Since late March, China, Hong Kong, Japan, Singapore, Taiwan and Vietnam have imposed further Covid-19 related restriction in responses to renewed concerns over case levels. This has attracted considerable attention and raised fears of a second wave of the virus sweeping through these countries. However, other than for Japan and Singapore, the increases have been comparatively small, in some cases very small (Table 1) and should at this stage be seen as highlighting the need for continued vigilance in combating the virus rather than a failure of control strategies (although see comments on Japan and Singapore below), or particularly, in China, the premature easing of measures in order to get the economy back on-line.
For it should be emphasised that the ‘success’ of these countries lay in controlling, but by no means eliminating the virus, and further spikes – even major outbreaks, perhaps in a more serious form – have been widely predicted and, indeed, planned for in all these countries, not least China. In addition, certainly in the case of China, Hong Kong, Taiwan and, initially Singapore, the spikes and concerns appear to be to be principally related to returning nationals.
However, it should be stressed that while in China and South Korea numerically very serious outbreaks led to extremely tight-lockdowns, strict border controls and rigorous social distancing, testing, isolating, and tracing contacts. Hong Kong, Singapore, Taiwan and Vietnam followed similar policies, but without the lockdowns.[ii] Their policy was to keep things as normal as possible, particularly with respect to the economy, in this, for all except Vietnam, they were helped by low population numbers and, in the case of Singapore and Taiwan, by being small islands.[iii] In Hong Kong, although schools had been closed from February, public sector workers encouraged working from home and increasingly tight border controls impose, people could move freely around the city and business, bars, restaurants and entertainment venues continued to operate. While Singapore seemed even more determined to ensure that business and life in general should continue in as normal a manner as possible.
In taking this approach Singapore and Hong Kong, like the other ‘front-line’ states, were able to build on long-term planning for a major health crisis, a heritage of previous events, most significantly SARS in 2003,[iv] which were also firmly embedded in the collective of the population. People also appear to have trusted the health and crisis managements systems, which put in place highly coordinated measures that met with high levels of public compliance.[v] The latter being the case even when broader trust in the government was limited – as in Hong Kong following some nine months of demonstrations and disruption. All the measures being backed by effective national health systems – in Hong Kong, Singapore and Taiwan these being some of the best in the world.
The additional measures that have attracted attention since late-March initially centred on increase border controls. With, for example, Hong Kong responding to a small increased in imported cases[vi] by tightening controls from 25 March and 28 March, and then closing schools, bars and entertainment, and the banning of gatherings of more than four people (1 and 3 April).[vii]
Taiwan responded on 1 April to an even smaller increase in imported by tightening already very strict border controls and reinforcing social distancing measure. More drastic measures were taken in China on 8-9 April following citizen testing positive for Covid-19 following their return from Russia where the number of cases is rising rapidly. This has seen the border town of Suifenhe (population 70,000) in the Heilongjiang province (North East China some 150km from Vladivostok) with initially 46 case (rising to 326 cases by 16 April) being placed under lock-down and closure of the entire 4,300 km. border with Russia.[viii]
New Restrictions by Singapore and Vietnam
Much more serious are the domestic restrictions imposed by Vietnam and Singapore.
Particularly distinctive is Vietnam, which took particularly early action – from 1st February with rigorous quarantining, tracking of cases, high levels of surveillance (but initially limited testing, for which the capacity was not present),[ix] and a remarkably effective health provision given the countries level of per capita GDP.[x] This kept the reported rate of infection extremely low (Table 1) and saw much approving comment on the effectiveness of a ‘low cost model’, including from the WHO.[xi] However, between 23 March and 30 March the number of cases jumped from 134 to 212, including 45 cases at the Bach Mai hospital in Hanoi – one of the largest medical facilities in the country – where 15,400 contacts were identified. The government responded on 31 March with a 15-day national lock-down. In the event, all the traced contacts tested negative and the lock down eased from 16 April, with the number of confirmed cases having only risen to 268.[xii] Though, given the still limited testing this might be a case to watch.
