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Australia’s neighbours being ‘overwhelmed’ by Delta surge


Anastasia Tsirtsakis


4/08/2021 6:08:58 PM

Even countries that had successfully contained previous outbreaks – like Vietnam, which last week recorded a 546% increase in deaths – are struggling with exploding case numbers.

Person being treated for COVID-19 in the street.
Healthcare systems throughout the region are being overwhelmed, leaving many to be treated in the street, or sometimes not at all. (Image: AAP)

On 29 April, when the world registered a record 903,171 cases in one day, Vietnam had only 45 new cases.
 
Just over three months later, it is a different story; the south-east Asian nation has averaged nearly 8000 cases per day over the past week, while yesterday it tallied a record 376 deaths.
 
Elsewhere in the Asia-Pacific is a similar story – Thailand, which also fared well in the first 12 months of the pandemic – registered a record 20,000 cases in one day this week, while Indonesia’s situation has seen it labelled the new ‘epicentre’ of the global pandemic.
 
All of these outbreaks have been fuelled by the Delta variant of concern, which is estimated to be 55% more transmissible than Alpha, which was around 50% more transmissible than the original strain.
 
Now detected in at least 132 countries, infections have increased on average by 80%, or nearly doubled, over the past four weeks in five of the World Health Organization’s (WHO) six regions.
 
‘Hard-won gains are in jeopardy or being lost, and health systems in many countries are being overwhelmed,’ WHO’s Director-General Dr Tedros Adhanom Ghebreyesus said.
 
With uncontrolled outbreaks already having been linked to the emergence of variants of concern, newsGP takes a look at some of the countries in the Asia-Pacific region that have been most affected so far.
 
Vietnam
Until recently, Vietnam had been hailed a success story in its handling of the pandemic thanks to proactive public health policies, including strict border control – but that changed with the emergence of Delta.
 
As of 28 March 2021, the country had reported 2591 confirmed cases of COVID-19 and 35 deaths. But in just over three months those figures have jumped to more than 170,000 cases and 2071 deaths, as of 4 August. According to the WHO’s latest weekly epidemiological update, in the last week alone, Vietnam has seen a 546% increase in deaths.
 
Authorities were initially successful in controlling localised outbreaks in Hanoi and Bac Giang province, but cases, particularly in the city of Ho Chi Minh, have continued to surge with daily cases exceeding 7000 since 22 July.
 
A lockdown enforced on 31 May was extended on Monday for two weeks in Ho Chi Minh City and another 18 cities and provinces throughout the country’s south.
 
Vietnam’s Deputy Prime Minister and Head of the COVID-19 Taskforce Vu Duc Dam said the aim was to create ‘a safe belt’ around Ho Chi Minh City to not let the virus spread further, warning ‘it may take months to contain the situation in the area’.
 

 
A slow vaccine rollout also hasn’t helped, with just 0.7% of the population fully vaccinated, and 6.5% having received one dose, as of 2 August.
 
Through a mixture of home-grown vaccines, doses sourced through COVAX, and a planned facility aimed at manufacturing an additional 200 million doses of Sputnik V, Vietnam hopes to meet its 70% vaccination target by May 2022.
 
In the meantime, with state hospitals unable to meet demand, the Vietnamese Health Ministry has issued an urgent appeal to private hospitals to open their doors to COVID patients.
 
Indonesia
As of 4 August, Indonesia has recorded more than 3.4 million cases of COVID-19 and 98,889 deaths, with the Delta variant hitting the country in May resulting in a second wave that has placed it at the epicentre of region’s outbreak.
 
The resulting surge has seen healthcare systems overwhelmed. A record 114 doctors died during a 17-day period last month, while 2833 people died either while self-isolating at home or waiting for a hospital bed between 11 June and 30 July.
 
Daily case numbers have started to decline, with 33,800 per day on average last week. However, the WHO’s latest weekly update noted Indonesia is still among those reporting highest numbers in the region (273,891 new cases in the past week). It also reported the highest number of deaths at 12,444, an increase of 28%.
 
Moreover, cases are likely underreported, with a serology survey conducted by the Indonesian Centres for Disease Control in late March finding COVID-19 antibodies in 44.5% of Jakarta residents, suggesting 4.7 million of the city’s 10.6 million inhabitants had been exposed to the virus, while only 8% had been diagnosed.
 
Indonesia’s vaccine program, launched in January, has seen only 7.7% of the population of 270 million fully vaccinated and 9.8% having received at least one dose, as of 2 August.
 
Thailand
As of 4 August, Thailand had recorded more than 652,100 cases of COVID-19 and 5315 deaths, up from 28,863 cases and 94 deaths on 31 March.  
 
