Asia's new COVID waves

By early March, India had reason to be optimistic about the pandemic. COVID-19 infection rates were dropping, from 97,000 new cases per day in September to fewer than 15,000 in February, and experts openly proclaimed India had achieved "herd immunity." Health Minister Harsh Vardhan declared that month "we are in the end game" of the pandemic, after the world's largest vaccination drive began a month earlier.

But in dealing with an unpredictable, frequently mutating virus, optimism can be lethal. Four months later, India is just now emerging from the tidal wave of COVID-19 that began soon after Vardhan's remarks. Daily infections crossed over 400,000 in early May, the highest globally. As of July 5, India had confirmed about 30.6 million cases and 402,728 fatalities as the country first detected the new Delta variant, believed to be twice as infectious as previous variants.

The ordinary process of biological mutations had combined with another dangerous phenomenon: overconfidence. Convinced that success was just around the corner, authorities in several Indian states allowed a series of mass political rallies and religious gatherings. These are widely blamed for the subsequent outbreaks.

Across the Asia-Pacific region, the story is similar. As the pandemic broke out across the world in 2020, many Asia-Pacific countries became examples of what can be achieved with discipline and political will, despite having far fewer resources than wealthy countries of the West. While they distinguished themselves by quick action and effective measures that largely contained the virus, a year later that willpower seems to be fraying. Fatigue has combined with complacency, along with misplaced optimism about the speed of vaccine rollouts and their effectiveness in keeping infections at bay.

While cases climbed, Prime Minister Narendra Modi campaigned for his ruling Bharatiya Janata Party ahead of regional polls.   © AP

In Thailand, Vietnam and Cambodia, a trio of Southeast Asian countries that had experienced very few infections until this spring, the onset of cases was sudden. Taiwan, which locked down early and closed its borders, lapsed from its previous discipline and is now in the throes of a wave of infections. Japan, whose government has a more laissez-faire approach to controlling the virus, had nonetheless succeeded with a test and trace campaign and disciplined mask-wearing. This year, however, it has been subjected to two states of emergency.

The Nikkei COVID-19 Recovery Index, which we are introducing with this article, tells a similar story. It tracks various yardsticks along the path back to normality; these include mobility, case numbers, ease of travel and vaccine rollouts. Unsurprisingly, many Asian countries that have struggled with the virus, such as the Philippines and Indonesia, continue to struggle.

But as we introduce the index, it is important to point out a paradox: Many of the countries at the top of the index six months ago have since taken steep tumbles, partly due to new variants but also as a result of fatigue and complacency.

It might not be a coincidence that countries with low or falling case numbers and well-functioning economies in 2020 are now headed toward disaster. The rankings should be read with this in mind.

Vietnam, for example, was one of the rare superstars of 2020; it was among the three countries with the lowest COVID-19 mortality rates, a feat it managed while simultaneously still growing its gross domestic product by 2.9%. But the country now struggles with outbreaks at hospitals and factories and a dearth of quarantine space.

Thailand, which went many months last year without a single case of community infection, has been hammered by the virus. On July 5, Thailand ranked second in confirmed new cases on the Worldometer's global monitoring table at 6,166, a tally for one day that is almost as high as the total for 2020. There were 59 deaths all last year, and the daily rate now regularly eclipses that. Intensive care units are full. Many of the third wave cases were linked to high-end nightclubs.

Cambodia had registered 500 cases and no deaths until February. Advisers for strongman Prime Minister Hun Sen had even commissioned a book to praise the leader as a "dashing hero who went against the current to fight COVID-19." But that was before the "Feb. 20 event" in which two women infected a nightclub and derailed the country's success.

Bars and quarantine lapses also figure in Taiwan's worst outbreak since the start of the pandemic, which has been blamed on an outbreak at an airport hotel used by pilots after their required quarantine time had been shortened.

Meanwhile, Japan, which had largely controlled the disease, faces the opening of the Olympics on July 23 with the possibility of the event leading to disaster.

