Lao PDR Coronavirus Disease 2019 (COVID-19) Situation Report #19 Report as of 25 November 2020 17:00 GMT+7 (06 – 25 November 2020)

Situation Summary

Highlights of Current Situation Report ● Fifteen new cases have been reported since the last situation update, bringing the total to 39 confirmed cases of COVID-19, all with links to travel. There is one new recovered case (Case 24). ● Case 25 reported on 16 November is a 26 year-old-female, Lao student in Hungary. She arrived in Capital on 15 November, and had her sample collected before being moved to the quarantine hotel. She is asymptomatic and was transferred to the hospital since her positive result. All 30 close contacts have tested negative and are undergoing quarantine and monitoring. ● Seven cases (cases 26-32) reported on 23 November were passengers of the same flight from India to Vientiane Capital that arrived 20 November. All were detected from sample collection upon arrival. One case developed symptoms on 21 November, while the rest remained asymptomatic. All other passengers have tested negative and have been in quarantine since arrival. ● Seven other cases (cases 33-39) reported on 23 November were passengers of the same flight that departed Russia 19 November and arrived in Vientiane Capital last 20 November. All cases were asymptomatic and detected from sample collection upon arrival. All other passengers/crew have tested negative and have been in quarantine since arrival. ● All cases have been isolated since release of positive result.

Governance and Response ● The protocol for all incoming travellers will be continued, including testing and quarantine upon arrival. Additional central level hospitals are prepared by the Ministry of Health (MoH) should there be additional confirmed cases. ● The National COVID-19 Preparedness and Response Strategic Plan has been signed by the Minister of Health. ● A workshop was conducted on 16-17 November for strengthening the provincial EOC, with participants from all provinces. This was coordinated by DCDC, with WHO and PSI providing technical support, and financial support from the World Bank. ● DCDC conducted two Point of Entry (POE) workshops, the first for Wattay International Airport and the second for the three other international airports in Lao PDR (Luangprabang, and ). Participants discussed readiness of airports to operate during Covid-19 and staff safety. ● A Point of Entry (POE) workshop was held in Champasack on 16-19 November for Pakse International Airport and ground crossings with the support of IOM, UNODC and WHO. The workshop raised awareness on Covid-19, promoted staff safety, provided information on passenger screening and management of ill travellers. A similar workshop is being held 23-26 November in Savannakhet. ● High-level discussions are ongoing for the preparations for vaccine procurement and deployment. A COVID vaccine management committee, chaired by the Vice-minister, has been established. Lao PDR is officially eligible to receive official development assistance (ODA) support through the COVAX Advance Market Commitment (AMC) to receive doses of COVID-19 vaccines through the COVAX Facility. ● Finalization of the hospital accreditation standards to include COVID-19 related measures such as screening and testing (“new normal”) with Department of Health Care and Rehabilitation (DHR).

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Lao PDR Coronavirus Disease 2019 (COVID-19) Situation Report #19 Report as of 25 November 2020 17:00 GMT+7 (06 – 25 November 2020)

● The fourth version of the clinical management guidelines for Covid-19 has been approved and WHO is supporting its printing. The guidelines will be distributed to provincial and district hospitals designated to manage COVID cases. ● Guidelines on mental health during public health emergencies are being drafted. ● The Department of Hygiene and Health Promotion (DHHP), together with WHO staff, visited central COVID designated hospitals for a needs and capacity gap assessment on safe water, sanitation, and waste management. Activities include WASH for Health Facility Improvement Tool (WASH FIT) training, and provision of water tank, pumps and hand hygiene and waste management supplies and equipment.