More disturbing is the case is Singapore, where a sharp rise in cases from the end of March (Table 1) prompted a major raft of controls. From 7 April stringent self-distancing measures were imposed, schools closed, all food establishments restricted to take-away and delivery services, all non-essential businesses closed, and reusable face masks were issued to every household by 12 April. From 15 April it was mandatory to wear a mask when leaving home. The government is referring to the new measures as ‘the circuit breaker’, initially imposing them until 4 May, but on 21 April extending to 1 June. The extension was accompanied by increase restrictions including the closure of outlets just selling drinks and snacks, moving services such as laundries to on-line and home delivery, closing hairdressers, and mandating temperature screen at all supermarkets and malls, and cutting the work force in essential services[xiii]
However, by 22 April the number of confirmed cases had reached 10141. This very sharp increase since 13 April (Table 1) is attributed to the extension of Singapore’s large-scale testing regime[xiv] to include the foreign (‘work permit’) workers who comprise some 90% of the new cases.[xv]
These permit workers are involved in low paid construction and maintenance activities and mainly housed in large and extremely crowed dormitories located in the outskirts of the city. Currently there are 43 of these holding some 200,000 workers, mainly from Bangladesh, China and India. Twelve dormitory Coved clusters have been identifies and quarantined, though serious concerns have been raised over the conditions within these building and the risk of large scale infections.[xvi] Though, in order to control this (and support essential services) the government has started to transfer workers out of dormitories alternative sites, such as military camps, Housing Board flats and floating hotels – some 5,000 had been moved by 13 April.[xvii]
It is by no means clear how Covid-19 entered the foreign worker population or, indeed, how long it might have been circulating there. However, it does appear than on its efforts to control Covid-19 the government overlooked these people, they have only from 20 April been included in the testing programme. Which does bring very much to the fore the long- standing issue of the treatment of such foreign workers in Singapore and the attitude of the authorities towards them. There have also been suggestions that Singapore was not as cautious as it should have been in dealing with the earlier return of large numbers of its citizens – some 500 of which were later identified as bringing the virus.[xviii]
Sharp Rise in Japanese Cases
The sharp increase in Japanese cases is also a cause of concern. Here despite having the second case of Covid-19 outside of China diagnosed in early January, the government seems to have been rather slower and lower key in its response than its neighbours. Certainly, travel bans on South Korea and China were imposed at an early stage, Covid-19 added to the 2012 Special Measures legislation, and from late February the Ministry of Health started a tracing programme where clusters of cases were identified. However, there was little testing (see Note 13) or restrictions on activities. This led to very considerable criticism of the Abe government, with suggestions that the delays were linked to reluctance to damage the economy or the prospects for holding the 2020 Olympics. While the Governor of Tokyo demanded much sector controls and Hokkaido independently declared a state of emergency.[xix] However, the late-March / early-April surge in cases (Table 1) prompted the government to empower Tokyo, Osaka and five prefectures,[xx] to from 4 April take potentially highly restrictive measures, which were extended to the rest of the country on 17 April.[xxi] While there seems to be a high degree of compliance, with museums, cinemas, department stores, restaurants and bars closing, and reported 60% decline in rush hour use of the Tokyo subway lines, much business continues as usual.[xxii] The concern is that the measures may be too late and too little, with a fear that given the very high densities of Japanese cities and limited testing the virus could have spread very widely outside of the identified clusters.[xxiii]
That the virus has seemingly ‘outwitted’ the national systems of Japan and Singapore, underlines the need for continued vigilance, rapid response and ability to adjust strategies. There is no place for complacency, not least in the other front-line Asian states that seem (so far) to have situations under control. More specifically, the Singapore case should be a warning to governments everywhere, particularly where there are significant poor and excluded communities where the virus can spread below the radar. What Prime Minister Lee Hsien Loong referred to as a ‘hidden reservoir’ of cases.[xxiv]
Comments, corrections of facts and interpretations are welcome. As would offers of contributions on Covid-19 in Asia.