The virus's progress shows the unpredictability of the pandemic's path, as well as how perverse the entire exercise in prediction is. When predictions of imminent success cause politicians, regulators and the scientists advising them to drop their guard, optimism becomes fatal.

Japan, which had largely controlled the disease, faces the opening of the Olympics on July 23 -- and the possibility the event will lead to a viral disaster. (Photo by Wataru Ito) 

'The policymakers changed their behavior': India

A mixture of three things caused India's second wave, said Rajinder K. Dhamija, head of the neurology department at the Lady Hardinge Medical College in New Delhi. "The virus changed its behavior and a new variant [Delta] was formed," he said. "People also changed their behavior and started visiting crowded places, paying little attention to social distancing and mask-wearing; and policymakers too changed their behavior, believing that the pandemic was over and [allowing] rallies and religious gatherings.

"A pandemic or viral illness is never dependent on the virus alone."

The country witnessed a series of mass gatherings in March and April, including political rallies attended by thousands of people and the religious Kumbh Mela festival, during which millions of Hindus converged on the banks of the Ganges to take a dip in the river. This came as the far more infectious Delta variant, first detected in India and now present in over 80 countries, began appearing.

India held a series of mass gatherings in March and April, including political rallies and the Kumbh Mela festival, during which millions of Hindus converged on the banks of the Ganges.   © Reuters

India found itself in the grip of a deadly second wave in April and May. Chaos erupted as people attempted to arrange oxygen supplies, hospital beds and medicines for loved ones. Crematoriums and cemeteries, too, struggled to accommodate bodies.

Neha Bhatnagar, a New Delhi resident, paid futile visits to several hospitals in the capital city in the hope of finding a bed for her COVID-19 infected aunt before the disease won in May. "It wasn't easy to get medicines as most pharmacies had run out of supplies," she said. "There was chaos everywhere."

Abhishek Kumar Sinha, a doctor at a COVID-19 care center in eastern Bihar State, said he started working early in the morning and often stayed in the facility until midnight. "I was managing 50 to 60 patients daily on my own," he said.

Chaos reigned in April and May as Indians scurried to find oxygen supplies, hospital beds and medicines for their loved ones.   © Reuters

Politicians have paid a price for their misguided optimism. While cases climbed, Prime Minister Narendra Modi was busy campaigning for his ruling Bharatiya Janata Party ahead of regional polls. This "did not go down well with common people [who felt] he was more interested in winning an election ... rather than saving lives," said Sanjay Kumar, a professor at the Centre for the Study of Developing Societies.

Unlike the first wave, which was far less severe but inspired Modi to address the nation several times, there was a "complete period of silence" from the prime minister for a month during the second wave, despite an acute shortage of medicines, oxygen, hospital beds, etc., Kumar said. Another thing that dented Modi's image, he added, was that BJP leaders kept claiming everything was all right while on the ground things were "a mess."

'Trouble wrapping their minds around the problem': Thailand

Thailand's outbreak started at both ends of the socioeconomic spectrum. Ground zero was in the fish markets in Samut Sakhon, outside Bangkok, that employ many migrant workers from Myanmar. Meanwhile, at the other end of the scale, upmarket nightclubs in the residential and entertainment Thonglor neighborhood went back to business as usual. Government ministers, foreign diplomats and about 20 local police officers supposedly monitoring the area were among the infected.

As Thailand emerged as a COVID-19 success story last year, its economy sank.   © AP

Thailand was a COVID-19 success story last year, with the army taking the lead on securing borders and controlling quarantine locations. But the measures put massive pressure on the Thai economy, its GDP shrinking 6.1% in 2020, according to the Office of the National Economic and Social Development Council.

Despite the unprecedented death rates of the past month, Prime Minister Prayuth Chan-ocha remains undeterred from his optimistic announcement that Thailand would open fully in October. His optimism, he says, comes from confirmed orders that have been placed for vaccines, and the proportion of the population that should have received at least one dose by October. But vaccinations, which began in March, are going slowly. By Wednesday, some 10.7 million doses had been administered to a population of nearly 70 million.

