Ministry of Health and Sports Director and spokesperson Dr. Than Naing Soe recently sat down with Mizzima’s special correspondent Soe Zeyar Tun to discuss Myanmar’s efforts to contain the spread of the COVID-19 pandemic.

What have been the actions taken by Ministry of Health in fighting against COVID-19 since March?

After the Independence Day banquet (January 4, 2020), the Central Epidemiology Unit formed a team and this team consisted of the Deputy Director General and Director started health screening work at airports given the backdrop of a worsening situation of the epidemic that originated in Wuhan, China. And also on January 8, the permanent secretary of our ministry led the discussion on a possible cross-border epidemic outbreak in the country. Our health education and awareness promotion unit also heard about this unknown disease with flu-like symptoms. At that time the seasonal influenza period was not yet over in our country in December and January. So, we issued health precautions and protocols such as hand washing, social-distancing, covering of the mouth in sneezing and coughing, and so forth, which had to be maintained in this season.

The situation had reached an alarming level by about January 20. We heard about human to human transmission at that time but the World Health Organization (WHO) was still saying animal-to-human transmission only by that time. However, we stopped flights from Wuhan and explored how this disease could be tested and gave health education and awareness on this epidemic to the people.

During this observation period, our health ministry held a meeting. Our union minister led these daily meetings and discussed preparing for availability of hospital beds in States-Regions hospitals, upgrading of our diagnostic systems, containing the epidemic, clinical and treatment system at hospitals, etc. We held meetings with States-Regions Health Department chiefs when the video conference meeting tool was available. Our union health minister issued many guidelines on containing this epidemic totaling about over 600 orders and guidelines. We had to implement these guidelines and instructions.

At that time we could prepare for our healthcare providing system. We had testing equipment at that time because we needed such equipment for containing the epidemic. Our National Health Laboratory made great efforts for testing by cooperating with international laboratories and came to know how to test for this virus.

And on the other hand, the clinical committee contacted with colleagues in Wuhan and could exchange experiences. Wuhan had to send their submission and presentations to the World Health Organization (WHO) about this new virus. So we got all the information on giving treatment to victims of this virus. And also the WHO issued guidelines on this epidemic. Since that time, we have started our plans of testing for this virus.

Fortunately this time coincided with our traditional Thingyan festival. On the other hand, the COVID Contain, Control and Treatment Central Committee was formed and led by the State Counsellor. And the State Counsellor urged and requested people to follow the guidelines and protocols issued by this central committee. So we had got assistance given by the state and the following our guidelines by the people.

The people were in a situation of “Stay at Home” automatically. This “Stay at Home” tactic is the most effective in containing this virus at the earliest time but we could not prolong this tactic as it seriously affected people’s livelihoods and social activities. We got a budget for this epidemic with about 287 billion kyats for buying medicines and medical equipment to be provided to the labs and hospitals. In international aid, we got 10 million euros from Germany. We could enjoy the fruits of this project now. We received 40 ventilators yesterday and 70 more will come soon. The total number of 110 ventilators is not a small quantity. These ventilators are very expensive medical equipment. We have made such preparations.

What is the quarantine process? Why did you put about 30-50,000 people under quarantine. Did you take nasal and throat swab samples from them? And have all these people in quarantine centres tested positive for COVID-19?

Currently all these people in quarantine centres are primary contacts of the COVID positive cases. As you know the current rate of transmission is so fast, about 10 to 20 times that in the previous stage. Just having contact with the positive case can cause one to be infected. We designate primary contact with the criterion of how much got contact with a positive case without protection, how close they stayed with a positive case and how long. In consideration of these factors of long duration of contact with positive cases without protection and with closeness, we designate these peoples as primary contacts.

Primary contact is the high-risk category with having the best chance of being infected. So we have to test these people. We have to put these people under quarantine for the sake of all people. In Yangon, we fixed the quarantine period to seven days at a facility quarantine centre until today for observing his or her signs and symptoms and then seven days more under home quarantine.

