With only two health workers out of thousands on the frontline against COVID-19 having been infected with the SARS-CoV-2 virus, while the death rate due to COVID-19 in Vietnam is just 2.5%, falling in the elderly group with severe underlying medical conditions, it can be said that the Vietnamese health sector has achieved great victories on the treatment front.
Triumphs on COVID-19 treatment
COVID-19 is a test for the competency of the Vietnamese health sector. On the treatment front, doctors are racing day and night against the unusual transformation of the coronavirus.
Doctor Nguyen Trung Cap, Head of the Intensive Care Unit under the National Hospital for Tropical Diseases recalled that at the initial stage of treating COVID-19 patients, the world did not have many documents nor any standard treatment for COVID-19.
In Vietnam, Cap said, if applying the old knowledge in treating influenza and SARS, the patient must be intubated, even indicated to run ECMO – an extracorporeal life support. However, when doctors visited COVID-19 patients and saw them directly, they realised that they can completely interfere with non-invasive respiratory support.
“We made a rather reckless decision because it was not mentioned in any medical books or in line with other same pathologies. However, it was the right decision. Most of the patients who received our care were consistent with our treatment strategy and they recovered. Later, many researchers with other perspectives around the world also supported views similar to ours”, shared doctor Cap.
In a quick manner, treatment plans for COVID-19 patients in Vietnam were summarised and shared with colleagues. In the first wave of COVID-19 outbreak, the number of infections was quite low and there were no serious or critical cases. Therefore, doctors had time to adjust treatment options to suit the new pathologies.
After the first phase, doctors quickly summarised studies and proposed atypical lung damage hypothesis in COVID-19 patients, while discovering factors related to the severity development on them. Since then, the National Hospital for Tropical Diseases has reported to leading professors and proposed innovations and improvements in diagnostic and treatment to suit the lesion characteristics of COVID-19.
“Thanks to these efforts, 11 critically ill patients were then applied with a new treatment perspective that helped prevent the risk of their illness getting worse and they recovered and progressed well. Out unit has contributed to limiting the proportion of patients having to rely on ventilators," said Cap.
It can be said that up to the present, Vietnam has successfully controlled the COVID-19 epidemic, especially in the treatment, reflected by the following indicators: high recover rate, even in patients with serious illness and comorbidities and cross-contamination among health workers are low.
Vietnam recognises and treats COVID-19 cases through several episodes:
Phase 1: From January 22 to February 25: 16 cases recorded, 100% recovery, no serious illnesses, no cross-infection in hospitals.
February 25 to March 7: 11 days without new cases reported
Phase 2: From March 7 to April 16: 399 cases recorded of which two medical staff members were cross-infected, no deaths were reported.
From April 16 to July 25: 99 days with no infections recorded in the community
Phase 3: From July 25 to September 3: New outbreak occurred in Da Nang, with 550 cases recorded in the community; among them, 35 deaths were reported as a result of severe underlying diseases.
From September 3 to November 30: Vietnam enjoyed an 87-day streak without any new cases of infection in the community.
Phase 4: From November 30 to December 1: Ho Chi Minh City recorded an outbreak in the community with four cases reported due to transmission from a person in a quarantine camp.
From December 1 to present: 24 days without any new infections in the community.
During the fight against COVID-19, Vietnamese doctors have saved many lives, including foreign patients, of which the most spectacular victory was the battle for the life for a British male pilot – known as Patient 91.
That was the moment when the wave of infections from Europe came pouring to Vietnam. The virus has transformed with strengthened virulence. A healthy person like the British pilot also had unpredictable complications. All the most difficult things in treating any COVID-19 patients fell into this case.
Professor, Dr. Nguyen Gia Binh, Head of the Consultation Group for Severe COVID-19 Patients under the Treatment Sub-Committee of the National Steering Committee for COVID-19 Response, recounted that when Patient 91 was admitted to hospital he had many abnormalities and was put on ECMO immediately. Just in four days, the patient had to replace up to three filters due to blood clots in the membrane filter. Anticoagulants in Vietnam did not work in him.
