Vaccines, Boosters & Covid Treatment with Dr. Leigh Jones


The Vietnam Weekly Podcast is back after some delay with guest Dr. Leigh Jones, Head of Training at the Oxford Clinical Research Unit (OUCRU) in Ho Chi Minh City. Leigh has a PhD in Immunology and is one of my go-to sources for information related to COVID-19 vaccines and other scientific issues related to the pandemic.

We discussed the different types of Covid vaccines and how they work; the significance of the timing between your first and second doses; the global debate over the need for boosters; research on the use of vaccines in children; and what current clinical data says about Ivermectin, the medicine being widely touted in some corners as a cure-all to the pandemic.

Leigh is a fantastic science communicator who does a great job of breaking advanced concepts down into language that can be easily understood by people without a technical background. I learned a lot from this conversation, and I hope you do too.


Lockdown Extended in HCMC

While three districts start to re-open

Good morning! A warm welcome to new readers from still-locked down Ho Chi Minh City. I have to admit that the extension at the start of the week left me in a bad mood, though that has improved since. All eyes are now on the end of the month.

Yesterday I sent out an article for paying subscribers that looked at non-pandemic news from recent months, including infrastructure delays, overseas investment by Vietnamese companies, and strict proposed rules on social media livestreams. You can upgrade to a paid subscription (US$5/month, US$50/year) below.

Earlier in the week I had a piece on the difficulties faced by factory employees in Binh Duong who haven’t worked in well over a month due to lockdown restrictions published by China Labour Bulletin.

On to the news.

Data update

On Sunday evening, this outbreak had accounted for 608,998 cases (223,521 active), figures that are now 656,076 and 216,156. This is just one example of health indicators finally moving in the right direction: there are fewer active cases today than at the start of the week.

The national daily case total has noticeably dropped, though Ho Chi Minh City is still logging well over 5,000 cases on a daily basis (and over 6,000 on Tuesday). It accounted for over half of all infections yesterday.

The death toll has climbed from 15,279 to 16,425, with HCMC recording its lowest total since August 22 yesterday: 160.

Roughly 1 million vaccine doses are being administered on a daily basis, though it took a while for this to happen: according to VnExpress data, 11.1 million doses were delivered to Vietnam in August, compared to 776,300 so far this month. In the second half of last month, only 200,000-400,000 shots were being given on the average day, a trend that continued through September 4.

Lockdown extended, with some loosening

At the start of the week, we knew that HCMC’s lockdown would be extended beyond the 15th, but the details hadn’t been worked out yet. Now we know what the plan is through the end of the month.

The ‘shelter in place’ restrictions will last for another two weeks, except for District 7, Cu Chi and Can Gio, the three districts which have declared their outbreaks ‘under control.’ Residents there are now allowed to shop for groceries once a week, while officials will trial the app-based vaccine ‘green pass’ system in those districts as well.

That system is still a mess, with many people either having incorrect vaccine records in the database, or no records at all.

In a nice move, Saigontourist is arranging a tour to Can Gio’s mangrove forest for around 100 healthcare workers this weekend.

There are some other notable new developments. Small parks in apartment complexes and residential areas that are ‘green zones’ can be used for exercise, but only in the morning, and with strict social distancing in place. This is a bit unclear though, and huge complexes such as Vinhomes Central Park are keeping their common outdoor areas shut in order to prevent crowds from gathering.

Inter-district delivery has resumed as well, from 6am-9pm, and drivers must test negative for Covid every two days. The shortage of delivery drivers continues though, and there were articles yesterday about how some drivers were still sticking with delivery to just one district.

More businesses are also able to open during those hours, including postal services, computer stores and stationery stores, while restaurants and cafes are still only allowed to offer delivery. (In another shift, businesses can now use their own drivers as well, though they can only operate within their district - this will help take some strain off Grab and its competitors.)

These aren’t insignificant changes, and while some places are still finding it challenging to re-open, there are certainly more restaurants resuming delivery services every day, which will help to ease pressure on the grocery delivery system (and also give people the genuine excitement of eating food they haven’t had to cook for the first time in months).

Hopefully the gradual reopening of the Hoc Mon wholesale market - which should begin soon - will help with some of the food supply and cost issues.

