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

Updated on September 19, 2021

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.

Show you care! Please help save lives and do your part to help now through AmCham CARES, by contributing cash or in-kind for critically-needed ventilators and medical equipment via AmCham, or directly to our NGO members and partners providing COVID relief.

AmCham is invested in Vietnam’s success. Last year, thanks to generous contributions from our members, AmCham donated 250,000 surgical masks, Thermo Fisher PCR testing and analysis systems, and a fully-equipped Ford ambulance to Vietnamese health authorities. AmCham now is carrying out another AmCham CARES fundraising campaign. We expect to deliver four Medtronic ventilators, worth over $200,000, as well as more than $100,000 of other urgently-needed medical equipment later this month to support the Government’s response.

Please contribute NOW personally or for your company to support Vietnam and HCMC at this challenging time. AmCham CARES provides you a transparent mechanism to make contributions NOW for critically-needed medical equipment and supplies and know they will be delivered where in Vietnam they are needed most. We are looking into donations of ventilators and other medical equipment, including BIPAP and CPAP non-invasive ventilators, and SpO2 oxygen monitors. We also welcome contributions from other business associations and non-members and will ensure all donors are recognized. Contribute Now: https://bit.ly/3i4FHRn to demonstrate AmCham Cares! If you have any questions, please contact AmCham Office Manager Cindy Tran at [email protected].

The fourth wave of COVID-19 in Vietnam and the highly transmissible Delta variant are causing extreme hardship for many Vietnamese people, especially disadvantaged groups such as migrants and informal workers. We know many of AmCham’s members and friends want to contribute to help, but don’t know how best to do so. In addition to contributing directly via AmCham CARES to donate critically-needed medical equipment to support the Vietnamese governments, we provide information below about various AmCham INGO members’ COVID-19 relief programs in Vietnam, as well as links to some local NGOs vetted and supported by LIN. Contribute now personally or via your company. LINK. 

We are happy to highlight COVID-related contributions from our member companies on our social media. Please email details, including photos, to Cindy Tran. We will also recognize contributions of our member companies to support the Vietnamese government’s COVID response, as well as other innovative and impactful Corporate Social Responsibility Programs or Environment, Social, and Governance initiatives at our November 18 “Giving Thanks Dinner”.

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 [email protected] 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 @ [email protected] 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 @ [email protected] 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:

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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