece of good news is it appears that there will be Vaccine Passports! The quarantine period for Vietnam’s VaxPass is expected to be 7 days. Going the other way, Americans who receive the Astra Zeneca vaccine overseas will be considered vaccinated in USA. Details and the start time of the VN VaxPass are still pending.

Meanwhile, we know there is economic pain from the lockdown and unknown numbers of small businesses will not survive, costing jobs and prosperity. The Vietnamese government continues to take actions to pursue its dual goals of controlling COVID-19 and enabling economic growth and recovery. This war between the virus, the vaccine, and our lives and jobs goes on.

HCMC, in grip of a relentless outbreak of Covid-19, has seen record numbers of cases for 2 straight days (as of Saturday, 19 June).  There have now been 1481 cases, all but 5 since 27 May.  About 100 cases a day is becoming the norm, including at hospitals and state offices. The Vice-Chairman of HCMC People’s Committee, Duong Anh Duc, said Friday that, “everyone is now potentially a source of infection”.  So, maintain social distancing and take extra care, as the city steps up its efforts to obtain and rapidly vaccinate the population.  The city is also preparing for worst-case scenarios that include 5,000-10,000 cases.

There was a wide-spread rumor on Friday, firmly denied by City government, that Directive 16 (full lockdown) was imminent.  However, effective Sunday, HCMC is imposing further restrictions, just short of a full lockdown.  People are encouraged to stay in their homes and only leave for necessities.  Open markets will be tightly regulated.  Public transportation, including intercity travel, taxis and app-hailing services will be stopped.  Gatherings of more than three persons are prohibited.  Distance between people must be always 1.5 meters.

Like those in a fire cheering the arrival of the fire department, the 836,000 doses of AstraZeneca vaccine have been enthusiastically welcomed in HCMC, a city with an official population of about 9 million, but estimated to be about 13 million.

Medical workers and workers in vital industrial parks and export processing zones will receive priority for the vaccines.  Also, military, teachers, police, and other frontline workers are prioritized.  In a change of policy, those over 65 years of age are now eligible for vaccination.

The new doses were rolled out Saturday morning with plans to vaccinate, using all 836,000 doses within a week.  These are administered through the HCMC Department of Health, via local hospitals.  The vaccine doses are tightly controlled and given out to the hospitals by prearranged lists, as prioritized workers are already registered by the city.

Giving 125,000 vaccinations/day will be challenging.  Doctors and nurses are being recruited from private hospitals and polyclinics.  They will work as force multipliers in the government system, rather than through their own clinics.  The initial experience, due to the high volumes seen, means abandoning social distancing at these sites.  The danger is that a single dose of the vaccine is not fully protective and those vaccinated are at risk until they have a more robust antibody response only after two weeks.

Bloomberg, reporting on Asia nations’ decreasing ability to contain the pandemic, noted the decreased vaccination rate in much of Asia.  At the current rate, it would take VN 10 years to fully vaccinate its population.

In a setting where “everyone is now potentially a source of infection”, it is truly a race between the vaccination being protective and the rampant disease.  All measures to quickly roll out the vaccination process for the population need to be encouraged.

As Pandemic Rips through HCMC, Anticipated Delivery of Vaccine Raises Hopes

This is a time of irony.  The world is gripped in a pandemic that this year has killed more people worldwide than died from Covid-19 in all of 2020.  But as I write, today (Saturday, June 12) is WHO Global Wellness Day.

AmCham and its Healthcare Committee mark this day for increasing our awareness and dedication to health.  In this time of disruption, and continuing outbreaks, often with personal, workplace and family stress, it is even more important to focus on our optimal health and how to attain and maintain it.

The number of cases and clusters in HCMC continues to grow, even after a week in near-lockdown (“social distancing”).  News broke today (Saturday 12 June) that total cases from the beginning of the pandemic in Vietnam, has crossed 10,000.  6,849 are from this 4th outbreak in 39 cities and provinces. There has been a total of 57 deaths since the beginning, with 2 more added Friday.

HCMC with 650+ cases in 21 of its 22 districts, is now 3rd, behind 2 northern provinces.  42,500 are out of work since the beginning of the year, with an additional 3,500 on Friday as the virus was found in a large factory.  9,300 businesses have ceased operating since the beginning of the year.  Front-line healthcare workers are burning out.  There have been urgent calls for relief for those with no means of providing for their families.  24% of Vietnamese lost jobs and 65% experienced pay reductions.

Vaccinations have dramatically decreased disease rates in the USA, UK, and Israel, even with about 50% of po-population vaccinated, less than the “herd immunity” number of 70%.  The vaccines appear safer and more effective after delivery of about 2 billion doses, than registered in Phase 3 trials.  There have been rare complications, the most recent, possible heart inflammation, especially in young men with the mRNA vaccines.  However, this is very rare (275 cases out of 5million vaccinations) and 95% of cases were mild and returned to normal rapidly.  It appears that full vaccination is effective against variants, such as the “delta” in India and Vietnam.