His immune system was almost paralysed, so it was easy to be attacked by bacteria or fungi, leading to multi-organ failure. The risk of death was up to 80-90%.
100-day race to win back Patient 91's life.
After the first episode of infection passed, his lungs improved slightly, then the patient had another bacterial infection. Medications proved to have good results in the laboratory, but when used in his body, he was allergic, so his disease persisted.
At one point, the patient's lungs deteriorated, leaving them only 10% functional. A plan for a lung and kidney transplant for the patient had been considered. “We did not dare to answer for sure whether he could recover or not, just trying day after day. The patient no longer had resistance to bacteria and fungi at the same time. The consultation team had to coordinate many types of “weapons” to attack bacteria, including new drugs that are not available in Vietnam, while accepting the risks of using high doses. At that time, we had no way back,” said Dr. Binh.
The final efforts resulted in a resounding success. The plan for lung and kidney transplantation was not needed. After 105 days of treatment with 58 days relying on ECMO, as well as 68 days of continuous mechanical ventilation, the patient recovered well and was discharged from the hospital on July 12, 2020.
Director of the Medical Services Administration under the Ministry of Health Luong Ngoc Khue evaluated that the successful treatment for Patient 91 once again affirmed Vietnam's policy to focus on curing patients at the highest level, regardless of whether they are Vietnamese or foreigners. It showed the Government, the Ministry of Health and hospitals’ determination not to give up on any case.
The world media praised the 100-day journey to save Patient 91’s life is a miracle of world medicine, a symbol of Vietnam's success in the war with COVID-19.
Through three waves of COVID-19 in Vietnam, the second phase had many serious patients, but they were treated successfully. However, in the third phase, the fight was the most difficult, as the epidemic broke out in hospitals and in the clinical departments. The patients were almost all the elderly, with many complicated background diseases, many of whom are on dialysis, have cardiovascular, kidney diseases or even cancer.
The Treatment Sub-Committee and the Ministry of Health urgently dispatched teams to support localities and medical facilities to receive and treat COVID-19 patients, under the direct command of Associate Professor, Dr. Nguyen Truong Son, Deputy Health Minister cum Head of the Treatment Subcommittee under the National Steering Committee for COVID-19 response. Many experts from leading hospitals were dispatched to provide professional support to Da Nang, Hue and Quang Nam.
Deputy Health Minister Nguyen Truong Son directed the COVID-19 fight in Da Nang from the first days after the outbreak was discovered there late July.
Thanks to the combined efforts of the health sector, after nearly a month, the third wave of COVID-19 infections starting from Da Nang was stamped out. Despite limited treatment capacity and lack of facilities and equipment at that time, Vietnam overcame some of the toughest challenges since the start of the epidemic early this year. The success was once again praised by the world.
The imprints in the field of COVID-19 treatment:
> The Medical Services Administration under the Ministry of Health established 51 rapid response mobile teams to support hospitals when receiving confirmed cases and when there are critical situations that require professional assistance.
> Establishing the COVID-19 Online Support Treatment Centre: Periodically organising online briefings with facilities that treat specific cases, 2-3 times a week, especially on serious cases.
> The motto "four on the spot", dividing treatment lines: on-site command, on-site forces, on-site facilities and on-site logistics, and dividing treatment ranging across the commune, district, province and central levels.
> 57 medical facilities have been receiving and providing treatment for COVID-19 patients.
> Deploying 20 training courses on prevention and control of SARS-CoV-2 infection for district health care facilities in provinces and cities nationwide.
> Developing a nationwide testing system with 148 laboratories, of which 91 labs are licensed for COVID-19 affirmations, raising the testing capacity up to 40,000 samples a day.
Four important contents contributing to the success in COVID-19 treatment
Deputy Health Minister Nguyen Truong Son assessed that, in the fight with COVID-19, on the treatment front, many initiatives have been applied, including the initiative to establish the COVID-19 Medical Diagnostic Support Centre, setting up mobile teams to respond quickly, dividing treatment for positive cases, and developing and issuing a set of safe hospital criteria against COVID-19 and acute respiratory infections.