Cu Chi, Can Gio and District 7 will serves as models for other districts to begin opening from October 1 (assuming another Directive 16 extension isn’t needed). VnExpess had a nice photo essay of the city on the first day of this arrangement.

There’s a lot to do in the meantime: daily cases in the city are still high, the vaccine pass system is nowhere near ready, and the vast majority of residents still need their second shot. I’m also not sure what kind of surveillance testing will be maintained as things loosen up in order to make sure cases don’t explode again.

The small nod toward outdoor exercise is good to see, even if it doesn’t change much for most people here (though I did hear reports of some packed parks yesterday) - I was expecting that to be way down the list of priorities given how early in this lockdown that was banned: July 9, to be exact.

The capital

Hanoi’s outbreak, meanwhile, appears to be petering out (just 15 cases on Thursday), and yesterday a number of businesses in 19 of the city’s districts were allowed to re-open with pandemic precautions in place. Restaurants are able to deliver as well, though not after 9pm.

Residents of those districts will also no longer have to show travel papers in order to move around, removing an issue that had created massive headaches for people and businesses over the last couple of weeks.

Da Nang is also starting to open back up, but people are having a hard time embracing looser regulations since the issuance of travel permits isn’t keeping up with demand.

Moving forward

Dong Nai Province is planning to resume many aspects of daily life by mid-October, while Binh Duong is moving towards a similar goal. Getting those two provinces at least partially up and running will put hundreds of thousands of people back to desperately needed work - though I don’t think anyone knows how many migrant workers left during the outbreak’s peak, so it will be interesting to see if businesses are able to staff back up quickly. (Some are already having trouble.)

Speaking of migrant workers, last Sunday police in Binh Thuan Province found 15 people hidden in the back of a refrigerated truck. They were trying to return to their home provinces in north-central Vietnam from HCMC since they had no work and couldn’t afford to stay in the city. People are not currently allowed to leave HCMC under lockdown rules. In a humane move, Binh Thuan officials decided to transport them on to their hometowns. There are more details on this here (the migrants didn’t know they would be put in a truck).

Immense socioeconomic challenges remain as well, and as I’ve discussed here repeatedly, the human impact of the outbreak is awfully grim. Just take this story for example: 1,517 students in HCMC have lost either one or both of their parents to Covid, while over 10,000 high school students and 3,000 teachers have caught the virus. Over 60,000 students in the city are now living in poverty - and this is just HCMC.

There’s also this piece from VnExpress on the toll the outbreak is taking on the mental health of children.

Farmers in the Mekong Delta are also sitting on massive unsold inventories thanks to low demand and travel disruptions, with seven million chickens, 80,000 ducks, 6,000 goats and millions of chicken eggs piling up. (Many of the eggs were intended for mooncakes for the Mid-Autumn Festival, which falls on the 21st, but very few bakeries are open to sell mooncakes this year.)

A few provinces in the delta have also gotten direct attention from the Prime Minister this week after backsliding, with red zones spreading and infections rising. Dong Ha, in Quang Tri Province, implemented Directive 16 yesterday after detecting 10 COVID-19 cases in one day. This is likely to be the reaction to small flare-ups in provinces with low vaccination rates, so we’ll have to see what ‘living with the virus’ really means once the big cities with widespread vaccinations any kind of uptick in new cases.


Extra links:

Love in the Time of Corona: Long-Distance Relationships When You're Just 1km Apart (Saigoneer)

Long weekend becomes 9 week lockdown for AP Vietnam reporter (Associated Press)

Built on Rock, Raditori's Music Shines Thanks to Whimsy and Unpredictability (Saigoneer)

Have a safe weekend.

Mike Tatarski

Ho Chi Minh City Will Miss its Deadline

As policy whiplash continues

Good morning! Welcome to the latest edition of the Vietnam Weekly - I hope you had a good weekend. If you’re reading this through a shared link and would like to sign up, or if you’d like to upgrade to a paid subscription (US$5/month, US$50/year), you can do so below.

I’ll send out a new piece for paying subscribers this week, and a (much-delayed) new episode of the Vietnam Weekly Podcast will also be released in the coming days.

I wrote a dispatch on Vietnam’s outbreak for Deutsche Welle that was published late Friday.

On to the news.

