In Person

WHO Country Chief Urges Myanmar to Sustain ‘Amazing’ COVID-19 Response

By Kyaw Phyo Tha 1 July 2020

It has been more than three months since Myanmar reported its first COVID-19 case in late March, so it seems an appropriate time to reflect on how the country has performed in its fight against the coronavirus, which has killed more than half a million people globally.

As of Wednesday, the nationwide tally of overall confirmed cases in Myanmar is 299, of whom 222 have recovered. The death toll stands at just six, while neighboring countries like Thailand and China—both of which share long borders with Myanmar—saw 58 and more than 4,000 deaths, respectively, as of July 1.

When asked for his assessment of the country’s COVID-19 response, Dr. Stephan Paul Jost, the World Health Organization (WHO)’s representative in Myanmar, began by remarking simply, “Myanmar has done extraordinarily well so far.”

“The reason for being relatively successful so far is—there are many reasons. One is Myanmar started very early, in fact from Jan. 5 onwards,” he told The Irrawaddy this week, referring to the day the country started its preparedness for surveillance, particularly at border crossing points, just one day after it was notified by the WHO and others about the appearance of unexplained pneumonia cases in Wuhan, China.

He pointed out that Myanmar had taken a “whole-of-government” approach. This, he said, had resulted in such steps being taken as suspension of flights from Wuhan and on-arrival visas for travelers from China from Feb. 1, followed by the suspension of the Water Festival, of mass gatherings, and partial lockdown scenarios in all parts of the country, especially in Yangon Region. He said these were examples of how the country has really gone all out to strengthen the public health side and preparedness and response.

Dr. Stephan Paul Jost, the World Health Organization’s representative to Myanmar, during an interview with The Irrawaddy on Monday. / Kyaw Phyo Tha / The Irrawaddy

Furthermore, the formation of an interministerial committee encompassing all the key ministries, including representatives of both the civilian and military sectors, to prevent, treat and prepare for COVID-19, as well as State Counselor Daw Aung San Suu Kyi’s demonstration of handwashing on TV, had also been very important in ensuring that the right set of messages reach as many people as possible, the WHO representative said.

“So the country has really gone all out to strengthen the public health side and preparedness and response, which has been critically important to try and make sure we have as few cases as possible in Myanmar,” Dr. Jost said.

He stressed that the government had successfully expanded its capacity to test for COVID-19 starting in March, while focusing on clinical preparedness, keeping surveillance high at all border crossings and suspending international flights—steps that had kept the number of cases low—while now also guarding against domestic transmission through the implementation of quarantine measures.

“I think on all of these fronts Myanmar has moved far and fast,” he said.

Dr. Jost said the WHO had assisted by ensuring that the government was provided with a continuous flow of the best available technical and epidemiological information. He said this was important because the coronavirus is a new virus, so evidence on the nature of the disease has to be continually gathered so that health authorities can adapt to the changing situation.

The followings are excerpts from Dr. Jost’s interview with The Irrawaddy. The WHO country chief addresses his expectations regarding COVID-19 in Myanmar in the near future, skepticism in some quarters regarding the number of positive cases in the country, the fatal shooting of a WHO staffer during an attack on an agency vehicle in Rakhine State, and how the internet shutdown in western Myanmar has affected the COVID-19 response there, among other issues.

The Irrawaddy: Myanmar has already allowed domestic tourism and other businesses to reopen, and there are many more people out in the street. What is your projection for Myanmar’s COVID-19 situation in the near future?

Dr. Jost: Well, we need to keep the surveillance high; that is going to be very important. Which means watching out for possible symptoms for COVID-19; these are based on fever, but also on cough, particularly dry cough, and respiratory complaints and ailments. Now we’ve entered the monsoon season, and influenza is [also] an important disease … Fortunately, the prevention of influenza and COVID-19 are similar; social and physical distancing can help, frequent handwashing will help, wearing a mask can also help. Therefore the surveillance should be high for both COVID-19 and influenza, and the Ministry of Health and Sports [MOHS] is doing that. Also with tuberculosis, we need to keep an eye on that because that’s also a respiratory disease. We need to keep our health workers safe with personal protective equipment, which also the country is doing and many partners have contributed to; this is key for both the COVID-19 response, for tuberculosis prevention and control, but also for resuming and continuing the essential health services that will be necessary so that we don’t have an outbreak of vaccine-preventable diseases.

