Phnom Penh, Cambodia – Cambodia is in the grip of its worst outbreak of the coronavirus since the pandemic began more than a year ago, the World Health Organization (WHO) has said, warning that the Southeast Asian nation is on the verge of a “national tragedy”.
In less than a week, Cambodia has recorded more than 1,000 cases of the virus. As of Wednesday, 35 people had died.
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That compares with less than 500 cases in the first year of the pandemic and no COVID-19-related deaths reported at all.
On Thursday, the government ordered all residents of Phnom Penh, the capital, and the neighbouring district of Ta Khmau, to stay at home unless they needed to buy food or seek medical treatment.
The lockdown comes in the middle of the Khmer New Year, a three-day national holiday, which began on Wednesday, and usually sees thousands of Cambodians travel to their home provinces to celebrate.
The WHO earlier in the week implored people to stay at home.
“We stand on the brink of a national tragedy because of COVID-19. Despite our best efforts, we are struggling to control the virus. New cases occur every day and we are racing against the virus,” said Dr Li Ailan, the WHO Representative to Cambodia.
“Unless we can stop the outbreak, Cambodia’s health system is at high risk of being overwhelmed which would have disastrous consequences.”
Cambodia had previously experienced only small clusters of COVID-19 that were quickly controlled, but Dr Li says the emergence of the variant of COVID-19 that was first detected in the UK – known officially as the B.1.1.7 variant – meant things were different this time.
“The B.1.1.7 variant spreads more easily between people and can cause serious illness,” she said. “Many countries with strong health systems have been overwhelmed by this variant. We need to ensure the same doesn’t happen to Cambodia.”
All new cases are linked to an outbreak known as the February 20 event, marking the date it was first detected. The origin has been traced to four Chinese nationals who are alleged to have bribed security guards to leave hotel quarantine before the end of their mandated 14-day stay. Reports say the group had arrived from Dubai, one of more than 90 countries where the B.1.1.7 variant has now spread to.
Prime Minister Hun Sen in a speech last Saturday acknowledged that “bad governance” was a factor in the worsening outbreak, which is responsible for all of Cambodia’s more than 30 virus-related fatalities and has pushed the total number of cases in the country to more than 4,500 ones.
At least 50 people who tested positive for COVID-19 gave false information about their address, leaving authorities unable to locate them.
Causing further alarm, the virus has spread into the garment industry, which provides work to millions of people and is a crucial part of the economy. So far, at least 50 infections have been detected at Din Han factory in Phnom Penh, Cambodia’s capital and advocates fear that more workers are vulnerable.
May Sopheaktra, the secretary-general of President of Cambodian Alliance of Trade Union (CATU), says workers themselves were increasingly concerned about the risk.
Sopheaktra added there was insufficient monitoring within factories to guarantee workers were following COVID-19 guidelines, such as social distancing.
“The garment industry is not closely monitored,” he said, adding digital thermometers in use at sites appeared to be faulty.
Transportation is also a major concern, he said. Factories employ thousands of staff, largely women, from poor rural areas. Many travel to and from work in tightly packed trucks. While the trucks are open to the air, they are packed with passengers.
“When they are in trucks they don’t have social distancing, 30 to 40 of them in the same truck at once.”
Other hotspots include several local markets, which are also densely packed with traders and customers from across the country.
Dr Michael Kinzer, the programme director at the Division of Global Health Protection (DGHP) for CDC Cambodia, said such areas were high-risk.
“There’s locations that are called ‘three C’ locations, and the three Cs stand for close quarters, crowded and confined. And if you want to think of an example, a KTV [karaoke television lounge] would be a good example where everyone is indoors in a closed space crowded talking eating drinking, those are the high-risk environments,” Dr Kinzer told Al Jazeera.
“We are seeing transmission in family members, so people who share the same household, people who eat and drink together because you can’t wear a mask while you eat and drink. People who ride in cars. That’s another risk factor.”
Travel ban, curfew
In an attempt to curb the outbreak, the government has introduced a raft of restrictions and tough penalties for those who break the rules.
Hun Sen recently threatened people who breached the measures – which include a ban on inter-district travel, mandatory mask wearing and a nighttime curfew in the capital and some other areas – with immediate arrest and prison.
Some neighbourhoods in Phnom Penh with a particularly high number of COVID-19 cases have also been locked down and sealed off with roadblocks crewed by police and military police.
Cambodia has one of the region’s most underfunded healthcare systems. The most recent World Bank figures show that only 5 percent of government spending goes on healthcare, compared with 9 percent in Vietnam and 15 percent in Thailand. The burden is borne by Cambodians themselves: 57 percent of the country’s health expenditure comes “out of pocket” – only Myanmar, at 76 percent, is higher.
Cambodia also has the lowest reported figure in the region for hospital beds per 1,000 people – at 0.9. Access to healthcare is also particularly difficult for poor Cambodians in rural provinces, studies show.
To cope with the potential demand, the government has turned a hotel and a big wedding centre into makeshift COVID-19 hospitals, adding more than 5,000 beds, according to local media. It has also asked COVID-19 patients with mild symptoms to isolate at home.
Authorities are also rushing to dispense vaccines, which are now mandatory for civil servants and military officials. The majority of Cambodia’s vaccine stocks have come from China, which donated one million doses of the Sinopharm jab. Cambodia has also purchased the Sinovac vaccine.
It also has access to stocks of the AstraZeneca vaccine via the UN-backed COVAX programme which helps poor countries access vaccine supplies.
At the weekend, the government announced it had administered the 1,000,000th jab.
“Well, we have a few tools that we didn’t have last year,” said Dr Kinzer. “One of them is vaccines, of course. And vaccines should help us reduce the number of susceptible. And the number of severe cases.”
Kinzer warns, however, that the current pace of the outbreak, is exceeding the capacity of contract-tracing workers, as new cases were being discovered outside their lists of known contacts.
“So, we should expect that this will go on for several more weeks, even if we are successful,” he said.