This year, since COVID-19 attacked Vietnam, the Vietnamese health sector has rapidly established a Treatment Sub-Committee. There have been many good ideas and solutions approaching advanced experiences in the world, which are updated with the highest efforts by the Treatment Committee to save patients. As a result, the recovery rate is high (more than 90%) along with the high recovery rate of serious cases with background diseases, as well as minimising the death rate and limiting the rate of cross infection in medical examination and treatment establishments.
According to Khue, during the year, the Vietnamese health sector has updated the Guidelines for COVID-19 Diagnosis and Treatment four times, while looking at many treatment methods such as using antiviral drugs, anti-malaria drugs and using plasma. Vietnam has also developed health care guidelines for different patients ranging from those with chronic illnesses to people with disabilities, as well as building 37 criteria for safe hospitals against COVID-19.
To cope with the epidemic amid many serious illnesses reported, Vietnam has established the Online COVID-19 Medical Diagnostic Support Centre, which gathered a team of excellent experts in the consultation of severe COVID-19 patients and to operate hospitals medical facilities that were closed.
The establishment of the online professional support and management centre is the right decision, providing professional support to all levels, including remote areas. The centre stationed at the Medical Services Administration has connected all hospitals providing treatment to positive cases, with particular focus on counselling for critically ill patients.
According to Associate Professor, Dr. Khue, who is the director of the centre, there are four important issues that contribute to the success of COVID-19 treatment in Vietnam.
The country has rationally assigned treatment delegation on four levels according to patient development from the commune, district, and provincial level to the central level. In addition, Vietnam regularly updates diagnostic and treatment guidelines as recommended by the World Health Organisation and treatment experiences of countries around the world.
The delegated medical examination and treatment system for COVID-19 cases follows the principle of mild cases being treated at lower levels, while establishing a number of COVID-19 treatment centres at the provincial and final levels. Depending on the epidemic level, the Medical Services Administration has assigned specific hospitals for treatment at the central level. When the epidemic develops to a higher level, the Treatment Sub-Committee has directed concerned units to strictly follow the four on-site option. The treatment, managing, monitoring and isolating COVID-19 patients are thoroughly carried out right in the localities.
Experts at the COVID-19 online management centre for professional support, diagnosis and treatment has had more than 100 consultation sessions and professional meetings.
Up to now, the Online COVID-19 Medical Diagnostic Support Centre has organised more than 100 consultation sessions and professional meetings. There are over 30 leading experts from different fields who have directly consulted at the centre. Taking into account the number of network specialists of hospitals nationwide participating in teleconferences, there are more than 100 leading experts in all fields. This is a unique feature of the prevention and treatment of COVID-19 in Vietnam.
At the same time, mobile teams to quickly respond to the treatment of COVID-19 patients have been established. Currently, there are hundreds of such mobile teams with fast response, elite skills and expertise ready to support hospitals.
When the new outbreak broke out in Da Nang last July, Vietnam expanded its testing capacity. From only three units capable of testing SARS-CoV-2, the Treatment Subcommittee advised to expand the testing network at medical examination and treatment facilities. There are now more than 50 hospitals capable of testing SARS-CoV-2, helping hospitals to be proactive in testing, while reducing waiting time for patients and easing the overload on the preventive medical system in testing the potential cases.
In addition, the examination and treatment has been done effectively in coordination with the whole system of health facilities across the country to synchronously implement groups of measures against COVID-19. Especially, it must be mentioned, the activeness and willingness to come to the epicentre of the outbreaks to support, care for and treat COVID-19 patients of the medical staff.
The white-blouse "soldiers" on the front lines fighting the COVID-19 epidemic.
Specialists in the higher-level hospitals have been constantly closely monitoring each case at all medical examination and treatment facilities across the country. Experts and health facilities at the upper level provide consultation and give optimal treatment directions for patients, through online briefings with treatment facilities.
Lessons learnt from the Da Nang outbreak have helped tracing and extinguishing the outbreak in Ho Chi Minh City successfully just two days after recording the first infection in the community. As a result, the locally transmission cases found during the latest outbreak counted just four, and up to now, Vietnam has enjoyed 24 days without recording a new COVID-19 infection.
