A Mid-September Deadline

Can HCMC beat the outbreak in a month?

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Lots to get to this week - as always, if you have any comments, questions or general feedback, just hit ‘reply’ and let me know.

On to the news.

The latest data

At the start of the week, 206,439 cases had been detected in this outbreak. That figure is now 242,552, 152,561 of which are active. The death toll continues to rise substantially, from 3,397 on Sunday night to 4,813. There are 499 ICU patients, and 21 on ECMO treatment.

After recording over 9,000 cases both Sunday and Monday, the national infection figure improved for a couple of days, but climbed back to 9,653 yesterday (just 21 below the record set on Sunday).

Ho Chi Minh City’s numbers continue to move sideways/slightly down, and according to VnExpress, the number of new infections here over the last 14 days has fallen by 12% compared to the previous two weeks. This is excellent news, though I’ll discuss below how the city is not out of the woods.

Vaccinations are moving along well, though heavily concentrated in a few areas. According to the Ministry of Health’s vaccine portal, 1,435,212 doses were administered nationally on Monday, a massive record. 12,202,676 total injections have now taken place, with 57% of HCMC residents over the age of 18 now with at least one shot. (District 11 hit 94% yesterday, the highest of any district.)

This is by far the highest amount of any locality, and the national average is only around 13%. Officials have said that the country could hit 2 million shots per day in the future, given enough supply.

A healthcare system on life support

In the last two newsletter editions, I said that HCMC’s case situation had stabilized. I’d like to clarify a bit, as I meant that daily totals weren’t increasing, but the number of new cases is still outpacing recoveries, leaving the medical system here under immense strain.

For weeks, the health sector has been pursuing a ‘five-floor’ treatment model, in which the top floor treats severe/critical Covid patients, while patients in better condition are handled by lower ‘floors.’

This model is now at its limit, with reports that multiple field hospitals have run out of room for more patients, while doctors at the 500-bed COVID-19 Resuscitation Hospital in Thu Duc City are actually treating 600 patients, with plans to expand that facility to 1,000 beds.

Some COVID-19 patients with worsening symptoms have been stuck at home, unable to get an ambulance to the hospital, while others have been taken to hospitals that can’t admit them because there are lines out the door.

The ‘third floor’ and intensive care levels are under particular stress, while there have been issues transferring patients to the correct ‘floor’ between field hospitals, district-level hospitals, and major top-tier hospitals.

To help address an ambulance shortage, 500 taxis and other cars have been called into service. Mai Linh taxis, for example, are being deployed with medical students and members of the HCMC Youth Union who have undergone basic medical training and can use gear like oxygen tanks and rapid testing machines.

HCMC, along with nearby Dong Nai, Binh Duong, Tay Ninh, Binh Phuoc, Long An and Ba Ria-Vung Tau, have all asked the Ministry of Health for more personnel to help fight their outbreaks, but there are basically no reinforcements left, and many doctors, nurses and medical students have been working non-stop for weeks (or months).

As a result, the Ministry of National Defense may send medical personnel, and it is also expanding its medical facilities in HCMC (which are separate from the health ministry’s purview).

Amid all of this, earlier in the week the central government issued a resolution setting September 15 as the target for HCMC getting its outbreak under control. The date for Binh Duong, Long An and Dong Nai is September 1, and August 25 for the remaining southern provinces.

I don’t know what will happen if these targets aren’t met, and they seem a bit arbitrary (it’s also unclear what exactly ‘under control’ means).

Meanwhile, on Wednesday, Minister of Health Nguyen Thanh Long warned of a prolonged pandemic, especially in the south, something that Deputy Prime Minister Vu Duc Dam also mentioned this week. Frankly, this seems like the more likely situation.

The vaccination situation

After HCMC’s leaders warned last weekend that the city was about to run out of vaccines, a confusing spat over data between the city and the health ministry followed, and then 600,000 more AstraZeneca doses arrived in town.

The city is also negotiating on its own to buy 5 million Moderna doses, and has (very gingerly) begun using some of the 1 million Sinopharm doses bought by a private company that arrived a couple of weeks ago.

HCMC remains the national priority for vaccine supply. The rapidity with which the city has gone over 50% of adults with a shot is impressive, but also slightly misleading - it’s based on the official census population of 8.9 million, while all the way back in 2017 the city leader at the time said the actual population was 13 million, and I don’t think anyone knows what the real figure is right now.

Anyway, things seem to be on track to hit 70% of adults (again, based on the official population) by the end of this month, but given the Delta strain, it’s unknown what that means for herd immunity, while surrounding provinces are far less-vaccinated: just 12% of adults in Binh Duong, which remains a hotspot, have received a shot, while the figure in Dong Nai is just 8.8%.

Binh Duong recorded 3,028 cases yesterday, almost another record, and its infection numbers over the last two weeks are 184% higher than the previous 14 days. Dong Nai’s figure is 177% and is on an upward trajectory.

Given how interconnected the city is with those provinces (not to mention the Mekong Delta, etc.), I don’t see how HCMC could essentially re-open as an island while these other localities catch up on vaccination rates.

Elsewhere, Hanoi recorded 78 cases yesterday, and that is one to watch, as the city is in the middle of testing 3.3 million residents, a campaign that will run until next Tuesday.

Officials in Da Nang, which is averaging up to 80 new cases per day, is considering banning people from leaving their homes for seven days if the situation doesn’t improve by early next week. This sent residents rushing to supermarkets yesterday.

Briefly looking ahead

On the industry side of things (a topic I’m going to explore in an article for paying subscribers next week), factories are tired of the ‘three on the spot’ strategy, while supply chain struggles continue nationwide.

Even the rice production and distribution system is on the ropes, while high food prices are particularly hurting those who can least afford more expenses.

The number of flights between Hanoi and HCMC has been reduced from two to one (the civil aviation authority had asked for permission to cease these flights entirely, but the transport ministry said no). This was the second-busiest air route in the world last year.

HCMC’s most recent extension of Directive 16 expires this weekend, but that will certainly be extended again.

Prime Minister Pham Minh Chinh has said that if all goes well, the country will have a domestically produced vaccine ready next month. This can only be in reference to Nanocovax, but as far as I know, that still has a ways to go in its phase three clinical trials.

And with the traditional start of the new school year approaching - normally mid-August - only 18 of 63 provinces and cities have set a date for classes to resume.


Extra links:

Volunteers in Vietnam come to the rescue as coronavirus lockdown hits the vulnerable (South China Morning Post)

Life on the Last Remaining Ferries in Hoi An (Saigoneer)

Ngủ Ngày Ngay Ngày Tận Thế (Pitchfork)

[Illustrations] Mesmerizing Modern and Mythic Vietnam Re-Imagined (Saigoneer)

Have a great weekend!

Mike Tatarski