Nguyễn Thu Anh, is an epidemiologist and country director of the Woolcock Institute of Medical Research, the leader of the 5F team in Việt Nam, which includes doctors, epidemiologists, pharmacists, public health experts and social science experts working on providing science-based information on COVID-19. She spoke to Việt Nam News about the current pandemic situation and the team’s recommendations.
What is your assessment of the current COVID-19 pandemic situation in Việt Nam?
The pandemic is spreading from the south to other regions quite fast.
From April 27, 2021 to July 31, 2021, the number of COVID-19 cases increased rapidly and spread like never before in Việt Nam, with a total of more than 137,000 cases detected in 60 provinces and cities. Although the number of cases is mainly in the south, the pandemic has spread to the Central and Northern regions. We have seen a surge in new cases found in Hà Nội recently. Since June 19, 2021 till today, only Cao Bằng and Yên Bái provinces have not yet reported new cases.
The fourth wave includes multiple outbreaks simultaneously, in many localities, in crowded places such as industrial zones, neighbourhoods with high population density and in hospitals.
The actual number of cases in the community may be higher than the high numbers reported because reporting is delayed and testing is not extensive enough, so the pathogen in the community cannot be detected thoroughly. This is the risk of outbreaks in ‘green areas’.
The number of children infected with COVID is quite high, especially in Hà Nội and Bắc Ninh, but currently the data is incomplete to give a full picture nationwide.
Do you have any recommendations given the fact that the pandemic developments are quite complicated at the moment?
We have recommendations over the following main issues:
Firstly, testing. We should do periodic screen test all health workers, patients with coughs and fever who come to public hospitals, private clinics, pharmacies, and people working in essential service sectors, to detect outbreaks early.
Nationwide social distancing is essential in order to reduce the spread of the disease, creating an opportunity for us to concentrate efforts for the south. The early social distancing in Hà Nội city will certainly have the effect of reducing the speed of the spread, but even when successful, the city still faces the risk of infections from other localities if these localities do not impose social distance themselves. If such things happen, the current period of social distancing in Hà Nội will become a waste.
Also, we should prepare for the worst case scenario across the country from the lessons of Hồ Chí Minh City.
There should be a mechanism to mobilise scientists in many fields to participate in analysis and give suggestions to the government: Give them access to quality, complete and timely data.
It is necessary to have an objective index system to assess whether the implementation of pandemic prevention and control measures is as good as expected, this can be visually represented by graphs and maps.
Secondly, regarding test kits. Beside using international standard test kits to reduce false positives or negatives and save time on testing, mistaken quarantine or omission, we recommend purchasing automated systems that can process and test multiple samples at once. These machines are not discarded after the pandemic but can be used for other diseases later on.
We also encourage a change in the testing method to allow people to access testing more easily without creating overloading for the testing staff. (Self-test, testing at pharmacies, private clinics, agencies, etc.).
Thirdly, regarding the treatment method.
The number of deaths in HCM City and many other provinces is being reported not timely. As of July 31, there have been at least 1,300 deaths recorded by health authorities, and perhaps there have been COVID deaths in the community but have not been tested and recorded.
Currently, the identification of severe cases is based on: symptoms, age and background history. However, many patients under 60 years of age, with no underlying disease and no symptoms, have died, or even died before reaching the hospital. The identification of severe cases is not appropriate.
We recommend a classification of severe-risk cases based on the following criteria: age, underlying disease, and SpO2 indicator, a measure of the amount of oxygen-carrying hemoglobin in the blood relative to the amount of hemoglobin not carrying oxygen.
We can re-establish the health system with the criterion of early detection of severe cases in the community, thereby providing early treatment to reduce the severity/death rate. So there should be only three levels of medical care:
The first level is in the community: Establishing a community-based health team (like the one that is built and piloted in District 7, HCM City currently) to manage F0s' health at home, measure SpO2 to detect the risk of severe disease early, and provide treatment in the community and transfer to hospitals when the situation get worse.
The second level: field hospital/district hospital. These unit will treat early to moderate server cases, monitoring high-risk cases in a serious condition. This level needs to have the capacity to handle severe situations so that patients do not need to be transferred to the hospital, so it should be prioritised for investment.
The third level is for treating serious cases.
There should be warning and preparation for the care and treatment of children. When the number of children is high and when parents have to go to the hospital and may be seriously ill, there will be no medical and psychological care for them. So we need to be prepared for this risk.
The rate of vaccination Việt Nam is now 6 per cent with one dose. The province with highest rate is Bắc Ninh with 30 per cent. We need to reach 85 per cent to reach herd immunity since the Delta variant is super spreading.
We recommend simplifying the screening process prior to vaccination. It's best if there is a tool for people to pre-screen themselves at home, when they do not meet the criteria, there is no need to take the time to get injections.
In outbreak areas: vaccinations should cover the entire population. The list is made by residential groups and then sent to the health authorities, even including people without household registration in that area. We can organise mobile injections in the community, by mobile ambulances for clusters near each other.
In areas where the pandemic has not been complicated: priority should be given to the 16 groups as stated by the health ministry. But it is necessary to change the elderly group to the number two priority to reduce mortality. — VNS
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