Science’s COVID-19 reporting is supported by the Pulitzer Center and the Heising-Simons Foundation.
TOKYO—Many Asian-Pacific countries have weathered the COVID-19 pandemic remarkably well so far, recording some of the lowest case numbers anywhere and earning praise as models of how to handle the virus. But the sheen is coming off their performance. Many countries see cases ticking up sharply, triggered by complacency among officials, premature relaxation of control measures, and public fatigue with social distancing.
The most dramatic example is the Australian state of Victoria, which recorded a record 723 new COVID-19 cases on 30 July and declared a state of disaster 3 days later that empowers the government to impose an 8 p.m. to 5 a.m. curfew on Melbourne. Only one person per household in the city is allowed to shop for essential goods once a day, and the state has closed its borders to traffic with the rest of the country, effectively confining its 6.7 million inhabitants. It’s a surprising reversal for a country that was once deemed close to eliminating local COVID-19 transmission. Victoria reported zero new cases on 9 June.
Many other countries and cities have seen dispiriting rises in cases after months of relative calm. Hong Kong had 12 straight days with new cases topping 100 in July, after a tiny trickle in May and June. Vietnam went for 3 months without reporting any domestic transmission until an unexplained case appeared in the central port city of Danang on 24 July. The region has reported more than 200 cases in the past week—all the way from Hanoi in the north to Ho Chi Minh City in the south—as well as the first eight deaths. The government is putting hot spots under quarantine.
Japan is seeing a significant rise as well, and China, having thoroughly quashed the Wuhan outbreak earlier this year, reported more than 1400 new cases during the last week of July, most of them in the far west Xinjiang region.
Two notable exceptions to the trend are New Zealand and Taiwan, which have both ended local transmission and have lifted most restrictions on activities. Both test and quarantine returning citizens and residents to prevent new introductions of the virus, a task made easier by their oceanic isolation. The two owe their success in part to leaders who embraced “prompt and transparent evidence-based communication of risk, cost, and benefit to the citizenry” of measures to contain the outbreak, says Mark Wahlqvist, an internist and emeritus professor at Monash University.
False sense of security
To be sure, the numbers across the Asian-Pacific region are still low compared with many other parts of the world. Even today, Victoria’s total number of reported cases is only 12,335, with 147 deaths; Indiana, whose population is almost the same, has reported more than 68,000 cases and nearly 2800 deaths. The trend in East Asia is more similar to that in Europe at the moment, where cases are also ticking up, after having come down sharply from very high numbers in March through May.
But experts worry that early success may have given many countries a false sense of security. The resurgence “is a warning sign,” says Ben Cowling, an epidemiologist at the University of Hong Kong (HKU). Many people, and even some in the scientific community, thought handling the crisis would be “like a hurricane lockdown, [where] once it’s gone, life can go back to normal,” he says. With COVID-19, “that’s not what’s going to happen.”
Take Japan, where a combination of voluntary social distancing and a focus on finding clusters of cases drove the daily tally from more than 700 in mid-April to low double digits in May. “Many people got complacent about Japan’s success and assumed that the ‘Japan model’ did work,” says Kenji Shibuya, a global health specialist at King’s College London. But 1332 new COVID-19 cases were confirmed nationwide on Sunday, the fifth consecutive day with new cases topping 1000. Still, the national government is resisting the idea of declaring a new state of emergency, noting that younger people, who aren’t straining health care facilities, make up a large proportion of the new cases. That leaves Tokyo Governor Yuriko Koike relying on pleas for people to stay home and for bars and restaurants to close at 10 p.m. She has warned the city may need to declare a state of emergency on its own, possibly with stricter measures.
With cases among the young surging, “It is a matter of time [before] elderly and those with preexisting conditions get infected,” Shibuya says, which will lead to an increase in severe cases and deaths. (In the United States and some European countries, too, increased transmission among the young presaged a rise in cases among older age groups.) Japan needs to expand testing to fully grasp the extent of transmission, he says: “Japan is making things worse by just waiting and seeing.”
Cowling agrees that delaying action can cause trouble. Hong Kong’s daily tally started to creep up from single digits to 20 and then 30 in early July. The government hesitated over strengthening restrictions. “In the week they waited [daily] new cases went from 20 to 100,” Cowling says—and now testing and tracing capacity may get overwhelmed. “Numbers that seem small can get up steam pretty quickly,” Cowling says. Acting early might also have allowed Hong Kong to adopt milder restrictions. Now, the government has closed all gyms and bars, limited gatherings to just two people, made masks mandatory outdoors and in indoor public spaces, and banned dining in restaurants, though it had to relax that requirement in the face of a public backlash.
Cutting corners in countermeasures can also be costly. Genetic analysis has shown that most of the outbreak in Victoria originated from security staff guarding hotels where residents returning from overseas were quarantined, says Nigel McMillan, an infectious disease specialist at Griffith University. The guards had little if any training related to health care or personal protection, and many of them became infected. The virus spread to their extended families, into the community, and eventually into elderly care homes. The apparent lapse is under official investigation.
Even countries that so far had a stellar pandemic report card must keep working to fine-tune their messaging and sustain public support for control measures, says Catherine Bennett, an epidemiologist at Deakin University. Changing directives—for instance on masks, which were once deemed useless but are now recognized as important—can “lead to more pushback in some places,” she says, especially among those in their 20s where antirestriction sentiment has been growing.
Until vaccines arrive, countries will need to find ways to adjust control measures while minimizing their social impact, adds epidemiologist Keiji Fukuda of HKU. That balance, he says, “is very hard to achieve and maintain, but it is what countries should be striving to do.”