From Portside <[email protected]>
Subject Vietnam, COVID-19 and Public Health
Date March 27, 2020 4:46 AM
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[ Vietnam has had only 141 cases of COVID-19 as of March 23, and
so far, no deaths. Despite its proximity to China, and fewer resources
than countries like Singapore, the country seems to have kept the
virus under control.] [[link removed]]

VIETNAM, COVID-19 AND PUBLIC HEALTH  
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Stephanie Luce
March 26, 2020
xxxxxx

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_ Vietnam has had only 141 cases of COVID-19 as of March 23, and so
far, no deaths. Despite its proximity to China, and fewer resources
than countries like Singapore, the country seems to have kept the
virus under control. _

People wearing face masks take part in a motorcade as a public
awareness campaign for the prevention of the spread of coronavirus in
Hanoi on Monday (March 23). Vietnam imposed a blanket ban on all
foreigners on entering the country on Sunday., AFP // The Star
(Malaysia)

 

What can we learn from Vietnam? Below are two perspectives: (1) An
interview with public health leader Professor Le Vu Anh, and (2)
Observations from Cathy Dang-Santa Ana, based on conversations with
her mother who lives in Vietnam. And, (3) the video 'Jealousy Ms. Vy'
(Corona Song), produced by the Vietnamese Institute of Occupational
and Environmental Health, which as of Feb. 23, had already been viewed
by 25 miilion viewers on YouTube.

(1) Interview with Professor Le Vu Anh, March 23, 2020
(2) Observations from Cathy Dang-Santa Ana, March 25, 2020
(3) Ghen Cô Vy| NIOEH x K.HUNG x MIN x ERIK | WASHING HAND SONG |
CORONA SONG

(1) INTERVIEW WITH PROFESSOR LE VU ANH, MARCH 23, 2020

Vietnam has had only 141 cases of Covid-19 as of March 23, and so far,
no deaths. Despite its proximity to China, and fewer resources than
countries like Singapore, the country seems to have kept the virus
under control.   

Stephanie Luce interviewed Professor Le Vu Anh to see what we can
learn from Vietnam. 

Professor Le Vu Anh is a prominent public health leader and innovator
in Vietnam. As the founding Dean of Hanoi School of Public Health
(HSPH), he worked there for the latter half of his carrier before
retiring. He is now President of the Vietnam Association of Public
Health and editor of the _Vietnam Journal of Public Health_.

 

_WHAT IS THE OVERALL PHILOSOPHY AND ORGANIZING PRINCIPLES OF THE
VIETNAMESE HEALTH CARE MODEL?_
 

Like some other countries, Vietnam (VN) divides its health care system
based on administrational levels . We have four levels:
Central-Provincial-District and commune. Depending on population size
of each level, health care infrastructure is equipped more or less for
both human and material resources.  

Under the commune level, we have village health workers (more on this
below). With the increasing of a market approach, private sectors are
now developed rather fast including both medicine and pharmacy (for
both western and traditional medicine). For them to practice, they
would need some sort of license and to get that they would have to
pass some examination and a review of their infrastructure and of
course, their course of implementing practices would be supervised
periodically. Private sectors will be mobilized for providing some
services in some emerging cases such as Covid19. And of course, one
would be fined if they did anything wrong (both public and private
sectors).  

The slogan “prevention is better than curative” is always repeated
but in reality, only a maximum 30% of investment goes to prevention.
Hopefully, more and better evidence coming from the Covid19 epidemic
would change this proportion a bit toward more prevention. For this, I
would like to note that hospital and preventive sectors are working
separately. The latter is working under provincial CDC (since CDC is
only applied in provincial level). At central levels we still keep
some leading prevention institutes under their old names. For example
in Hanoi it is called The Hygiene and Epidemiology Institute, Pasteur
Institutes in Ho Chi Minh City.   

VN has developed a health insurance system (actually from beginning
of the 1990s). It now covers 89% of the population, of which some
certain percent be paid by government: for example, poor families,
those who have made contributions for the country’s revolution, and
some sort of old and disabled people/families.  

A health worker wearing a facemask amid concerns of the spread of the
COVID-19 coronavirus checks the temperature of a local resident on
Truc Bach street in Hanoi.
Telangana Today (Hyderabad - India)

 

_CAN YOU TELL ME WHAT WERE THE MAJOR IMPORTANT STEPS THAT WERE TAKEN
IN YOUR EPIDEMIC RESPONSE THIS YEAR?_
For this question, it may have two different approaches namely telling
a story or using some concrete data. I use both. For that, we first of
all need data.  

One may ask about the reliability of this data. I would argue that (1)
There are still all sorts of fake news and panic about the 2003
outbreak of Sars-Covy in VN. That outbreak killed a number of people
including Dr. Carlo Urbani from WHO and doctors and nurses who
provided services (especially at the V-P hospital). The lesson learnt
was that panic and fake news would bring about unexpected consequences
which are very difficult to control not only during that time but for
a long time later. Transparent reporting and up-dating real
information would be the best way of dealing with the outbreak in
terms of communication.  

