Restrictions on movement, which take varying forms in Malaysia, Indonesia, Thailand and the Philippines, must balance the need to suppress the infection and the care for the underprivileged, say four observers.

SINGAPORE: As COVID-19 continues to blanket countries worldwide, Southeast Asia has begun introducing stringent measures to combat the virus.

With more than 7,700 cases of infections have across the region, Malaysia tops with 2,470 cases.



Yet Indonesia has the highest number of deaths and a fatality rate of almost 9 per cent, one of the highest in the world.

These four most populous Southeast Asian countries so far also have the largest number of cases in the region, each with their capitals the epicentres of their outbreaks.

Knowing how these countries are combatting the pandemic while facing challenges pertaining to their geographical size and social heterogeneity, and observing whether these strategies would be successful in suppressing the infection, can draw important lessons for other countries sharing this common fight against the virus.





FLATTENING THE CURVE NOT THE OPTION FOR THESE COUNTRIES

Infectious disease experts have roughly outlined “flattening the curve” and suppression” as two key strategies to combat the virus.

The first aims to slow infection rates and keep it as low for as long as possible, so as not to overburden the healthcare system and protect those most at risk. Social distancing, testing and contact tracing are among the methods used.

People are seen wearing protective face masks at Orchard Road, Singapore on Mar 11. (Photo: Gaya Chandramohan)

In contrast, suppression aims to reverse an already rapid epidemic growth and slash daily infection rates.

A complete lockdown, like in Wuhan, where people are made to stay at home for weeks, have their temperature taken like clockwork thrice a day, with harsh penalties for anyone caught going outside, seems to have successfully suppressed the infection.



Large Southeast Asian countries, such as Malaysia, Thailand and the Philippines, have opted for tough restrictions on movements, which bear some semblance of a lockdown - although not China’s version of a total lockdown – to stem the coronavirus spread across cities and regions.

Meanwhile, Indonesia, facing the prospect of one of the most serious outbreak, dithers, and has opted for less serious quarantine measures, apart from some new plans to restrict mobility in Jakarta.

Where flattening the curve is not a strategy most countries facing a rapid surge in cases can afford, suppression will be their chief approach. There is no rigid formula for a lockdown, but there are similar aspects employed across countries: Travel bans, the restriction of movements and closures of schools and businesses (except for food and essentials).

But the specifics in state involvement vary, including the extent of restrictions, enforcement efforts, the penalties imposed and whether the military is enlisted, sometimes fuelling unforeseen consequences such as the impact on the vulnerable.



MALAYSIA: AN EXTENSION OF THE MOVEMENT CONTROL ORDER EXPOSES WEAK FUNDAMENTALS

Last Wednesday (Mar 25), Malaysia’s two-week Movement Control Order (MCO) imposed to curb the COVID-19 contagion was extended for a fortnight.

This includes the prohibition of mass gatherings, restrictions on overseas travel for Malaysians, and entry for foreign visitors as well as the closure of schools, government and private premises except those involved in essential services. Interstate travels require written police permission.

Violators face penalties up to US$229 and up to six months imprisonment. The Malaysian Armed Forces, including personnel and drones, have been mobilised in detection and enforcement.

A couple wearing protective face masks cross a street in Kuala Lumpur, Malaysia, Mar 6, 2020. (Photo: REUTERS/Lim Huey Teng)

The MCO has functioned alongside efforts to trace, isolate and quarantine active cases. The government has since announced it will ramp up its testing capacity, having so far carried out only just over 35,500 tests.



The decision to prolong existing restrictions may have been inevitable, given the doubling of cases within a week and a rising death count.

But Malaysians are struggling with restricted mobility, fears of food shortages, uncertainties over livelihoods, and the immediate loss of income.

The Malaysian government, advised by dedicated medical and law enforcement personnel, has demonstrated its seriousness in addressing this pandemic.

“I know it is not easy to stay at home for a long time ... But the reality is that we have not faced something like this before,” Prime Minister Muhyiddin Yassin spoke frankly in a press conference on Wednesday.