Surveillance ● The second workshop for implementing multisource surveillance at the provincial level was organized by the Department of Communicable Disease Control (DCDC) on 12-13 November, with participants from provincial health districts of six central provinces. Workshops were conducted on using multiple sources of information for timely detection, situation assessment, and response decision-making. The participants also provided feedback to the draft of the SOP for implementing multisource surveillance at the provincial level. WHO and US CDC provided technical support. ● Multisource surveillance technical working group meetings were held on 18 and 25 November to review the transmission status of Covid-19 in the country, the risk of Covid-19 importation from neighbouring countries, and the risk of community transmission from imported cases. ● A national specimen transportation guideline was disseminated for specimens including Covid-19 on 20 November. ● Supervision visits of mobile-PCR testing in northern provinces (Oudomxay, Luangprabang, Luangnamtha and Xayabhoury) from 10 -19 November was conducted by NCLE with support of WHO. ● A mission to Luangnamtha was conducted from 17-19 November to prepare for setting-up laboratories to test Covid-19 by RT-PCR in Boten and the Provincial Hospital. ● Tablets are being distributed to all provincial hospitals for the collection of healthcare capacity indicators in hospitals using the District Health Information Software (DHIS-2). Daily data submission has started for central level hospitals and some provincial hospitals. ● District health offices are conducting community engagement activities to support event detection and contact monitoring at the village level. Vientiane Capital, Xiengkhuang, Savannakhet, and Luangprabang provinces have started reporting to the central level. Monitoring and supervision visits in Vientiane Capital are being conducted by the National Centre for Laboratory and Epidemiology (NCLE) with support from WHO.

Communication ● Workshops on sensitization of monks for five districts in Vientiane Capital are ongoing. ● A survey to understand knowledge, attitudes and perceptions in relation to the “new normal” is being conducted by the Centre for Communication and Education on Health (CCEH) this week. ● Preparations for risk communication strategies for the COVID vaccination strategy are underway.

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Lao PDR Coronavirus Disease 2019 (COVID-19) Situation Report #19 Report as of 25 November 2020 17:00 GMT+7 (06 – 25 November 2020)

Upcoming Events and Priorities Governance and Response ● A follow-up high-level joint meeting on local governance in four provinces is being planned together with UNDP, MOH, and Ministry of Home Affairs (MoHA). Vice-ministers of MOH, MoHA, and Prime Minister’s Office, and four provincial governors are expected to attend. ● Training for district hospitals on clinical management for Covid-19 being planned. A Training-of- Trainers will be conducted first for central level staff, and then for provincial level staff in each province.

Surveillance

● The SOP for implementing multisource surveillance at the central level is being finalized, while the provincial level SOP is being reviewed during provincial-level meetings. The workshop for implementing multisource surveillance for the southern provinces are planned in December. ● Preparations by NCLE to certify biosafety cabinets to expand mobile PCR capacity to all provinces are being undertaken. ● Distribution of tablets and trainings on its use for data collection of health capacity indicators in provincial hospitals are to be conducted in the next month. ● Training on community engagement to support event detection and contact monitoring at the village level is being rolled-out to all provinces. ● There are plans to conduct training on medical certification for causes of death, including COVID-19. ● A memorandum of understanding is underway with MoHA to share data on death notification.

Communication ● A 2-day workshop on risk communication will be held next week, with funding support from World Bank. WHO is providing technical support.

National Transmission Assessment:

1-Imported cases There have been 39 cases reported, with 15 new cases in the last 28 days, all detected among incoming travellers upon their arrival to the country. Identified close contacts of the confirmed cases have tested negative and are being monitored in quarantine. There are no clear signals of community transmission. Nationally, weekly cases of sentinel Influenza-like illness (ILI) have increased above previous years, while Severe Acute Respiratory Infection (SARI) cases from the notifiable disease surveillance remain within the range of previous years, except in certain provinces where SARI cases are higher than the average. All ILI and SARI specimens tested have so far been negative for SARS-CoV-2 but recent samples have tested positive for influenza A(H3). SARI cases should be managed as suspected COVID cases, but implementation including collection of specimens has been challenging. There have been no reports of undiagnosed respiratory clusters or unusual deaths through event-based surveillance, and no observed increase in weekly hotline calls. Data collection on healthcare utilization from each province is still being strengthened. Assessment done by Lao PDR WCO with concurrence from the Ministry of Health of Lao PDR

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Lao PDR Coronavirus Disease 2019 (COVID-19) Situation Report #19 Report as of 25 November 2020 17:00 GMT+7 (06 – 25 November 2020)