We’ve also mobilized 23,000 doses of influenza vaccine, which is for the seasonal flu, so that critical health workers in the main referral hospitals and in the main laboratory services can be vaccinated against the seasonal flu. Which is also helping to reduce the burden and therefore reduce the possible overlap that might be between COVID-19 and influenza. And we recommend, the WHO, also for members of the public to be vaccinated against the seasonal flu. It’s recommended for everybody over 65, for pregnant women, for babies above 6 months. And people with risk factors, who have poor mobility, and also health workers. You know we do recommend it; it’s useful, helpful. It’s not 100 percent effective, actually no vaccine is, but it helps to reduce the severity of disease and also will reduce some episodes of influenza, and that is much better than not having it—particularly at this time.

So far the total number of COVID-19 cases in Myanmar is nearly 300, which is still relatively low. On the other hand, some people are quite skeptical of the number. They claim the actual number is much higher. What is your take on that?

Actually Myanmar has been very good on all the actions that I’ve mentioned so far, the “whole of government” approach, the early actions being taken, the surveillance being kept high, the public health measures being strong, trying to isolate every known contact and every known case, treating every known case, quarantining people who are coming back from abroad or [on] relief flights, or who have had trouble that might have exposed them to COVID-19. These measures have been followed through systematically here, and [they started] very early—earlier than other countries.

So that would’ve really kept cases down. At the same time the testing has been expanded. So, actually, if there were many missed cases, we would see that in other ways. We would see many unexplained cases of pneumonia, for instance, which we are not seeing. We would see other events that might be unusual, and you can’t really hide outbreaks of this kind, and nor do I think the MOHS is trying [to hide it], because they know very well the earlier they get in there the better they will be.

For me the worry is a slightly different one, which is, for how long can we keep up this excellent effort? Because people are exhausted. If we work around the clock, seven days a week, what do we expect? You know we will get tired at some point. And for me that is the possible danger ahead. All of us are only human beings and we need to make sure that we somehow sustain the amazing response that Myanmar has put in.

So frankly speaking I don’t doubt the fact that Myanmar has been successful. Myanmar has been successful through that great mobilization across the sectors, through the cooperation between the civilian and the military side also. Many have contributed to this, but the main work was done by the national health authorities, leading this effort and making sure it goes to the front line and to be there when it matters. It’s fascinating to see that a country that, yes, is struggling in many ways, has limited resources, and is still a poor country, has really pulled out all the stops and … we [must] make sure we stay on top of this and we don’t succumb to COVID-19 with opening the floodgates.

Community screening for COVID-19 symptoms is conducted in Yangon in May. / Aung Kyaw Htet / The Irrawaddy

Of course this is an unpredictable virus and it can hit you the moment you don’t look or you don’t try and do any more about it, and really it’s sustaining this amazing effort that will be the more difficult challenge, and not to believe that it wasn’t a success, because I believe it was and you can see in several ways—again, some I’ve already mentioned but also the fact that we haven’t had local transmission much over the last five weeks, and almost all the cases have been … through the relief flights [of Myanmar nationals returning from other countries]. The country has been very careful with that and has just extended the restrictions on flights coming into Myanmar … [At] the WHO we don’t go to subscribe individual measures. We give a general set of guidelines but we don’t say to countries you must do this or that. But the countries are taking the right balance according to their own circumstances between public health, and the economy, and the social factors, and the cultural factors, and the environmental factors that are prevalent within the country and within that context I certainly believe Myanmar is taking the right decision in continuing to be cautious and guard against the importation of cases.

Despite your optimism, Myanmar’s response to COVID-19 seems virtually unknown outside the country. International media reports have focused on how some people in the country took nonmedical remedies, rather than how things really unfolded as a whole.    

