COVID-19 in Myanmar in the aftermath of the coup

To: Safeguarding Health in Conflict Coalition

CC: UN Special Rapporteur Tom Andrews, Special Envoy of UN Secretary-General on Myanmar Christine Schraner Burgener, Yanghee Lee Special Advisory Council for Myanmar, United Nations High Commissioner for Human Rights Michelle Bachelet, President of International Criminal Court (ICC) Judge Piotr Hofmański, President of the International Court of Justice Joan Donoghue, Executive Director of Global R2P Dr. Simon Adams, Director-General of WHO Tedros Adhanom Ghebreyesus, President of the International Committee of the Red Cross (ICRC) Piotr Hofmański, Secretary of State Antony Blinken, National Security Advisor Jake Sullivan, U.S. Ambassador to the United Nations Linda Thomas-Greenfield, Executive Director of Global Centre for the Responsibility to Protect Dr. Simon Adams, Amnesty international, Human rights watch, Human Rights Without Frontiers, Burma Campaign in UK, US Campaign for Burma, Physicians for Human Rights, International Federation for Human Rights, Human Rights Foundation, Public Services International, Johns Hopkins Bloomberg School of Public Health, Open society foundations, Safeguarding Health in Conflict Coalition, Insecurity Insight,

Background Statistics

Before the coup

On the 10^th of October 2020, during the second wave of the COVID-19 pandemic in the country, Myanmar had the highest number of new cases of COVID-19 per day of all time, with 2158 new cases. This number later fell to a relatively more manageable 218 new cases by the end of January 2021, one day before the coup. The number of active cases on the 31^st of January 2021 was 11,942 cases. 

Myanmar was also one of the earliest countries in Southeast Asia to receive COVID-19 vaccines and to start the vaccination program. On the 22^nd of January, the country received 1.5 million Covishield/AstraZeneca vaccine doses from India’s Serum Institute (Link) (Archived Link). Myanmar also purchased 30 million doses of Covishield/AstraZeneca vaccine doses which would be delivered in batches (Link) (Archived Link).

The country was also planning to start providing COVID-19 vaccines to about 20 percent of its 54.4 million population in April 2021 under the global Covax affordable medicines program, and the vaccination program would run from April 2021 to June 2022. The International Monetary Fund (IMF) also sent over USD $350 million just days before the coup to combat the COVID-19. 

After the coup

However, after the February 1^st coup, the number of new cases per day dropped to just 21 cases on the 9^th of February. It stayed at very low numbers until the 26^th of May, where only 22 cases were reported. Starting from the 27^th of May, the number of daily new cases surged exponentially, at 96 new cases on that day, reaching a new peak on the 1^st of July with 2070 new cases, the highest since the beginning of the coup and a level unseen since the all-time-high in the second wave back in October 2020. With this trajectory, it is highly possible that the number of new cases might surpass the previous all-time-high within a day or two after the 1^st of July. 

As evidenced from the data presented above, the COVID containment strategy in the country–specifically regarding contact-tracing and effective quarantine and treatment–have completely broken down after the coup. Between February and May 2021, the number of cases have mostly been low and stable. However, this does not mean COVID-19 has been controlled in the country, but rather the inability to carry out testing at the capacity demonstrated before the coup.

Present Scenario

As of the 1^st July 2021, there are at least 240 documented attacks on healthcare personnel and facilities, which involved at least 17 deaths. 79 of these attacks directly impacted the patients in their ability to get medical attention. These attacks on healthcare not only hampered the ability to provide comprehensive care during the critical times of the pandemic but have also created difficulties for those seeking medical care.

Government hospitals are not able to function properly due to the nationwide strikes by their in-service doctors. To fill the current healthcare void left by the hospitals, the charity clinics in various areas have been set up by the striking in-service doctors. However, these makeshift clinics are continuously raided and the doctors abducted and charged with high-treason. Among the worst hit by these attacks on healthcare are those that cannot afford the more expensive private medical care and have traditionally been reliant on the government’s free public healthcare.