In other States-Regions, we fixed this quarantine period to 14 days because we need 14 days to see signs and symptoms of this virus from asymptomatic cases. Having these facility quarantine centres by the Health Ministry is for the benefit of the people, the people under quarantine and their family members, friends and relatives. It is not for the benefit of our ministry.

Previously we took swab samples from all people under quarantine in the beginning. And then we studied more important issues. We can say there were two types of quarantine in our country in the beginning. The first one is people coming from hard COVID-hit countries. At that time only 3-4 countries such as Laos, Myanmar and Timor had a very low number of positive cases. All other countries had thousands and tens of thousands of COVID positive cases. Even our neighbouring country had such high number of positive cases. So we put the travellers coming from these hard- hit countries under quarantine for 21 days. Fourteen-day quarantine is not enough and not safe. Twenty-one-day quarantine can guarantee 98.7% in containing the virus, 99% will be impossible to infect others. We can say we could have achieved these things.

Most of these people in quarantine centres don’t have symptoms of this virus, maybe they are either asymptomatic cases or negative cases. So we have to put them under quarantine.

What about the situation in the quarantine centres? Do you provide meals there? What facilities do you provide them?

Providing meals at the facility quarantine centres is not taking place in more than 5-10 countries in the whole world, especially in the poor countries like Myanmar. There will be no more than five countries. You can count them with only one hand. Even in the most developed and the richest countries, the people must pay for expenses in quarantine centres. All are at their own expense for accommodation, meals and testing. Nothing can be available free of charge.

In our country the people can get all these facilities free of charge thanks to the well-wishers and donors. This is a very significant service we can find in the world. It should be put on a world record. This can be achieved because of the unique spirit of Myanmar people. They have the community spirit, sharing whatever they have in their hands at a difficult time. Find such country in the world. Please come back and tell me if you can find five in the whole world.

According to the statistics issued by the Health Ministry, we have 15,524 positive cases in the country (as at the time of the interview). The death toll is 353 (at the time of the interview). What does it mean when a person died of COVID? How many people died of COVID and how many people died of other diseases?

They did not die of quarantine. Some died when they reached hospital, some died after arriving at hospital. Some died at their homes. Some died at hospitals after arriving in a serious condition. Some died of car accidents. So we have to recheck and rechange these figures. We did post mortems on some car accident death cases if the victims came from hot spot areas and a containment zone. The docotrs did autopsy on these victims with full protection by wearing PPE. And then we found some positive cases from these victims.

After finding positive from these cases, they were tallied in COVID positive deaths. So we must delete such cases from our total COVID death tolls. There are many hospital COVID death cases with comorbidities but one significant thing we found is death of young people with COVID without such comorbidities. Most of the death cases are old people with comorbidities. So we must keep in mind that even the young people can die of COVID.

Where did the ministry of health get this COVID-19 containment and controlling strategy?

We did not get this strategy from a foreign country. Our union health minister is one of the top professionals in the public health service field. We can say he is the number one in this field. He got a Ph.D. from the prestigious John Hopkins University. He got this degree about 30 years ago, not recently. One of my friends is working in United States Centre of Disease Control (CDC) as director. You can imagine how much our union health minister is senior and reputed in this field by seeing even the director general from the WHO came and paid homage to our minister by recognizing him as their senior.

We have such a very senior person in our leadership role in combating against COVID. Even the student of M.Sc. (Public Health) course understands what to do and how to do it at the time of an epidemic outbreak. The theory is well tested and tried and well known to many people but the strategy of containing the virus must be compatible with ground reality. And it must be accompanied with a real time monitoring and evaluation system. We are using this strategy in our country.

Does Myanmar need to study the experiences of Vietnam which has a very low death toll, Thailand with just nearly 60 deaths, and Singapore? In these countries the situation is reportedly back to normal.

Please recheck the death toll in Singapore. They do not count deaths with diabetes and other comorbidities in the COVID death toll. They counted only the deaths with COVID so that their number is too low. And another factor is the size of this country. Singapore is a tiny island state and it has perfect rule of law. So they can impose a heavy fine on COVID protocol violators, S$ 300 for not wearing a mask, S$ 300 for visiting other areas, S$ 50 reward to those who inform by phone to authorities about unauthorized visit to other areas, etc. With these strict regulations and systems, they can contain and control the virus rapidly.

