Mainland Southeast Asia’s COVID-19 “success”: policy, culture or mere luck?

Image by UN Women Regional Office for Asia and the Pacific via Flickr

Two weeks ago, Thailand emerged in the endless global coronavirus news cycle with good news; the Southeast Asian country reported no new COVID-19 cases on Thursday, the 16th of July. In fact, for a country of its size, Thailand’s rate of infection has remained surprisingly low throughout the pandemic, having recorded fewer than 3,240 cases and 58 deaths.

This encouraging statistic points at a wider trend in mainland Southeast Asia. Thailand’s success at containing the spread of the virus appears to be shared by other countries in the Mekong River region—Vietnam, Cambodia, Laos, and Myanmar. Vietnam has especially shocked its observers: in a country with a population of 97 million, it currently claims no deaths from COVID-19. Similarly, the smaller countries of Cambodia and Laos have zero reported deaths, and only 141 and 19 confirmed cases, respectively. Myanmar claims just six deaths from 317 cases.

In contrast to countries in Europe, North America, Brazil, and more recently, India, the COVID-19 pandemic seems to have spared much of mainland Southeast Asia. These numbers stand out even more when compared to neighbouring maritime countries such as the Philippines and Indonesia, where cases and deaths continue to rise.

This phenomenon has been particularly confounding due to how, just months ago, much of Southeast Asia appeared to be on the brink of a major coronavirus epidemic. Many of its countries share long and porous borders with China the source and original epicentre of COVID-19, and all mainland Southeast Asian states share deep and extensive business, trade and tourism ties to their giant neighbour. Thailand, as a favourite holiday destination for Chinese tourists, was predicted to be especially vulnerable to the virus’ spread. Cambodia, Laos and Myanmar, on the other hand, are widely held to have public health systems that were chronically underfunded, leading to legitimate doubts about their capacity to deal with an outbreak.

Such concerns looked as if they would soon be validated. In January, Thailand confirmed the world’s first case of the coronavirus outside of China when a tourist arrived from Wuhan. However, Thailand soon managed to get its infection rate under control, and Vietnam, Cambodia, Laos, and Myanmar never experienced the explosions of infections that had been predicted of them. Given the wide degree of difference in government responses, policy implementation, and strength of pre-existing public healthcare systems, observers have been struggling to come to a consensus on what explains these exceptional results, and why they have been concentrated in these particular countries.

One widespread suspicion, raised in part by relatively low levels of testing (as of July 14th Laos had conducted 10,146 tests for its population of over 7 million), is that the virus is far more prevalent than what these governments are admitting and that both cases and deaths are going unreported. However, hospitals have not been overwhelmed, and there hasn’t been a sharp rise in unexplained deaths. In addition, many health experts on the ground have reported no evidence of widespread transmission. Against all the odds, Mainland Southeast Asia has managed to keep COVID-19 at bay. The question is, how.

A swift and effective government response certainly had a part to play in how these countries weathered the virus. Many of them acted quickly and were helped in part by well-established systems that had been put in in place following the SARS epidemic in 2002. Thailand especially, with its model health care system (Thailand is among the world’s leading medical tourism destinations), was able to contain the epidemic by vigorous testing, monitoring and tracking cases through electronic surveillance reporting. Just three days after China first reported the outbreak in Wuhan on December 31, Thai airports were screening visitors from the city. A day later, the public health ministry set up an emergency operations centre. Thailand has also prioritised contact-tracing; there are reported to be more than 1,000 epidemiological teams investigating and monitoring cases. Also, the government signalled to its population early that it was taking the virus seriously. It cancelled the Songkran water festival, Thailand’s national new year’s celebration, and banned alcohol nationwide.

Vietnam’s success can similarly be attributed to its well-developed public health system, as well as a strategy of comprehensive testing, tracing, and quarantining. The Vietnamese government also did not shy away from massive social closures and the extensive surveillance of its population. From the early onset of the pandemic, Vietnam shuttered non-essential businesses and schools and enacted large-scale quarantines. Hot spots such with community transmissions were locked down immediately. The province of Vinh Phuc for example, with its 10,000 strong population, was placed under a 21-day quarantine starting February 13, after six of the country’s sixteen cases came from that commune. Tens of thousands of citizens have also been placed in quarantine centres or “camps” run by the military.

