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Since the earliest days of the Covid-19 pandemic, three Asian countries have been singled out for praise for their effective response. First, it was South Korea. The country has a population of 52 million, and as of April 22 it has 10,702 cases and 240 deaths. Taiwan has drawn a lot of media attention because of its spiky relationship with the World Health Organization, and, with 24 million people, its numbers are much better than South Korea’s: 427 cases and only six deaths. Singapore, finally, with a population of 5.5 million, has 11,178 cases and 12 fatalities, and was held up as a model until last week, which brought a new surge that appears to have begun in a hostel for South Asian migrant workers.
The glaring omission from this list is Vietnam. Almost three months since its first case was detected on January 23, the number of recorded infections has inched up to only 268, and so far no one has died. The population of Vietnam is 95 million—more than South Korea, Taiwan, and Singapore combined.
Yet Vietnam has received very little attention in the American press. If we take The New York Times as a yardstick, other than brief pickups of shorts from Reuters, the only substantial story was a piece—six weeks ago—about the impact of Covid-19 on the fashion industry. This was centered on a 27-year-old socialite named Nga Nguyen, who attended a Gucci fashion show in Milan and a St. Laurent event in Paris in late February, then lied about her travel itinerary on the mandatory health reporting form when she returned to Vietnam. She received a positive diagnosis in early March, having infected her sister and seven other passengers on her flight. The daughter of a steel magnate, she has been reviled in Vietnam ever since as a symbol of the country’s arrogant and over-entitled nouveaux riches.
The painstaking April 11 analysis by the Times of what the Trump administration knew about the novel coronavirus and when it knew it, what expert advice it received and ignored, and when it finally acted once the horse was out of the barn, is a useful template for reconstructing a chronology of how Vietnam has responded.
Like many Asian countries, it had a psychological head start. Vietnam had one of the first cases of SARS in 2003, and was praised for its quick and successful handling of the outbreak. The region was traumatized by SARS, which accelerated the habit of wearing masks in public, something that people in many Asian countries were already doing as a health precaution. I vividly remember my consternation when I checked into a hotel in Taipei some years ago to find that all of the receptionists lined up behind the reception desk were masked. In the case of Covid-19, Vietnam was also predictably on higher alert than most other countries because of its land border with China and the large amount of travel between the two countries, both business- and tourist-related.
Vietnam’s approach was never based on mass testing, which has been the panicky and inadequate response of the United States and most other Western countries. And this was not because its resources were limited; it was a deliberate preemptive strategy to minimize infections. The gross number of tests—about 175,000 so far—is the wrong yardstick to use. What is significant is the ratio of tests to confirmed cases, and that ratio in Vietnam is almost five times greater than in any other country. Testing was followed by strict contact tracing (including secondary contacts) for anyone known to be infected, immediate isolation followed by quarantining, and the prompt creation of a real-time database and two mobile apps by which people could record their health status and symptoms. All this was backed up by the mass mobilization of the country’s military, public security forces, the health care system, and public employees, and an energetic and creative public education campaign that included TV cartoons, social media, and posters that draw on the traditional iconography of official propaganda but replaced heroic workers and peasants with heroic doctors in face masks.
On January 11, with the first death in Wuhan, Vietnam tightened its border and airport controls. Four days later, when there were still only 27 cases in China’s Hubei Province, Vietnamese officials met with the World Health Organization and counterparts from the Centers for Disease Control, and the WHO praised Vietnam for its rapid risk assessment and issuing of protective guidelines.
The first cases in Vietnam were detected in three airplane passengers returning from Wuhan in January. Twenty-one of their contacts were traced and isolated. By January 31, the government had formed a National Steering Committee for Covid-19 Prevention and Control, headed by Deputy Prime Minister Vu Duc Dam (the US equivalent, under Vice President Mike Pence, was not set up until February 28).
By the middle of March, Vietnam still had only 61 confirmed cases. Patient 61 was a Muslim returning from a mass religious festival in Malaysia. The government immediately shuttered the mosque he had visited in Ho Chi Minh City and ordered a lockdown of his home province of Ninh Thuan. At this point anyone who had come into contact with a known case was put into immediate quarantine, and secondary contacts were ordered into self-isolation. Passengers arriving at international airports were quarantined for 14 days in camps run by the military—benignly, by all accounts—and on March 21 all inbound international flights were canceled, and most domestic flights and trains were canceled soon thereafter. Anyone leaving Hanoi, where most new cases were being detected, was quarantined when entering another province.