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[i] The situation in all the countries is extremely fluid and all the data may have changed before this is posted. In addition, all the data cited should be treated with caution, particularly when making comparisons between countries with very different methods and effectiveness of reporting, definitions and levels of testing / diagnosis.
[ii] It may also be that North Korea with the closure of border adding to its already comparative isolation, and reportedly strict quarantine measures, is controlling Covid-19 (Gabriela Bernal ‘North Korea’s silent struggle against Covid-19’, Asia Times, 31 March 2020, https://asiatimes.com/2020/03/north-koreas-silent-struggle-against-covid-19/).
[iii] See for example: Dennis Normile ‘Suppress and lift’: Hong Kong and Singapore say they have a coronavirus strategy that works’, Science, 13 April 2020, https://www.sciencemag.org/news/2020/04/suppress-and-lift-hong-kong-and-singapore-say-they-have-coronavirus-strategy-works
[iv] Which was followed by the H1N1 influenza pandemic in 2009, Ebola virus disease preparedness in 2014, Middle East respiratory syndrome coronavirus (MERS-COV) in 2015; and, Zika virus disease in 2016.
[v] Populations in which mask wearing when unwell and related hygiene and, where possible, distancing measures were widely accepted.
[vi] The increase was 37. However, this did include a small cluster of what were believed to be local transmissions in the popular entertainment district of Kwak (Jean Kirby ‘What we can learn from the second wave of corona virus in Asia’, Vox, 17 April 2020, Fong https://www.vox.com/2020/4/17/21213787/coronavirus-asia-waves-hong-kong-singapore-taiwan; Chris Lau, Victor Ting, Lillian Chang and Karen Zhang ‘Coronavirus: 1,200 pubs and bars in Hong Kong to close as government orders two-week shutdown’, South China Post, 2 April 2020, https://www.scmp.com/news/hong-kong/health-environment/article/3078130/coronavirus-two-beauty-parlour-employees-among.
[vii] Restaurants remain open but are restricted to 50% of normal capacity, with no more than four to a table, and they must check patrons’ temperatures at the door and provide hand sanitizer.
[viii] Huizhong Wu ‘Remote Chinese city hit by coronavirus after weeks of feeling safe’, Reuters, 16 April 2020,https://www.reuters.com/article/us-health-coronavirus-china-border/remote-chinese-city-hit-by-coronavirus-after-weeks-of-feeling-safe-idUSKCN21Y0J2; Tommy Yang ‘Unease at the border: Russia and China seek to downplay Covid-19 outbreak in Suifenhe’ Guardian 18 April 2020, https://www.theguardian.com/world/2020/apr/18/unease-at-the-border-russia-and-china-seek-to-downplay-covid-19-outbreak-in-suifenhe
[ix] The testing rate was the lowest in the front-line states (see Note 13),
[x] Jörg Reinhardt ‘Vietnam’s impressive health care strategy, ASEAN Post, 25 June 2019, https://theaseanpost.com/article/vietnams-impressive-health-care-strategy
[xi] John Reed and Pham Hai Chung ‘Vietnam’s coronavirus offensive wins praise for low-cost model, Financial Times 24 March 2020, https://www.ft.com/content/0cc3c956-6cb2-11ea-89df-41bea055720b; Hong Kong Nguyen ‘Vietnam’s low cost COVD 19 strategy’, ASEAN Post , 13 April 2020, https://theaseanpost.com/article/vietnams-low-cost-covid-19-strategy
[xii] See: ‘Vietnam Says 15,000 People Linked to COVID-19 Hotspot Tested Negative’, April 9, 2020, https://www.usnews.com/news/world/articles/2020-04-09/vietnam-says-15-000-people-linked-to-covid-19-hotspot-tested-negative; Vietnam Briefing, 20 April 2020, https://www.vietnam-briefing.com/news/vietnam-business-operations-and-the-coronavirus-updates.html/
[xiii] ‘Coronavirus: Hairdressing, barber services, standalone outlets that sell only beverages, packaged snacks to be closed’, The Straits Times, 21 April 2020, ‘https://www.straitstimes.com/singapore/hairdressing-barber-services-to-be-closed-so-will-standalone-outlets-that-sell-only
[xiv] As of 19 April 2020 Singapore had a testing rate of 15.97 /1000, compared to Hong Kong 17.46, South Korea 10.24, Taiwan 2.09, Vietnam 1.35 and Japan 0.71, retrieved on 22 April from, Our World in Data, https://ourworldindata.org/grapher/full-list-cumulative-total-tests-per-thousand?time=2020-02-29..&country=HKG+JPN+KOR+Singapore%2C%20swabs%20tested+TWN+VNM+IDN+PHL+MYS+THA
[xv] ‘Spike in Covid-19 Cases in Singapore Due to Extensive Testing of Foreign Workers: Health Ministry’, News 18, 21 April 2020, https://www.news18.com/news/world/spike-in-covid-19-cases-in-singapore-due-to-extensive-testing-of-foreign-workers-health-ministry-2585845.html
On 20 April, the Ministry of health reported that out of 1426 new cases, 1369 were work permit holders living in dormitories, 32 were work permit holders living elsewhere and 25 were Singaporeans or permanent residents.
