Covid report card

Covid report card

Like their counterparts worldwide, Asean states fighting the pandemic have been learning on the fly about what works and what doesn't.

A health worker wears sports goggles at a coronavirus testing station in Depok, on the outskirts of Jakarta. Photos: REUTERS
A health worker wears sports goggles at a coronavirus testing station in Depok, on the outskirts of Jakarta. Photos: REUTERS

Covid-19 has put countries around the world to an unprecedented test. As the outbreak that began in China enters its sixth month, many governments are still racing against time to curb the health and socio-economic impacts of the pandemic.

Different countries have been trying a variety of approaches to contain the spread of the virus. Some have worked better than others, but the number of countries that deserve an A on their report card can be counted on the fingers of one hand.

In fairness, the scale of the outbreak is massive, and political leaders and health professionals alike have all been learning on the fly. Political leaders in particular have faced some hard choices in terms of lives versus livelihoods, as attempts to control the virus lead to a dramatic curtailment of economic activity.

Responses to Covid-19 in Southeast Asia and indeed around the world have been very dramatic and even draconian in some countries, says Prof Zachary Abuza of the National War College in Washington DC, who specialises in Southeast Asian politics and security studies.

Differences in countries' responses are reflected in huge disparities in the number of confirmed cases and enormous differences in fatality rates.

"Countries that are disciplined and focused in their responses and are willing to take short-term economic and political hits are going to come out ahead," Dr Abuza told an online panel organised recently by the Institute of Security and International Studies (ISIS) Thailand about Southeast Asian countries' response to the outbreak.

Singapore and Vietnam were the two countries that took the swiftest and most proactive responses in Southeast Asia with testing, travel restrictions, school closures and quarantine measures. Vietnam, despite the limitations of its healthcare system and testing capacity, has managed to keep the number under control with only 270 confirmed cases and no deaths.

Singapore, however, is now facing a severe test from a surge in Covid-19 cases among migrant labourers, a group that its renowned health planners appear to have almost totally ignored in their initial strategy planning.

The city-state of 5 million now leads Asean in infections -- more than 16,200 compared with just 1,500 a month ago. However, only 15 people have died as the vast majority of the recent cases are mild and involve otherwise healthy young people.

Indonesia, meanwhile, has the highest Covid-19 fatality rate in Southeast Asia at 8.4%. The world's fourth most populous country, according to data from Johns Hopkins University, reported over 10,100 confirmed cases and 790 deaths.

Like the Philippines, Indonesia's public health system is under-resourced and overtaxed with only 4.27 doctors and 12 beds per 10,000 people, according to data from the World Health Organization (WHO). The Philippines has just 6 doctors for 10,000 people, compared with 23 in Singapore.

Dr Abuza also highlighted the uptrend in authoritarian behaviour during crises such as the one the region and the world are now facing. "This is something governments around the world often do, using crises to amass powers and authority they would otherwise not have," he said.

For example, Thailand and the Philippines quickly relied on emergency powers to curb the pandemic while Cambodia's veteran strongman Hun Sen has exploited the situation to extend sweeping control of the media and digital surveillance in the one-party state through an emergency decree.

In Indonesia, the government introduced more curbs on freedom of speech and greater authority for the military to help. At least six Indonesians have been charged with posting fake news about Covid-19, including a man who took to Twitter to criticise President Joko Widodo's slow initial response. Spreading misinformation can bring a person up to six years in prison.

In Dr Abuza's view, five interrelated things are required for an effective response to Covid-19. They are leadership, government transparency, government legitimacy, intergovernmental coordination, and government planning and preparedness.

"No government should be blamed for a pandemic that comes naturally, but they do deserve to be scrutinised for how they respond to it," he said. Governments are soon going to take the real hit, whether at the polls in the short run with their surrogates, or in legislative elections based on their responses to the pandemic.

"Thailand's responses signify its centralised governance from the national to local levels," says Assistant Prof Pitch Pongsawat of Chulalongkorn University. SUPPLIED

CRITICAL STATES

Singapore, at least initially, set an example for a perfect response in terms of leadership and effective communication. Prime Minister Lee Hsien Loong addressed the public frequently on national television about the Covid-19 situation, speaking English, Chinese and Malay, the most commonly used languages in the country. The city-state has also imposed a partial lockdown that has been extended until June 1.

