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Vietnam. South Korea. Taiwan.

All three countries are placed uncomfortably close to China, the initial epicentre of the coronavirus pandemic that’s now swept across the world.

But they also have one other thing in common: They’ve each managed to contain their Covid-19 infections, preventing the new coronavirus from reaching epidemic proportions within their borders.

How they did so might provide lessons to the United States and elsewhere, experts say.

Tried and true way

Reacting early was key.

South Korea, Taiwan and Vietnam each recognised the novel coronavirus as a threat from the outset, and aggressively tested suspected cases and tracked potential new infections, public health experts said.

“Finding cases and isolating them so they’re not transmitting forward – that’s the tried and true way of controlling an infectious disease outbreak, and when you analyse what was done in many Asian countries, you will find that at its core,” said Dr Amesh Adalja, a senior scholar with the Johns Hopkins Center for Health Security in Baltimore.

The first cases of what is now called Covid-19 appeared in Wuhan, China, in early to mid-December, linked to a live animal and seafood market located next to a major train station.

Most of the world took a watch-and-wait approach, but not Vietnam, said Ravina Kullar, an infectious diseases researcher and epidemiologist with Expert Stewardship Inc. in Newport Beach, California.

“They actually started preparing for this on 31 December 2019. They were testing on 31 December,” Kullar said. “They were proactive, and that I think is a key to preventing epidemics. They were overly cautious, and that really benefited the country.”

Authoritarian measures

Vietnamese government officials also began hosting press conferences at least once a day, where they supplied honest and forthright information about the status of the coronavirus.

“They were very open and honest with the citizens of Vietnam, and that really served them well,” Kullar said.

There have been just 153 confirmed cases in Vietnam, which has a population of more than 96 million, according to Johns Hopkins coronavirus tracking.

A lack of testing in other countries has led to the widespread implementation of authoritarian measures like lockdowns to prevent the spread of coronavirus, Adalja noted.

“If you don’t have the diagnostic testing capacity, there may be a tendency to use very blunt tools like shelter-in-place orders, because you don’t know where the cases are and where they aren’t,” Adalja said.

South Korea initiated a system of patient “phone booths” to help people get quickly and safely tested for Covid-19, Kullar said.

Lessons from the 2003 SARS epidemic

“One person at a time can enter one side of this glass-walled booth, they grab a handset, and they are connected with a hospital worker standing on the other side of the glass,” Kullar said.

Using a pair of rubber gloves set into the wall, the healthcare worker can swab the patient without potentially exposing themselves to the virus, Kullar said.

“The hospital is able to tell the patient their results within seven minutes. We don’t have anything like that at all,” Kullar said. “They had this quickly put in place in most hospitals to get patients swabbed in a way where you don’t have direct contact with a healthcare worker.”

A country of 50 million, South Korea currently has 9 241 confirmed cases of Covid-19. While cases continue to climb there, they have done so with a much more gradual slope in March after a steep spike in February.

South Korea, Vietnam and Taiwan all learned lessons from the 2003 SARS epidemic and built up their public health infrastructure to be able to immediately respond to future crises, experts said.

Just 81 miles from mainland China, Taiwan had every reason to become a hotbed of Covid-19 activity. There’s a regular and steady flow of population between the island and China.

Quick communication

But there only have been 252 confirmed cases among the island’s 23 million citizens.

As with Vietnam, Taiwan began screening passengers flying in from Wuhan as early as 31 December, according to the Asia Times.

The island expanded its screening within a week to include anyone who recently travelled to either Wuhan or the Hubei province in which the city is located.

Taiwan also instituted border controls, quarantine orders and school closures, and set up a command centre for quick communication between local governments and their citizens.

Although the United States missed its chance to head off a Covid-19 epidemic, and is well on its way to becoming the pandemic’s new epicentre, these lessons drawn from other countries could still be used to help manage infections in the months and years ahead, Adalja and Kullar said.

Public health measures like quick testing and contact tracing need to be in place and ready to go by the time states start to lift their lockdowns, Adalja said.

“There is going to be a point where we have to start thinking about how we move forward into a next phase of the response, and that will be finding cases and isolating them,” Adalja said. “As part of that, we will need to have diagnostic testing hopefully at the point of care to be able to identify those patients. We missed the early opportunity to do this, but we do have the ability to do that now as we go into a different phase of the response.”

Germany’s nursing corps

The experience in Taiwan and South Korea show that democracies can respond effectively to an epidemic, Kullar noted. And China, with its totalitarian regime, has seen no new cases of local spread in almost a week.

Another example, and a European one at that, is Germany. Although the country has the world’s fifth-highest number of confirmed cases (43 646), there only have been 239 deaths.

Kullar cited the German healthcare system as the reason why people are surviving the virus, in particular the country’s nursing corps.

“They have 13 nurses per 1 000 people, which is some of the highest than any of the other heavily affected Covid-19 countries,” Kullar said. “The higher number of nurses show that nurses are the backbone of the hospitals, especially in ICU care. They’ve made sure to really focus in on patient management and survival.”

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The new coronavirus has been identified as more infectious than the 2003 SARS virus due to the rapid rate at which it is spreading around the world.

The virus can spread through droplets expelled by coughing and sneezing, direct contact and by coming into contact with contaminated surfaces and objects, explains the World Health Organization (WHO). And more recent research has sparked curiosity around another way the virus might spread: through tears.