Data update

On Thursday, this outbreak had accounted for 571,746 COVID-19 infections (223,459 active). Those figures are now 608,998 and 223,521 - this shows that daily national recoveries have been high. There are currently 6,057 critically ill patients.

Ho Chi Minh City continues to log high daily case totals, though the city’s average recorded death toll in the first eight days of this month fell by 38% compared to the previous eight days.

Nationally, the death toll increased from 14,470 to 15,279.

According to the health ministry’s vaccine portal, vaccinations have picked up speed: fewer than 500,000 doses were administered every day from August 17 to September 4, but over 1 million shots have gone into arms four times in the last week.

Nonetheless, the national figures remain dismal, with just 5.2% of the population fully vaccinated (18.8% has received one shot). HCMC officials are concerned about a vaccine shortage as they work to fully vaccinate the city - Sinopharm (which is called Vero Cell in local media, a name I hadn’t seen before it started being used here) is currently making up the bulk of shots here.

The deadline

In Friday’s newsletter, I discussed how the 15th (Wednesday) loomed large as the deadline for ‘controlling’ the outbreak. We’ve gotten more details on what Ho Chi Minh City’s gradual re-opening could look like, and it starts by creating a ‘green pass’ for fully vaccinated people and those who have recovered from Covid in the last six months.

Anyone with one vaccine dose, meanwhile, would be given a ‘yellow pass.’

The first phase of opening would run from September 16-October 31 and allow ‘green pass’ employees of businesses to return to work, though karaoke parlors, spas, nightclubs, bars, restaurants, sports and amusement centers, cinemas and malls will remain closed. Also during this phase, those with a green pass would be able to freely move around the city, while yellow pass holders would need a negative Covid test to do so.

From November 1-January 15, 2022, malls, sports centers, outdoor entertainment venues and restaurants serving under 20 people would open to ‘green pass’ holders.

And after January 15, all businesses would open, but karaoke places, spas, nightclubs and bars will only be able to admit people with a green pass.

The emphasis on green passes has created a lot of anxiety for people, as this status requires your vaccination records to be accurate on an app from the Ministry of Health, and hundreds of thousands of people have incorrect records. (Neither of my shots show up in the database, and based on my unscientific Twitter poll, I’m not alone.)

The city has said that all records would be updated by the 15th - but now it seems that date doesn’t actually matter.

Walking back the deadline

The whole concept of this deadline was a huge risk from the start, and yesterday Nguyen Van Nen, the municipal Party Secretary, announced that HCMC was going to need two more weeks, as only three districts have announced ‘control’ of their outbreaks. (Confusingly, he also mentioned the difficulty of achieving ‘zero-Covid’ in a set amount of time - other officials, including the Prime Minister, have openly talked about ‘living with Covid’ in recent weeks, so it’s not clear what the strategy is at this point.)

While this is certainly not surprising, it’s another blow to the morale of city residents. Group chats had been full of optimism in recent days, though I cautioned people not to get too excited - in this instance, I hate being right.

For privileged people like me - who can basically work from home indefinitely - this is very frustrating, but for those who haven’t worked in months and were anticipating being able to starting making an income again this week, this is absolutely crushing.

At the moment it’s not clear what this delay means for the phases discussed above, or what kind of lockdown will continue beyond the 15th. I expect we’ll get some details on that tomorrow, but the number of policy about-faces the people of the city have endured at this point is incredible, and there’s no guarantee the city government won’t demand more time once these additional two weeks are up.

Also waiting on details regarding what will happen in Can Gio, District 7 and Cu Chi, the three districts which have declared their outbreaks ‘under control.’ (My hẻm has been tested three times in the last week, which I hope means we’re on our way to becoming a ‘green zone’ and at least a tiny smidge more freedom of movement.)

Speaking of policy surprises, last week’s unexpected (and highly regulated) restaurant delivery resumption has been of limited benefit to business owners, with most holding off due to high costs and a dearth of delivery drivers. (I did manage to score some bún chả yesterday - my first delivered Vietnamese food in over two months - but it was sourced through my neighborhood Zalo group and walked over from down the street.)