Well, I would say you [should] wait…this is not over. And it’s very important [to understand] that COVID-19 is a marathon with a changing route. We don’t yet know which route will protect [us]. It’s a new virus and we don’t yet understand some of the fundamentals of it. At the same time we do understand what works is that you isolate every known contact, every known case, you do contact tracing of every known contact, and you isolate them, you have a quarantine in place for possible contacts, then of course isolation once you know they are confirmed as contacts, and then especially if they are confirmed as cases. So we know these things work, they have worked everywhere, and they are the main fundamentals in the time to come. And one day when the story will be told, I think Myanmar has every chance to be among the successful countries also, but it’s too early to say that because it’s a global pandemic.

We don’t have a vaccine, we don’t have effective therapeutics, it will take quite some time for that to happen, so this is far from over, sadly speaking. It’s a new situation for humanity, but I believe with the current approach and the seriousness and intersectorality and good leadership that has been shown, Myanmar has every chance to be among the successful countries in the end but it will take continuous application of caution and consistency to get there. We need to continue to invest in surveillance, continue to invest in case management, continue to invest in the health system.

In April, one of the WHO’s health workers was shot dead in Rakhine State while carrying COVID swabs to Yangon. The government has formed an investigation committee and they have visited the scene two times. Do you have any update on the case?

Allow me not to comment on an ongoing investigation. That would not be proper for me to do. It’s an independent investigation that the government has initiated. We welcome the fact that they have done so and the UN resident coordinator and myself and concerned staff have also met the [investigative] panel at the beginning and that was kind of them to seek our views at the beginning, and that is right. I will not comment further on an ongoing investigation. Let the investigation be completed. This has been, of course, to lose a personnel has been a very painful episode for WHO and the whole UN family and it’s very important that we observe the dignity and decency that is required in that regard. Peace is so important, it shows that, because no one should suffer, no one really should suffer as a result of the absence of peace. And that is the most important [point]. Nonviolence is the way the world can be saved, not the violent way.

A man wears a surgical mask while traveling on Yangon’s circular train line in May. / Aung Kyaw Htet / The Irrawaddy

Some rights groups are also complaining about the internet shutdown in northern Rakhine and Chin states, saying it leaves people in the dark about COVID-19. CNN reported—and I’m quoting them—that “hundreds of thousands of people” there may know nothing about the virus thanks to the yearlong internet shutdown. Is this true? What is your comment on that issue?

Well, I don’t think it’s as true as bluntly as stated, no. I think the health authorities have made every effort to get the message out there. There are other ways to get the messaging out there. The radio is still widely used in Myanmar, rightly so. A lot of excellent messaging has gone out on the radio. A lot of excellent messaging has gone out on television, and that is extremely important. We have in a small way supported this at WHO, [with] newsletters that we have put out in both English and Burmese languages.

If you were to make a comparison with neighboring countries, what do you think of Myanmar’s performance in terms of responding to COVID-19?  

First of all, as mentioned I’m very happy with the seriousness, the proactiveness, the intersectorality, the leadership that Myanmar has brought to bear regarding COVID-19. OK, it’s been a fantastic response that the country has pulled off so far. I keep saying, “so far”, because we don’t know what will happen tomorrow. I hope not, but there could always be a raft of cases from somewhere; we need to keep investing in the system, including in Rakhine State, to make sure that doesn’t happen, because I mean just look at Bangladesh, with 125,000 cases? Close to 130,000 cases in Bangladesh alone. Just next door. So we need to invest in Rakhine State, in the health facilities, in continued preparedness, in order to be better equipped for the possibility of the virus coming, finding its way through. I mean it’s a very small virus, it’ll find its way through, so we need to be ready for that.

How has the fighting between the government troops and the Arakan Army in Rakhine and Chin states affected the coronavirus response there?

Well yes, of course it makes it more difficult, I mean the UN secretary general, Dr. António Guterres, has actually called for a global ceasefire of all warring parties to stop fighting and to join humanity’s great goal to tackle COVID-19 together. And it is my fervent and sincere hope that the parties to the conflict here can also do that and stop fighting and focus on COVID-19 preparedness and response, because that’s the great thing to succeed against, and don’t imperil that, and indeed many other things. As we have seen with our driver, and as so many civilians have seen in Rakhine, don’t imperil so many other things as a result of conflict. There are nonviolent ways of resolving disputes that work, and that has been shown all over the world.

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