"A lot of the vaccine problems at the beginning were because the government and bureaucracy had trouble wrapping their minds around the problem," one observer told Nikkei Asia. "The doctors wanted to play safe, not muck around too much and not sign these [vaccine orders] -- they didn't want to go to jail."

Thailand's death rate has been soaring, but Prime Minister Prayuth Chan-ocha remains optimistic that the tourist-dependent country will fully reopen to international travelers in October.   © AP

Success will depend heavily on whether Siam Bioscience, a company wholly owned by King Maha Vajiralongkorn, meets production targets of 10 million AstraZeneca doses per month for Thailand. The company also has export obligations. Only 5.37 million doses were delivered locally in June, and the figure is not expected to exceed 6 million in July, according to one of the ministries involved.

High society vaccine queue jumpers, meanwhile, have widened the social gap in one of the world's most unequal societies. "There are real incidents of people with connections being able to get vaccines for themselves and their families," a retired civil servant told Nikkei Asia. "This is not gossip; people boast about it openly, even on Facebook."

'Golden time lost': Vietnam

Just after sunrise one day in June, a group of police on motorbikes descended on a Ho Chi Minh City park to thwart an offender: an old man on a stroll without a mask.

"Don't you know you're putting society at risk?" an officer scolded. Authorities are taking a stricter line than ever, locking down the city since the start of June as Vietnam battles its fourth and deadliest COVID-19 surge.

Things have changed in what many saw as a charmed country. Vietnam had some months in 2020 without any reported COVID-19 cases, but the current wave of infections has lasted the longest and threatened all-important tech supply chains. Thousands of cases appeared for the first time at industrial parks, including those housing Samsung Electronics and Apple suppliers, with workers sleeping at plants to curb the spread.

Driving the outbreaks are complacency, vaccine delays, low test rates and unknown sources of infection in crowded areas. More contagious variants are also playing a role.

The University of Copenhagen's Robyn Stuart told Nikkei the more-contagious Delta strain has been key during this wave, which has stretched beyond two months.

Still Vietnam's rapid response has been called a COVID-19 exemplar, based on targeted shutdowns, public messaging, "surveillance, isolation and quarantine, testing, and contact tracing," according to an April study published in the medical journal The Lancet.

Heavy-handed measures ranged from an effort to screen every driver leaving one district, forming a choke-point nightmare, to closing pools and parks despite most clusters emerging indoors. Locals have caught the coronavirus by inhaling it in factories, a church, karaoke bars, and clinics during this surge.

The government will keep cases down until vaccines come, said Victoria University of Wellington political researcher Nguyen Khac Giang. He said authorities were slow to inoculate partly because they thought a "zero COVID" strategy of elimination would work until they developed a vaccine, a domestic ambition. The ruling Communist Party of Vietnam also devoted months of effort to select leaders for five-year terms in January, confirmed in April, which required effort poured into a government transition, Giang said.

"That is lost time, golden time that Vietnam lost," he said.

In Vietnam, heavy-handed measures ranged from an effort to screen every driver leaving one district to closing pools and parks despite most clusters emerging indoors.   © Reuters

'The level of cooperation was not high': Taiwan

Until mid-May, Taiwan had totaled around 1,000 confirmed cases, mostly imported. Little over a month later, cases had swelled to more than 14,000 after an outbreak in April among pilots led to community spread.

The pilots had been undergoing quarantine in an airport hotel building that had not been approved for that purpose. Hotel staff and their family members caught the virus. Authorities fined the airline, Taiwan's China Airlines, and the Novotel hotel at Taoyuan International Airport for not following epidemic prevention rules.

Some opposition politicians and public health experts have blamed authorities for lowering the number of days unvaccinated pilots had to quarantine, from five days to three, in mid-April.

