Having contained its first brush with the novel coronavirus even as infections in neighboring countries surged, Myanmar is now straining to check a soaring second wave with a health care system blighted by decades of neglect under military rule.
In early August, the Southeast Asian country of 54 million was still going days without logging a single new COVID-19 infection and had only 374 total confirmed cases by the middle of the month. Cases have skyrocketed since then, however, to more than 31,000 as of Oct. 14, according to Johns Hopkins University's Coronavirus Resource Center in the U.S.
Myanmar logged 2,158 cases on Oct. 10, its highest daily count to date. COVID-related deaths have also jumped, from just six as of Sept. 3 to 732.
Local reports say monasteries, schools and government offices are being repurposed as quarantine facilities to help share the load with a creaking public health care system, and that patients who have tested positive for the virus have been forced to share rooms with those who have not.
World Health Organization country representative Dr. Stephan Jost called this an "emergency period" for Myanmar.
Critics have accused authorities of being slow to take the virus seriously. Well into March, government spokesperson Zaw Htay told reporters the country was still case-free because of people's lifestyle and diet.
But Jost insisted Myanmar was on top of the pandemic starting in early January, banning flights from Wuhan, China, where it began, by the end of the month, canceling visas-on-arrival for visitors from all of China on Feb. 1, and setting up a powerful committee — later led by State Councilor Aung San Suu Kyi — to coordinate the government's response.
He said the "turning point" came in mid-August when a communal transmission case was detected in Sittwe, capital of the far western state of Rakhine, which borders Bangladesh, where major outbreaks were well underway.
"And it's really from then on that this second wave was, if you like, culminating into a very big challenge for the country, which it continues to be," said Jost.
Confirmation took a few days, he added, which "means that there was transmission happening a few days before that. And this also showed that with the continuing communication, say, by domestic flights, the potential of spread from Sittwe to practically every other part of Myanmar via Yangon [Myanmar's commercial hub] is obviously there. And that is borne out by the transmission pattern that we have been seeing since."
Cases of COVID-19 have been confirmed in the capital, Naypyitaw, and 13 of the country’s 14 states and regions.
Jost said Myanmar's success keeping the first wave relatively small may have lulled authorities into lowering their guard, making way for the second. Lockdown orders on Yangon and elsewhere were lifted by the end of June.
"Perhaps some of the measures were relaxed a little early, like we've seen in other places, without the virus actually having gone away," he said.
Given how infectious the novel coronavirus is, though, and how threadbare the public health care system Myanmar had to meet it with, Jost said the latest wave was to some degree "almost inevitable."
Myanmar is one of the poorest countries in the region. The WHO ranked its heath care system the worst in the world overall in 2000, the last time the U.N. agency published a global index. For the next decade the military junta spent less than 2% of Myanmar's gross domestic product on health care per year on average, World Bank Figures show. Spending on health care only began to rise after the country started transforming into a quasi-democracy in 2011.
Even so, the second wave might have been smaller had the government locked down Rakhine sooner than it did, said Joshua Poole, country director for Catholic Relief Services, a U.S.-based charity.
Within a week of detecting the communal transmission case in mid-August, the government had locked down Sittwe, followed by a few more townships and the entire state by the end of the month.
"It just wasn't fast enough," said Poole, who is also a member of the steering committee of Myanmar's International Non-Governmental Organization Forum, which has been working with the government in responding to the pandemic.
He believes a quicker return of stay-at-home orders in Yangon, which came in late September, would likely have helped even more.
Most COVID-19 cases are now being found in greater Yangon, Myanmar's most populous region, with more than 8 million residents, and also its most densely packed.
"It took a while to get back to the point where there was the stay-at-home orders, and I think that's really what caused the cases to blow up in Yangon," said Poole.
Considering that the population has been following authorities' diktats fairly closely, he added, "if the government would have done that a week or two earlier then, you know, I think that would have helped quite a bit."
On the whole, though, Jost and Poole have been impressed with the government's response to the pandemic, given the budget and health care staff it has to work with, and said the outbreak was not yet out of control.
Jost has been especially impressed by the rapid rate at which Myanmar has been ramping up its testing capacity, from "literally zero" at the start to between 10,000 and 15,000 a day now, one reason for the rising infection numbers.
That may not yet be enough, though. Poole said the government was reporting positivity rates of between 15% and 19%, suggesting that transmission was also high and that many infections were still not being caught. Countries that have managed to test a much larger share of their populations and started to bring their own outbreaks under control tend to report positivity rates of around 5% or less.
Eyes on Rakhine
Poole said more and faster testing will be key for Myanmar to turn the corner. That's tough enough in Yangon. It will be harder still in Rakhine, where the second wave started and infections are also mounting.
Intense fighting between the military and Arakan Army, an ethnic armed group that wants autonomy for Rakhine, has consumed the north of the state since late 2019, killing hundreds and displacing many thousands into dangerously crowded camps.
The International Crisis Group, a global research and advocacy nonprofit, warned that the conflict was a "potential health disaster" in May. Richard Horsey, a senior advisor to the group based in Myanmar, said the fighting has only picked up since then, putting added strain on the local health system and making it all the harder to test and see how the virus is spreading.
"It just isn't possible to roll out the kind of public health measures and responses that you need to do in a context of conflict," he said.
"Although Yangon is currently the focus of a lot of effort because of the large number of cases there, it's very important that the public health authorities and the government don't take their eye off Rakhine state," he added.
Myanmar's Health and Sports Ministry did not reply to VOA's repeated requests for an interview.