Hong Kong, Macau, Vietnam, Taiwan, Myanmar
All of the current evidence suggests that COVID-19 has been eradicated in these places. Hong Kong has just passed 22 days of no local cases, Taiwan is celebrating a month. While it is possible they have missed clusters that were burning unnoticed like Singapore did, the longer term risk is how long these places can continue testing, quarantining, or banning all or nearly all international arrivals.
Korea recently made headlines for a new cluster associated with a nightclub in Seoul. The new outbreak is relatively small by international comparison. At the time of writing, more than a hundred people have been tested positive connected to the Itaewon clubs and more than 7000 have been tested. Worryingly, people have tested positive who were clubbing but not at the club in question. A look at the numbers reveals that Korea re-opened with roughly ten new cases a day from mid-April until early May unlike Taiwan, Macau, Vietnam, Myanmar, Hong Kong, and other neighbors that have had zero new cases in the same time period.
This outbreak is going to raise two questions about contact tracing. First, can KDCD handle the potential scale of it? Many people have pointed to Korea as an example of a country that defeated COVID19 without a lockdown. If contact tracing alone seems insufficient, we might see Korea’s first lockdown. Second, the club in question was a gay club. There are concerns that contact tracing might ‘out’ closeted gay Koreans, who are already being blamed.
As with most countries that launched strong interventions in March, the Philippines first saw an overall plateauing of new cases and deaths followed by a drop. The doubling time of total cases was less than two days on March 11th and is now more than ten days. In line with these changes in the situation and concerns about issues like hunger, the Duterte regime announced a revision of Enhanced Community Quarantine (ECQ) that will be implemented on May 16th. Thankfully, it seems like COVID19 has had little penetration in the rural interior outside Luzon Island.
Manila National Capital Region (NCR), Cebu City, and Davao will slightly loosen ECQ to something called Modified ECQ. Most of Central Luzon, Cebu Island, Bohol, and about half of Mindanao will go into General Community Quarantine for ‘containment.’ Of note, Cebu is emerging as a COVID19 hotspot recently with an R0 recently calculated at over 4. Cebu now overtakes Quezon City as the Philippines city with the most confirmed cases. However, this may reflect better testing and contact tracing.
|Modified ECQ||GCQ||Modified GCQ|
|Who Can Go Out?||People will be allowed to leave their homes only to obtain essential goods and go to work in industries allowed to resume by the government.||People will be allowed to move around for work and essential services in barangays without coronavirus cases.||Movement goes back to normal but mask-wearing, physical distancing, and other health protocols will be enforced|
|What kind of industries can operate?||Essential industries allowed under ECQ will continue to be allowed as before, but now certain manufacturing and processing plants will be allowed to operate at only 50% capacity. Government offices also resume work at 50% capacity.||Government offices and more industries and establishments can operate at a maximum of 75% capacity.||Work resumes in private and public sector at 100% capacity but with enforcement of mask-wearing, physical distancing, and other health protocols.|
|Transport and School||Transportation will be allowed but only for essential work and services.|
Physical classes can’t resume yet.
|Transportation services to resume only for government work and allowed industries.|
Flexible learning arrangements that include physical classes in a limited manner will be allowed.
|Public transportation resumes but with health protocols observed.|
Normal physical classes may resume with health protocols enforced.
- Testing capacity has expanded now to 8k/day, up from 2k/day in March and 6k/day through most of April.
- Mayors are beginning to adopt centralized quarantine, like using school buildings and hotels in Pasig.
- The percentage of positives per test is dropping.
- Hospitals have so far been able to cope with COVID19 without going over capacity, though nearly a fifth of confirmed cases are healthcare workers.
- The food security situation in Manila slums has not significantly deteriorated
- Genetic samples submitted have been sent to GISAID and, while limited in number, show a curious pattern of all being very closely related. They point to a mid- to late-February introduction, likely from India.
Despite the economic pain of ECQ, the Philippines government at various levels appears to have decided path to containment and eventual eradication. A forecast produced by the Philippines Institute of Development studies might have re-invigorated their efforts. What their study showed was that relaxing ECQ too soon meant unpausing an epidemic that roared to a peak in the fall or winter, depending on different scenarios.
As we wrote earlier, there may be no other country more committed to eradication than China is right now. They do NOT want a repeat of January through March and will use whatever measures available to contain COVID19 wherever it shows up. It has recently shown back up, if in small numbers that are of course difficult to confirm. First it showed up from likely Russian imports in Heilongjiang, where the cities there might or might not have gone back on lockdown but intercity travel was cut.
There were early concerns that it had already spread to other cities. Second Wave imports from Nigeria seemed to have spread through some of African community there, causing a public relations nightmare for China when Africans were evicted from homes and hotels and even banned from entering a McDonalds. There have been scattered reports of other mid-sized cities going on lockdown.
More concerning, however, is a case found in Wuhan. It is so concerning, in fact, that the city is mobilizing to have everyone there tested in ten days. By all outward appearances, Wuhan did everything it should have done to get zero new community infections by mid-March. Wuhan went out of lockdown on April 7th. The prospect that COVID19 might have nonetheless been spreading and only detected in early May is, of course, terrifying. It is only less worrisome if it came from somewhere else in China. Watch this space.