The Taiwan Centers for Disease Control (CDC) said that as of June 12 it had gone back to five-day quarantines for unvaccinated flight crew members. On July 1, the period went up to seven days.

The CDC said that Taiwan was effective at controlling its borders, "but there was room for improvement in its domestic defenses."

"Because the epidemic situation was suitably controlled in the past, there was no need for a large number of virus screenings, so the monitoring system did not uncover asymptomatic infections. On top of that, the public willingness to get vaccinated was low," the CDC said in written answers to questions submitted by Nikkei.

Yang Sen Hong, a University of California Berkeley-trained public health expert in Taiwan, said the island's strategy for controlling the virus "has been quite successful, but some people failed to follow the rules," including the airline, hotel and ordinary people who failed to be honest with their contact history.

In May, cases emerged that were linked to small teahouses in Taipei's Wanhua district that are known informally as "grandpa bars." These hostess bars that serve an older clientele have a seedy reputation, which stymied Taiwan's contact tracers, previously a strong suit as the island fought off infections.

The seedy reputation of small teahouses where women serve an older clientele stymied Taiwan's once-ballyhooed contact-tracing efforts.   © AFP/Jiji

"In this incident, most people did not want to expose their connections with the teahouses, and their level of cooperation with the epidemic investigation was not high, which made it more difficult to trace the sources of infection," the CDC said.

The Taiwan Centers for Disease Control said the island was effective at controlling its borders, “but there was room for improvement in its domestic defenses.”   © Reuters

Health system pushed to the limit: Cambodia

Like those in Taiwan and Thailand, Cambodia's outbreak is being blamed partly on the sex industry or the difficulty of tracing patrons of certain establishments. Until the "Feb. 20 incident," as the outbreak is known, Cambodia had recorded fewer than 500 COVID cases and no deaths. A handful of minor outbreaks, including one linked to a visit by Hungary's foreign minister, had been quickly snuffed out.

On Feb. 20, according to local news reports, two women infected with the Alpha variant mingled with patrons at N8, a windowless nightclub in a nondescript district of Phnom Penh. It turned into a superspreader event.

The pair were among four female Chinese nationals who had arrived in Cambodia from Dubai, reportedly to work as high-end sex workers, according to local media. The group allegedly bribed security guards at the Sokha Hotel in Phnom Penh to allow them to leave on Feb. 8 before finishing a mandatory two-week quarantine.

Four months after the N8 outbreak, Cambodia's success story has been derailed; almost 750 deaths have now been linked to the Feb. 20 event and more than 55,000 cases have spread through markets, garment factories and prisons. A health official recently warned Cambodia was close to crossing a "red line" as infections rise and migrant workers returning from Thailand test positive for the Delta variant.

As cases mount, Cambodia's underfunded health system has been pushed to the limit. The government converted a large wedding center into a 1,800-bed COVID-19 hospital. Other facilities have also been asked to take patients infected with the virus.

As cases mounted, Cambodia converted a large wedding center into a 1,800-bed COVID-19 hospital.   © AFP/Jiji

Michael Thigpen, a medical epidemiologist working with the U.S. Centers for Disease Control and Prevention in Phnom Penh, said a major factor behind authorities' inability to quickly suppress the outbreak was that the new variant was 75% more transmissible.

Cambodia last week recorded 1,130 cases in one day, its highest 24-hour tally, which was followed a day later by its second-highest tally. Thigpen said measures taken by the government like aggressive testing and contact tracing had helped avoid an explosive outbreak, but the situation remained "very tentative." Worryingly, infections were increasingly appearing outside cities where there were fewer resources and visibility.

"The concerning part is that we're now seeing more reports of COVID cases in more rural areas," he said.

Cambodia has delivered at least one shot to more than 3 million people using mostly Sinovac and Sinopharm shots, along with some AstraZeneca vaccines supplied by a United Nations-supported program. The country's inoculation drive has been encouraging, Thigpen added.