Teething problems such as the delay in imposing such restrictions, a reluctance to accept and prepare for an outbreak, and initial confusion over the MCO, have now been eventually corrected, aided by regular television updates by Prime Minister Muhyiddin, direct text messages from the government, and a new stimulus package to help Malaysians cope with the pandemic.

But hiccups remain. When Senior Minister of Works Fadillah Yusof announced only heads of households could venture out to buy provisions under the MCO, the resulting scene of confused husbands struggling with grocery shopping may have been comical but reveal the government’s little understanding of the gender division of labour at home, and how such blinkered policies can lead to ineffective outcomes.

Malaysia's Senior Minister and Works Minister Fadillah Yusof. (File photo: Bernama)

More worrying is how the outbreak has exposed how many live from pay cheque to pay cheque, with little savings to tide them over.

One than one in five Malaysians surveyed say they do not save money each month, despite nine in ten believing their Employees’ Provident Fund savings are not enough for retirement, a 2019 financial literacy survey revealed.

Understandably, Malaysia’s focus is rightly on combatting the spread of the virus, but a revisit of national priorities, inequality and investments in people will be needed once this crisis is over.

THAILAND: A PANDEMIC THREATENS TO SPREAD TO THE COUNTRYSIDE

Thailand, with 1,338 infections and 7 deaths as of Mar 29, has incredibly low numbers, considering how internationally connected, large and early the country was exposed to its first few cases.

Yet two super-spreader boxing events in the second week of March have sparked panic, resulting in a partial lockdown of Bangkok and several cities since Mar 24.

An empty arrivals terminal following the COVID-19 outbreak, at Suvarnabhumi Airport in Bangkok, Thailand on Mar 28, 2020. (Photo: REUTERS/Jiraporn Kuhakan)

An emergency degree banning entry by foreign visitors and encouraging people above 70 and children under five to stay at home. Public gatherings are banned, high-risk venues have been closed, although shops selling food and essentials remain open.

Commuting between provinces are discouraged, with travellers subject to health checks and quarantine. Violations are punishable with a jail term of up to two months.

Despite these stringent measures, some experts have deemed the policies “too little, too late”. “We’ve forecast three scenarios of widespread transmission. If we can’t control it, about half of the population could be infected in this period,” deputy director of the Disease Control Department Dr Thanarak Phaliphat said in an interview with CNA.

There are growing calls for a partial lockdown but concerns about the under-privileged, who will suffer the brunt of businesses closing and thousands losing their jobs, have placed the government in a catch-22.

To address unemployment, the Social Security Board will pay 50 per cent of worker salaries, effective from March. Workers outside of the social security system will get 5,000 baht (US$153) each month for three months.

Still, this hasn’t stopped the poor and those unable to afford staying in Bangkok from returning to their villages, in numbers large enough the government issued an advisory urging people to stay in Bangkok on Mar 22. Concerns over homelessness have risen.

Treatment for COVID-19 has been covered under Thailand’s universal healthcare scheme since early March but tests are not, which experts have pointed affects the poor disproportionately and could mask true numbers.

THE PHILIPPINES: A PRESDIENT IMPOSES A NATIONAL EMERGENCY AS THE HEALTHCARE SYSTEM IS OVERWHELMED



The Philippines has seen cases spike to 1,546 as of Mar 29, surpassing Thailand and Indonesia, including 78 deaths, second only to Indonesia with the most casualties in Southeast Asia.

FILE PHOTO: Philippine President Rodrigo Duterte gestures during his fourth State of the Nation Address at the Philippine Congress in Quezon City, Metro Manila, Philippines July 22, 2019. REUTERS/Eloisa Lopez/File Photo

The Philippine government’s approach to stemming transmission is little different from Malaysia and Thailand, with restrictions on movement, mass gatherings, travel and non-essential businesses.

But like both countries, containment measures to curb the in-country spread of the virus, were imposed very late, with the country now struggling to wrestle back control with tough moves.

President Rodrigo Duterte’s partial lockdown of the National Capital Region and subsequent expansion to the whole of Luzon came five weeks after the first case, and has generally leaned on stricter restrictions, including the declaration of a State of Emergency on Mar 25, which bestows on him extraordinary powers



Strong calls by human rights organisations for mass testing, which could arrest exhausted hospital capacity and a depleting supply of protective gear, have gone unheeded.

