Rafi Kot, a former Israeli who is at the heart of Vietnam’s efforts to cope with the new coronavirus, admits the country was taken by surprise by the epidemic.

But three weeks after its first case of coronavirus was confirmed, it seems the Southeast Asian country has achieved something South Korea and Italy have not, by containing the virus. Vietnam has had no confirmed cases since February 13, and all 16 people who were infected have recovered.

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“It’s an enigmatic disease,” Kot said in an interview, explaining the challenges health officials in Vietnam faced and those in Israel may be facing in the weeks ahead. Excerpts from the interview appear below.

Open gallery view Doctor Rafi Kot. Credit: FMP

“First, the biggest problem is that the coronavirus was the perfect epidemic because it happened just as millions of Chinese and Vietnamese were traveling for Chinese New Year. That was a major factor in its spread. Second, it’s different because in contrast to SARS, for example, it infects people long before they show symptoms. A large number of patients have no idea they’re sick and continue to go around and spread it.”

Kot has lived in Vietnam for 32 years. “I built the first health care system for the tribes of North Vietnam and the northern delta in 1988. Afterward, I spent a year in North Korea during the great famine. Then I returned to Vietnam and opened a network of clinics in the country,” he said.

As the manager of a chain of clinics that service foreign nationals who arrive in Saigon, he's very influenced by the plague.

"We implement all screening orders from the government and health ministry, in order to keep patients safe during this coronavirus crisis. To do so, we meet almost daily, sometimes several times a day, sometimes in the middle of the night, in order to implement updates and government guidlines."

Why was Vietnam unprepared?

“It began a little after Chinese New Year, at the end of January. We knew about the coronavirus in China, but we were pretty calm. We’ve been through so many coronaviruses, like SARS, swine flu and avian flu, we had built a team and a system, but we didn’t relate to it. After SARS we thought it couldn’t get any worse because SARS was so terrible: The first patient died in Vietnam, as did the doctor who treated him.”

Tourist traps

Why only Saigon and not the rest of the country?

“The war on the coronavirus is being fought by province. Korean tourists visit several major places in Vietnam and ignore the other 90 per cent, so we’re concerned with places with big, urban populations and cosmopolitan traffic – Chinese, tourists from other countries, etc.”

How did you finally realize the problem was bigger than you imagined?

“The numbers in China began to climb and we quickly realized that all the Chinese who were coming to Vietnam, to resort areas, weren’t from Beijing or Shanghai but from Wuhan and Hubei [the epidemic’s epicenter]. They are less wealthy. In addition, both Vietnamese and foreigners were traveling to five or six resort areas. We said, ‘Wow, if there was an intermixing of people in those resorts, then these first 14 days will be critical. That’s why we recommended closing schools all over Vietnam and waited to see what would happen. We didn’t know children rarely get sick [from the coronavirus]. That’s only something we know now.”

Kot says Vietnam chose not to quarantine whole cities, but many people chose not to go to work for fear of contracting the virus. In addition, demand to be tested for the coronavirus soared.

“We immediately realized everyone would want to be checked because of the hysteria, so Vietnam’s center for disease control prepared a questionnaire to determine who is a candidate for an examination, for instance temperature, whether he had contact with Chinese, etc. ... At the same time, we knew many people would lie on the questionnaire because they feared the diagnosis and maybe we would miss someone, so we learned to ask questions from different directions.”

The problems were compounded by the fact that the test kits were returning false negatives, so there were people with the virus who were potentially spreading it.

“We had three cases like that. Singapore had 20. Meanwhile, the U.S. Centers for Disease Control admitted there was a problem with the kits. It was the same day the Chinese announced to hell with the examination, we’re going to identify the sick by symptoms.”

Tell us about the first patients you found.

“We began finding confirmed cases when people coming to the hospital with symptoms tested positive. We found that north of Hanoi, in one village a group of workers had just returned from Wuhan. They had been sent there by a Japanese paint company for a course, came home and infected their families. That was February 4, or 5. All told, 16 people were infected.”

Since then, you’ve had no new cases. How could it be?

“The sick were put under military quarantine in a way only a totalitarian state can do. They were put into a hospital that had been evacuated. They erected a barbed wire fence and placed army sentries around it. They dispatched doctors with special equipment. Two [patients] were very ill, but all of them have been discharged.”

How did you prevent it from spreading?

“I think we have more than just 16 cases, I assume we haven’t identified everyone. But we’re watching every case of double pneumonia and so far there has been no increase in the rate.”

In other words, you could still turn into another South Korea, where the number of patients grew exponentially in a few days.

“Correct. On [Tuesday] we decided not to let 4,000 Vietnamese workers now in South Korea return home. They want to come back and [Monday] their families made a big stink and demanded they be let back.”

How do you explain that in Italy and South Korea patients numbers rose so quickly, but not in Vietnam?

“A possible reason is the weather, In South Vietnam it’s hot right now and in South Korea and Italy, it’s cold. When it’s cold, people gather at home where it’s warm and get close to each other – and infect each other. But, again, we don’t know if the number of cases won’t grow.”

Testing at home

Israel has decided to conduct tests at the homes of people with symptoms who have been quarantined.

“I think that’s great. You need to do everything to keep people away from hospital. In Vietnam they haven’t internalized this. … You need to encourage people to be checked because so many people are afraid to, but, again, it’s hard to declare we’ve stopped the spread. While there are no flights from China, the land border is open between the two countries and Chinese can enter Vietnam.”

The border is open for political reasons?

“Undoubtedly. Vietnam can’t close its border with China. The Chinese have put immense pressure on everyone: the Koreans, Vietnam, everyone. Asian countries cannot act as they want vis-a-vis China because it’s the big power in the neighborhood. Economic and political relations between Vietnam and China are like yin and yang.”

What do you think will happen if the epidemic reaches Israel?

“The level of care most patients receive will fall very fast to first aid, like Acamol [acetaminophen]. How many intensive care beds does Israel have? 100? 200? 300? The Chinese moved 115,000 medical staff to Hubei and even that didn’t help. [Greater Tel Aviv] is a crowded urban area like Wuhan. Israel has almost no geographical depth of clean areas, as China does.”

On the other hand, spring is coming.

“True, every day that passes and it gets warmer is good news. The Health Ministry is right when it says the key is to buy time until it gets warmer or a vaccine is developed. It could be that by the summer it will all be behind us.”