The Successful Front-line States
Official date continues to suggest that while China, Hong Kong, South Korea, Taiwan and Vietnam to have imposed significant control over Covid 19, they are far from eliminating it and continue to take measures to deal with generally highly localised spikes in cases.[i] These include: The closure of Da Nang to tourist for 14 days from 27 July, following 4 locally transmitted cases – the first nationally for nearly100 days; the closure of the public transport system and cancelling of almost all flights in and out of Urumqi, capital of China’s far-western Xinjiang region, on 17 July in response to six confirmed cases of Covid 19 with symptoms and 11 asymptomatic infections; the more serious and extensive restrictions place on much of Beijing following the identification of 57 cases between 11 and 15 June, after 55 days with no new reported cases;[ii] the imposing from 15 July in Hong Kong of stricter social distancing, the mandating of face mask wearing on public transport, closing of fitness centre, restrictions on restaurants and a return of public sector workers to working from home[iii], in response to 52 new cases identified on 13 July – 41 locally transmitted;[iv][v] and on the same day South Korea imposing controls on arrivals from high risk locations in response to 62 new cases – 42 of which were imported. The authorities have taken these outbreaks extremely seriously, while recognising that they are almost inevitable, particularly as restrictions on activities and travel are relaxed. In all cases very rapid action has been taken to test, trace and localise the infection, and extending and / or re-impose restrictions were deemed necessary. To date these actions appear to have been successful and underline the need for continued vigilance, even where few if any cases are still being detected. With the ever present concern that major pockets of infection could be spreading below the official radar, particularly amongst marginal communities, as they did amongst Singapore’s migrant work force and more broadly in Japan, after lengthy periods during which it appeared that high levels of control has been established.[vi]
In Japan a steady fall in new cases and deaths (Tables 1a, 1b and 1c) led to the opening from 1 June of Tokyo schools, cinemas, sports clubs and department stores and proposals to open the borders to travellers from Australia, New Zealand, Thailand and Vietnam.[vii] However, the July 15-16 recording of a record number of cases (280) in Tokyo and a rather sharp rise in the overall national rate of increase from 6 July (Tables 1a and 1c) shows that the outbreak has not yet been fully controlled. Though Japan still has the same sort of low death rate exhibited by China, Hong Kong, South Korea, Taiwan and Vietnam (Tables 1b and 2).
In Singapore the surges in cases during April and May which led to a major lock-down and high levels of testing,[viii] tracing and isolating, has slowed significant, but the number of new cases remains significant (Tables 1a, and 1c) with only a very small number of cases outside of the migrant worker community. Such that an easing of the ‘Circuit Breaker’ lock-down started on 2 June. Though, not before the testing of the city state’s 5.8 million people had revealed one of the world’s the highest levels of infection,[ix] but with the same low death rate exhibited by China, Hong Kong, Japan, South Korea, Taiwan and Vietnam (Table 1b and 2). While only 2 deaths have been recorded since 2 June, there has been a slight increase in the rate of increase of cases during 13-27 July (Table 1c).
The New Successes
A second group of South East Asian countries appear to be emerging from the pandemic with low infection and death rates (Table 2). This, despite some slow initial responses which enabled a series of potential ‘super-spreading’ events[x] and domestic and cross border population movements to take place.[xi] These led to concerns that Indonesia, Malaysia, Philippines and Thailand, could face very major Covid 19 outbreaks, and even more serious ones in the far poorer Cambodia, Myanmar and Laotian economies. The latter concern based on the large-scale movement of migrant labourers back from Thailand, as the economy closed down and before effective movement controls were in place. And the very much weaker medical provision, administrative capacity, and reporting of mechanisms these countries. However, so far these fears have not be realised, though see comments below on Indonesia and the Philippines.
Only a small number of cases and deaths have been recorded in Cambodia, Laos and Myanmar. (Tables 2, 3a and 3b). The number of new cases in Thailand has fallen to a trickle and infection and death rates remain exceptionally low (Tables 2, 3a, 3b, 4a and 4b). While the outbreak was more serious in Malaysia and slower to decline, the overall death and case rates are also low (Tables 2, 3a, 3b, 4a and 4b) In both cases restrictions on movement and business have been relaxed since the start of June, but with continued border controls, social distancing, mask wearing, promotion of self-monitoring, testing and contact tracing The latter being much more vigorously employed in Malaysia.