Breakthrough infections occur in about 0.25% of cases, but those infected are typically not very ill and have much less viral shedding (transmissibility).  This is strong evidence of the safety of the vaccine passport in revitalizing the economy safely.

Vaccine availability in Vietnam, as elsewhere in the newsletter, is seen as the salvation.  In the meantime, it is important to stay strong, healthy, and follow the guidelines for personal and public safety.

Vietnam’s fourth wave COVID-19 outbreak continues, mostly in northern Bac Giang and Bac Ninh provinces, with 8,682 cases and 53 deaths, 5562 cases and 18 deaths since April 27th.   Vietnamese Government focus on vaccines has increased as it negotiates new commercial deals, seeks bilateral donations, and elicits private sector support, both through contributions to a government vaccine fund, and potentially through more direct private sector purchases

The good news is most new cases are occurring in areas that are already quarantined, and the government has made vaccines available to workers in some hard-hit industrial parks, designated as an additional priority group.  Fifteen provinces, including Da Nang, have gone more than 14 days with no new cases reported.

And, with increased urgency, Vietnam has gotten secured more vaccines, with reportedly 120 million doses now in the pipeline for delivery by the end of the year, out of the 150 million targeted to achieve 70 percent of the population vaccinated for herd immunity.  That figure includes 39 million doses of AstraZeneca through the COVAX program and 30 million through commercial purchases, as well as 31 million doses of Pfizer-BioNtech, and a new purchase of 20 million doses of Sputnik V.  In addition, Japan announced a planned donation of 1 million doses (of Pfizer or Moderna) and the United States designated Vietnam a priority country in its first tranche of global vaccine sharing (amount TBD out of 7 million doses of Pfizer, Moderna, and J&J vaccines for a group of SA and SEA countries).  The government is also actively negotiating with Moderna and J&J and just approved SinoPharm’s vaccine for emergency use.  Its own indigenous NanoCovax, now in Phase 3 trials, may be available by year’s end.

In the meantime, the outbreak has disrupted our lives as well as the economy and some supply chains. At least 15 healthcare facilities have closed because of unrecognized F0 cases, demonstrating the difficulty of recognizing cases proactively.  HCMC is essentially locked down, with most service businesses closed. International travel, or even between our cities here, is limited.

The Vietnamese government continues to modify policies as it seeks to balance health and safety with economic costs.  Airports in Hanoi and HCMC were reopened to international travel days after it was banned.  The PM has discouraged overly strict policies by some provinces.  And Vietnam is again considering reducing the quarantine time for vaccinated individuals from 21 days to one week.

We support the Government’s strict COVID control and social distancing measures, but recognize they can take a toll on your mental and physical health as you try to work from home and juggle additional responsibilities.  We will be offering additional guidance as part of a new AmCham Wellness Initiative that will kick off with June 12 Global Wellness Day.  Meanwhile, do your best to get enough sleep, eat healthy foods, and exercise.  Be well!

Health Ministry allows 36 companies to import Covid-19 vaccines – Jun 6, 2021 – The Saigon Times

More effective COVID-19 prevention needed to protect hospitals – Jun 5, 2021 – VietNam News

Vietnam adds 75 to local Covid tally – Jun 5, 2021 – VnExpress International

WHO warns of June-July Covax doses shortfall – Jun 5, 2021 – VnExpress International

Vietnam Covid-19 death toll rises to 51 – Jun 4, 2021 – VnExpress International

Vietnam to get 120 mln Covid-19 vaccine doses this year – Jun 3, 2021 – VnExpress International

Vietnam considers shortening quarantine period for vaccinated entrants – Jun 3 – VnExpress International

Vietnam’s Covid-19 tally tops 200 for 10th straight day – Jun 3, 2021 – VnExpress International

WHO rules out new ‘hybrid’ Covid-19 variant in Vietnam – Jun 3, 2021 – France 24

The pandemic turned us into barbarians – Jun 2, 2021 – The Week

Slow Vaccine Rollout Creates Risks for Pandemic Standout Vietnam – Jun 1, 2021 – Bloomberg

Vietnam leaders stress equitable access to Covid-19 vaccines – May 31, 2021 – VnExpress International

Vaccine Covid-19 Nanocovax có thể được cấp phép khẩn cấp – May 31, 2021 – VnExpress International

Vietnam sets up Covid-19 vaccine fund – May 27, 2021 – VnExpress International

Super informative COVID event! Thanks to all who joined live! If you missed, it’s not too late to get informative insights from expert panelists at a May 26th multi-chamber virtual event on the COVID-19 Virus, Variants, and Vaccines: WHO’s Dr. Kidong Park; UNICEF’s Rana Flowers; OCRU’s Professor Guy Thwaites; AZ’s Nitin Kapoor; and KPMG’s Luke Treloar. More about the event and speakers at the LINK.