And (2): We learned lessons from China when they kept saying nothing
during the first two golden weeks of Covid-19 until Dr. Li Wenliang,
an ophthalmologist in Wuhan decided to announce on his fan page about
a new disease. This lesson reminded us not to go that way. And in VN,
WHO has been invited to work closely with MoH from very beginning of
any outbreak.    

See the graph below. The black line is number of those who have
Covid (+); Red line: people those who shared space with Covid (+) and
seen as suspected; Blue line: people who have been healed and their
test turned to Covid (-). 

FOR THE BLACK LINE: All were asked to hospitalize. Those who have
symptoms will be treated until healed and they test Covid (-). These
people may need longer than 14 days. No dead have been recorded so far
among this group. You may see the case 16 started hospitalization from
February14 and lasted until March 5. Between that period, one case has
been identified. 

FOR THE RED LINE: Not all, but those who have symptom(s), and those
who had close contact with a positive case (black) will be tested.
These people will be called F1. Whenever any F1 turned into a case, F1
will automatically be named F2 and be called for quarantine. Before
that they have been remind that they are at risk but can be
quarantined at home with very careful instructions of how to best do
home quarantine. This is a bit trade-off between two difficult
choices: applying quarantine to all suspected people and financial
limitation! 

FOR THE BLUE LINE: Since no dead has been recorded, the blue line
reflects (1) Those who have been healed with Covid19 (-). and (2) The
number of days under treatment in the hospital. For example, patient
number 16 has 35 days in the hospital! Note that all central
quarantine and treatment in hospital will be free of charge. This says
something about the cost for the Covid epidemic and is the reason for
government to call for support nationally and internationally. This
also has been a focus of all mass media and communication about the
government for helping its citizen in such critical time especially in
comparison to other countries where people have to pay a lot for both
testing and treatment.  

It has been shown recently that the payment strategy for Covid19 has
changed in some countries like Canada and the UK toward free for all!
But VN did this immediately, from the very beginning and for
foreigners also.  

Mass media and communication also strongly addressed what they
called “fake news” and panic control. Unlike China, Vietnam is
still allowing FaceBook, Twister, Zalo etc. together with official
communication. This is very effective in addressing communication
problems. For example, one man used chloroquine phosphate for
prevention of Covid19 following news in FaceBook and had to go to the
ICU due to intoxication. Immediately the afternoon TV news covered
that case with some comments from the Vice-Minister of Health, giving
warning about using news, especially during Covid time! Or a clip
about a Polish-Vietnamese person who arrived at the Airport and was
asked to go into quarantine. She complained and shared her
dissatisfaction, but her case was spread widely and she was criticized
by the internet community and she ended up openly sorry for that
behaviors.  

_HOW IS THE EPIDEMIC RESPONSE COORDINATED, WHAT ARE THE ROLES OF
NON-MEDICAL SPECIALISTS? DO YOU HAVE A ROLE FOR COMMUNITY HEALTH CARE
WORKERS?_
 

From the very beginning VN has created a so called National Steering
Committee (NSC) for Covid19 chaired by a Vice-Prime Minister. The
Vice-Standing Chair is the Vice-Minister of Health and other members
are all related Ministries. Steering committees have also been
established in each province as well as in each Ministry in order to
make sure that all instructions and activities proposed by the NSC are
carried out. This reflects clearly a multi-disciplinary approach that
should be used in integrated planning during an emergency situation.
The Prime Minister appeared daily on the TV news addressing all issues
and problems. This emphasizes the roles of different partners involved
and encouraged them to do good works.  

_IT SEEMS VIETNAM HAS DONE SO MUCH FOR PUBLIC HEALTH UNDER A MUCH
SMALLER BUDGET THAN MANY COUNTRIES. HOW DO YOU MAXIMIZE YOUR
RESOURCES?_

I suppose that some explanation above has explained partly what VN is
doing. We have to consider the financial limitation and the best way
to solve it in reality. Having more money, VN may do it a bit
differently! I do not know in detail how much has been paid for
whatever strategy since we don’t have such kind of data.  

_CAN YOU TELL ME ABOUT COMMUNITY HEALTH CARE PRACTICES?_

VN has a commune health station in each commune with around 3-5-7 paid
positions depending on the population size of the commune. They are
pediatric-obstetric staff(s), traditional staff and preventive staff
in charge of vaccination etc. They are all being trained in medicine
and pharmacy, and/or public health depending on individual people’s
choice since the kind of training degree will decide one’s salary
and promotion. At the lower level, VN has some positions for village
health worker, working on population issues or nutrition etc. They
will be paid also but only with some small amount of money. At higher
levels: district, provincial, central levels, the professional
training functions a bit different.
_WHAT LESSONS FROM VIETNAM HEALTH CARE ARE IMPORTANT TO SHARE?_

1. Quarantine can be seen as a rather cheap and effective approach
where you have enough facilities like the Army with their camps, and
human resources. 

2. Testing is important but a bit costly and that makes you have to
think carefully before deciding who to test. 

3. Free of charge for all services is a good way when you have enough
choices and supporters and the number of those who use the services
are still under control.

 

 

Credit: South China Morning Post (Hong Kong)
 

(2) OBSERVATIONS FROM CATHY DANG-SANTA ANA, MARCH 25, 2020

_Cathy Dang-Santa Ana is an activist who lives in New York City. She
shares these comments based on conversations with her mother._

Every time I get off the phone with my mom in Vietnam, my mind is
blown away about all that the government is doing for our people
there. 

1)      Some people may feel this is authoritarian, but I think
aspects of it are justified. Anyone who travels into the country has
to get their temperature checked and if they appear sick, they take
you in for 14-day quarantine (paid by the government). If you seem
fine, they will still take you in but just for a few days to see how
you’re doing and will let you go home. But they ask that you stay in
the house for 2 weeks. They then publish person’s name and what they
look like to the district newspaper to let their neighbors know
someone recently traveled abroad in that house and if they leave, to
call the government. 

2)      If you live in a large building and if one person is sick
in your building, the whole building isn’t allowed to leave. But the
government will cook you fresh meals and deliver it to your doorstep,
3 meals a day for less than $2-$6. For. Each. Person. In. The.
Household. For two weeks until everyone is clear. 

3)      They are setting up sanitizing systems not just hand
sanitizers to sanitize a person’s entire body, at the entrance and
exit of every large building. 

4)      If you are sick and don’t feel comfortable living in
your current home around others and don’t want to get them sick,
they’ve set up a discounted cheap rate for you to rent a hotel room
since the tourism industry is down. They’re doing it to quarantine
people who are carrying but not really ill and to support the industry
and workers. And if you choose to stay at a hotel, the government will
send a doctor (a doctor, not a PA or nurse. a doctor) to your hotel to
check on you at NO COST (all paid by the government). 

5)      Because it’s a country that already heavily uses masks,
everyone has one for when they drive on their mopeds. But when you go
out now, everyone is asked to wear one. 

6)      There is no price gouging at all nor hoarding. Soap and
hand sanitizers are affordable and available to everyone. 

7)      If the government finds out you’ve been traveling out
of the country, they come to your house to check if you’re sick and
if you are, they take you into quarantine.

And according to Daniel Hoài Tiến Nguyễn, "the Prime Minister
stopped all exports of rice to ensure food security for the country.
From the beginning, the Prime Minister said 'no one will be left
behind.' The government has made it their mission to ensure Vietnamese
who want to come home will be brought home. A huge part of the effort
is they also mobilized neighborhood self defense militias and
neighborhood organizations to help spread the information and keep
people posted about new government directives (yesterday all gyms, for
example, now must close until April 4th and all morning people are
door knocking to let everyone know). This is organizing and
preparedness. Imagine Hurricane Katrina with this kind of response!" 

This is all with just less than 150 cases in the country. And
there’s probably some kind of rent moratorium she doesn’t even
know about yet.

 

(3) GHEN CÔ VY| NIOEH X K.HUNG X MIN X ERIK | WASHING HAND SONG |
CORONA SONG [[link removed]]

Watch here [[link removed]].

This was viewed by 25 million on YouTube, as of Feb. 23.

Here is a rough Google translation

'Jealousy Ms. Vy' is a creative project of the Institute of
Occupational and Environmental Health, in collaboration with musician
Khac Hung, singer Min and singer Erik.

Through this project, we look forward to empowering and trusting the
community, so that we can join hands to combat COVID-19 (aka
nCoV-2019).

In this critical moment of fighting the plague, we hope the song can
spread more fire and less stress to the frontline soldiers of this
war. That is the team of experts, physicians, health workers and
millions of workers who are in the front lines of exposure and daily
struggle with the disease.

Let our community take the initiative in implementing preventive
habits as recommended by specialized agencies and spreading good and
kind things to win the disease together.

Vietnam is determined to win the epidemic!

Follow updates on the disease on the Ministry of Health website
[[link removed]]. 

Or on the Institute's website [[link removed]]: 

Credits:

Producer: Institute of Occupational and Environmental Health

Author: Khac Hung

Music production: Khac Hung

Singer: Min x Erik

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[_Stephanie Luce is a professor at the CUNY School of Labor and Urban
Studies and a member of the Professional Staff Congress/CUNY-AFT. She
is a member of the xxxxxx collective.]_

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