However, perhaps rather more than the earlier group of Asia ‘success’ cases, concerns remain that significant reservoir of infection could be developing below the radar, especially amongst remote and / or marginalised communities. Particular concerns include the 3.1 million migrant workers in Thailand, the porous borders with Cambodia, Laos and Myanmar, and the possibility that cases might go undetected in these three countries, not least given the low level of testing (Table 2).[xii]
The Problem Cases?
The situation is less clear in the Philippines, and even more so in Indonesia. In both cases the rates of increase of cases and deaths have fallen from the March-April peaks, but this has been a rather uneven process and the rates remain high (Tables 3a, 3b, 3c, 4a and 4b). While, the death rates per million is still low, a gap is opening between these countries and the rest of the region (Table 2).
In the Philippines comprehensive lockdowns and travel restrictions were imposed from the 17 March and by late May there were clear falls in the number of deaths (Tables 3b and 4b). However, new case numbers remained high, if variable a (Tables 3a and 4b). Despite this, there was a general easing restriction from 1 June. This has seen a continuation of the generally high rates of increase in the number of cases, averaging 20.0% between June 8 and July 27 (Table 4a). Though deaths rates continued to fall, until they spiked in early July (Table 3b and 4b). Both cases and deaths remaining heavily concentrated in urban centres within Metropolitan Manila, where the expected further relaxation in restriction have been postponed until, to 29 July. While a more localised spike in cases has resulted in Navotas, a city of 250,000 within Metropolitan Manila, returning to lockdown from 16 July. The signs now are of further extension of controls and increased levels of enforcement, particularly of quarantining, in an urban complex where control of Covid has not been established despite the imposition of what is generally seen as the world’s longest and strictest lock-down. In this context it is worth reflecting that between 29 June and 27 July the Philippines recorded some 56% of total cases and 35% of deaths.
It may well be that the easing of restrictions in Metropolitan Manila was premature, particularly when combined with the low levels of testing (Table 2). However, apart from the impact on the economy of a continued lockdown, large numbers of people were confined in extremely poor and crowded conditions, with many loosing access to income, food and other necessities. Conditions that were conducive to the spreading of the virus and other diseases, not least seasonally spiking dengue, and malaria, and inimical to general health, nutrition and wellbeing.
Unlike, Malaysia, Thailand, and the Philippines,[xiii] Indonesia did not instigate anything like a comprehensive lockdown, and the government, including President Joko Widodo, significantly played down both the threat posed by Covid 19 and the need for action. Though from 15 March restrictions were imposed on Jakarta – social distancing, closures of schools and non-essential workplaces and limiting religious activities and public gatherings. However, there were no controls on movement in and out of the city and inter-city trains and buses continued to operate. This appears to have allowed major movements out of Jakarta by people seeking ‘safe havens’ or after losing their jobs.[xiv]
Following a steep rise in cases the declaration of a Public Emergency, on 31 March, the Jakarta measures were extended to entire country, but intercity trains and buses remined in operation and cities and provinces were not authorised to close their borders. Though starting in the first week of April some administration imposed curfews and border controls,[xv] they were reminded that this was the province of the central government.[xvi] This led to a very patchy imposition of controls, in Java, Sumatra and Kalimantan, and even more elsewhere in the country.[xvii] This absence of effective national controls over movement lead to fears of major contagion resulting from the very large-scale population movements the Mudik (exodus) normally associated with Ramadan (23 April to 23 May) and concluding national Idul Fitri holiday (23-24 May),[xviii] Only on 21 April was it announced that the exodus would be banned from 24 April as would travel by intercity bus, commercial and charter flights, sea transportation, and long-distance passenger trains. Toll roads were closed and check points put in place around Jakarta. However, by this time large numbers of people had departed.
