Luck, Culture Helped Cambodia Contain Coronavirus

Count Cambodia among the lucky countries when it comes to the coronavirus.  With only 141 confirmed cases this year and zero reported deaths, Cambodia has one of the world's most enviable records for containing the virus and the disease it causes, COVID-19. But independent experts say that has more to do with good luck and long-established cultural habits than with government policies.  In fact, Cambodia was slow to act as the virus began spreading out of China early this year. In mid-February, when cruise ships were turning out to be floating incubators of the disease, Prime Minister Hun Sen made a public show of welcoming more than 2,200 passengers aboard the MS Westerdam who had been refused entry by other countries.    Luckily, it turned out that no one aboard the Westerdam was infected.  Despite Cambodia's weak health infrastructure, it was not until mid-March, when the virus started to hit hard in Europe and the United States, that Hun Sen introduced strict measures including a shutdown of schools and entertainment clubs. Since then, there have been few new cases and most of those infected have recovered, leaving only 12 patients still in hospitals, according to the health ministry.  Independent experts have doubts about those figures, especially the claim of no deaths from COVID-19.  "I would say [that is] almost certainly an undercount," said Dr. W. Courtland Robinson, associate professor at the Johns Hopkins Bloomberg School of Public Health, in an interview with VOA Khmer.  "That's a system that does not know how to do proper diagnosis of COVID-19 because doctors and nurses aren't seeing very much of it," he said. "They may say that it's pneumonia, and that's something else."  Despite his doubts, Robinson acknowledged that Asian nations have been relatively successful in fighting the coronavirus, in part because of their experience in fighting other communicable diseases such as malaria and dengue.  "I'm not saying that COVID-19 is the same, but I think that the system of public health surveillance, of rapid testing and identification, of early cases, containing those early outbreaks, and continuing to monitor, even if you have low resources, does prove to be successful," he said.  Neighbors Health experts and analysts also credit other factors, including international aid, the Asian custom of wearing a face mask when sick, and the effective responses of Cambodia's immediate neighbors.  "Cambodia did screw up in every way," said Greg Poling, a senior research fellow for Southeast Asia and director of maritime initiative at the Washington-based Center for Strategic and International Studies (CSIS), in an interview with VOA Khmer.     "Cambodia refused to restrict travel from China. Hun Sen largely ignored the virus and downplayed it. There is very low capacity for testing and treatment. I think the result is half simple luck … that Cambodia's neighbors were so effective.  "So the early lockdowns in Vietnam and Thailand, combined with China's ability to get a halt of the outbreak, probably benefited Cambodia because it locked down most of the travelers that would have come to Cambodia."  Vietnam began closing schools in late January and was quarantining all visitors by mid-March. Thailand imposed a state of emergency in late March and a nighttime curfew on April 3. At the same time, tourists stopped coming to Cambodia from Europe and Japan because of their own travel restrictions.  Vietnam in particular has been praised for its COVID-19 response. The communist state reported 355 cases and no deaths as of Thursday, with only 19 cases remaining active.  When it finally did act, Cambodia suspended visas for people from the most affected countries, including the United States, Germany, Spain, France and Italy. It also closed schools and entertainment clubs, restricted internal travel, imposed a 14-day quarantine for anyone who had been exposed to the virus, and canceled large-scale celebrations of its traditional new year.  It also increased testing, but only for people who had traveled overseas. The ministry of health said more than 36,000 tests have been conducted.  "I believe that this was because [the prime minister] has seen large infections in some countries, and if he let that happen throughout the country, it would eventually affect his leadership," said Heng Kimkong, a visiting senior fellow at the Cambodian Institute for Cooperation and Peace.  Face masks Robinson, the Johns Hopkins professor, stressed the importance of mask-wearing, which is much more common in Cambodia and other Asian countries than in the West.  "To me, mask wearing was very common, you'd see people wearing masks all the time, it wasn't just COVID-19," said Robinson, who has worked in the region for more than 25 years.  "So, it became a common thing to see masks, and when we saw the outbreak occurring … it wasn't a surprise to me that more people in Asia kind of understood and said that this is the way to protect ourselves, to show courtesy to other people, to say that I'm not gonna sneeze in your face. I'm wearing a mask."    Some believe Cambodia's poor infrastructure became a blessing in disguise.  "I think that Cambodia is fortunate – having so many poor and dusty roads, people already wear masks," said Sophal Ear, an associate professor at the Occidental College in California, in an e-mail to VOA Khmer. "Also, they don't shake hands normally, so no transmission there. Neither of these things are thanks to the government."  International assistance has also helped. Cambodia received personal protective equipment (PPE) and other medical gear from China in mid-March, followed by aid from Japan, the United States, the European Union and other international donors. The U.S. has donated more than $11 million to help Cambodia fight the virus, according to a database maintained by the CSIS.  Online restrictions On the negative side, health practitioners and human rights advocates have sharply criticized the government for restricting any online discussions about COVID-19 that are deemed critical of the government, and for promulgating a state of emergency law.  "All institutions, not just the health department, need accurate information from the region that can be collected from people's witnessing an event and their views," said Kimhun Thit, a pharmacy technology instructor at Davidson Community College in North Carolina. "If authority threatens and prevent them from talking about the virus, they would not dare seek treatments."  From January through June, Cambodian authorities detained 15 people who spoke about the virus or shared content on social media. Another 80 people were released on bail and could face re-arrest at any time, according to Human Rights Watch.  "The story that comes out of this if you're Cambodian, is that Cambodia – despite what the international community says – we're not weak," said Peter Keo, a senior research fellow at the Center for Compassion and Altruism Research and Education at Stanford University School of Medicine.  "In fact, look at our cases. To me this is what they are doing, they are concealing so that they can appear to be bigger than what they really are."   

From Health - Voice of America | VOA
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