So does China. In our country, the people followed the rules and regulations first and then they relaxed their seriousness in the COVID menace and broke the rules and regulations easily. Following discipline in our country is very weak and low. Now the state counselor and health minister are personally and repeatedly urging the people to follow the rules and regulations in the COVID control and containment programme. So the people need to follow them. Following these guidelines, rules and regulations by people is the main point.

How has social media affected and impacted the vision of the people? In Myanmar, the deaths by car accidents are more than COVID and in US the deaths by seasonal flu are more than COVID deaths.

If you see the fatality rate, yes, the deaths by car accident are more than COVID but the nature of this epidemic COVID is terrible. Unlike car accidents, it can cause many deaths in very short time as the number of positive cases is increasing at an alarming rate. The high fatality rate and high number of positive cases created a heavy burden on our healthcare providing system. And the high fatality rate has a severe impact on the socio-economic situation, progress and is degrading in politics.

We did not suffer much in the first wave of this pandemic but in the second wave attack our status is close to number two rank even in the ASEAN. What requirements do we need in fighting COVID? Do we lack health conscious and education?

It is not because of a lack of health conscious and education. In our country, you can ask even a child on the street and he can say well on what to do in this time but we have weakness in following these guidelines and COVID protocols. They will be serious again when they see ambulances running in their blocks to pick up the persons to be sent to quarantine centres, when they see dead bodies in the blocks, and when they see the high rate of prevalence in their blocks but at that time it will be too late for containing and controlling the virus.

Why the findings of testing positive only after death and testing positive from aysmptomatic cases?

We first found such a case in Rakhine State with case number 375. We found this case on August 16. He had neither COVID symptom nor anosmia. And then 90% of positive cases were found with such aysmptomatic cases without anosmia. 90 out of 100 tests show asymptomatic without acute anosmia. Our health minister assumed this situation is similar to just the tip of an iceberg. This is the answer of the question that we most want to know, wherther there is a big volume of an iceberg underneath.

Some have to go out their homes inevitably with various reasons especially in Insein and Thingangyun, And in other cities and towns too, there are people going out on election campaigns. What are the bad impacts on health from these situations?

There will be various reasons for going out from home. Some have to go for their livelihood, some have to go for shopping and buying provisions, and some for another reason. The announcement made by our Ministry of Health is not the “Lockdown” order. It is just the “Stay at Home” order. So we allow such inevitable outings from home as exceptions under inevitable circumstances and situations in this “Stay at Home” order.

What are the reasons behind imposing a “Stay at Home” order in Yangon Region?

In taking a decision on imposing a “Stay at Home” order, we cannot decide by taking consideration only into the viewpoint of security and health issue. We have to consider also socio-economic issues. This decision is taken by the national-level central committee of COVID pandemic led by the State Counsellor and by consultations with union government and local governments of all States-Regions. We took this decision as the best option.

What about the Yangon situation? Will it be worsening or getting better?

We see no increase in this two-week “Stay at Home” period. It is the good point but it will be too premature to conclude we can flatten the curve. In epidemiology theory, after flattening the curve, there will be a decline soon. We have to see how long this falttening period will take. It need not to jump again in this period. Refraining and restraining by all of us in this period will not be useless and fruitless for us.

Some say indigenous medicine or herbal medicines have good effect in containing and stopping the COVID pandemic. Some say recently in social media that some herbal medicines, for instance, black cumin and onion can cure anosmia. How do you view these claims?

Herbal medicines are popular in China. No other country can see more popular and widely use of herbal medicines than China but they did not say anything about herbal medicines in presenting to the WHO in fighting against this pandemic. They have not got specific and scientific proof in treating this pandemic. So we give only a combination of four medicines to the people for fighting against this virus. They are, one, stay at home, two, wear face mask, three, wash hands and, four, avoid social gatherings.