The country is now facing its biggest outbreak, with 17,669 new cases and 165 deaths reported on 29 July, its highest on record since the pandemic started.
 
Reports have emerged of hospital facilities struggling to meet demand, and people dying in the streets or in their homes while waiting for treatment.
 
A number of field hospitals are in operation or being set up, including a cargo building at Don Mueang International Airport in Bangkok which has 1800 beds made from cardboard and is expected to be ready for use in two weeks.
 
Hospital morgues have also been overwhelmed by COVID deaths, with Thammasat University Hospital near the capital Bangkok resorting to storing bodies in refrigerated containers, a measure it last adopted following a tsunami in 2004.
 
The Thai Government has been criticised for its slow vaccine rollout, with only 5.7% of the population fully vaccinated and 15% having received one dose, as of 2 August. The aim is to vaccinate 70% of the population by the end of the year.
 
India
To date, India has recorded more than 30 million cases of COVID-19 and 425,789 deaths.
 
After the Delta variant was first detected in India in October 2020, it resulted in the country’s devastating second wave that started in February. Cases jumped from around 10,000 per day to a record 414,188 on 7 May, placing strain on hospitals and already stretched medical supplies.
 
Daily case numbers have since started to decline, but with the seven-day average still hovering above 40,000 new cases daily, the country is reporting some of the highest infections in the region.
 
And according to the WHO’s latest weekly update, despite a 45% decline in deaths, it is still reporting the second highest death toll in the region, with 3800 deaths in the past week.
 
Currently administering up to 4.8 million doses a day, as of 1 August, India has so far fully vaccinated 7.5% of the population and 19% have received at least one dose.
 
Malaysia
Like Vietnam, Malaysia had been celebrated for its response to the pandemic thanks to the governments’ quick move to lockdown, and investment into testing.
 
That has since changed, with the country’s per capita infection rates and death toll now surpassing India at the peak of its second wave.
 
In the past week alone, Malaysia has seen a 29% increase in new cases, with 116,879 reported – the highest in the Western Pacific region. It has registered the most deaths during this time – 1122- up 8%.
 
Reports have emerged of the healthcare system being overwhelmed, as healthcare workers struggle to keep up with the rise in COVID-19 admissions – scenes described as being ‘akin to a disaster movie’.
 
Malaysia’s inability to curb the growing outbreak has been attributed in large part to government complacency around public health measures such as social distancing and mask-wearing.
 
As of 2 August, 22% of the population is fully vaccinated and 22% have received their first dose.
 
Fiji
Despite managing to remain relatively COVID-free for most of 2020, Fiji has recorded more than 27,000 infections since April.
 
Cases peaked on 15 July, with 1845 daily new infections, with the seven-day average now at 1085. Overall, 32,733 cases and 261 deaths have been identified as of 4 August.
 
The rapid rise in infections, which started after a returned traveller from India passed on the virus to a soldier at a quarantine facility in April, is seeing an already under-resourced medical system buckle under pressure, with some COVID-positive patients being turned away due to a lack of beds.
 
Locals are being advised self-isolate at home and only seek medical assistance if their symptoms worsen, resulting in some people dying at home or on their way to the hospital.
 
The Fijian Government is now focused on vaccinating as many people as possible; however, there is concern about widespread vaccine hesitancy. A ‘No Jab, No Job’ policy was introduced in July for all public servants and private sector employees.
 
The first Pacific nation to receive AstraZeneca vaccines through the COVAX program, as of 2 August, 16% of the population is fully vaccinated and 38% have received at least one dose.
 
Last week the US organised the delivery of more than 150,000 doses of Moderna and Australia is continuing to fly in supplies of AstraZeneca. Meanwhile, India, New Zealand and Japan are also assisting with vaccine doses, as well as personal protective equipment.

Correction: This article previously incorrectly stated Ho Chi Minh is the capital of Vietnam.
 
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Dr Dominic Francis Barnes   5/08/2021 7:17:45 AM

And what about our closest neighbour PNG?


Dr Ruth Appleby   5/08/2021 5:05:53 PM

First comment is a correction of impression. The article reads as though Ho Chi Minh City is the capital of Vietnam, which it it not. Vietnam's capital is Hanoi.


