The fourth wave of Covid-19 has proved deadly for Ho Chi Minh City, and shed light on some long-standing problems in Vietnam’s health system as well as in leadership and governance.
The highly infectious Delta variant brought about Vietnam’s fourth wave in late April 2021. The densely populated Ho Chi Minh City was the worst hit. The city of nine million, along with 18 southern provinces, went into lockdown in mid-July when cases began to surge. Total lockdown was enforced between August 23 and October 1, when residents were not allowed to leave their homes even to buy food. In Vietnam’s largest city, total lockdown involved setting up makeshift barriers to block city streets, and checkpoints to control traffic. Military personnel were deployed to enforce lockdown rules, and to assist with food delivery to residents.
With the steep rise in daily new cases, the hospitals were quickly overwhelmed. Doctors and nurses from other parts of the country have been brought in to deal with the rising caseload in Ho Chi Minh City. Despite multiple field hospitals being set up in the city, many Covid-19 patients have no access to medical care.
Ho Chi Minh City residents tell horror stories of infected persons being taken by government personnel, along with their primary contacts, and placed in group quarantine facilities. Many people became infected during isolation in these facilities. Many who die of Covid-19 in a public facility would die without seeing their family. Their bodies would then be taken to the crematorium, and their ashes delivered to their relatives afterward.
The epidemic also saw an outpouring of compassion and support from local residents for those most in need. There have been numerous charity groups and volunteers stepping in provide practical assistance: from donating free meals to health care staff, to delivering food packages to struggling families, to transporting oxygen tanks to patients in home care, to collecting bodies of those who have died in their home.
Over the three months, 770,000 people were infected, and at least 19,000 died.
At the roundtable discussion organised by BBC News Vietnamese programme on September 16, some failures were identified in Vietnam’s response to the epidemic. Dr Tran Tuan, an independent reviewer from the Vietnam Union of Science and Technology Associations (Vusta), said that the Administration’s passivity and confusion in its response to the epidemic can be observed in the failure to predict the evolution of the epidemic, the lack of an effective disease surveillance system, and even the lack of a strategy research consultative team. This led to the failure to recognize that the epidemic had changed, with community transmission being the dominant mode of transmission for a long time before a rise in new cases was reported. According to this public health policy analyst, the local authorities were not able to grasp the impact of strict lockdown on high-risk groups, nor able to attend to the issue of social welfare effectively, which in turn further increased the burdens on the health system.
Dr Tran Tuan of Hanoi observed that the health response in Ho Chi Minh City in May until June, even in July 2021, followed the first response pattern of 2020 with its focus on protecting the community from persons infected overseas. That was why contact tracing, centralized quarantine of infected individuals and their primary contacts, and widespread lockdowns were the main strategies for fighting Covid-19. The isolation of infected individuals (F0) and their primary contacts (F1) in a centralized treatment area both increased the rate of transmission among people held in these facilities and exhausted the health resources. By the time the epidemic really hit hard, the health resources and medical staff had been over spent, and unable to deal with the high influx of patients infected in the community. This flawed response strategy led to a higher mortality rate, Dr Tran said.
A noticeable point in Covid prevention in Vietnam is the policy of Chống dịch như chống giặc (fighting the epidemic like fighting the enemy) nationwide. Commenting on this, Dr Phan Xuan Trung, who directly treated Covid patients in Ho Chi Minh City and a founding member of the group, Giúp nhau mùa dịch (Helping each other during the Pandemic), said that when natural calamities strike, all efforts have to be aimed at relieving suffering and saving lives. It is not the case of fighting the epidemic like fighting an enemy, with street fences and barricades to protect ourselves from the enemy. That is a naïve approach to fighting the epidemic. It requires the knowledge and mindset of a professional, not the mindset of a politician or a military officer, Dr Phan said.
Family and community physician Dr Phan Dinh Hiep of Melbourne, Australia observed that there was also a failure of people in public office to take responsibility for what happened. No local public officer was seen on television or news media giving daily reports. They were afraid of saying the wrong thing, and afraid of taking responsibility, and their failures proved harmful for the people.
Dr Phan Xuan Trung commented that in the Vietnamese context today, government officials are only accountable to their own organisation, but not accountable to the public. There might be officials who truly love the people, but it is hard to discern how they are accountable to the people, while it is clear that they are accountable to their superiors. Dr Phan also observed that where people followed rigidly a uniform set of lockdown orders from above, there were negative outcomes. But areas where people were able to break down fences had better outcomes, like Districts 6, 7, and Cu Chi of Ho Chi Minh City.
This seems to point to the need for both a nation-wide set of guidelines and subsidiarity in the implementation of these guidelines in fight against this virus.
Dr Phan Dinh Hiep stressed the need to support residents during lockdowns, because in many cases government assistance has become their main hope of survival.
As of November 17, 2021, Vietnam’s Ministry of Health confirmed a total of 1,045,397 cases of Covid-19, of whom 870,997 have recovered. Vietnam has recorded 23,270 deaths due to the pandemic.
As the fight against Covid-19 continues globally, Vietnam’s experience highlights the need for compassion, responsibility, leadership, accountability and subsidiarity. Most heartening is the tremendous generosity and goodness among ordinary people towards each other. It makes all the difference.