Health authorities have issued stay at home orders for all of Rakhine State as they struggle to control a COVID-19 outbreak that has grown from 80 to 179 confirmed cases in barely 24 hours.
By AUNG PHAY KYI SOE and KAUNG HSET NAING
Ten days ago, Myanmar seemed to have COVID-19 under control. Just a handful of local transmission cases had been confirmed in the past three months.
The Ministry of Health and Sports has now reported more than 100 new cases within 24 hours, including 99 in Rakhine State, and has issued stay at home orders for the state’s approximately 2.5 million residents in an effort to control the spread of the virus.
The number of confirmed infections in Rakhine since August 16 has surged to 179, as of 9pm on August 26, and those infected include frontline health workers and the elderly. Many have no history of international travel or known contact with COVID-19 patients, and there are concerns that the state’s limited health facilities could soon be overwhelmed.
Early last week, masks were a rare sight in Sittwe, the epicentre of the outbreak, and markets and schools were still open. Rising case numbers though have left many people in Rakhine on edge, and Sittwe residents told Frontier they are living in fear of the disease.
“People are getting scared because the number of cases in the city keeps increasing every day,” U Khin Pe, a 61-year-old resident from Sittwe’s Myo Tha Gyi Ward, told Frontier on August 26. “They just go outside in the morning, before 9am, to shop. There are very few people outside by noon … Every single person is worried this second wave of COVID-19 will be serious.”
In addition to the stay at home orders, the authorities are cracking down on people who leave their homes without masks on. The state’s borders have also been closed, although a handful of flights are running between Sittwe and Yangon. Nevertheless, four cases linked to the outbreak in Rakhine have been confirmed in Yangon and another one in Mawlamyine, the Mon State capital.
“There were no local transmissions in Rakhine State for more than 28 days beginning in July,” Ministry of Health and Sports spokesperson U Than Naing Soe told Frontier. “Now we are seeing the reemergence of COVID-19 infections in Rakhine at a very rapid rate. We can say that the second wave has started in Myanmar.”
In a televised statement on August 24, State Counsellor Daw Aung San Suu Kyi, who chairs the National-Level Central Committee on Prevention, Control and Treatment of COVID-19, said the government had no choice but to impose restrictions on travel into and out of Rakhine State.
“Some people in Rakhine wish to leave the state. They think they will be safer outside of it. But once you’re infected, it doesn’t matter where you go. You’ll carry the infection with you,” she said. “You can receive treatment. The COVID virus is not incurable,” she added. “The earlier this virus is detected, the more effective the treatment is.”
Before this new surge, the last COVID-19 case in Rakhine – Myanmar’s patient 339 – was a 27-year-old male from Kyauktaw Township. Diagnosed on July 16, he had no known contact with a COVID-19-confirmed patient and no international travel history, according to the health ministry.
One month later, on August 16, a 26-year-old CB Bank employee tested positive, four days after developing a fever, nasal congestion and loss of smell. Since then, the rate has more than doubled nearly every day.
Of the new cases, 87 had no known contact with other COVID-19 patients or recent history of international travel. They include healthcare workers, government and INGO staff, monks and students.
In her address on August 24, Aung San Suu Kyi said the Ministry of Health and Sports believed that local markets in Sittwe had been a major infection point.
Dr Soe Win Paing, assistant director and spokesperson of the Rakhine State Public Health Department, told Frontier that 22 healthcare workers employed by the Ministry of Health have tested positive.
There are no known cases in camps for internally displaced people, where mass overcrowding and substandard housing make social distancing impossible.
Soe Win Paing said testing was taking place in the camps, but did not disclose the number of tests that had been conducted.
The possible spread of the virus to these camps – home to hundreds of thousands of people – has been a top concern for government and civil society leaders.
“Camp residents are more vulnerable than the general population in Sittwe because they have limited access to basic healthcare. It is not easy for them to come to the hospital,” said Dr Nay Lin Tun, a medical doctor volunteering at Sittwe General Hospital. “If COVID-19 is found in the camps, the infection rate can rise much more quickly than in the general population.”
Adding to the fears of an outbreak, several confirmed patients are INGO staffers that had visited camps in recent weeks. Relief International confirmed that three of its staffers who tested positive – patients 408, 440 and 441 – were members of a mobile health team that recently visited five Rakhine IDP camps. The organisation has suspended its activities and all of its Mrauk-U staff have been tested and quarantined at government facilities.
Another challenge for the government is lack of resources in Rakhine State, which has only basic facilities and the lowest number of health workers relative to population in the country.