“We are always ready for helping our patients”
"Our promise to the Prime Minister is when the pandemic is over, we just come back home," as saying by Associate Professor, Dr. Nguyen Truong Son, Deputy Minister of Health, is the words from the responsibility and orders from the hearts of Vietnamese physicians, who are in the front lines to fight the epidemic during the tough war in Da Nang. During the year, many health workers have defied dangers, even faced death, in order to be stable in the front line against the epidemic.
On the 5th day of the Lunar New Year (Tet) Festival, Doctor Nguyen Trung Cap (Head of Intensive Care Unit, currently Deputy Director of the National Hospital for Tropical Diseases) and Doctor Than Manh Hung (Deputy Head of the Intensive Care Unit) decided to stay together at their hospital. At that time, Vietnam discovered the first cluster of infection cases in Vinh Phuc Province who were Vietnamese repatriated from Wuhan, China. They knew that they were facing an invisible enemy, with a very powerful poison and a very high risk of infection.
They didn’t have much time to hesitate. It was time for them to stay up day and night to study documents and read news around the world to identify the new coronavirus.
After the first wave seemed to be okay, just over half a month later, Vietnam entered the second wave of a fierce fight against a new virus strain on returnees from Europe and South America. The virulence became stronger as the virus strain changed, causing the number of critical patients to increase. The SARS-CoV-2 virus at that time was far more dangerous than what Vietnam had experienced.
The first doctors contracted COVID-19 at the National Hospital for Tropical Diseases. It was March 21, just 12 days after the outbreak in the second wave. Two doctors, one male, one female working at base 2 of the Intensive Care Unit of the National Hospital for Tropical Diseases got sick during the support of their COVID-19 patients.
Confusion began to spread. The invisible fear had come true. At that time, in China, a healthy doctor also died. No one dared to say it, but it was heavy inside. The process of examining patients and maintaining contact between medical staff was tightened a step further.
According to doctor Than Manh Hung, during their isolation, the two doctors infected with COVID-19 only wondered if any of their colleagues to turn into patients. “Instead of worrying about their health, they just worry about infecting others. It was very touching teamwork,” said Doctor Hung.
Along with that, in the "front line" in the South, Cho Ray Hospital had also had an unpleasant Tet holiday when the first two COVID-19 patients recorded in Vietnam - a Chinese father and his son – were being treated there.
In April 2020, young doctor Ngo Viet Anh, from the Intensive Care Unit, Cho Ray Hospital, officially "stationed" at the Ho Chi Minh City Hospital for Tropical Diseases. At that time, Anh and his colleagues faced a critical case – a patient with a strong viral reaction and a 90% risk of death – that was the British male pilot. The story of Patient 91 had been updated a lot, and was even marked as a miracle for the world when Vietnam brought the patient back from the dead.
Doctor Anh was then sent to Ho Chi Minh City Hospital for Tropical Diseases to intervene in ECMO for the patient. He spent nearly a month with other doctors there struggling to deal with the unusual happenings of Patient 91.
After returning home, Anh prepared to equip for a new war that was assessed as "fiercer" in Da Nang. He continued to have nearly two months of active duty in the frontline, directly treating the most severe cases that required emergency resuscitation transferred from Da Nang to Hue.
During the fight against COVID-19, although there were medical staff infected with the coronavirus, many hospitals were blocked and the risk of infection with the medical force was always at the highest level, at the front lines, such as in the National Hospital for Tropical Diseases, Cho Ray Hospital, Ho Chi Minh City Hospital for Tropical Diseases, Da Nang Hospital and Hue Central Hospital, professors, physicians and medical staff were not concerned about the dangers posed by the deadly disease. They strived day and night, accepting social distancing orders, to diligently, creatively and determinedly cure their patients.
As of December 25, Vietnam had 24 days without any cases of infection in the community. Nearly 100 days have passed, and the patients recorded in Vietnam during that period have had mild progress without no serious cases. The treatment front is now in a stable phase. And now, Vietnam is much more confident because it has overcome the most challenging and tough times to win more victories.