The extent to which the spike in new cases and deaths during late May, particularly in East and West Java, was related to people returning from the Idul Fitri holidays, is unclear. But it saw an extension of areas under restriction and deployment of the army to enforce restrictions, including social distancing across 4 provinces and 25 cities, including Jakarta.[xix]
Overall, the late imposition of effective movement controls resulted in a markedly more diffused pattern of infections and deaths in Indonesia than was the case in the Philippines and Thailand, though with a concentration in Greater Jakarta and the urban centres of West Java.
In addition to the lack of comprehensive controls on movement there are has also been little testing (Table 2), detection and isolating, with reports of overloaded medical services and shortages of just about everything needed.[xx] In which context it should be noted that Indonesia has only 4 doctors per 10,000 people, within ASEAN, only Cambodia has less (Table 5). Overall, Indonesia would appear to have been by far the least well prepared of the major South East economies, and the one with the least good records of dealing with health and environmental crises. The low levels of testing, limited availability of data and concerns over the level of recording and reporting of Covid cases and deaths,[xxi] does raise concerns the present extent of infection, the ability of the authorities ability to contain the virus and the possibility of a major surge still to come.
Despite these issues and continued high rates of increase in cases and deaths (Table 4a and 4b), since 5 June, there has been a general relaxing of restrictions, opening of businesses, public transport, public facilities and religious institutions, though as with the restrictions, these moves have been extremely uneven across the country.[xxii] While understandable in economic terms and indeed, the issues noted above with respect to Metropolitan Manila, it is difficult to justify in terms of the level of control over Covid 19. Reflected in some 45% of total cases and 42% of deaths being recorded between 29 June and 27 July.
Questions and Lessons
While it appears that significant control over Covid 19 has been achieved by China, Hong Kong, Malaysia, South Korea, Taiwan, Thailand and Vietnam – a group that Japan and Singapore may be expected to join – the situation is becoming more precarious in Indonesia and the Philippines. In all of these countries the prospects are of more spikes in cases and deaths, any of which could, particularly if not rapidly detected, herald major national outbreaks or even a region-wide second wave. That means there can be no let-up in monitoring and the preparedness to reimpose controls.
To date these successful North East and South East Asian economies, all exhibit broadly similar deaths rates that are low by global, and very much more, Western European and North American standards and are remarkable similar. While, as in all countries there are undoubtedly issues of diagnosis, recording and reporting, it is difficult to dismiss either the distinctively low levels or the regional similarities on such grounds. Though this does warrant much closer examination.
This comparative success has been achieved by a group of countries that vary greatly in national situations and in the intensity, balance and timing of their testing and Covid control regimes (Tables 2, 5 and 6). As was outlined in my earlier 7 April 2020 Opinion, there are some clear commonalities: Comparatively early imposition of national and local restrictions, willingness to impose very stringent local lock-downs where necessary, clear instructions from the authorities, high levels of compliance, shielding of vulnerable groups and institution, flexibility, preparedness, and the experience of SARS and other health emergencies. The significant of the latter should be underlined with respect to the national authorities and the collective memory and responses of the public, particular when combined with the generally much greater sense of community and willingness to comply with health advice than that is common in Western societies.
A further possibility is that in some of the North East and South East Asian countries there were significant levels of immunity as a result of previous Coronavirus outbreaks.
It may also be that rapid and early moves to halt flights to and from China, South Korea and other countries with early major outbreaks, could well have significantly limited the levels of initial infections, that entered, particularly through major urban centres. This could account for the limited spreading effect of the large-scale labour movements within Thailand and into Cambodia, Laos and Myanmar. A similar argument could also be applied to the Philippines where there were large-scale movements out of Metropolitan Manila and Luzon as a whole before effective controls were in place. With subsequently, significant growth of infections within the heavily restricted and urbanised metropolitan regions surrounding Manila and Bangkok – where cases and deaths have been heavily concentrated. A similar possible gain in Indonesia seems to have been squandered by the extremely late, comparatively limited and often confused government response.
