Can Myanmar’s second wave lend a voice to the formation of Asean CDC? — Aung Win

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NOVEMBER 3 — The rapid rise of Covid-19 in Myanmar has caught the attention of Asian neighbours as well as international organisations. Singapore, Vietnam, Thailand, South Korea, Japan, and China have provided aid to Myanmar to fight the virus. They are well aware that if the second wave in Myanmar is not controlled, it can become a threat to the health securities of their countries. The article published in Quarterly Journal of Medicine (QJM) called for the formation of the Asean CDC. The article says, “Asean countries are divided into the South-East Asia Region (SEARO) and Western Pacific Region (WPRO) by the World Health Organisation (WHO).

“Asean CDC can collaborate in sharing of real-time surveillance data and best practices, eliminating wildlife trade, maintaining supply chains, combating disinformation and vaccine development. The organisation can act as the permanent regional body to combat the current and future pandemics. Moreover, Asean CDC can enhance inter-regional collaboration between the SEARO and WPRO regions.” The Asean countries with the weak health systems are especially vulnerable to new waves of Covid-19.

China and Thailand reported the first cases in the world but they have successfully contained the virus. On the other hand, India and Bangladesh are still facing high burdens of Covid-19. With poorly controlled border areas, there is the danger of spill over from neighbours with high burdens of Covid-19. If the human traffic at the porous borders is not controlled, Myanmar is at risk for new waves of infection. After case 375 was reported on August 16, the authorities should have stopped all traffic and flights immediately. That is what China is doing when they discover new cases in their cities. China locked down the entire city of Ruili and stopped all commute from the city.

Furthermore, the driver substitute policy at the Chinese border is a good example to follow. Truck drivers entering from out of state should hand over their vehicles at the border. When case 339 was discovered on July 16. The authorities should have done more aggressive contact tracing and testing. Thailand has sealed its border with Myanmar for fear of the virus spreading to their soil. When a local transmission was discovered in Bangkok, Thailand, the authorities tested over 600 people.

In Vietnam, the fight against the virus is seen as a national duty from the government down to the individual level. As a result, visitors to the city of Da Nang voluntarily reported themselves to the authorities and this helped control the second wave in Vietnam. Whereas, in Myanmar, passengers from the Rakhine flights to Yangon did not cooperate with the health officials and this contributed to the nationwide outbreak. A sense of responsibility is lacking in people who do not cooperate with the health authorities. Some people are still refusing to wear masks, social distance and wash their hands. These simple measures can help prevent flu.

Flu and coronavirus can become a syndemic and this can increase the death rates, specifically among the vulnerable seniors. IDPs are another vulnerable group and an antibody study of 1000 random people in Rakhine State found that IDP camps were virus free. No information was released on how many tests were conducted in the IDP camps. The antibody study done by the CDC reported that the undiscovered cases can be at least ten times as many as the diagnosed cases. Some of the UN and NGO workers who visited the IDP camps were infected, therefore, they should be tested weekly.

Other groups that should be tested weekly are health care workers, volunteers, the police, passenger vehicle drivers and factory workers. Sentinel surveillance should be done on markets, banks, KTVs, construction sites, delivery services, places of worship, monasteries, elderly homes and prisons. A weekly random testing should be carried out in those hot spots, using the rapid antigen test kits.

Additionally, anyone leaving Yangon by bus, car, or train should be tested with the new antigen test kits. The last thing we need is new clusters appearing in the rural areas where hospitals are not equipped to handle an outbreak. For a country with limited resources, the officials should consider doing a sewage study to estimate the scale of infection in the community.

Self-isolation at home is a problem for some because they live in very crowded homes. New information about the virus is being discovered every day and medical professionals must be on the alert for new routes of transmission such as fecal-oral, vertical and sexual transmissions.

So far, the WHO has approved no treatment for the virus but the FDA has approved Remdesivir as a treatment for the virus. That drug is costly, however the Oxford University study revealed a less expensive dexamethasone as the potential drug to reduce mortality. Low dose dexamethasone is reserved only for severe cases. Rapid access to oxygen and a bed in a well-staffed facility can also reduce mortality. The virus targets multiple organs and causes severe coagulopathy so thromboprophylaxis should be part of the treatment for ICU patients. We already know that the coronavirus affects multiple organs in the body and it can cause acute kidney injury.

So, hospitals should stockpile dialysis machines. Additionally, the virus can cause new onset diabetes. Most of those who died in Myanmar have pre-existing diseases, so, it is important to treat these diseases. The viral infection can lead to the exacerbation of the pre-existing conditions and in such cases; the coronavirus is the secondary cause of death. Throughout the pandemic, people are afraid to go to the clinics and hospitals for illnesses other than the virus. Disruption of treatment services for noncommunicable diseases are also contributing to the excess deaths.  

The election is a nationwide event and we are seeing clusters among the police even before the election starts. So, a surge can almost certainly occur during or after the elections, even with all the necessary precautions. Patients who recovered from the virus report long term effects ranging from fatigue, anxiety, depression, cognitive impairment, and memory loss to organ damage. There are rehab centers in Europe staffed by respiratory therapists, physiotherapists, mental health professionals and GPs to manage the patients so called “the long haulers”. Myanmar must also take this problem seriously because the younger generations are the future workforce and any adverse long-term effect on them can have severe consequences for the economy.

In the first wave, Myanmar was lucky to have avoided many cases and fatalities. In a pandemic, we can never let our guard down even when there are no cases. Covid-19 might never go away even with a vaccine. After vaccines become available, we still face obstacles such as who gets it first, transportation and other logistics. We have to learn to live with the virus for at least one more year. Global health experts have been calling for the formation of Asean CDC for some time. Many Asean government bodies are cooperating to contain the virus but it is time to consolidate them into one body. The EU has European CDC and the African Union has Africa CDC. The time is ripe now for the Asean to have its own CDC.

* This is the personal opinion of the writer or publication and does not necessarily represent the views of Malay Mail.

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