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Despite a long border with China and a population of 97 million people, Vietnam has recorded only just over cases of Covid on its soil and not a single death. Nearly a month has passed since its last community transmission and the country is already starting to open up. Experts say that unlike other countries now seeing infections and deaths on a huge scale, Vietnam saw a small window to act early on and used it fully.


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In late Januarythe Ministry of Science and Technology met with virologists to encourage the development of diagnostic tests. Regardless, Da Nang General Hospital was the epicenter of the Da Nang outbreak, with at least cases reported among patients, caregivers, and staff. At the end of the ten-day Lunar New Year holiday on January 31—and with only five confirmed in-country cases—the government mandated that all schools nationwide remain closed.

When users are notified of exposure, they are encouraged to contact public health officials immediately.

'extreme but sensible' measures

The high proportion of cases that never develop symptoms 43 percent suggests that this approach may have been a key contributor to limiting community transmission at an early stage. To bring the outbreak under control, Vietnam turned to the same strategies that had been successful in ending earlier outbreaks: targeted lockdowns, travel bans, business closures, mass quarantines, and widespread testing. For SARS, a strategy of identifying and isolating symptomatic people was effective because the virus was infectious only after symptoms started.

In preparation for the COVID pandemic, Vietnam further strengthened hospital procedures to prevent infection in health care settings. Initially, the lockdown was set for 15 days, but it was extended to 21 days in 28 out of 63 provinces. Vietnam implemented mass quarantines in suspected hot spots based on evolving epidemiological evidence over time see Table 1.

Infectiousness begins two days before symptom onset. Between July 25 and September 8, locally transmitted cases were reported from 15 cities and provinces across the country, with Da Nang and nearby Quang Nam Province most affected.

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During the Da Nang outbreak in August, 10 provinces were locked down. Vietnam has invested heavily in its health care system, with public health expenditures per capita increasing an average rate of 9 percent per year between and For example, infant mortality and maternal mortality decreased by more than half between and Similarly, its experience with epidemic preparedness and response measures may have led to greater willingness among people in the country to comply with a central public health response. To enable contract tracing of the more than 1.

Contain: As a result of its detection process, hundreds of thousands of people, including international travelers and those who had close contact with people who tested positive, were placed in quarantine centers run by the government, greatly reducing both household and community transmission. Vietnam entered a nationwide lockdown on April 1. Da Nang was especially crowded in July because people were eager to travel after a tense spring, and the government promoted domestic tourism as a way to compensate for the economic losses from international tourism.

People with respiratory symptoms or those exposed to the three epicenter hospitals in Da Nang were placed in a centralized quarantine facility and tested; others were isolated at home and monitored by local commune health staff. From July 1 to July 27, it was estimated that more than 1. Within a day after the first case of the second wave was detected, the government had tracked and isolated about close contacts of those infected. Most confirmation laboratories where these tests are analyzed use in-house versions of WHO protocol, allowing tests to be widely administered without long wait times.

This document provides comprehensive guidance to hospitals on screening, admission and isolation of confirmed or suspected COVID cases, establishment of isolation areas in hospitals, use of personal protective equipment PPEcleaning and disinfection of environmental surfaces, waste management, collection, preservation, packing and transport of patient samples, prevention of laboratory-acquired infection of COVID, handling of remains of confirmed or suspected COVID cases, and guidance for COVID prevention for family members and visitors.

One of the reasons Vietnam was able to act so quickly and keep the case count so low is that the country experienced a severe acute respiratory syndrome SARS epidemic in and human cases of avian influenza between and As a result, Vietnam had both the experience and infrastructure to take appropriate action. Between July 23 and September 24, more thantests were conducted, and those who had visited high-risk areas in Da Nang as identified by the Ministry of Health were required to fill out a health declaration form via mobile app and notify local health authorities for sample collection and testing.

All were negative.

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By August 20, the application had exceeded 20 million downlo. In the wake of the SARS epidemic, Vietnam increased investments in its public health infrastructure, developing a national public health emergency operations center and a national public health surveillance system.

Since the s, Vietnam, a country of nearly million people, has undergone a ificant economic transformation. There is a very small window of time in which to track and quarantine contacts before they become infectious.

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It is critical to move fast, mobilize the contract-tracing apparatus, and locate the contacts. Preventing transmission to health care workers, and from health care workers to the community, is another important containment strategy. When community transmission was detected even just one casethe government reacted quickly with contact tracing, commune-level lockdowns, and widespread local testing to ensure no cases were missed. Contact tracing is comprehensive, with three degrees of contacts traced for each positive case.