However, in light of the huge uptick in cases among its hundreds of thousands of migrant labourers, an even more aggressive trace-test-quarantine regime is now in place. The focus is on the dormitories on the outskirts of the city where young men, mainly from South Asia, are packed into rooms and share bathrooms by the dozen. The S11 Dormitory @ Punggol cluster alone has been linked to 2,275 confirmed cases.

China, the epicentre of the pandemic, is now returning to a semblance of economic normality but extra precautions have become a fact of daily life. The five-day holiday that began last Friday will be the first major test, as tens of millions of people were expected to travel. Should this lead to a marked increase in coronavirus cases in the coming weeks, more restrictions could well be on the cards.

Beijing brought the coronavirus under control with a series of stringent top-down measures including complete lockdowns for two months with schools and businesses closed, all transport banned and strict limitations on movement. As a result, total cases there have changed only marginally in the past four weeks and are now at 83,944 with 4,637 deaths.

Despite the stabilised numbers, Dr Abuza believes the number of cases and deaths could have been much higher than those reported by Chinese Communist Party. He points to a pattern of behaviour including initial attempts by local authorities to cover up the seriousness of the outbreak and suppress research and social media posts related to Covid-19. As well, the number of cremations in Wuhan and subsequent outbreaks in other parts of the country suggest there may be more discrepancies in reporting.

Thailand and Malaysia, meanwhile, have fared better than most, despite being slower to react initially, thanks to robust healthcare systems and public health budgets. Malaysia imposed a tougher lockdown -- known locally as a movement control order -- than its neighbour, which used an emergency decree. In any case, Malaysia has managed to reduce new daily infections to the low double digits on most days, while Thailand has had mostly single-digit days for nearly three weeks running.

Dr Abuza said Malaysia's handing of the outbreak was complicated by the political power struggle that resulted in an abrupt change of government in late February after the abrupt resignation of former prime minister Mahathir Mohamad. Dr Mahathir had warned that the current pandemic was set to hit global economies harder than even the 1997 financial crisis.

"The new government which came to power through fairly questionable means was not a government with a lot of trust and doesn't have a high degrees of legitimacy," said Dr Abuza. Thankfully, though, new Prime Minister Muhyiddin Yasmin has deferred to scientific and medical expertise to guide policy to flatten the curve.

Similar to its neighbour, "Thailand is a regime with questionable legitimacy. We've seen flip-flops on decisions from the very start and leaders trying to look for scapegoats outside," said Dr Abuza.

The headlines in the early days of the outbreak were dominated by allegations of face mask hoarding and incompetent management of medical supplies, anti-foreigner slurs from the public health minister, and great confusion over travel bans. Thai citizens and others seeking to enter the country were confronted with requirements for fit-to-fly certification that were almost impossible to meet, leading to more resentment of the government.

Eventually, the politicians took a back seat to the professionals and the country's response has been more organised in recent weeks. But now the attempts to mitigate the economic damage are in the spotlight. A government programme to provide 5,000-baht monthly handouts to those affected financially has been widely criticised for shutting out millions of people who should have qualified. The extension of the partial lockdown by another month until May 31 has also been controversial given low rates of infection for nearly a month.

"Thailand's responses signify its centralised governance from the national to local levels, indicating that not only was it unable to cooperate with its own agencies but also the private sector," said Assistant Prof Pitch Pongsawat in the Department of Government of the Faculty of Political Science at Chulalongkorn University.

For example, even though sporting events were supposed to have been halted as of March 4 under the Communicable Disease Act, an army-run boxing stadium two days later staged what turned out to be the country's biggest super-spreader event.

Mr Pitch also said the decision by the prime minister to seek advice from 20 Thai billionaires had yet to produce a concrete solution to mitigate the socio-economic impacts.

In the Philippines, meanwhile, President Rodrigo Duterte has assumed special powers under the new Bayanihan to Heal as One Act (bayanihan is a Tagalog word for communal work). The country ranks third in the Asean coronavirus tracking table with 8,488 confirmed cases and 568 deaths owing to its halting responses, insufficient testing and under-resourced public health system.