Members of the health ministry’s Central Epidemiology Unit arrived in Sittwe on August 16 to assist with contact tracing. A 24-member volunteer medical team including physicians, nurses and pathologists arrived on August 23 to assist local medical staff at Sittwe General, while another 22 volunteers arrived on August 25.
As of August 25, the hospital was treating 86 COVID-19 patients and was already nearing capacity.
“We can treat about 120 in the hospital. If the number exceeds that, we can send another 100 patients to our nurse training school nearby,” said U Zaw Lwin, senior medical superintendent of Sittwe General Hospital.
He said a lab capable of testing 50 swab per day has been set up at the hospital with the help of the health ministry.
Civil society is also rallying to help bring the outbreak under control. The Arakan Humanitarian Coordination Team, formed by six local organisations, is helping to expand quarantine facilities in the state capital. About 300 people were in quarantine as of August 25, said U Khaing Kaung San, director of Sittwe-based Wan Lark Rural Development Foundation, one of the members of the team.
“We are preparing to transform the old Sittwe University into a quarantine center,” said Khaing Kaung San. “We plan to provide food to 250 people in quarantine for four months – we’ve budgeted K6,000 per person a day.”
However, he was critical of some aspects of the government response.
“I don’t think the government has managed things properly so far. It isn’t cooperating with other stakeholders or civil society organisations yet – they just like to give instructions from above … the doctors elsewhere in Myanmar know what the real situation in Sittwe Hospital is, so they are coming to work here,” he said.
“The main thing we need is not buildings – it is getting enough qualified medical staff,” he said. “Other volunteers can help too … we need to educate people on how they can control the spread of the virus … If the government is willing to accept constructive criticism, it should listen.”
These comments were echoed by a volunteer doctor who recently began working at Sittwe General Hospital.
Dr Aung Naing Lin, who arrived on August 23 and was previously working at Thingangyun hospital in Yangon, wrote on Facebook that there was a shortage of senior medical personnel in Sittwe.
“I would like an experienced expert on … communicable disease control to come to Sittwe to supervise the situation on the ground,” he said, “before everyone is infected.”
At 8pm on August 20 the health ministry imposed a stay-at-home order for all Sittwe Township, after three cases of local transmission had been reported.
Only one person from each household is allowed to shop for essentials and two can travel for medical needs. There are limits as to what vehicles are allowed on the streets, as well.
The Sittwe township general administration department imposed a night curfew from 9 pm to 4 am in Sittwe starting from August 21.
State government spokesperson said some streets, houses and building where the COVID-19 confirmed patients were residing or working in had already been lock down.
State high schools in Rakhine have been ordered closed until further notice.
“The reopening of schools will depend on getting the virus under control,” state education officer U Tin Thein said.
The state government has ordered the UN and all foreign and domestic NGOs to cancel all meetings and to avoid large gatherings. Their tasks are now restricted to distributing food, medicine, protective equipment and health care.
The state also banned contact with IDP camps, ordering humanitarian groups to leave food and goods with camp authorities to distribute.
On August 25, the ministry extended its stay-at-home order to Kyaukphyu, Ann, Taunggok and Thandwe townships, and on August 26 added the remaining townships in the state.
Express bus lines between Yangon and Sittwe were suspended on August 22 and buses between Mandalay and Sittwe were suspended on August 20.
Only passengers departing from Kyaukphyu, Taunggok and Thandwe and holding health certificates were allowed to travel, and they had to undergo a 21-day home quarantine upon arrival, said U Aung Myint Win, an Aung Mingalar Highway bus station administrator. “When buses and trucks from Rakhine enter Aung Mingalar highway bus station, health workers will check all passengers for fever and collect their addresses,” he said.
With the outbreak worsening, the authorities decided on August 25 to suspend all bus services between Rakhine State and Yangon, U Hla Min from Yoma Thitsar bus line told Frontier.
Myanmar National Airlines MNA is still running round-trip flights from Yangon to Sittwe three days a week, with passengers arriving in Yangon required to quarantine in a hotel or government-approved facility for 21 days and submit to swab testing.
Despite the growing concern over the outbreak and the government’s measures to curb the spread of the virus, officials said some were still not following their orders.
“Some residents still aren’t following instructions. Some don’t wear masks when they’re outside,” said U Win Myint, a spokesperson for the state government.
The rapid rise in cases has many worried the “second wave” will spread to other parts of the country. “How big will the second wave of COVID-19 be in Myanmar? It depends on us,” said Than Naing Soe from the health ministry. “If everyone follows the ministry’s instructions and works with the government, we can control the virus. These are the most important things we can do.”