The Phu Quoc sandbox

This has been talked about for months, but Prime Minister Pham Minh Chinh has officially approved the pilot program to allow vaccinated international tourists to visit Phu Quoc. PM Chinh said the island could expect up to 3 million total arrivals by the end of the year, while island officials anticipate 40,000 foreign arrivals over six months. (Obviously meaning domestic tourism will make up the lion’s share.)

There is a huge hurdle in the way, however: just 35% of adults on Phu Quoc have received their first shot, while officials have said 90% of residents need to be fully vaccinated before tourism can resume.

Given how much demand there is for doses in outbreak hotspots (the island is Covid-free, as far as I know), diverting vaccines to Phu Quoc will be a hard sell, but this is something to keep an eye on.

Visitors would only be able to go to designated hotels - meaning this will likely benefit big players like Vinpeal, Sun World and the numerous international five-star resorts which have opened in recent years.


Extra Links:

The young Vietnamese helping tackle the illegal wildlife trade (Al-Jazeera)

Lá Dứa: The OG Queen of Vietnamese Desserts (Saigoneer)

A New Generation of Vietnamese Chefs Is Shaking Things up in Prague (Urbanist Hanoi)

Have a great week.

Mike Tatarski

The Race to Vaccinate

As everyone awaits the 15th

Good morning! Hello new readers, and welcome back to returning subscribers. If you’re reading this through a shared link and would like to sign up, or if you wish to upgrade to a paid subscription (US$5/month), you can do so below.

On to the news.

Data Update

At the start of the week, 482,498 cases (215,269 active) had been recorded during this outbreak. Those figures are now 571,746 and 223,459, while the death toll has risen from 13,074 to 14,470. The national daily infection average over the last week was 12,750.

Ho Chi Minh City (278,703 cases and 11,277 deaths) continues to log high daily infections and deaths, with the former attributed to increased testing (I was tested twice this week). These figures are cause for concern as the 15th approaches and residents anticipate some loosening of restrictions. (More on that below.)

Vaccinations have finally picked up speed, with over 1 million shots administered nationwide on Monday, by far the most in nearly a month. HCMC and several other locations are racing to vaccinate their adult populations in the coming days in order to begin some form of ‘new normal,’ though the national figure remains very low: just 3.9% of the population is fully vaccinated.

According to the health ministry’s vaccination dashboard, 101.2% of adults in HCMC have received a shot - it seems fully vaccinated people are being counted twice. The ministry also approved the mixing of Moderna and Pfizer vaccines given a shortage of the former. Previously, only AstraZeneca and Pfizer were mixed.

The chairman’s appearance

On Monday night, Pham Van Mai, Chairman of the HCMC People’s Committee, participated in a Facebook livestream to discuss the ongoing lockdown and plans for when Directive 16 expires on September 15.

A local Twitter user provided an extremely helpful rapid translation, though the event was light on specifics. This wasn’t surprising, but the fact that this took place at all was, I believe, unprecedented. High-level Vietnamese officials are almost never placed in a public setting, and certainly not one where members of the public can directly submit questions.

At one point over 70,000 people were watching, and comments on the Facebook stream were non-stop: I had Google Translate running in my browser, which couldn’t keep up with all of them, but a huge number were from people saying they had received no financial or food support from the government for months. I don’t know how or if all of these were conveyed to the chairman, but it was still rather extraordinary.

The main policy takeaway from this was that HCMC’s ‘stay in place’ lockdown will continue until the 15th (it was originally scheduled to end at the start of this week). It seemed that people in ‘green zones’ would potentially be able to resume in-person shopping once a week, but there haven’t been further details on that.

The delivery surprise

That extension was fully expected given the ongoing COVID-19 situation. What wasn’t expected was the announcement late Wednesday night that restaurants in HCMC would be able to resume delivery services immediately.

This was met with a ton of excitement and many WhatsApp messages in all-caps, as food deliveries have been shut down for two months, but the rules placed on restaurants are onerous.

They can only operate from 6am-6pm, must arrange delivery through Grab or other tech platforms, can only deliver within their district, all staff must have at least one vaccine dose and be tested every two days, and they must follow the ‘three on the spot’ model which some factories maintain, meaning employees have to work, live and eat on-site.

