Abstract
The successful experience of Vietnam, with a population of almost 100 million, in handling the COVID pandemic from March to November 2020 is presented as a case study. It is posited that lessons learned apply to every other country—even at this late stage of the epidemic. Detailed aspects of detection, containment, testing, contact tracing, quarantining, targeted lockdowns, public health messaging, and travel and mobility restriction policies are discussed.
Keywords
Vietnam, with a population of almost 100 million, reported its first case of COVID-19 on January 23, 2020. Since then, it has reported 1213 cases (1070 recovered) and 35 deaths. (Zero deaths were reported during the first 4 months.) This success has been attributed to a well-developed public health system, a strong central government, and a proactive containment strategy based on comprehensive testing, tracing, and quarantining.
In regard to detection, Vietnam has taken a targeted approach to testing, scaled-up testing in areas with community transmission, and conducted three degrees/levels of contact tracing for each positive case.
In regard to containment, hundreds of thousands of people, including international travelers and those who had close contact with people who tested positive, were placed in quarantine centers run by the government; this greatly reduced transmission. Hotspots with demonstrated community transmission were locked down immediately, and the government communicated frequently with citizens to keep them informed and involved.
One of the reasons for these measures is that Vietnam had experience with SARS (2003) and avian influenza (2004), and the infrastructure to take appropriate action. As the COVID-19 pandemic continues to unfold in the rest of the world, Vietnam has relaxed many of its restrictions, with monitoring and vigilance still being particularly important.
Vietnam developed a national public health emergency operations center (2013), in addition to four regional centers (2016), and a national public health surveillance system. This network runs exercises and trainings to prepare key actors in government for outbreaks.
Since 2016, hospitals have been required to report notifiable diseases within 24 hours to a central database, ensuring that the Ministry of Health can track epidemiological developments across the country in real time. The goal is to identify clusters of people who have similar symptoms that might suggest an outbreak is emerging.
Outbreak Timeline
On January 23, the first patients were a man from Wuhan and his son, who were based in Vietnam. A week after the first case was confirmed, Vietnam formed a national steering committee to coordinate Vietnam’s “whole of government” strategy. Shortly thereafter, leaders locked down a commune named Son Loi, isolated patients and their close contacts in quarantine camps for 14 days, and activated community-wide screening at the first evidence of community spread.
A second wave hit on March 6: These cases were imported from new hotspots, including Europe, Great Britain, and the United States. The government tracked and isolated about 200 people who had close contact, lived on the same street, or were on the same flight.
On May 1, Vietnam had confirmed just 270 cases despite extensive testing, with no community transmission since April 15. The majority of cases (67% as of May 25) in Vietnam were imported from COVID-19-affected countries: first China and then Europe and the United States.
Detection and Testing
Starting in early February, publicly funded institutions in Vietnam developed at least four locally made COVID-19 tests. Subsequently, private companies offered the capacity to manufacture the test kits. Laboratory facilities allow tests to be widely administered and analyzed without long wait times.
As of May, 63 sites were able to confirm testing. Given its low case numbers, the country decided on a strategy of using testing to identify clusters and prevent wider transmission. When community transmission was detected (even just one case), the government reacted quickly with contact tracing, commune-level lockdowns, and widespread local testing to ensure no cases were missed. This helps explain why Vietnam has performed more tests per confirmed case than any other country in the world, even though testing per capita remains relatively low.
Containment and Contact Tracing
Testing is used as a tool for detection in contact tracing. Contact tracing and quarantine are the key parts of containment. Vietnam's contact tracing strategy is based on tracing degrees of contact from F0 (the infected person) through F1 (those who have had close contact with F0 or are suspected of being infected), F2 (close contact with F1), and all the way up to F5.
Given that infectiousness begins 2 days before symptoms, there is a period of only 3 days from the point of contact with a case to find and quarantine contacts before they could potentially infect others. It is critical to move fast, mobilize the contract-tracing apparatus, and locate the contacts.
The process in Vietnam worked as follows:
Once a patient with COVID-19 is identified (F0), local public health officials, with support from health professionals, security officers, the military, and other civil servants, work with the patient to identify who they might have been in contact with and infected in the past 14 days. All close contacts (F1), defined as people who have been within approximately 6 feet (2 m) of or have had prolonged contact of 30 or more minutes with a confirmed COVID-19 case, are identified by this process and tested for the virus. If F1s test positive for the virus, they are placed in isolation at a hospital—all COVID-19 patients are hospitalized at no cost in Vietnam, regardless of symptoms. If F1s do not test positive, they are quarantined at a government-run quarantine center for 14 days. Close contacts of the previously identified close contacts (F2s) are required to self-isolate at home for 14 days.
One noteworthy aspect of Vietnam's approach is that it identified and quarantined suspected cases based on their epidemiological risk, not on whether they exhibited symptoms. The high proportion of cases that never developed symptoms (43%) suggests that this approach may have been a key contributor to limiting community transmission at an early stage.