Cambodia’s vaccination program has delivered at least one shot to more than 3 million people using mostly Sinovac and Sinopharm shots.   © AFP/Jiji

"The really positive thing about Cambodia's response currently is how well they're doing with the expansion of the vaccination campaign," he said.

'There is no strategy': Japan

Japan initially succeeded in managing infections through contact tracing, but the country's response became shaky in the second half of 2020, said Kentaro Iwata, a professor at Kobe University. The government launched campaigns to promote domestic traveling and dining out, which were criticized for spreading infections.

The Japanese government was criticized for subsidizing travel and restaurant dining amid the pandemic. (Photo by Koji Uema) 

Tokyo was under a state of emergency from Jan. 8 to March 21 and again between April 25 and June 20. "The state of emergency [declared in January] came too late for areas such as Tokyo," said Koji Wada, a professor at International University of Health and Welfare. Iwata also suggested that the government loosened the restrictions too early in March, when infections were not low enough.

"There is no strategy in Japan" as the country merely responds to events, Iwata said.

Looking ahead, there is a major source of concern: the Olympics, which open in Tokyo on July 23. Going ahead with the sports pageant has been unpopular among the Japanese public amid worries that it could become a superspreader event.

'The back of the queue': Asia-Pacific looks to vaccines

Across the Asia-Pacific region, quick, decisive action helped to control the virus early on. But governments by and large failed to translate this into fast access to vaccines. Success, in many cases, created a disincentive to work quickly and take risks.

Japan's early success in controlling the virus might have also made the country complacent with respect to vaccines. Unlike some countries that used emergency authorizations to expedite the deliveries of vaccines, Japan's rigid bureaucracy and legal system made no such allowances.

Trials had to be conducted in Japan, even for vaccines developed by Pfizer or Moderna that already had been widely tested in other countries.

"There is no atmosphere to approve anything new," said Ken Ishii, a professor of vaccine science at the University of Tokyo. Those who suffer illness after being vaccinated could sue the government or even individuals, such as responsible officials in the health ministry. Vaccine approvals and rollouts thus entail risks, and nobody wants to be blamed, Ishii suggested.

Japan’s early success in controlling the virus might have made the country complacent when it came to expediting vaccine rollouts. (Photo by Rie Ishii)

Elsewhere, governments have taken initiative, but the public sees no urgency. In Hong Kong, perhaps the easiest place to be vaccinated in Asia, many citizens were reluctant to receive shots due to their distrust of the government and worries over side effects. Another disincentive: The city of 7.5 million recorded only four locally transmitted cases in a more than two-month period.

Dr. Taweesin Visanuyothin, the spokesman for the Thai government's Center for COVID-19 Situation Administration, in February told a news briefing in Bangkok: "It doesn't matter if the vaccine arrives soon or later because it has no impact on the Thai people. As we have seen, we have been using face masks, cloth or surgical, to protect individual safety and hygiene."

Success has also gotten in the way of efforts to procure vaccines from abroad. Australian finance minister Simon Birmingham on July 1 said his country has had supply challenges "because European countries and drug companies have favored those nations who've had high rates of COVID for the delivery of vaccines like Pfizer."

He concluded that this "has put countries like New Zealand and Australia at the back of the queue in terms of receipt of some of those vaccines."

For the time being, the most successful countries are those furthest ahead in terms of vaccinations. But as we have seen, success can breed overconfidence. For example, Britain, now number 48 on the Nikkei COVID-19 Recovery Index, is experiencing a mass wave of cases despite a highly successful vaccination campaign. Emboldened by low hospitalization rates, however, the government plans to end almost all COVID-19 restrictions by July 19, which experts say may lead to a huge jump in cases.

But the pandemic continues to teach a harsh lesson: Optimism is often fatal.

Reporting by Kenji Asada in Tokyo, Dominic Faulder in Bangkok, Lien Hoang in Ho Chi Minh City, Akane Okutsu in Tokyo, Kiran Sharma in New Delhi, Shaun Turton in Phnom Penh and Louise Watt in Taipei.