Subnational Transmission Assessments: Imported Local Reports of clusters of cases cases Total SARI trends (Notifiable undiagnosed illness or Province Stage (past (past cases disease trend for week 46) death, or increased 28days) 28days) healthcare utilization Vientiane City 15 0 35 Low None Stage 1 Phongsaly 0 0 0 Higher than mean* None Stage 0 Luang 0 0 0 Higher than mean None Stage 0 Namtha Oudomxay 0 0 0 Increasing None Stage 0 Bokeo 0 0 0 Low None Stage 0 Luangpraban 0 0 3 Higher than mean None Stage 0 g Huaphanh 0 0 0 Decreasing; Low None Stage 0 Xayabouly 0 0 0 Low None Stage 0 Increasing; Higher than Xiengkhuang 0 0 0 None Stage 0 mean Vientiane 0 0 0 Low None Stage 0 province Bolikhamxay 0 0 0 Higher than mean None Stage 0 Khammuane 0 0 0 Low None Stage 0 Savannakhet 0 0 0 Decreasing; Low None Stage 0 Increasing; Higher than Saravane 0 0 0 None Stage 0 mean 0 0 0 Low None Stage 0 Champasack 0 0 0 Low None Stage 0 0 0 0 Low None Stage 0 Increasing; Higher than Xaysomboun 0 0 1 None Stage 0 mean *Mean is the average number of SARI cases reported from previous years.

Epidemiology

Epi Update 15 0 0 0 COVID-19 Imported Cases in past 28 Cases in past 28 days Active Clusters Active clusters with days (%) with no link (%) >3 generations

Tests Cases Deaths ICU Admissions 8,650 14 0 0 NAT Tests past 14 days New cases past 7days Deaths past 7days ICU Admissions past 7days (-1% 7-day) (0% 7-day) (0% 7-day) (0% 7-day)

77,216 39 0 0 Cumulative NAT Tests Cumulative Cases Cumulative Deaths Cumulative ICU Admissions

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Lao PDR Coronavirus Disease 2019 (COVID-19) Situation Report #19 Report as of 25 November 2020 17:00 GMT+7 (06 – 25 November 2020)

Health 618 0 39 242 Service Health care workers Healthcare worker Hospitals admitting Total ICU beds trained in COVID19 Case cases reported past COVID-19 patients (15/18 provinces) Provision Management week COVID-19

Table 1. Cumulative and new (past 7 days) cases and deaths by age and sex. Female Male Age Group Cases Deaths Cases Deaths 0-4 0(0) 0(0) 0(0) 0(0) 5-14 0(0) 0(0) 1(1) 0(0) 15-24 7(1) 0(0) 3(0) 0(0) 25-34 4(0) 0(0) 8(3) 0(0) 35-44 2(1) 0(0) 7(5) 0(0) 45-54 1(0) 0(0) 4(2) 0(0) 55-64 0(0) 0(0) 1(0) 0(0) 65+ 1(1) 0(0) 0(0) 0(0) Total 15(3) 0(0) 24(11) 0(0)

ILI/SARI surveillance

● For 8-14 November, 117 flu samples (43 SARI ,74 ILI) were tested for SARS-CoV-2 from sentinel sites, and all were negative. Out of them, 6 samples tested H3 positive. There are 4 samples with invalid results. The cumulative number of samples tested is equal to 1,940. ● The number of sentinel ILI cases has increased compared to the previous four years. The number of SARI cases reported to the notifiable disease surveillance system remain lower than previous years. ● Three ILI samples (out of 74 samples collected) and three SARI samples (out of 43 samples collected) tested positive for influenza (Flu A/H3), for an overall proportion of flu positive of 5.3% in week 46.

Figure 1. Weekly number of ILI presentations at sentinel sites, as of week 46, 2020 (Source: NCLE)

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Lao PDR Coronavirus Disease 2019 (COVID-19) Situation Report #19 Report as of 25 November 2020 17:00 GMT+7 (06 – 25 November 2020)

Figure 2: Weekly number of SARI cases reported to the notifiable disease surveillance, as of week 46, 2020 (Source: NCLE)

Figure 3: Proportion of ILI positive results from influenza RT-PCR testing by week, as of week 46, 2020 (Source: NCLE)

Strategic Approach National and Provincial Public Health Response ● National EOC activated and continuing to meet daily Monday-Friday. ● Finalisation of operational plans for the next 2 years to ensure COVID-19 response is adequately supported within the larger health system. ● Strengthening community engagement for COVID-19 response is critical to ensure implementation of the government's response plan. There are ongoing efforts to collaborate with relevant Ministries to strengthen the local government's role and responsibilities for community engagement. ● Continued efforts to monitor and maintain essential health services have been made to ensure performance of the broader health system during COVID-19. ● Transparency and visible leadership: MOH holds regular press conferences and publishes short updates online regularly.