From January 23 to May 1, more than 200 000 people spent time in a quarantine facility. “On-demand” quarantine facilities were also established in selected hotels for those who were willing to pay.
Infection Prevention and Control in Health Care Settings
Preventing transmission to health care workers and subsequently back into the community is another important containment strategy. Vietnam has significantly improved hospital infection control by investing in organizational systems, building physical facilities, buying equipment and supplies, and training health workers. Guidelines now provide comprehensive guidance to hospitals on screening, admission, and isolation of confirmed or suspected COVID-19 cases; establishment of isolation areas in hospitals; use of personal protective equipment; cleaning and disinfection of environmental surfaces; waste management; collection, preservation, packing, and transport of patient samples; prevention of laboratory-acquired infection of COVID-19; handling of remains of confirmed or suspected COVID-19 cases; and guidance for COVID-19 prevention for family members and visitors.
Although most COVID-19 patients in Vietnam were hospitalized at specialty hospitals in Hanoi and Ho Chi Minh City, health care facilities at all levels were prepared to receive them, to avoid overwhelming the acute care system in the event of a larger outbreak. Only 4 health care workers have been infected to date.
Targeted Lockdowns
Vietnam implemented mass quarantines in suspected hotspots based on evolving epidemiological evidence. It entered a nationwide lockdown on April 1. Initially, the lockdown was set for 15 days, but it was extended to 21 days in 28 out of 63 provinces.
Mass Gathering, Travel, and Mobility Restrictions
Vietnam took many steps to implement closures and limit mobility for citizens and international travelers. Inbound passengers from Wuhan received additional screening. Visas for Chinese tourists were no longer issued beginning on January 30, just a week after the first case was confirmed. Flights to and from China were suspended on February 1 and trains were canceled shortly thereafter, on February 5.
Flights from the Schengen countries and the United Kingdom were suspended on March 15, and all visa issuance was discontinued on March 18. Vietnam closed borders and suspended all international flights by March 22.
On January 31—with only 5 confirmed in-country cases—the government mandated that all schools nationwide remain closed.
In early February, Vietnam began its practice of placing international arrivals from COVID-19-affected countries in large, government-run quarantine centers for 14 days. Vietnam began using the centers for all international arrivals beginning March 20–22.
Clear, Consistent, and Creative Public Health Messaging
The government communicated in clear, strong terms the dangers of the illness even before the first case was reported. On January 9, the Ministry of Health first warned citizens of the threat; since then, the government has communicated frequently with the public, adding a short prevention statement to every phone call placed in the country, texting people directly, and taking advantage of Vietnam's high use of social media.
In late February, released a well-known pop song with new lyrics that turned it into a public service announcement about hand washing. An ad hoc dance challenge was launched on Tik Tok. In March, the Ministry of Health sent 10 SMS messages to all cell phone users in the country. Throughout these communications, the government constantly used the motto: “Fighting the epidemic is like fighting against the enemy.” This messaging engendered a community spirit in which every citizen felt inspired to do his or her part, whether that was wearing a mask in public or enduring weeks of quarantine.
On April 14, Vietnam passed a decree allowing authorities to fine people who use social media to spread false, untruthful, distorted, or slanderous information.
Conclusion
Certain aspects of Vietnam's response to COVID-19 may not be replicable in other countries. Its experience with past epidemics encouraged citizens to take significant steps to slow the spread of the virus. Because Vietnam features a one-party government with a chain of command reaching from the national level down to the village level, it is particularly suited to mobilizing resources, implementing public health strategies, and ensuring consistent messages while enforcing regulations stringently.
Many lessons from Vietnam are applicable to other countries, including:
Investment in a public health infrastructure (e.g., emergency operations centers and surveillance systems) enables countries to have a head start in managing public health crises effectively. Vietnam learned lessons from SARS and avian influenza, and other countries can learn those same lessons from COVID-19. Early action, ranging from border closures to testing to lockdowns, can curb community spread before it gets out of control. Thorough contact tracing can help facilitate a targeted containment strategy. Quarantines based on possible exposure, rather than only on symptoms, can reduce asymptomatic and pre-symptomatic transmission. Clear communication is crucial. A clear, consistent, and serious narrative is important throughout the crisis. A strong whole-of-society approach engages multisectoral stakeholders in decision-making processes and activates cohesive participation in appropriate measures.
Vietnam began to lift its national lockdown on April 22. Schools opened between May 4 and May 11. Public transportation, domestic flights, and taxis are now allowed to operate, but most international flights remain grounded. Everyone must wear a mask in public.
Since April 16, Vietnam recorded no new cases of COVID-19 related to community spread. However, as more Vietnamese citizens were repatriated into the country, positive cases were detected in airports and in quarantine centers.
This next phase of Vietnam's COVID-19 journey will be important to watch. The big question is how and when will Vietnam open up its borders, and will it be able to maintain this success when it does?
Footnotes
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author received no financial support for the research, authorship, and/or publication of this article.