Many restaurants won’t be able to manage that last rule, though some family-run Vietnamese places do that already since they are part of a house. Nonetheless, local media ran several stories yesterday about how restaurant owners are reluctant to open under these regulations: traditional markets are still closed so sourcing ingredients is time-consuming and expensive, while paying for employee testing is an added cost and delivery services are already overwhelmed (and expensive) without the added demand of food orders.

Without a doubt, some places will figure this out in the coming days, but it’s hard not to sympathize with restaurant owners who don’t want to take the risk, especially given how quickly rules can be reversed/changed.

The plight of health workers

VnExpress published three articles this week that placed the brutal conditions health workers face in stark relief. The first detailed a proposal from the Ministry of Health to revoke medical licenses from doctors or nurses who quit their job and reward those who contribute to pandemic control.

There’s really no word for this other than cruel: health workers nationwide have been working non-stop for months at this point, and it’s understandable if they are burned out. Potentially ending their career for deciding they need a break is a horrible approach to mental health.

Another article noted that in HCMC’s field hospitals, each doctor and nurse has to care for an average of 150 patients while spending up to 10 hours straight in full-body protective suits.

And finally, this piece (in Vietnamese) covers the financial stress that medical workers must deal with. One nurse, for example, has had her salary cut for “underperforming” and only makes around US$200 per month. It also details the allowances that doctors receive when treating Covid patients: they work on 21-day rotations and receive VND300,000 (US$13) per day.

But after that rotation, since they came into contact with positive patients, they have to quarantine at their hospital for 14 days, and then spend another seven days at home. During this three-week period, they receive no daily allowance.

VTV released a gripping 50-minute documentary on a hospital in HCMC which treats pregnant women infected with Covid. It is a brutal watch, but shows what hospitals are up against. It’s in Vietnamese, and this Twitter thread translates some of the main scenes (warning: this is really not for the faint of heart).

There was also grim news regarding children this week: HCMC alone has around 3,000 child COVID-19 patients, while 250 kids in the city have been orphaned by the virus.

Looking to the 15th

All eyes are on next Wednesday, which is now not only HCMC’s ‘deadline’ for controlling the outbreak, but the entire country’s. Setting a deadline for a virulent infectious disease is a huge risk, but here we are. Given how complicated this is, I’d expect new rules for HCMC to come at the last minute and not be dramatic, but then again the food delivery about-face was a big surprise, so I could be wrong.

Perhaps the economic and financial pain is just too overwhelming at this point.

Can Gio became the city’s third district to announce that they have ‘controlled’ the outbreak (relatively easy as the district is sparsely populated and only connected to the rest of the city by ferry).

City officials are discussing a ‘green pass’ for fully vaccinated residents, though the vaccination database is very incomplete: neither of my shots show up in it, and anecdotally this is not uncommon.

Dong Nai Province is working on a similar plan for fully vaccinated residents, though only 62,000 of almost 4 million people there have gotten two shots. Four districts in Binh Duong have eased their lockdown back to Directive 15, though the rest of the province is still in a challenging situation.

Hanoi has received an additional 2 million vaccine doses, including 1 million Sinopharm doses, as it pushes to administer at least one shot to all adult residents by the 15th. Officials in the capital also aim to test the entire city by next week. (I would love to know why neither Hanoi or HCMC ever truly tested their entire population - recently, testing has been touted, along with vaccinations, as the way to get this under control, but it just hasn’t happened.)

Huge traffic jams also hit Hanoi this week due to confusing, inconsistent travel permit regulations - the exact situation which HCMC dealt with multiple times earlier in the outbreak.

Da Nang, whose outbreak is easing, is also beginning a vaccine push, and up to 20 million various doses are expected to arrive in the country by the end of this month.

And Lam Dong, home to Da Lat, reopened tourist attractions, restaurants and hotels to province residents. To quote Liz Lemon: I want to go to there.


Extra links:

As Lockdown Intensifies, Animal Shelters Struggle to Rescue, Care for Abandoned Pets (Saigoneer)

The Young Vietnamese Artisans Breathing New Life Into Animals Carcasses (Urbanist Hanoi)

‘Hunger was something we read about’: lockdown leaves Vietnam’s poor without food (The Guardian)'

'My saviour': Hanoi's tiny balconies a refuge in lockdown (AFP)

Have a safe weekend.

Mike Tatarski

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