Overall, it should also be stressed that none of these countries got everything right – the far from popular Thai government was slow to respond and initially lacked effective coordination – while any detailed examination of the other North East and South East Asian countries reveals a variety of changes of approach, emphasis and message, often following significant domestic criticism. But on balance these countries got enough right, in marked contrast to much of Western Europe and North America.
[i] Very much the situation noted in my April commentary (Chris Dixon ‘The Asian front-line states and the Covid 19 challenge’, GPI Opinion, 24 April 2020).
[ii] By 2 July and after over 7 million tests this had increase to 326 cases, with only 1-2 new cases being reported each day, suggesting that the outbreak might have been contained within 21 days.
[iii] This moved the Oxford COVID-19 Government Response Tracker, which measures the stringency of restrictions, from 41.67 to 62.96 – only a little short of the highest level imposed (66.67) during April and May. See Table 6 for details of this index.
[iv] ‘Hong Kong: Authorities tighten COVID-19 restrictions’, Garda World, 14 July 2020, https://www.garda.com/crisis24/news-alerts/359351/hong-kong-authorities-tighten-covid-19-restrictions-july-14-update-32
There had been a slightly rise in daily case numbers since the end of June, this accelerated from 6 July (Table 1a) and by 27 July had reached 2,624 with 18 deaths A disturbingly rapid surge , though it should be stressed that the numbers remain comparatively small, and rapid action has been taken.
[vii] It must be stressed that given differences in reporting and recording of Covid cases and deaths, all comparisons between countries do need to be treated with caution.
[viii] At 172,494 / million, this was by far the highest in Asia (Table 3). While, globally 15 countries had tested at a higher rate (as of 20 July 2020), only 6 had populations of more than a million: UEA 441,069 (population 9.9 million), Bahrain 417,720 (population 1.7 million), Denmark 225,564 (population 5.8 million, UK 189,863 (population 67.9 million) and Lithuania 175,095 (population 2.7 million).
[ix] As of 20 July 2020 only 8 countries had a higher infection rate than Singapore 8207: Panama 11,966 (population 4.3 million), Armenia 11,473 (population 3.0), Andorra 11,388 (population 0.8 million), USA 11,386 (population 331.1 million), Peru 10,473 (population 33.0), Mayotte 10,188 (0.3 million), Brazil 9,635 (population 212.6 million), and Luxemburg 8,635 (population 0.6 million).
[x] These included a national boxing contest held in Bangkok’s Lumpinee Stadium (6 March) and a major religious gathering (in Kuala Lumpur (Tablighi Jama’at) – March 28-1 April- in which 1500 of the 1600 participants were from other parts of the region. Subsequently, several Lunpinee clusters of Covid were identifies in Thailand and Tablighi clusters in Brunei, Cambodia, Thailand and Singapore. While by late March the Malaysia’s Ministry of Health claimed that at least 943 of the country’s 1,518 confirmed cases were linked to the Tablighi event and were projecting some 40,000 related infections.
[xi] All the major South East Asian countries have high internal levels of movement of labour and interaction between communities, the latter being particularly evident during major public holidays, celebrations and religious festivals – most strikingly lunar new year and Ramadan. Large-scale cross-border movements are also long-standing, with much highly informal movement across borders that are, in many cases, highly porous and difficult to control. Though formal movements have become generally much easier with the rolling out of the ASEAN Economic Community free movement and citizenship since 2015.
[xii] Though the official crossing points were closed, and some significant controls on activities and movements imposed.
[xiii] From the middle of March, Malaysia, the Philippines and Thailand imposed lockdowns and movement controls. In Thailand, this left much in the hands of local administrations, as did the Philippine government outside of Luzon, though the two levels of control and – Community Quarantine and Enhanced Community Quarantine – were very clearly set out. In Malaysia the situation, certainly in the Peninsular was very much more centralised. All three countries made use of the military, though the levels of compliance appear to have been of a high order.