Dr Ruth Appleby   5/08/2021 5:27:56 PM

So much focus on those countries that are struggling or doing poorly in the current phase of their journey through the pandemic, and especially if that contrasts with perceived previous success. Are we trying to make ourselves look better? I have some comments regarding the reporting on several of these countries:
India: After noting that India's peak of daily infection occurred on 7 May, the article proceeds to say, "Daily case numbers have since started to decline...". In an article published on 4 August, this form of words gives a very incorrect impression of gradually declining reported cases which are still only slightly improved compared to the peak. To be fair, it then mentions that "... the 7-day average [is] still hovering above 40,000 new cases daily..." without pointing out that that represents a 10-fold drop from the peak. Nor does it mention that the bulk of that drop occurred quite rapidly after the peak; reported cases have been fairly steady for the past 6 weeks.


Dr Ruth Appleby   5/08/2021 5:42:50 PM

Vietnam: It would be worth mentioning in the article that the lockdown in Ho Chi Minh City (which, BTW, is NOT the capital of Vietnam) is extremely strict with almost 9 million people living under measures that make Australia's harshest "lockdowns" look like a walk in the park. (After all, most Australian lockdowns have still allowed people to go for a walk in the park.) Also that authorities set a goal of testing every person in HCMC in the space of a month. In spite of such strong action, in such a densely populated city they have not been able to prevent spread. And yes, being behind the eight ball in regards to getting vaccines out has made it all that much harder. It is yet another sobering example of how much impact Delta has on the trajectory of outbreaks and the pandemic overall.


Dr Ruth Appleby   5/08/2021 7:07:53 PM

Finally, Cambodia: Sandwiched between Vietnam and Thailand, and poorer than either of them, a 2020 success story with only about 500 cases and no deaths up to February 2021, since then also engaged in a major struggle against by far the worst outbreak it has encountered. But not mentioned in the article. Why not? Because it's not dire enough? Doesn't fit the narrative?
Alpha slipped out of hotel quarantine into Phnom Penh in early February 2021, but went undetected for a couple of weeks until the 20th of Feb. The genie was out of the bottle. Just two days after the night that 4 women escaped from their mandatory quarantine, while the country was blissfully unaware of what was coming down the tube, Cambodia's vaccination campaign began, using a combination of donated and purchased Sinopharm and Sinovac vaccines from China. It was a bit chaotic at first, but under pressure from an expanding outbreak, the rollout quickly got more organised and gathered momentum.


Dr Ruth Appleby   5/08/2021 7:09:52 PM

Responding to local realities, the initial strategy of target groups was replaced with a strategy of rapidly vaccinating all adults based on geographical areas. To increase capacity, the military were enlisted to work in parallel with the Ministry of Health to deliver vaccines to the population. Starting with the "red zones" in the capital that were hardest hit initially, and expanding by local government areas to encompass the whole capital and surrounding vulnerable provinces, vaccines have now been delivered in all of the 24 provinces.


Dr Ruth Appleby   5/08/2021 7:10:46 PM

The government's initial target was 10 million adults aged 18 and above. Recently young people age 12-17 have been added to the campaign, and the latest goal is 13 million people to be fully vaccinated by the end of November, representing 81% of the TOTAL population of the country which is 16.5 million. That goal is already 6 months ahead of the initially proposed schedule, and realistically may be reached even earlier than November. And that's not even mentioning the planning now going into delivering booster shots.


Dr Ruth Appleby   5/08/2021 7:12:01 PM

As of yesterday, 4 August, just over 13 million out of the 26 million doses required to meet the target had been delivered into arms. 77% of adults (45% of Cambodia's entire population) have received their first doses, while 52% of adults (32% of the population) have had two jabs. 160,000 (8% of the target) 12-17 year olds have had their first jab in the 4 days since that campaign began on 1 August.


Dr Ruth Appleby   5/08/2021 7:12:43 PM

And what impact has this astonishingly successful vaccination campaign had? The contrast with neighbouring Thailand and Vietnam is stark. Their sharply escalating figures are quoted in the article. Meanwhile, Cambodia's community-acquired cases have been steadily declining since the peak of 991 on 30 June. Today's new community-acquired cases were 408. Deaths have been mostly in the range of 20-40 a day throughout July, with a gradual downward trend. Apart from a fairly harsh initial lockdown of three weeks in Phnom Penh back in April, this has been achieved with only minimal restrictions on travel, though schools and places of worship have been closed since March and some classes of businesses have also endured prolonged closures.


Dr Ruth Appleby   5/08/2021 7:13:40 PM

It should also be noted that many hundreds of frightened migrant workers have been streaming across the borders every day from Thailand to escape the scourge of the Delta-fuelled outbreak there. Inevitably they have brought Delta with them, and it is now beginning to circulate in the community. Doubtless it will supplant Alpha as the dominant strain, further challenging Cambodia's limited health system and resources. But despite being dependent on vaccines that have been looked down on by the west, Cambodia is arguably better positioned now to handle Delta than Australia is.