Table 5

Snapshot of transmission monitoring measures implemented in six Asian countries

IndonesiaSingaporeSouth KoreaThailandThe PhilippinesVietnam
Contact tracing strategiesA contract tracing application, PeduliLindungi was developed in April 2020 to augment manual contact tracing efforts. As the restrictions started to ease in mid-2021, full digital contact tracing was adopted. WHO supports the training of contact tracers and the military and police force augmented civilian contact tracing manpower.As cases from the first wave spiked, manual contact tracing was supplemented by TraceTogether (TT) mobile application and Safe Entry QR Code digital check-in systems. A physical TT token was issued to help those without a smartphone. These interventions have persisted since their implementation.Contact tracing was done by checking medical facilities records, cellular geolocation, credit card histories and CCTV footage. The government subsequently introduced the COVID-19 Epidemiological Investigation Support System as a centralised data collection and multi-agency coordination platform, accelerating data request and approval procedures. In mid-2020, an electronic entry log, KI-Pass, was enforced.Thailand had relied on village health workers to support official contact tracing teams. The initial strategy of using individual contact tracing was shifted to active case finding as numbers swelled during the second wave. However, individual case finding is still performed in areas with smaller clusters. Efforts were aided by a community-driven mobile application called ThaiChana. The use of the app became mandated for entry into all public spaces.Contact tracing was to be conducted by Local Government Units (LGUs) overseen by the Department of the Interior and Local Government. Guidelines were set up since the nation’s brush with MERS. An active case finding strategy was adopted during the earlier stages of the pandemic with house-to-house symptom checking. StaySafe.ph had been launched as the official, centralised contact tracing system for COVID-19, although initiatives by different LGUs also produced parallel contact tracing modalities (eg, digital apps, paper-based forms) as cases continued to rise in 2020.During its early stage, Vietnam used an aggressive contact tracing strategy with an epidemiological tracing of F0-F5 evaluation system. The use of contact tracing mobile applications was subsequently rolled out amid a backdrop of increasing caseloads, which sped up contact tracing efforts.
Surveillance strategiesA Public Health Operating Centre existed since 2017 and had a surveillance system in place that monitors infectious disease outbreaks via sentinel sites which have been linked to the country’s Early Warning Alert and Response System.Sentinel surveillance was upheld in tertiary hospitals and primary care clinics since the beginning of the pandemic. A further routine rostered testing was initiated at all high-risk industries and cases reported to the Ministry of Health. As more strains entered the country, routine rostered testing (RRT) requirements were extended, and wastewater testing was deployed in residential estates.After the experience with MERS-CoV, the Infectious Disease and Control Act incorporated aspects of surveillance into legislation. These provisions permitted a strong active surveillance approach with enabled health authorities to collect the same information as law enforcement in order to focus testing and quarantine on individuals who are more likely to be infected.Surveillance had been an integral part of Thailand’s public health function before the pandemic, which performs sentinel surveillance in all 77 provinces. In the initial months of the pandemic, lab-based surveillance and data reporting was paper-based, but as the pandemic brought more infections throughout 2020, a national online laboratory and epidemiological database was formed to facilitate national surveillance.A combination of events-based and sentinel surveillance is adopted by the Philippines. All private and public providers that identify confirmed or suspected cases are reported to COVID-19 coordinators that maintain and update the national COVID-19 information system. A COVID-19 tracker called COVID-KAYA was subsequently rolled out to electronically manage the heightened spread by consolidating data on all cases monitored, test results, health statuses from all accredited providers.Vietnam used both active and passive surveillance strategies whereby prospective cases presenting at hospitals are tested and self-report through mobile applications. The country uses a suite of mobile applications including Bluezone and NCOVI to monitor the symptoms and track close contacts. The data is then synchronised to a centralised national database for surveillance purposes.
Testing strategiesAt the start, testing of suspected cases was centralised. However, rigid criteria for PCR testing eligibility had limited testing numbers during the first few months of 2020. As the cases continued to overwhelm testing sites in 2021, RAT tests were permitted for rapid and early detection of infection. The cost of testing was covered by the government for suspected cases at public testing sites but not covered in private testing centres, but a price cap was instated in December 2020 for private testing which also varied based on jurisdiction.At the initial phase of the pandemic, all suspected cases and close contacts were required to undergo PCR testing. In October 2020, RAT testing was explored and incorporated as part of existing RRTs. The costs of these tests were initially made free to the public, which can be taken at public and privately run testing centres. As the country moved towards living with the virus endemically, more social responsibility was levied on the population as they were given the prerogative to perform their own RATs, which were issued to every household by the government via the national postal service.Emergency Use Authorisations were permitted for test kits as part of a multipronged national testing strategy. Initially, only PCR testing was used for persons suspected to be infectious, but as the numbers of infected individuals grew in 2021, self-testing was permitted. In the face of an Omicron wave, the protocol for prospective cases have shifted to those who tested positive with RAT do not need to take PCR before emerging from quarantine to save PCR tests for higher risk groups. Notably, the National Health Insurance Service covers the costs of tests for suspected and positive cases.PCR testing served as the main gold standard from the beginning until the fourth wave in mid-2021 as testing bottlenecks become a massive challenge due to high demand from patients and high-risk contacts. The high demand was due to the need for a PCR result before hospital admission as home isolation was prohibited. The problem was relieved when RAT testing and home isolation became accepted. Importantly, the National Health Security Office covers the cost of testing for all nationals and the Ministry of Public Health agreed to cover the costs for non-nationals at both public and private testing centres.Since May 2020, testing guidelines issued were stratified into four subgroups based on risk levels, with health workers or patients at risk of severe symptoms or with recent travel history prioritised for PCR testing. As testing capacity increased, PCR testing was offered to the general public. Testing services were covered by PhilHealth and a cap on co-payments at private testing sites were instated. The allowable conditions of use of RAT tests were expanded at the end of 2020 to include a wider spectrum of potential cases. A positive RAT test among close contacts is interpreted as a confirmed COVID-19 case, whereas asymptomatic close contacts who test negative with RAT test must have further confirmatory test (either through RT-PCR or a RAT).In the first three waves, PCR tests were largely for people with symptoms, close contacts, inbound travellers and hospital patients. After the fourth wave when Delta emerged, testing strategy evolved to a large scale one with high testing frequency where more affordable rapid self-tests were used to detect and isolate source of infection, especially for asymptomatic cases while PCR tests were only used for confirmation purposes. The Health Insurance Fund covered the cost of testing for suspected cases and close contact of cases in both public and private testing centres.
  • MERS-CoV, Middle East Respiratory Syndrome Coronavirus; RAT, rapid antigen test.