[xvi] ‘Coronavirus: Singapore spike reveals scale of migrant worker infections’, BBC Asia, 17 April 2020, https://www.bbc.co.uk/news/world-asia-52320289
[xvii] ‘Coronavirus: Healthy workers to be moved to army camps, floating hotels’, The Straits Times, 10 April 2020,;https://www.straitstimes.com/singapore/healthy-workers-to-be-moved-to-army-camps-floating-hotels: ‘Coronavirus: Floating accommodation for workers ready’, The Straits Times, https://www.straitstimes.com/singapore/floating-accommodation-for-workers-ready
[xviii] Anna Jones ‘Coronavirus: Should the world worry about Singapore’s virus surge? BBC News, 10 April, https://www.bbc.co.uk/news/world-asia-52232147
[xix] Though Hokkaido took independent action in late-February in declaring a state of emergency, closing schools, banning large-scale gatherings, encouraging people to stay at home, while following the national policy of tracing and isolating. Restrictions that were lifted on 19 March following a drop in the number of cases (Rupert Wingfield-Hayes ‘Coronavirus lockdown: Lessons from Hokkaido’s second wave of infections’, BBC News, 16 April 2020, https://www.bbc.co.uk/news/world-asia-52305055).
[xx] Chiba, Fukuoka, Hyogo, Kanagawa and Saitama. On 14 April, the Governors of Aichi, Ishikawa and Hokkaido declared states of emergency.
[xxi] Which could include requesting residents to stay at home except for essential tasks, closing schools, childcare, entertainment and public facilities – but there are no legal penalties if they are not followed. Prefectural governors would also be able to requisition land to build temporary medical facilities and could do so forcefully if a landowner refuse. Similarly, prefectural governments would also be able to order medicine and food suppliers to sell their goods to authorities. See: Satoshi Sugiyama and Eric Johnson ‘Abe to declare state of emergency over COVID-19 covering Tokyo, Osaka and five prefectures’, The Japan Times, 6 April 2020, https://www.japantimes.co.jp/news/2020/04/06/national/japan-state-of-emergency-covid-19/#.XosQOIhKhPY
[xxii] ‘Dennis Normile ‘Did Japan miss its chance to keep the coronavirus in check?’, Science, 22 April 2020, https://www.sciencemag.org/news/2020/04/did-japan-miss-its-chance-keep-coronavirus-check
[xxiii] Dennis Normile ‘Did Japan miss its chance to keep the coronavirus in check?’, Science, 22 April 2020, https://www.sciencemag.org/news/2020/04/did-japan-miss-its-chance-keep-coronavirus-check
[xxiv] ‘Concerns over “hidden reservoir” of coronavirus cases: PM Lee Hsien Loong’, The Straits Times, 22 April 2020, https://www.straitstimes.com/singapore/concerns-over-hidden-reservoir-of-virus-cases-pm-lee