However, research published in the journal of the American Academy of Ophthalmology (AAO) this week confirms that there is a very slim chance that infected patients are passing on the virus through tears.

The paper, titled Assessing Viral Shedding and Infectivity of Tears in Coronavirus Disease 2019 (COVID-19) Patients involved eight researchers from the National University Hospital in Singapore who collected tear samples from 17 patients with Covid-19. 

Traces in eye secretions

The samples were taken from the time the patients displayed symptoms until their recovery – about 20 days later. Their research indicates that a total of 64 samples were collected over the study period (around three weeks).

Samples were also taken from the patients’ back of the nose and throat during this period, and the overall results showed that while all patients’ tears were clear of the virus, it was, in fact, detected in the nasal and throat swabs.

The team explained that the results “suggest that transmission through tears regardless of the phase of infection is likely to be low”, although they added that further research is needed into the virus transmission.

A small-scale Chinese study carried out in February found that one of 30 patients who had Covid-19 was found to have conjunctivitis, also known as pink eye.

The researchers also found traces of the virus in the patient’s eye secretions. However, a news release by the AAO explained that infection of the virus through tears is highly unlikely. 

How long can coronavirus survive on surfaces?

Although there is clarification around the transmission of the virus, it is not yet entirely certain how long it can survive on surfaces, notes the WHO, adding that it seems to behave like other coronaviruses.

This means it may persist on surfaces of a couple of hours, or up to several days. This all depends on the conditions, such as the type of surface and the temperature of the environment.

As a precautionary measure, you should clean surfaces with a disinfectant, and ensure you wash your hands thoroughly with soap and water or use hand sanitiser with an alcohol content of 60% or higher. Also, avoid touching your face as your mouth and nose are key gateways for the virus to enter your body. 

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Compiled by Zakiyah Ebrahim

In a video posted online, the prime minister says the UK can get through the pandemic “together”.

Smokers and vapers who are infected with the new coronavirus could possibly expect a more severe infection, health experts warn.

Many advisories have focused on the risk facing older people, those with chronic conditions such as diabetes, and people with compromised immune systems, such as cancer patients. But doctors also caution that users of electronic cigarettes and tobacco are more in danger from the new coronavirus than the average healthy person.

If you vape, “you’re going to make lungs more vulnerable to severe infection,” said Dr Panagis Galiatsatos, an American Lung Association spokesman who is also director of the tobacco treatment clinic at Johns Hopkins Hospital, in Baltimore.

Vaping introduces toxic chemicals that harm lung cells and change their metabolism, Galiatsatos said, and it also curbs the body’s immune system.

Higher odds of disease progression

Data from China’s coronavirus outbreak showed infected smokers and residents of cities with high levels of air pollution had more severe symptoms, he said. Galiatsatos predicted use of e-cigarettes will have the same effect.

A study of 78 patients with Covid-19 pneumonia in Wuhan, China, published recently in the Chinese Medical Journal, listed history of smoking as one factor contributing to poorer patient outcomes.

Stanton Glantz, director of the University of California, San Francisco (UCSF) Center for Tobacco Control Research and Education, cited that study in a recent online UCSF commentary.

“The odds of disease progression (including to death) were 14 times higher among people with a history of smoking,” he wrote, calling on the public to stop smoking and vaping, and to also steer clear of second-hand smoke.

Because vaping is a recent phenomenon, less is known about its harmful long-term effects than about smoking tobacco, which has been studied for decades.

But e-cigarettes have come under growing scrutiny since last year when more than 2 000 cases of severe lung damage and death were reported among vapers. Most of those cases were associated with products containing an additive called vitamin E acetate, and THC, the psychoactive component of marijuana, according to the US Centers for Disease Control and Prevention.

Higher rate of hospitalisation

As cases of Covid-19 continue to spread, the consequences for smokers and vapers should soon be clear. But evidence pointing to poorer outcomes already exists.

Dr Sucharita Kher, director of the outpatient pulmonary clinic at Tufts Medical Center in Boston, said animal studies have shown e-cigarette vapour “adversely affects the lung cells’ ability to fight against a virus”.

She added that smokers also have a higher rate of hospitalisation for influenza, another viral respiratory infection.

But Kher added that the Chinese data do not prove smoking caused worse outcomes for Covid-19 pneumonia patients. They do, however, show a link. There’s much to learn about the virus, she said.

“We have to interpret it with caution,” she explained.

Vaping substances that contain THC or nicotine “definitely has short-term health consequences,” said Dr Alexa Mieses, a family doctor in Durham, North Carolina, who expects studies will eventually show similar long-term links.

Researchers know tobacco smoking has long-term consequences, including chronic obstructive pulmonary disease (COPD), emphysema or cancer, she said, but no long-term studies have yet been done on vaping.

A threat to overall health

“My gut … or I should say, my medical education, leads me to believe” years of e-cigarette use will eventually be linked to these or similar outcomes, Mieses said.

“First and foremost, vaping and smoking don’t just affect your respiratory system, but pose a threat to your overall health,” she said.

Mieses and Kher recommended people who wish to quit vaping contact their family doctor for help.

Kher noted that vaping has not been shown to be an effective smoking-cessation aid and e-cigarette users are more likely to become tobacco smokers. She said seven drugs have been approved by the US Food and Drug Administration to help people quit smoking, but there is no approved medicine for those wanting to quit e-cigarettes.

“I highly recommend they talk to their doctors and try to quit vaping or try to cut down,” she said.

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