Even the poorer countries adopted measures that helped slow the spread of the coronavirus. Migrant workers returning to their villages in Myanmar often had to quarantine for 14 days in a shack outside their village. In Cambodia, 2,900 health workers were trained and deployed throughout January and February. Dr Li Ailan, WHO representative to Cambodia, praised it’s government’s implementation of “aggressive rapid detection and contact tracing.”

However it is doubtful that their success stems from government action alone, as many of the policies implemented were not too different from those in countries that have been far less successful in containing the virus. Additionally, despite strides made in recent years, the public healthcare systems in Cambodia, Laos, and Myanmar continue to be limited in their capacity. This fact has been compounded by what many criticised as a slow and lacklustre response from their governments at the onset of the crisis.

In Myanmar, Government spokesman Zaw Htay suggested that the “lifestyle and diet” of Myanmar’s people protected them from the novel coronavirus. Cambodia kept flights from China open long after its neighbours shut off international travel, and in February it permitted a cruise ship filled with potentially infected tourists (that had been turned away from numerous countries) to dock in the port city of Sihanoukville. Prime Minister Hun Sen, having visited Beijing a week earlier, personally greeted disembarking passengers, and even sent them on complimentary tours of Phnom Penh. Though both eventually instituted lockdowns and social distancing requirements, these were often left to communities themselves to enforce.

Despite their government’s minimal response,  Cambodia, Laos, and Myanmar still boast one of the smallest outbreaks in the world. This has led to accusations that their low caseload appears to have come less from official response than from luck.

The lack of a consistent or heterogenous government response across these countries indicate that there are other factors at play, most likely to be either cultural or demographical. Health experts have offered up a whole slew of explanations, including  the high number of people living in the countryside rather than in crowded cities, the fact that people are more likely to live with fans and open windows than air-conditioning, and a pre-existing culture of mask-wearing due to the dangerous levels of pollution in cities. The young demographic in some countries may also mean populations are less vulnerable—although the rapid spread in India and more affected neighbours in maritime southeast Asia, with similar or younger age profiles, appears to undermine this.

Many have suggested a religious factor as well. The one thing these countries do have in common is that they have largely Buddhist populations. While karmic intervention might be harder to prove, Thai officials have suggested that the wai, a Buddhist greeting of palms pressed together, rather than a full embrace, has helped with social distancing. Dr. Taweesin Visanuyothin, the COVID-19 spokesman for Thailand’s Ministry of Public Health asserts that “It has to do with culture. Thai people do not have body contact when we greet each other,” later adding that “This is how the countries in the Mekong region greet each other as well.”

Finally, some assert that there a genetic component in this success, and believe that the immune systems of inhabitants of the Mekong River region are naturally more resistant to the coronavirus. According to Dr Wiput Phoolcharoen, a public health expert at Chulalongkorn University in Bangkok, more than 90 per cent of those who tested positive in Pattani in southern Thailand were asymptomatic, a much higher percentage than usual. He asserts that research shows Thais and other groups from Southeast Asia were more susceptible to certain severe cases of dengue fever than people of other regions, and thus believes that similar genetic differences could explain why these groups appear to be more naturally resilient to COVID-19.

We still have much to learn about the coronavirus, and until more research is done, cannot conclusively prove which of these factors, or indeed, what amalgamation of elements have led to mainland Southeast Asia’s low caseload. And while these countries seem to have avoided the explosion in cases that have hit much of the world, health experts urge that there is little room for complacency as countries open up again. Crucially, while COVID-19 might have had a limited health impact on these states, it has not been as forgiving on their economies, all of which are heavily dependent on tourism. As international travel ground to a halt, critical tourism industries have been devastated, with the Thai ministry for tourism estimating that 60 per cent of hospitality businesses could close by the end of the year. While dealing with these painful economic blow, many observers also warn that Southeast Asian governments have taken advantage of the pandemic to expand their powers, accelerating the authoritarian trends of the leadership in a region where civil liberties have struggled to take root.

Mainland Southeast Asia may avoid the exponential spread of COVID-19 but the social and economic repercussions of the pandemic loom large on the horizon.