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The adoption of economic reforms known as the Doi Moi policies in the mids turned a centrally planned economy into a socialist-oriented market economy, setting Vietnam on a path to its current middle-income status. Flights from the Schengen Area—26 countries in Europe—and the United Kingdom were suspended on March 15 after the second wave of cases, traced to people who had been traveling in Europeand all visa issuance was discontinued on March In early February, Vietnam began its practice of placing international arrivals from COVID affected countries in large government-run quarantine centers for 14 days.

Since containing the Da Nang outbreak, Vietnam has continued reopening plans, although the country borders have remained closed except for specific circumstances, and the day centralized quarantine policy continues to apply to most incoming Vietnamese and international travelers. In August, the hospital was locked down. Sincehospitals are required to report notifiable diseases within 24 hours to a central database, ensuring that the Ministry of Health can track epidemiological developments across the country.

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Event-based surveillance empowers members of the public, including teachers, pharmacists, religious leaders, and even traditional medicine healers, to report public health events. Approximately 98 percent of cases were either related to major hospitals in Da Nang or had a history of visiting Da Nang.

A second wave of cases, imported from new hot spots in Europe and the United States, was discovered on March 6. Although Vietnam is a highly centralized country, a of key decisions were made at the local level, which also contributed to the swift response.

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Beginning on March 20—22, all international arrivals were placed in the quarantine centers. Vietnam makes many key containment decisions in a matter of days, which may take weeks for governments in other countries to make. Vietnam has long maintained robust systems to collect and aggregate public data, and in it shifted to a nearly real-time, web-based system. Therefore, only three days are available from the point of contact with a case to find and quarantine contacts before they could infect others.

However, the of tests administered increased during the Da Nang outbreak. Most other countries waited to make these types of decisions until s were much higher. A temporary hospital for treatment of suspected and mild cases was built, and two other hospitals were deated for COVID treatment and put under the direction of a special committee from the Ministry of Health.

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From January 23 to May 1,overpeople spent time in a quarantine facility, 26 but the s increased dramatically after the Da Nang outbreak. International flights were also diverted away from airports still used for domestic travel. Throughout the COVID pandemic, the government has continued to incorporate new lessons and regularly conducts intra-action and after-action reviews. NCOVI includes a map of detected cases and clusters of infections and allows users to declare their own health status, report suspected cases, and watch real-time movement of people placed under quarantine.

Masks were recommended in early February, before WHO or most countries did so, and were made mandatory nationwide in mid-March. As of September 10, 61, people were being monitored, were quarantined in health care facilities, 15, were quarantined in centralized facilities, and 45, were self-quarantined at home. Hot spots with demonstrated community transmission, including Da Nang during its outbreak in July and Augustwere locked down immediately, and the government communicated frequently with citizens to keep them informed and involved in the public health response.

Vietnam began using the centers for Vietnamese arrivals from China on February 4 and expanded the practice to Vietnamese arrivals from South Korea on March 1. Even before the first cases in the country were confirmed, Vietnam took early steps to implement closures, require masks, and limit mobility for citizens and international travelers. Contact tracing and quarantine are the key parts of containment.

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Detect: Vietnam has taken a targeted approach to testing, scaling it up in areas with community transmission. Visas for Chinese tourists were no longer issued as of January 30,just a week after the first case was confirmed. As of May 1, a hundred days into the outbreak, Vietnam had confirmed just cases, despite extensive testing, and with no community transmission since April On July 25, Vietnam marked 99 days without any community transmission, until an outbreak occurred in the city of Da Nang, a city with a population of more than 1 million that receives about 8 million tourists annually.

What started as nosocomial transmission quickly spilled over into the community, and during the last week of July new incident cases increased by about 30 percent, the fastest growth rate since the beginning of the epidemic.

Protection against the asymptomatic

Subsequently, private companies including Viet A and Thai Duong offered capacity to manufacture the test kits. Given its low case s, the country decided on a strategy of using testing to identify clusters and prevent wider transmission. During the SARS outbreak in —, dozens of Vietnamese health care workers were infected; apart from the index patient, everyone in Vietnam who died from SARS was a doctor or a nurse. As of December 31,a total of 10, people had been placed under quarantine:in health care facilities, 4, in centralized quarantine facilities, and 5, at home. Testing capacity also ramped up quickly, from just two testing sites nationwide in late January to by May.

Plans are underway to further expand laboratory testing to include use of GeneXpert machines within the lung hospital system.

The goal is to identify clusters of people who have similar symptoms that might suggest an outbreak is emerging. With SARS-CoV-2, however, such a strategy would be inadequate, since infectiousness can occur before the onset or in the absence of symptoms. Flights to and from China were suspended on February 1 and trains were canceled shortly thereafter, on February 5. The incubation period between contact with the virus and start of symptoms is on average five days.

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These restrictions were implemented when cases were in the single digits.