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Lao PDR Coronavirus Disease 2019 (COVID-19) Situation Report #19 Report as of 25 November 2020 17:00 GMT+7 (06 – 25 November 2020)

Strategic Approach to COVID-19 Prevention, Detection and Control ● Establishment of multisource information surveillance to increase the net for early identification of cases and inform evidence-based decision-making. ● Increasing laboratory testing capacity through establishment of regional molecular laboratories. This will increase both the testing capacity and shorten the time for results to be available. ● Risk communication on COVID-19 and “new normal”. ● Easing of restrictions, but also keeping the public informed to remain vigilant and the possibility of reintroduction of restrictions.

Best Practices / Lessons Learned ● Whole of government coordination, through ad-hoc committees, taskforces and EOC. ● Planned expansion of the hotline as both a source of information for the public and a listening / surveillance point. ● Regular, timely and open public risk communications. ● Engagement of other sectors to assist with both the COVID-19 response and the larger socioeconomic impacts caused by COVID-19.

Challenges Encountered

● Increased confirmed cases detected among incoming travellers as more flights allowed to enter the country. There will be a need to mitigate the risk associated with the re-opening of international borders. Quarantine and laboratory testing procedures will need to be adapted using a science-based approach. ● Ensuring provincial and district hospitals are prepared for an increase in Covid-19 cases including case management capacity, IPC measures and adequate medical equipment and PPE. ● Discontinuation of screening at hospitals after relaxing public health and social measures – need to update hospital standard and monitoring of implementation for institutionalization for the “new normal”. ● There are limited resources to operate safe quarantine centres. Incorporation of best practice for physical distancing, hygiene, WASH standards, mental health needs of people in quarantine and safety/security of those in quarantine centres are needed. ● There is a need to strengthen communication on public health and social measures with communities. ● The indirect impact of Covid-19 on health including promotion and utilization of essential health services. ● Indicators from relevant sectors for multisource surveillance including healthcare capacity indicators and data from the community level need to be validated and followed-up. ● Awareness raising and understanding of the revised suspected case definition for front-line health workers.

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Lao PDR Coronavirus Disease 2019 (COVID-19) Situation Report #19 Report as of 25 November 2020 17:00 GMT+7 (06 – 25 November 2020)

Non-Pharmaceutical Interventions (NPI)

Narrative Non-Pharmaceutical Interventions

● Majority of restrictions have been lifted. International travel restrictions for tourists are still being implemented, but there are more flights approved by the Ad hoc committee to enter the country. Risk assessment is being done to support recommendations on the resumption of additional international flights and implementation of self-quarantine from countries with no ongoing community outbreak. Requests for fast-track immigration with ASEAN+ countries are currently being discussed by the Ad hoc committee.

Monitoring status Implementation Partial lift Lifted Geographical NPI Date first Date last (national or sub- Recommended or Lifted for Lifted for all implemented modified national) Required some areas areas

Wearing Face Masks, Hand Hygiene, Respiratory 3 February None National Recommended No No Etiquette

School Closure 17 March 2 June National Recommended - Yes

Workplace Closure 29 March 29 May National Required - Yes

Mass Gatherings 2 March 1 July National Recommended Yes Yes

Stay at Home 1 April 3 May National Required - Yes

Restrictions on Internal - Yes 1 April 15 May National Required Movement (within country)

Restrictions on International 29 March None National Required No* No Travel

Others; None None - - - -

*Incoming charter flights to Vientiane City are allowed upon approval by the Ad hoc committee

Figure 4: Epi curve by onset date* (n=39) and timeline of implemented and lifted public health and social measures in Lao PDR

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