The epicenter of the outbreak in Hanoi turned out to be Bach Mai Hospital, which is famous for being badly damaged during Richard Nixon’s 1972 bombing campaign. It was traced to a man who had visited the hospital on March 12; his home commune of 11,000 people was immediately closed off from the outside world. On March 29, the hospital itself, where the caseload had now risen to 45, was locked down. All visitors to a hospital anywhere in the country now had to be tested. Three days later, the government imposed mandatory social distancing nationwide for two weeks—again a preemptive action, not one taken, as in some but not all US states, to minimize deaths from an infection already spiraling out of control. By April 9, more than 1,000 health care workers at Bach Mai and 14,400 visitors to the hospital had been tested.
The skeptic might pose all manner of questions, of course. The US Navy has ascribed the cases of infection aboard the aircraft carrier Theodore Roosevelt to a port call in Da Nang, Vietnam’s third-largest city, and conspiracy theorists immediately jumped on this to say that it pointed to concealment of an outbreak there. In fact, the most plausible explanation appears to be that two British tourists, also later found to be infected, had stayed in the same hotel as crew members from the ship. All 40 of their known contacts were then tested and found negative. Da Nang, a city of more than a million people, has had precisely six confirmed cases.
A more common argument is that Vietnam is an authoritarian one-party state, so its numbers can’t be trusted. One fiercely anti-communist Viet Khieu—an “overseas Vietnamese”—told me that the numbers are a lie to avoid losses to the huge tourist industry. That makes no sense, since tourism has already been wiped out by the cancellation of all air travel. In neighboring Cambodia and Laos, there may be some justification for doubting official statistics. In both countries, the health care system is rudimentary (when I visited the main hospital in Vientiane, the Lao capital, last year, I was told that there is just one MRI machine in the whole country). And remembering the enthusiasm with which Hun Sen, the Cambodian premier, allowed cruise ship passengers to disembark freely in Sihanoukville in February hardly breeds confidence. However, says Todd Pollack, a professor at Harvard Medical School who directs the Partnership for Health Advancement in Vietnam in Hanoi, “I see no reason to mistrust the information coming out of the government at this time. Vietnam’s response was swift and decisive. If the epidemic were much larger than is being officially reported, we would see the evidence in increased emergency room visits and hospital admissions—and we’re not seeing it.”
There’s no question that Vietnam is an authoritarian state, and its human rights record is poor, including severe restrictions on freedom of expression and the control of information. Yet its handling of the pandemic has been strikingly transparent. It also has an enormous capacity for mass mobilization (not to mention a long history of it). It’s no coincidence that the government calls its campaign against Covid-19 the Spring General Offensive of 2020—an obvious echo of the General Offensive, General Uprising of 1968—the Tet Offensive.
So what comes next? Remarkably, as I write, Vietnam has had no new cases since April 16. That may not last, of course. Sooner or later Vietnam will have to open up its economy, which is massively dependent on the country’s place in the global supply chain, including many factories that were previously based in China. Mandatory social distancing was extended for a week, but now applied to only 12 provinces that were considered to be at risk, and on April 22 it was suspended altogether except for parts of Hanoi and Ho Chi Minh City and two other provinces. The airports will inevitably have to reopen. And an epidemiologist might argue that the low number of infections has equipped few people with the antibodies to resist a second wave of the pandemic.
Nonetheless, what Vietnam has accomplished in these first three months is to buy precious time, and it has used it well. It has shipped 450,000 hazmat suits, bought and paid for, to the United States from a local DuPont plant. It has had enough excess capacity to send 550,000 surgical masks to the worst-affected countries in Europe, and another 730,000 to its neighbors, Laos and Cambodia. With the apparel industry one of the mainstays of its economy, Vietnam has now geared up its domestic production capacity to 7 million new fabric masks and 5.72 million surgical masks a day, and Vietnam’s biggest publicly traded corporation, Vingroup, has retooled automotive and smartphone factories with a promise to produce 55,000 ventilators a month. In preparation for a second wave of infections, the head of the Oxford University Clinical Research Unit in Vietnam notes that a spanking new 300-bed hospital has just been opened near Ho Chi Minh City—with 10 “negative pressure rooms” equipped with special air filters—to prepare for new cases. In late March, Vietnam imported another 200,000 rapid-test kits from South Korea to further improve its readiness.
So when the second wave comes, as it surely will, Vietnam has a fighting chance of controlling it as well as it controlled the first. There are many lessons to be learned from its extraordinary success, although sadly it is much too late now for the United States to learn them.
Clarification: A sentence referring to SARS was adjusted to reflect the fact that wearing masks in public was common in Asian countries even before SARS.