[xiv] ‘Coronavirus: Indonesian capital Jakarta to close schools, workplaces to curb outbreak’, The Straits Times, 7 April 2020, https://www.straitstimes.com/asia/se-asia/indonesia-grants-jakarta-more-powers-to-tackle-coronavirus-outbreak
[xv] Curfews were imposed in Aceh, Balikparan, Mataram, Sikka, Pekalonga (all on 2 April) and West Java (7 April) – and Aceh, Bengkulu, Maluku, Papua and Tegal City in Central Java, announced border closures.
[xvi] See: Nivell Rayda ‘Explainer: What now for Indonesia after Jokowi signed regulation on social restrictions to tackle COVID-19?, CNA, 2 April 2020; Jakarta Post ‘Indonesia’s Strategy to combat COVID 19: What we know so far’ 3 April 2020, https://www.thejakartapost.com/news/2020/04/03/indonesias-strategy-to-combat-covid-19-what-we-know-so-far.html; Rebecca Ratcliffe ‘Jakarta to start shutdown as burials, and fears, rise amid coronavirus outbreak’, Guardian, 8 April 2020; Emma Connors ‘Indonesia’s provinces go it alone as crisis deepens, Financial Review, 1 April 2020, https://www.afr.com/world/asia/indonesia-s-provinces-go-it-alone-as-crisis-deepens-20200401-p54fyw
[xvii] Ni Komang Erviani ‘COVID-19: Bali has no intention of applying large-scale social restrictions. The Jakarta Post, 14 April 2020, https://www.thejakartapost.com/news/2020/04/14/covid-19-bali-has-no-intention-of-applying-large-scale-social-restrictions.html
[xviii] From Jakarta and satellite urban centres, some 20 million people were expected to return to their home provinces. See: Malcolm Surer ‘Indonesia’s Ramadan exodus risks spreading Covid-19 across the country’, France 24, 8 April 2020, https://www.france24.com/en/20200408-indonesia-s-ramadan-exodus-risks-spreading-covid-19-across-the-country; Nivell Rayda ‘COVID-19: Jakarta on verge of massive Idul Fitri exodus amid social restrictions, layoffs for low-wage workers’, CNA, 9 April 2020, https://www.channelnewsasia.com/news/asia/ramadan-eid-covid-19-jakarta-indonesia-exodus-12624458
[xix] Arys Aditya and Harry Suharton ‘Indonesia Deploys Army to Enforce Lockdown Before Reopening’, Bloomberg.,26 May 2020, https://www.bloomberg.com/news/articles/2020-05-26/indonesia-deploys-army-to-enforce-lockdown-as-reopening-looms
[xx] Will Doran ‘Indonesia and COVID 19: Living dangerously again’, The Diplomat 6 April 2020, https://thediplomat.com/2020/04/indonesia-and-covid-19-living-dangerously-once-again/
[xxi] As was noted at the outset, such doubts can be raised over the data for almost every country. However, Indonesia has released data on burials in Jakarta – this suggests that during March, April and May there were at least 4,500 more deaths than usual, while by the end of May only 520 deaths in Jakarta were officially attributed to Covid (see ‘Tracking Covid19 excess deaths across countries’, The Economist, updated on 13 June 2020, and retrieved on 29 June 2020 from https://www.economist.com/graphic-detail/2020/04/16/tracking-covid-19-excess-deaths-across-countries#
[xxii] This was in line with the government’s 11 May announcement that it would begin the easing of restrictions in June, as part of a five-stage draft framework on the resumption of economic activities – prompted by the then falling rates of increase in deaths and cases (Dzulfiqar Fathur Rahman and Adrian Wail Akhlas ‘Govt plans to reopen economy by Q3 as experts caution against COVID-19 ‘second wave’, The Jakarta Post, 12 May 2020, https://www.thejakartapost.com/news/2020/05/12/govt-plans-to-reopen-economy-by-q3-as-experts-caution-against-covid-19-second-wave.html). See also: WHO ‘Indonesian Situation Report’, No 12, 17 June 2020, https://www.who.int/docs/default-source/searo/indonesia/covid19/who-situation-report-12.pdf?sfvrsn=811c7f19_2: See also: WHO ‘Indonesian Situation Report’, No 13, 1 July 2020, https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports