As the World Health Organization (WHO) warns that the pandemic is accelerating and Victoria grapples with community outbreaks, extending its state of emergency declaration until 19 July, public health researcher Alison Barrett shares some global perspectives – in the latest edition of the COVID-19 wrap.

WHO Director-General: on COVID-19 pandemic accelerating

World Health Organization, 19 June and 22 June 2020

On 21 June, more than 183,000 new cases of COVID-19 were reported to the WHO – to date, this is a record number of reports for a single day.

Just two days earlier, the WHO’s Director-General, Dr Tedros Adhanom Ghebreyesus warned that the pandemic was accelerating.

Almost half of the cases reported were from the Americas and large numbers also were reported from South Asia and the Middle East.

Tedros said:

The world is in a new and dangerous phase.

Many people are understandably fed up with being at home. Countries are understandably eager to open up their societies and economies.

But the virus is still spreading fast, it’s still deadly, and most people are still susceptible.

We call on all countries and all people to exercise extreme vigilance.”

He urged people to remain physically distant from others, stay home if feeling unwell, to wash hands frequently, wear a mask when appropriate and cover mouth when coughing.

He said: “We continue to urge all countries to double down on the fundamental public health measures that we know work.” That is, to find, isolate, test and provide care for every case of COVID-19; and trace and quarantine contacts.

Due to inadequate access to health services, shelter, water, sanitation and nutrition, WHO is concerned about the high risk of COVID-19 infections in refugee camps. Tedros advised that in May, WHO signed an agreement with the United Nations High Commissioner for Refugees to collaborate on improving public health measures for refugees around the world.

WHO is also helping supply countries with personal protective equipment and diagnostic kits, and helping countries to maintain essential health services. A recent survey by WHO found that dental and rehabilitation services have been disrupted by the pandemic, as well as routine immunisation programs and treatment for noncommunicable diseases and family planning.

Tedros concluded:

The world is learning the hard way that health is not a luxury item; it’s the cornerstone of security, stability and prosperity. 

Now more than ever, all countries must make universal health coverage a priority.

It’s not a question of whether countries can afford to do this, it’s a question of whether they can afford not to.”

All COVID-19 media briefings by Tedros can be viewed here.

COVID-19 monitoring and response among US Air Force Basic Military Trainees – Texas, March-April 2020

Centers for Disease Control and Prevention, 5 June 2020

Throughout the pandemic, outbreaks of COVID-19 have occurred in crowded settings, including, among others, long-term care facilities and cruise ships.

This report describes how the United States (US) Air Force limited the spread of COVID-19 at an air force base in Texas where approximately 40,000 new airmen receive basic military training each year.

Air force living and training conditions are conducive to COVID-19 transmission: communal quarters, group activities, classroom lectures, and trainees are always with at least one other fellow trainee.

From the beginning of March, the Joint Base San Antonio-Lackland implemented a rigorous testing and symptom screening regime, and isolation rooms were set up for quarantining those who were positive. If a trainee had symptoms for SARS-CoV-2 (cough, fever or shortness of breath), they were isolated for seven days and tested.

The base also restricted access for all non-essential personnel, banned visitors from attending graduation ceremonies, and training instructors remained in the local area to avoid travel-related transmissions. From 17 Mar, all new recruits had to quarantine for two weeks upon arrival to the base.

Other non-pharmaceutical interventions (NPIs) included physical distancing (six feet between one another) and compulsory wearing of face coverings (from 6 April).

Of the 10,579 trainees present at the air force base during the seven-week study period (1 March – 18 April), 345 were eligible for testing and five tested positive for SARS-CoV-2. All cases had developed symptoms, and isolated until they met criteria to return to training.

While the authors acknowledge that NPIs may not be as successfully implemented in less structured or resourced settings as a military base, this report highlights that when implemented early (in this situation, they were implemented before the first case on base), they can prevent the spread of COVID-19.

Here are 4 ways Vietnam has managed to control COVID-19

Fages, V, Gavi: The Vaccine Alliance, 25 May 2020

On 23 January, Vietnam was one of the first countries outside of China to report a COVID-19 case. While some wealthier countries have been badly impacted by the novel coronavirus, as of 21 June, Vietnam had 349 confirmed cases of COVID-19 and had not reported any deaths.

Vietnam responded quickly to the coronavirus epidemic; on 11 January, after the first death from the virus was reported in China, they implemented health checks at airports.

The country has previous experience dealing with infectious diseases such as SARS, MERS and measles, and they have been working with Gavi Vaccine Alliance for many years to help improve their health system so that they can respond to other infectious outbreaks.

Four main strategies have guided Vietnam’s response to COVID-19.

1. Strategic testing at airports

From 11 January, all travellers arriving at Vietnamese airports had their temperature measured; and people with chest pain, shortness of breath, cough or a fever were tested for COVID-19. Any confirmed cases plus their contacts, fellow passengers and aircrew were quarantined for 14 days.

“Quick action and effective testing helped slow the spread of the virus in its earliest stages,” Fages writes.

2. Aggressive contact tracing

From 22 March, Vietnam closed its borders to international visitors; those who were granted exceptions were required to undergo a 14-day quarantine upon arrival and medical checks. Anyone showing symptoms was monitored in medical facilities and their contacts traced.

Vietnam was able to conduct extensive contact tracing due to “the rapid mobilisation of health professionals, public security personnel, the military, and civil servants” in using the Ministry of Health’s records on infected, suspected and exposed cases of COVID-19. Members of the general public were also encouraged to report anyone returning from overseas.

A mobile app, NCOVI, has been implemented successfully to ensure that new infections are reported and isolated as the public shares their health status daily.

3. Effective public communications campaign

In February, the Ministry of Health released a pop song video emphasising the seriousness of COVID-19, including public health messages about handwashing and hygiene. It was very successful and shared around the world.

A public fundraising campaign to buy personal protective and medical equipment for frontline workers also helped raise awareness of the pandemic.

4. Rapid development of testing kits

In addition to purchasing 200,000 testing kits from South Korea, Vietnam has developed their own test kits using WHO-approved techniques.

While quick implementation of these four key strategies has helped Vietnam succeed in preventing large numbers of COVID-19 infections and deaths, child immunisation programs have been disrupted. Gavi is working with the government restart programs to ensure that children do not miss out on vaccines as a result of the pandemic.

Japanese citizens’ behavioral changes and preparedness against COVID-19: An online survey during the early phase of the pandemic

Muto, K et al, Plos One, 11 June 2020

Japan’s response to COVID-19 has been touted as a success story. With a population of 126 million people, crowded public transport and the world’s oldest population, there were concerns Japan would experience the same devastation as Italy or New York.

In comparison to Italy (238,720 cases/34,657 deaths) and New York (411,966 cases/31,265 deaths), as of 22 June, Japan had experienced 17,813 cases and 955 deaths from the novel coronavirus.

Researchers found in an online survey conducted between 26 and 28 March 2020 that 86% of respondents reported avoiding mass gatherings and 80% of respondents reported avoiding closed spaces with limited ventilation, crowded places and close contact settings, otherwise known in Japan as the “overlapping 3Cs.”

“’Avoid the overlapping 3 Cs has been the core and unique message against COVID-19 in Japan,” the authors write.

Regular handwashing was reported by 86% of respondents and 70% reported individual measures to strengthen their immune system, such as rest, sleep and a healthy diet.

The three most important events prompting these actions were the COVID-19 infections on board the Diamond Princess cruise ship quarantined in Yokohama, Japan, for nearly a month in February; the request by Japan’s Prime Minister for nationwide school closures from late February; and the announcement of the worldwide outbreak in early March. 

Of 11,342 Japanese citizens who participated in the survey, males, unmarried people and people aged between 20 and 29 years were most likely not to practise the preventive measures.

The authors acknowledge that a limitation of the study is that people aged 65 years and older were not included, so they could not examine the preventive behaviour of older people.

Other limitations include the self-report nature of the survey; potential selection bias, as those with internet and/or more likely to adhere to preventive measures against COVID-19 may be more likely to participate; and that the survey was conducted before the peak of cases in Japan. The researchers recommend the survey be conducted again at different times during the pandemic to capture potential changes in behaviour.

Despite the limitations, the survey provides an indication of the Japanese population’s adherence to preventive behaviours.

In highlighting those most likely not to adhere to these actions (male, younger and unmarried), they can future target messaging to these populations to prevent the further spread of infection.

Alison Barrett is a Masters by Research candidate and research assistant at University of South Australia, with interests in public health, rural health and health inequities. Follow on Twitter: @AlisonSBarrett. Croakey thanks her for providing this column as a probono service to our readers.

See previous editions of the COVID wrap.

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