The country recently received test kits donated by Singapore and China, suggesting testing capacity is sorely lacking, helped hopefully by news on Monday of the Food and Drugs Administration’s approval of testing kits produced by the University of Philippines, meaning 120,000 kits will be available within the week.

Even if the country could manage testing, the overworked healthcare system is in dire need of rescue, when private hospitals in Manila have started turning away patients.

On the bright side, COVID-19 has brought out the best in Filipinos, propelling collective efforts to assist the vulnerable, seen when Vice-President Leni Robredo campaigned to raise funds to support healthcare workers. Filipino conglomerates SM Investments Corp, Aboitiz Group and Jolibee have also rolled out salary guarantees or expanded healthcare benefits for employees.

INDONESIA: IN CRISIS AND FINALLY ENACTING CIVIL EMERGENCY

Indonesia has seen 1,285 cases, 114 deaths and 64 recoveries as of Mar 29 but it is worrying assumed that due to under- reporting and lack of testing, the actual numbers are higher.



Medical officers prepare before administering a test for coronavirus disease (COVID-19) to a patient at a drive-through testing site in a parking lot at the regional lab in Depok, near Jakarta, Indonesia March 29, 2020, in this photo taken by Antara Foto. Antara Foto/Muhammad Adimaja/ via REUTERS

Reports have outlined infections spiking to 71,000 or more by the end of April if nothing changes.

Despite the distressing projection and the high fatality rate, the Indonesia government has not slapped lockdown measures on cities, opting for a differentiated approach instead.

“Every country has different characters, cultures and levels of discipline”, President Joko Widodo said, adding physical distancing, rather lockdowns, will be more appropriate, though he backtracked after a public outcry.



President Jokowi on Monday declared the outbreak a civil emergency and announced curbs on large-scale gatherings.

Indonesians are waiting to see what this means in practice. More can be done to socialise Indonesians to differentiated forms of quarantining and social distancing, in the absence of a lockdown.

Jakarta, with 647 cases and 66 deaths as of Mar 29, the highest in the archipelago, is the epicentre of the pandemic in the country.

Jakarta hospitals are at a breaking point. Hospitals are overwhelmed. Medical protective gear is scarce, according to nurses and doctors. Many hospitals rely on the kindness of citizen groups who supply them with masks out of their own pockets.

The Indonesian Doctors Association and University of Indonesia’s Medicine Faculty have strongly urged the government to consider a lockdown to substantially limit the movement of people to help curb the spread.

Worker sprays disinfectant at Gelora Bung Karno main stadium after Indonesia's capital began a two-week emergency period to prevent the spread of coronavirus disease (COVID-19) in Jakarta, Indonesia, Mar 26, 2020. (Photo: REUTERS/Willy Kurniawan)

Tegal, a town in Central Java took the extra step to announce a city quarantine for four months starting Tuesday. Some communities in Jakarta also began to impose self-quarantine, while still supporting local small groceries by ordering foodstuff by phone.

NO FORMULA TO FOLLOW

These four Southeast Asia’s responses to the COVID-19 pandemic show that there is no specific formula to beating this dreaded disease – when the most effective combination of measures to curb the spread must be tailored to socio-economic conditions.

While a total lockdown like in Wuhan may not be the most suitable solution to some Southeast Asian countries contemplating how to suppress the coronavirus spread, a range of efforts to tackle the sources of the outbreak, whether closing city borders to address imported cases, and compelling people to stay at home where community transmission is rife, should be seriously considered.

Dr Deasy Simandjuntak is Associate Fellow at ISEAS – Yusof Ishak Institute, Singapore, and Visiting Fellow at Academia Sinica, Taipei.



Dr Beng Hui Tan is Independent Researcher, Co-author of Feminism and the Women's Movement in Malaysia (2009), based in Kuala Lumpur.



Dr Eakpant Pindavanija is Director of the Institute of Human Rights and Peace Studies, Mahidol University, Bangkok.

Mr Joel Mark Barredo is Director of SHAPE-SEA, Mahidol University, Bangkok.