If you are an AmCham Vietnam member and are interested in viewing a recording of the event, please contact us @ amcham.it@amchamvietnam.com to obtain a password.
If you are not yet an AmCham Vietnam member, the recorded video clip is available at VND 200,000. Please contact us @ amcham.finance@amchamvietnam.com to purchase.

The 4th Covid-19 wave is still spreading, now with all major cities and provinces affected, a new variant, and no end in sight.  New social distancing directives go into effect in HCMC on May 31st. Vaccine availability is eagerly awaited, to return to a safe and predictable life to commence.
The current Covid-19 wave is the topic of every conversation. It is now in 34 cities and provinces with almost 3900 cases nation-wide and 12 deaths. Two major hospitals in Hanoi are closed to new Covid-19 patients, as they are so overloaded from the massive wave in the North.
There are 108 confirmed cases in HCMC, most linked to a religious group. As the government relentlessly tracks the cases and contacts, there are tens of thousands in quarantine. But with so many clusters with no initial case known, this wave has a “Whac-A-Mole” feel, as more clusters appear or continue, even with the intense tracking. Although some experts predict an end to this wave by the end of June, it has not begun to stabilize yet.
Because of the seemingly random cluster outbreaks, the disease seems always to be lurking, not far away. The government has been sensitive to the human toll of this worst wave. Initially, the citizenry was not directly locked down, although those over 60 years-old were advised to stay at home. Starting Monday, May 31, social distancing measures go into effect for HCMC, with stricter measures for residents of Go Vap and Thanh Loc.
Businesses are suffering damage from such recurrent disruptions, with many going out of business or losing leases. Without a vaccine, these outbreaks will continue with control through the same effective but disruptive measures currently used. Such outbreaks will only end when a large share of those living in Vietnam can be vaccinated.
As PM Minh Chinh has so wisely said, “We are all in this together.” The key to controlling the pandemic – worldwide as well as in Vietnam – is for the masses of people to become immune through vaccination. Businesses would find it futile to be the only ones vaccinated – it will take most of the entire population.
In the meantime, the government has been very specific about closures and exposures, and we must all follow this plan, as we, indeed, are all in this together.

The current outbreak has brought a sense of urgency for controlling the rapid spread and has highlighted the need for prompt, widespread vaccination.  For the most authoritative up-to-date information, we encourage you to join a special multi-chamber virtual event on Wednesday, May 26th from 4:00-5:30 PM with a panel of experts:

The COVID-19 Virus, Variants, and Vaccines: a Virtual Business Intelligence Briefing

The latest outbreak’s seeming randomness and wide distribution (30 cities) has heightened concerns, especially with 99 percent of the population lacking the protection of a vaccine.

The facts are that it is spreading rapidly, although still mostly contained to the North, including Hanoi.  There have been a few cases in HCMC, with eight local areas locked down.  There are said to be 60,000 quarantined or confined, nationally. The total count of those infected since April 27th is approaching 2000, with six deaths to date.  Also of concern is the prevalence of the Indian variant, which may be much more transmissible.

As always, the government has reacted swiftly and with a long reach.  So far, the virus has not penetrated deeply throughout the country and a general lock-down has not been imposed.  However, the government is very concerned and the HCMC Department of Health is working overtime with all healthcare facilities (two of which have discovered cases and are locked down) to assure prompt and effective response.  The government is taking additional preventative measures to facilitate elections on Sunday, May 23rd and to enable reopening of industrial parks in the North and continuity of operations in the South to maintain global supply chains.

Prime Minister Pham Minh Chinh continues to make resources readily available for rapid acquisition and deployment of the vaccine.  Last Sunday, a new shipment of almost 1.7 million doses of the AstraZeneca vaccine arrived under the COVAX program.  The government has announced plans to purchase 31 million doses of the Pfizer vaccine in the second half of the year.

At the G20 Global Health Summit in Rome on May 21, world leaders and pharmaceutical company leaders also made commitments to boost supplies of vaccines for low- and middle-income countries.

The country and everyone who lives here awaits the vaccine.  Many private-sector organizations have expressed willingness to support Government efforts when more vaccine is available, both companies offering to fund costs of vaccines for their employees, and private hospitals and clinics offering to support distribution.

Meanwhile, some expats are preparing to include vaccinations in plans for travel back home in coming months, despite the current requirement on arrival back in Vietnam for a 22-night stay in a quarantine facility, followed by a 7-day home quarantine, regardless of vaccination status.

