Asian countries impose new restrictions as coronavirus cases come roaring back

Vietnam has banned public gatherings of more than two people. Hong Kong has closed nightclubs, karaoke bars and mah-jongg parlors, and deployed health inspectors to check that restaurants are seating parties at least 6 feet apart. Singapore has warned that anyone standing within 3 feet of another person in line could face up to six months in jail.

Suddenly, Asian governments that appeared to be bringing the coronavirus under control are imposing new social restrictions as the numbers of infections — many from overseas — continue to rise.

In places that took early, effective action against the COVID-19 outbreak, the stepped-up measures in recent days are a sign that fighting the disease will take much longer than anticipated. They also show that governments must adapt their responses as the threat from the virus evolves, epidemiologists say.

“We have to find measures that can control, slow down the virus, and do so in a way that is sustainable — not just for two weeks, two months, but all the way through to the end of the year,” Lawrence Wong, co-chair of Singapore’s coronavirus task force, said this week.

The novel coronavirus “is now so widespread that it is highly unlikely that our current control measures would be able to drive this virus out of the human population,” said Ooi Eng Eong, deputy director of the Emerging Infectious Diseases Program at the Duke-NUS Medical School in Singapore. “Without a vaccine or antiviral drug, we should expect to deal with this virus [for] the long haul.”

Singapore Imposes Social Distancing As The Coronavirus Continue To Spread
Observing new government guidelines, people sit at a distance from each other at Singapore’s Marina Bay on Monday.

That has become clear as several Asian countries see infections rising rapidly, most commonly in people who traveled to newer hot spots such as the U.S. and Europe.

Singapore and Vietnam, despite their proximity to the source of the outbreak in China, managed to keep a lid on coronavirus cases starting in January thanks to vigilant traveler screening, contact tracing and quarantining of suspected infections.

Hong Kong quickly closed schools, museums and government buildings, although residents were otherwise spared the hugely disruptive shutdowns and shelter-in-place orders now in force in much of the U.S.

A security guard in a Hong Kong shopping mall.

As COVID-19 cases surged in the U.S. and Europe, Asian countries also began to close their borders. But starting in early March, residents who were living or studying abroad rushed back home, bringing with them a second wave of infections.

In the last two weeks, the number of cases in Singapore has quadrupled to more than 1,000. Most were recent travelers who were immediately placed in isolation to reduce the risk of transmission.

New infections are also emerging in people with no recent travel history, a worrying sign that the disease continues to circulate in the community more than two months after Singapore’s first controls were implemented.

On Thursday, Singapore notched 74 new infections, its highest single-day total, 54 of them from transmission within the community. Ten were linked to a senior citizens’ home, prompting the government to announce a monthlong ban on visitors to nursing homes island-wide.

Experts say countries must be alert to a resurgence of the virus when existing measures lapse or people start to grow complacent.

“With the second wave, we are finding it a lot harder to control local spread as well as stop imported cases,” said Paul Ananth Tambyah, Singapore-based president of the Asia Pacific Society of Clinical Microbiology and Infection. “That is something that all countries will probably eventually discover.”

Hong Kong Imposes Social Distancing As The Coronavirus Continue To Spread
Hong Kong has limited the size of weddings to 20 people as part of social distancing measures.

Hong Kong, known for its nightlife, last week banned gatherings of more than four people but let bars and pubs remain open, even as dozens of infections were linked to such venues. On Thursday, as the government recorded 37 more cases to bring its total to 802, watering holes were ordered to close for two weeks.

Vietnam, among the first countries to block travel from China and close schools, went three weeks without recording a new infection. In the last month, however, the number of confirmed cases has risen from 16 to more than 220.

The communist-led nation has since banned all foreign visitors and ordered a two-week lockdown starting Wednesday, a dramatic tightening in what had been one of Asia’s fastest-growing economies.

Vietnam Imposes Social Distancing To Contain Spread Of The Coronavirus
Traffic was light in Hanoi on Wednesday, the first day of Vietnam’s two-week nationwide shutdown to stop the spread of the coronavirus.

Experts say that Vietnam is still seeing mostly clusters of infections, meaning the virus isn’t spreading in the population in a significant way. Vietnam’s rulers are hoping that tough measures will keep its still-developing health system from being overwhelmed with COVID-19 patients.

“I’m sure that’s what’s on their minds, that if they can prevent transmission now perhaps they can have an easier time in the future,“ said Todd Pollack, an infectious diseases specialist at Harvard Medical School who leads a Harvard-based health initiative in Hanoi.

