"We know we can't stop the virus but we can slow it down, and that is crucial."
I have known Dr Stephan Jost for twenty years. I trust him. He has has provided Myanmar Times with a clear and informative interview.
Just two comments:
Myanmar has not as yet *detected* any 'community transmission'. But in all likelihood transmission is taking place undetected in the community.
The length of both isolation and quarantine in Myanmar may be too long. It might be helpful to differentiate between the two.
Jamie
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WHO urges vigilance as COVID-19 situation in Myanmar remains “manageable”
John Liu
Myanmar Times
2 May 2020
Myanmar has seen COVID-19 confirmed cases rising to 151 with six deaths and 31 people recovering.
Despite the increase in cases, the country has been able to trace the majority of transmission chains, maintaining that the virus spread is “manageable”, said Dr Stephan Paul Jost, World Health Organization (WHO) representative to Myanmar.
He urged the government and public to be vigilant, and to continue following health guidelines such as social distancing.
The Myanmar Times spoke with Dr Jost about the country’s contact tracing ability, quarantine measures, and risks the country should heed as the situation drags on.
Dr Jost also took the opportunity to pay tribute to Pyae Sone Win Maung, a WHO staff driver who was shot dead in Rakhine state last week when transporting COVID-19 surveillance samples to Yangon.
“It has been a very difficult episode for the whole UN family in Myanmar and of course for us at the World Health Organization it's a tragedy. Violence is never the answer to anything,” he said.
How has Myanmar done in terms of contact tracing? How else can we improve?
Contact tracing has been carried out professionally in Myanmar, and from the very beginning, this is evident in the information and the data put out in the public domain by the Minister for Health and Sports.
For the overwhelming proportion of confirmed cases, we know the transmission chains. This is very important for early detection of cases for isolation, for improving the surveillance further, and for targeting possible cases properly and treating people promptly. Even the largest share of the confirmed cases, more than 60 have been traced to a single religious event. It shows you how epidemiology works in tracing contacts, making sure that we can then isolate both contacts and cases to stop the chain of transmission. That’s why we do not yet have community transmission.
We are still in the phase where there are clusters of cases that have been identified, in addition to the religious event, which is the largest cluster of cases so far. There were also workplace-related clusters and family clusters. Several cases were also found with people in quarantine, which is another good sign because we can see that there is an effort to early detect and isolate.
We know we can't stop the virus but we can slow it down, and that is crucial.
There have also been cases that have no contact history with the confirmed cases, how do we see those cases?
First of all, it's a success in the surveillance to pick them up. There are further investigations underway to make sure it is possible to trace a contact that wasn't immediately evident. We need to take it as evidence that there may be more transmissions going on. Therefore, we need to maintain vigilance and make sure that the series of measures taken by the authorities are fundamentally on the right track.
We know for instance, in a normal Asian or European setting, people would, on average, have 15 contacts. Since this is a very transmissible virus that can – on average – infect three people based on one infected case, we need to reduce the reproduction number. The ultimate aim is to keep it below one because then you would have a decline in the new infections. But once you have a large number of cases, that is very difficult to do.
Even now, we are going to see more cases being detected. But we hope that we can contain this to a manageable number that does not overstretch either the health or the social systems in the country.
For accuracy, some patients may need to be tested up to three times. How do we ensure that each person is tested thoroughly before we can discharge them?
We didn't have the capacity to test initially. Since the middle of February, we started testing at the National Health Laboratory. There has been continuous transformation regarding testing from what was initially a very cautious approach with a very limited number of test kits. And the WHO case definition also kept changing as the epidemiology changed. Now, the approach of testing has been transformed. Currently, more than 6600 people have been tested. So, it's a whole range of different testing scenarios that are being used to detect cases early.
No test is 100 percent accurate and there is the possibility of a small number of false positives and false negatives, so we cannot rule those out. But the PCR-based technique is more accurate. A rapid diagnostic test for instance, which some have called for, much less sensitive, maybe only about 30pc accuracy rate.
If a person in hospital has recovered, they will be tested twice within 48 hours. If they test negative both times, the person can be discharged. Even then the person needs to spend further time under home quarantine for at least seven days and possibly longer, depending on the circumstances.
On the quarantine side, we need to be aware of the possibility of asymptomatic cases and pre-symptomatic cases. That is one reason why the quarantine period has been extended to take into account that observations by some countries that pre-symptomatic cases may be longer than 14 days.
Ultimately, what would be better is to use Genexpert-based testing, because then you can have equally accurate and quick, as well as a fairly large number of tests, done quickly. This is US technology, and I think the US authorities have permitted that technology to be used outside the country.
The Government of Myanmar has put in place some tough restrictions for quarantine purposes. How effective have they been?
These measures are important, and they need to be seen in the overall context, in bringing down the number of contacts per person. The measures on quarantine and lockdowns that both Myanmar and other countries have taken are painful measures.
But none of these measures are taken lightly. WHO is not advocating specific measures in that regard, other than to say to practice social distancing, which is at least staying six feet apart; frequent washing of hands; observing good cough etiquette to make sure that droplets are not disseminated; and care for people who are sick but do it to also protect yourself by wearing masks.
It’s also important to cut down on other risk factors like smoking. Also, make sure that you are also not taking risks in travel, have good ventilation when travelling and at home. Poor ventilation is a very conducive environment for COVID-19 and other viruses to spread.
As this kind of situation is set to last at least two months, what are some other risks we can pre-empt?
Fundamentally, there's risk everywhere. And Myanmar also is no exception. The good thing is Myanmar knows that, and is taking proactive measures to stay ahead. At the same time, no one can know exactly what will happen.
It is possible that the equivalent of crowded dormitories in Singapore could happen in Myanmar, but we must try and avoid that. This virus is very clever, and we need to be on our guard at all times to focus and be targeted with the testing, the quarantine, and the contact tracing, because that can give us early clues of the virus’ early moves and where we need to focus our efforts.
The risk of the rainy season coming is also very important. We should also be stepping up preparedness for influenza. For instance, we know that often there are floods in the monsoon season. It is good to be prepared for that now, in terms of making more disinfectants available, pre-positioning vital kits for medical supplies and essential drugs, and protective influenza seasonal vaccination.
With more migrant workers returning, it's important to have some of the quarantine facilities available close to the border. And I think that has always been happening in Mon and Kayin states. The good thing is that Thailand and Myanmar have had a good understanding of this and there is the phasing of this return so that it is not happening all in one go.
Also, there needs to be surveillance at the point of entry, particularly the key ones between Myanmar and Thailand, so that those workers are under surveillance for people who might have fever and signs and symptoms. There are a number of migrant workers coming from China as well, so the same applies to them.
https://www.mmtimes.com/news/who-urges-vigilance-covid-19-situation-myanmar-remains-manageable.html