Links:

We’re in it together: PM calls for open access to Covid-19 vaccines – VnExpress International

PM moves to speed up purchasing of COVID-19 vaccines – Society – Vietnam News | Politics, Business, Economy, Society, Life, Sports – VietNam News

Hospitals tighten COVID measures following two new domestic cases in HCM City – Society – Vietnam News | Politics, Business, Economy, Society, Life, Sports – VietNam News

Vietnam’s new Covid wave to last longer, spread further: health minister – VnExpress International

Vietnam’s Covid-19 domestic tally crosses 1,900 – VnExpress International

Covid vaccine priority sought for manufacturing workers – VnExpress International

Game changer: Vietnam to secure 110 million vaccine doses.  According to news reports, Vietnam will receive a total of 110 million doses from three different sources this year, including 31 million doses of the Pfizer-BioNTech mRNA vaccine.   A shipment of 1.7 million doses of AstraZeneca vaccine is scheduled to arrive Sunday. LINK to read more.

The lack of vaccines has been the missing link in Vietnam’s world-class control of COVID-19.  With new variants and outbreaks throughout the region just across porous land borders, the COVID situation in Vietnam could become deadly for a vulnerable, largely unvaccinated population.

Details on delivery of the vaccines to Vietnam are not yet known. Distribution to the population is also a question mark. There are various proposals for how to distribute.  Some would include private sector partners, either healthcare organizations or businesses directly.  At this point, decisions are in the hands of the Prime Minister and Ministry of Health officials who are acutely aware of the need to rapidly roll out the vaccines.

The Pfizer and Astra-Zeneca vaccines are in the pipeline. Each requires two doses, 2-3 weeks apart. During the rapid vaccinating period in the UK, first doses were prioritized, with delays of months for second doses. Fortunately, a single dose is about 65% effective, and importantly, makes death and serious illness extremely unlikely.

The risks of anaphylaxis and blood clots are likewise very unlikely and certainly much less risky than contracting the disease itself.

Priorities for the queue are frontline healthcare workers, case trackers, other frontline workers such as airport and quarantine workers, military, police, and teachers. Only then, elderly and chronically ill people would receive vaccines. It could be a long line.

Less than 1,000,000 Vietnamese have been vaccinated to date.  Vietnam is also applying for rights to produce mRNA Vaccines indigenously.  VN’s NanoCovax vaccine may be ready by 2022.  So, plans are being made to further enhance vaccine availability.

Without a vaccinated population, nonpharmacologic means of control (testing, contact tracing, quarantining, use of masks, and social distancing) continue to be necessary.   Vietnam is a model for this, but even in Vietnam, complacency is seen as a contributing factor to the current outbreak.  A “new normal” remains far in the distance with a mostly unvaccinated population.

In the meantime, Viet Nam continues to see new COVID-19 cases every day, with 165 on Saturday alone, and now more than 1,000 since the latest outbreak began on April 27.  Fortunately, these have remained contained in 26 locations and nearly all recent new cases are among those already quarantined.

Unfortunately, Vietnam also experienced a COVID-related fatality on Saturday, an 89-year old woman, with multiple pre-existing conditions.  This was Vietnam’s first COVID-related fatality in over eight months and 36th total, out of about 4000 total cases to date since the pandemic began.  There are nearly 60,000 people quarantined, with the quarantine period extended to 21 days in a supervised facility, then another 7 days of home quarantine.

At this point, stay safe in all the ways that we have become accustomed to – and don’t let down your guard.

Links: Vietnam to get 31 million Pfizer vaccine doses this year – VnExpress International

Vietnam calls for Covid-19 vaccine patent waivers – VnExpress International

Infection tally in Vietnam’s new Covid wave crosses 1,000  –  VnExpress International

Vietnam’s Covid patient dies  –  VnExpress International

Infection tally in Vietnam’s new Covid wave rises to over 800 – VnExpress International

Coronavirus mutants, socioeconomic disparities pose endemic threat: experts – VnExpress International

1.7 mln AstraZeneca vaccine doses to arrive Sunday – VnExpress International

For the most accurate, up-to-date information, check:

Also, check:

If you are a U.S. citizen, register for the STEP program at  travel.state.gov  to receive updates on health and security information from the U.S. Consulate.

AmCham Covid Policy Update/Event Level Rating

AmCham Vietnam places a high priority on promoting health and safety.  We value Vietnam’s vigilant response to the COVID-19 pandemic, and strive to support the Vietnamese government in its continuous efforts to prevent and control its spread. Thus, we have created a four-level event rating system that allows us to adapt and respond appropriately as the pandemic progresses, and to ensure that our members and friends can make informed decisions about which events they choose to join.

For AmCham Event Level Rating, please see LINK