Non-functioning testing and treatment facilities

Since the coup in February, the testing and contact tracing facilities for the COVID-19 has been mostly crippled and unable to run at full-capacity. In contrast to the free COVID-19 tests offered by the government, many are now forced to get themselves tested for COVID-19 at certain private facilities–some of which can cost upwards of $150 equivalent Myanmar Kyats for a single test, which is not an affordable amount for the less fortunate to spend upon a single test.

Also, most of the government hospitals are not properly staffed, with most of the doctors participating in the nationwide Civil Disobedience Movement (CDM). Hospitals that have been declared open by the doctors not participating in the CDM have been found to be referring cases to other hospitals rather than treating them. In any case, it is obvious that people who need treatment for any reason, not just COVID-19 would experience difficulty getting treatment in a government hospital.

The SAC has also declared that the military hospitals, which were previously only available to members of the military and their families, would start treating civilians who are seeking treatment. However, the general public are having difficulty receiving their life-saving treatments at these military hospitals because of various reasons, including the break in the chain of referral system. Most military hospitals are simply turning away the civilians and are telling them to go back to government hospitals which referred them in the first place. In one situation, a patient suspected of COVID-19 was referred by a private hospital to a military hospital which has been deemed as accepting and treating COVID-19 patients. However, the ambulance carrying the patient was not even allowed into the hospital compound. This patient was then brought to multiple hospitals where admission was repeatedly denied. Eventually and fortunately, the patient was finally admitted at a private hospital. All of this is not even taking into account the inability to establish trust between care-givers and their care-recipients due to the violent suppression of the protests by the same members of the military who would be looking after these civilian patients.

Continued attacks on healthcare

Moreover, the SAC has continued its relentless assault on medical equipment and supplies since the coup. Much of the medical equipment donated by people to hospitals during the COVID-19 pandemic was confiscated by the SAC troops back in February; such equipment has not been seen since. The SAC has also destroyed medical supplies in various charity clinics. In one instance, a patient in an ambulance died shortly after the ambulance was ambushed by SAC forces and all the equipment within the ambulance was also confiscated. 

The need for proper control of the disease

In Myanmar, the vaccination programme which began rolling out in late January virtually came to a halt shortly after the coup. Proper social distancing and wearing of masks in outdoors and indoor locations also stopped with the mass demonstrations on the roads against the SAC. With the lack of proper contact-tracing and data, it was difficult to estimate the number of those infected among the population. It was speculated that COVID-19 might be already running rampant in the community.

However, even with these alarming facts in sight, the SAC has been forcing schools to reopen and parents to admit their children to in-person schooling in the middle of the pandemic to show some semblance of normality under their iron-grip control. They have been threatening to permanently shut down shops which refuse to stay open. On the 27th of June, it was reported that the SAC was severely restricting the use of online learning platforms and banning the use of one such platform.

Such questionable decisions to forcibly reopen schools for political purposes has led to completely preventable tragedies such as the mass COVID-19 infection of many students and teachers at schools such as, TTC and Mahawthahtar private schools. Over 100 teachers and students were also found to be COVID-19 positive on the 27th of June after they were forced to come to school. After such events, many parents are rightfully wary of sending their kids to school while the COVID-19 was surging again in the country. However, the SAC has threatened the parents to continue sending their children to school regardless of the pandemic.

Current vaccination status

The vaccination status and the vaccine coverage of the country has been extremely difficult to track compared to the flow of information before the coup. It has been noted that the SAC has been giving out a vaccine manufactured by China, instead of the originally planned Covishield, a version of the Oxford-AstraZeneca vaccine developed by the Serum Institute of India. But, many health workers and civilians have rejected vaccinations offered by the junta due to the lack of trust between the involved parties. Moreover, this vaccination process has been mostly prioritized for the members of the military and the current government officials.