“But the borders can’t stay closed forever. And if other countries haven’t had that same level of success against the virus, you’re going to continually deal with imported cases.”

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In prosperous Singapore, which had earlier banned large gatherings and instituted temperature checks at high-traffic buildings, stricter measures implemented last week limit private gatherings to 10 people. Authorities suspended all religious services and closed bars, karaoke lounges and nightclubs.

Officials also ordered commercial establishments to ensure 3 feet of space between patrons. At cafes and shopping centers, employees taped a large “X” on every other seat, denoting where people aren’t supposed to sit.

Singapore Imposes Social Distancing As The Coronavirus Continue To Spread
People observe safe distancing at a shopping mall in Singapore.

Government inspectors fanned out to office buildings this week to ensure that companies were allowing most employees to work from home. While schools remain open, officials have told campuses to prepare for home-schooling if needed.

Experts say Singapore’s gradual approach has allowed life to carry on more or less as normal for a population accustomed to efficient public services. But the government is now working to convince people that they must take the pandemic more seriously.

At a news conference this week, Wong, the coronavirus task force chief, lamented that some Singaporeans were still asking whether they could go to malls or have parties of fewer than 10 people. Such requests were “missing the point” of the need for social distancing, he said.

Ooi at the Duke-NUS Medical School said all governments had to balance society’s patience with what was needed to tame the virus.

“Working out sustainable disease control measures, which may be different from city to city due to local nuances, are just as important as implementing emergency measures,” he said.

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In a sign of how difficult it will be to contain the coronavirus over time, Asia is reporting spikes in new cases of the disease known as COVID-19 after weeks of relative calm.

Hong Kong, Singapore and Taiwan recorded new highs for daily cases this week and South Korea reported its highest daily tally in eight days on Thursday.

The development should worry policymakers in the United States and Europe, which are now the centers of a growing pandemic that began in China.

Asia has been viewed as a model for the West to follow because of its rampant testing and the seriousness in which its populations have followed health guidelines.

For instance, China for the first time on Thursday reported no new domestic transmissions of the virus. Authorities there did record 34 new cases, however, all from abroad.

After tamping down domestic transmissions of the virus, Asia is finding itself vulnerable to travelers returning from hot spots overseas.

Thirty-three of the record 47 new cases Singapore recorded Wednesday were linked to travel in Europe, North America and Asia.

Of the record 25 new cases Hong Kong reported Wednesday, 22 involved people who had also recently traveled, including 18 to Europe and one to the U.S.

Both Hong Kong and Singapore have substantial expatriate communities whose links to Europe and the U.S. are now sources of risk in a similar way links to China were earlier in the outbreak.

The pandemic, which started in Wuhan, China, has infected over 200,000 people worldwide and killed at least 8,657, according to the World Health Organization.

Taiwan, which had been lauded for its containment of the virus much like Singapore and Hong Kong, recorded 23 new cases of the coronavirus Wednesday, the most the country has reported in a single day.

Taiwan’s health minister, Chen Shih-chung, said 21 of the new cases were linked to travel in Asia, Europe and the U.S.

“We are seeing worrying numbers of imported cases,” said Ben Cowling, an epidemiologist at the University of Hong Kong, “worrying because we know only a minority of imported cases will be picked up and many will never be detected.”

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“I am expecting to see increases in unlinked local cases within the next two weeks — cases in Hong Kong or Singapore who do not know how they got infected,” Cowling added. “These could be the third or fourth generation of infections from undetected imported cases.”

Cowling cited a recent study from the U.S. that estimated screeners at airports missed more than half of infected people because carriers of the disease can appear asymptomatic.

“We find that most cases missed by screening are fundamentally undetectable, because they have not yet developed symptoms and are unaware they were exposed,” the study said.

Some governments are trying to mitigate that risk by mandating 14-day quarantines for all arrivals from abroad.

Hong Kong and Taiwan introduced the measure Thursday. Singapore will do the same starting Friday — after prohibiting entry for short-term visitors with recent travel history in China, France, Germany, Iran, Italy, South Korea and Spain.

It’s unclear how many of South Korea’s 152 new cases reported Thursday — the country’s most in a single day since March 11 — were due to overseas travel. The increase in cases were largely linked to a new outbreak at a nursing home in Daegu. The southeastern city has nearly three-quarters of South Korea’s confirmed cases of COVID-19 because of an outbreak at a local church.

South Korea had won plaudits for slashing the number of infections after issuing stringent lockdowns and testing hundreds of thousands of its citizens for the virus.