"He's communicated poorly to the public," Dr Abuza said, referring to the president's trademark bluster in the past, and his recent televised address threatening people who violate quarantine with shooting.

NO ONE SIZE FITS ALL

The Indonesian government has stood its ground in defending the way it has been responding to the outbreak, with Foreign Minister Retno Marsudi reiterating on her press briefings that "there is no one size fits all formula" in handling the crisis.

There were no assurances, she said, that certain policies implemented by one country could be applicable in another. The challenges that came with the outbreak have forced countries to "go the extra mile and to effectively deal with our own domestic needs and situation".

"Policies adopted by governments are always based on relevant and unique characteristics of a country, whether it's culture, demographic conditions or the economy," she said.

In the regional context, Ms Marsudi noted that Indonesia was among the first to propose the Asean Special Summit and Asean+3 Special Summit on April 14, during which President Widodo called on his regional counterparts for unity, synergy and cooperation to effectively combat Covid-19.

Dr Abuza, however, maintains that the Widodo government overall has shown poor leadership . "The president was in denial for a long time and intentionally kept concerns under wraps for fear that it would have a negative impact on the economy and tourism," he said.

"His public health officials were peddling absolute junk science and promoting herbal remedies at a time when they really needed to be marshalling resources and starting quarantines," said Dr Abuza, adding that both the Philippines and Indonesia have the lowest testing rates in the region next to Myanmar and Laos.

It has also been suggested that for all the talk about Asean integration, the 10-country bloc may be overlooking some valuable resources that all members could tap in the fight against Covid-19.

Beginda Pakpahan, a political analyst on global affairs at the University of Indonesia, said that while most member states have resorted to their own national resources so far, the regional bloc already has an agency that can be deployed to respond to the crisis: the Jakarta-based Asean Coordinating Centre for Humanitarian Assistance on Disaster Management (AHA Centre).

Such support may be late in coming, he said, but Asean could assign the agency to support member states in their responses to the pandemic while it also manages available resources and donations.

Prof Zachary Abuza of the National War College in Washington DC specialises in Southeast Asian politics and security studies SUPPLIED

ROLE MODEL NEARBY

Any country in the world looking for pointers on how to do things right will find one just outside the Asean neighbourhood. Taiwan has been praised for its ability to curb the spread of coronavirus despite being excluded from membership in the World Health Organization (WHO), which at times appeared to have gone out of its way to ignore Taiwanese researchers' valuable suggestions.

Timely and effective responses helped Taiwan limit the spread of Covid-19 to 429 confirmed cases and six deaths in a population of 24 million, receiving praise from experts and leaders around the world.

With its schools and businesses still running as usual, Taiwan rapidly took various actions using technology and data analysis to fight the virus. For example, infrared thermal imaging scanning was installed early in all airports to screen travellers with fever.

The government has also integrated its immigration and customs database with its National Health Insurance programme to group passengers' risks based on travel history within the previous two weeks. As well, mobile phone location tracking is used to ensure self-quarantine, while users can also access real-time maps of stores where face masks are available.

Yu-hsuan Lin, an assistant investigator/attending physician with the Institute of Population Health Sciences at the National Health Research Institutes in Taiwan, examined the situation in 21 countries and came to one interesting conclusion. Examining the frequency of online searches for "hand-washing", the research team saw that there was a negative correlation with the growth of confirmed cases.

He points out that the extent of people valuing hand-washing is the key factor enabling Taiwan to effectively contain the outbreak of Covid-19. Dr Lin also suggests the government keep advocating the importance of hand-washing as part of a broader public health policy.

People these days have to wear masks to enter public spaces, yet there is no mechanism to check if they have washed their hands, he notes.

Ming-cheng Lo, a professor of sociology at the University of California-Davis at the University of California-Davis, observes the concept of "community resilience" in an article titled "Taiwan's State and its Lesson for Effective Epidemic Intervention".

He attributed Taiwan's success in controlling the spread of Covid-19 among undocumented workers to the government's reaching out to those "outsiders within" who might otherwise have fallen through the cracks in the social health network, helping them to get tested.

(Additional reporting by Yu Hsiang Wang)

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