It was also reported that there may be new COVID-19 variants already widespread within the community with one particular case occurring in a person having been vaccinated twice against COVID-19, once with the Indian-made Covishield and the second time with a Chinese-manufactured vaccine. (Link) (Archived Link) 

Situation inside IDP camps

One of the methods to prevent the spread of COVID-19 is to maintain social distancing. However, such a method is not feasible when people are forced into cramped spaces, such as ‘Internally Displaced Persons’ (IDP) camps. To date, there are over 200,000 IDPs in various regions of the country due to the armed conflicts between the SAC and the local resistance forces. The situation has not been helped with the SAC deliberately blocking and actively seeking out and destroying the essential supplies and humanitarian aids, including medicine for the IDPs. Being forced to run from conflict zones into deep jungles, the IDPs are not only at a higher risk of contracting many tropical diseases but also COVID-19. 

Recommendations

The COVID-19 situation in Myanmar has the potential not only to reach the levels of a reckless man-made disaster, but also threaten the regional and international attempts to control the pandemic due to border-trade and essential travel. With the current officials still forcing schools and markets to open no matter how widespread the disease is, with no concrete efforts or measures to contain the disease, there is an undeniable chance that the country will become the breeding ground for new variants of the virus. 

As such, it is highly essential that the spread of the virus be stopped before it reaches alarming levels. The number of new cases has been rising by amounts higher than the days before the coup and it has only been a short time since that the number of new cases per day has exceeded the previous all-time highs back in the middle of the second wave. Myanmar Doctors for Human Rights Network would like to urge the international community to aid the country in containing the disease starting with the following measures: 

• 1. Donation of humanitarian aids to control the disease such as PPE, N95 masks and surgical masks directly to those who are currently working to contain the spread. This is of utmost importance in the IDP camps and should be prioritized to these areas as these camps are currently overcrowded and the disease could exponentially spread at any time.
• 2. Donation of humanitarian aids to prevent the spread of the disease such as vaccines. It is also important to consider that the vaccines may be used to politicise, such as not giving out the vaccine unless the recipient pledges to support a political cause. As such, it may be necessary to set up a third party, non-partial and non-political body by the international community so that everyone is able to trust the vaccine provider and is able to safely get themselves vaccinated–regardless of their political affiliations. 
• 3. Manage a way to ensure the supplies (such as medications and oxygen) to treat those who have already contracted the disease actually reach those in need instead of falling into the wrong hands or getting destroyed before reaching those in need. 
• 4. Make the deliberate attacks on healthcare infrastructure and personnel stop by whomever is targeting them – especially at this time when such personnel are needed most. This would allow many doctors, nurses, and other healthcare workers who have been hiding themselves in fear of unjust abduction and persecution to openly help the population in need.

While implementing these changes, it is important to note that the international community should be speaking to the SAC (currently in de-facto control of the country) to allow such implementations to happen openly and freely for the benefit of the whole country and to hold the SAC accountable. The failure to abide by the ASEAN 5 Points Consensus with no follow-up action, for example, only encouraged the SAC to commit more crimes openly knowing that there will be no consequences. Impunity only begets more impunity. 

References 

1. Worldometer COVID live update Myanmar 

2. Wikipedia 

3. WHO Surveillance System for Attacks on Healthcare 

4. Myanmar COVID-19 Vaccination Expected from April (Archived Link) 5. Myanmar: Attacks on healthcare jeopardizing COVID-19 response, UN team says (Archived Link) 

6. ‘The presumption is we have Covid running rampant’ (Archived Link) 7. Myanmar COVID-19 outbreak hits health system shattered after coup (Archived Link) 8. Myanmar doctors sound Covid warning as neighbours see record cases (Archived Link) 9. PHR Condemns Myanmar Military’s Arrest of Former Head of COVID-19 Vaccine Rollout (Archived Link) 

10. Myanmar faces COVID surge amid lack of medics and jabs (Archived Link) 11. Myanmar’s Covid Cases Are Soaring, but Generals Hold the Vaccines (Archived Link)