Extract from ABC News
As India experiences a COVID-19 wave unlike any they have seen before and with many other countries in the region seeing small outbreaks, Australians are being warned to take note.
Nations once celebrated for their response to the coronavirus pandemic are now grappling with a sudden surge in cases, with large swathes of their populations left vulnerable and unvaccinated.
Thailand, for example, had until a few months ago been considered to be in the top five countries for its response to the pandemic.
But an outbreak of the UK variant at Bangkok's Thonglor district at the end of March eventually led to cases skyrocketing.
Neighbours Cambodia, Laos and Malaysia have recorded similar spikes, although the source of their outbreaks varied.
In Vietnam, another COVID-19 success story from last year, health workers were told to prepare for 30,000 patients after cases began climbing in mid-April.
And Singapore, which had so successfully contained coronavirus that it was looking to open a travel corridor with Hong Kong, recently reported a string of untraceable infections. The travel bubble has now been postponed, and social restrictions are back in place.
Already, the developments in Asia are being watched with some nervousness back in Australia.
Victoria's Chief Health Officer, professor Brett Sutton, identified the recent outbreaks in countries that had been in a state of "no COVID-19 transmission" as a lesson for others.
But according to experts, it is a recent spike in Taiwan, heralded as having one of the world's best responses to the pandemic last year, which should be of particular concern.
With a similar population size and quarantine system, the acceleration of cases in a matter of days is both "remarkable" and a lesson for Australians, according to professor Mary-Louise McLaws, an epidemiologist from the University of NSW.
Like Australia, Taiwan benefited from being an island and moved swiftly to shut its borders. It also had success with its public health strategies and became the gold standard in keeping the pandemic contained.
Taiwan — population 23.57 million — has recorded only 2,533 cases and 14 deaths. In comparison, Australia, with a similar population size of about 25 million, has recorded 29,955 cases and 910 deaths.
But Taiwan's status for having successfully contained the virus was challenged in April when a cluster of cases was traced back to a hotel at the island's main international airport at Taoyuan, outside of Taipei.
Rules had been relaxed prior to the outbreak, allowing pilots to quarantine for three days instead of the full 14.
At first, infections were reported from pilots, hotel workers and their family members. But as cases continued to rise, Health Minister Chen Shih-chung came under scrutiny amid reports that Taiwanese were staying at the same hotel as the quarantining pilots.
From there, the virus is believed to have made its way into Taipei's Wanhua district, which along with old temples is known for its trendy shops, hostess bars and "tea houses" — which refers to adult entertainment venues.
Professor Chen Chien-jen, an epidemiologist and former vice-president of Taiwan, told the BBC that given many who tested positive were unwilling to declare they had visited such adult entertainment venues, it made contact tracing even more difficult.
As cases continued to grow, talk in Taiwan turned to how its success in preventing an outbreak of the virus may have played a hand in its current situation, with citizens becoming complacent.
"It's been quite an alarming jump," Helen Davidson, who is The Guardian's correspondent in Taiwan, told ABC News Radio.
"For well over a year now life has been relatively normal in Taiwan and there's a lot of talk about how that has perhaps made people a bit complacent, particularly around travel and reporting symptoms."
Professor Chang-Chuan Chan from the College of Public Health at National Taiwan University said this year people were "not as aware there is still danger out there".
"If you can say this is complacency, it is," he told the ABC.
He said the outbreak at the airport hotel laid the groundwork for the recent spike in cases, with pilots coming into Taiwan spending just three days in quarantine.
"That has been suspected by some authorities as a loophole," he said.
Professor Chan also said Taiwan "relied on border control and didn't get systemic testing", and activities were allowed to continue this year despite new variants emerging.
Taiwan raised its coronavirus alert level on May 15, closing venues, limiting gatherings, and encouraging people to stay home.
But the slow rollout of vaccines has been a concern, according to Professor Chan, who added that Taiwan could not get enough vaccines until now.
"The vaccine rate is excruciatingly low in Taiwan — it's a great warning to us of how important that is to get protection," Professor McLaws said.
Taiwan has received about 700,000 vaccine doses to date, and only 1 per cent of the population has been vaccinated, according to Reuters.
Singapore: Cases silently spread through airport
Singapore
was widely praised for its initial handling of the coronavirus
outbreak, keeping cases low through rigorous contact tracing and
isolating infected patients.
But like Australia, the island experienced a sudden surge in infections several months into the pandemic as the virus ripped through its migrant worker community.
Since bringing its second wave under control, Singapore has vowed not to become complacent, encouraging mask wearing, and ordering clubs and karaoke bars to stay closed even as cases continued to fall.
The situation was so good that Singapore last month briefly dethroned New Zealand in Bloomberg's ranking of the best country to live during the pandemic.
"The city-state has brought down locally transmitted cases to near zero thanks to border curbs and a strict quarantine program, allowing citizens to largely go about their everyday lives, even attending concerts and going on cruises," Bloomberg declared.
But even as Singapore was being celebrated, cases were quietly spreading through the island's one vulnerable location: Changi International Airport.
It's believed that airport workers who came into contact with travellers from high-risk nations may have contracted the virus before visiting Changi's food court, which is open to the public.
Many of the cases linked to the airport cluster were later found to have a highly contagious Indian variant, known as B.1.617.
Some of the airport workers had been fully vaccinated, but still managed to contract the virus.
Dale Fisher, an Australian professor of infectious diseases at the National University of Singapore, said the current outbreaks were an illustration of how dangerous new variants of the virus could be.
He said the fact that some people were still getting the disease even after vaccination was not surprising
"The vaccine is designed to stop people getting severe disease but not fully stopping transmission," he said.
Despite having the highest vaccination rate in South-East Asia and a viral advertising campaign encouraging people to get their jab, only 29 per cent of Singaporeans have received one dose.
Dr Fisher said although there has not been "systematic hesitancy" to getting vaccinated in Singapore, there have been pockets of reluctance.
"There's people who are naturally hesitant and there are people that say, 'Look, I think I'll just wait a while. I don't want to be first,'" he said.
"Now there's community spread, people will be more eager to get a shot."
With two thirds of Singaporeans unvaccinated and the virus circulating, the government had no choice but to require people to work from home, close most schools and gyms, and limit gatherings to no more than two people.
They're also now considering ripping up the city-state's vaccine strategy, lengthening the time between doses, vaccinating younger adults, and lowering the minimum age for shots from 16 to 12.
"This wretched virus can be as transmissible as it wants to be — particularly these variants of concern," Professor McLaws said.
"In Taiwan, like Singapore, like everywhere in the world, the epidemiology says that the majority of people with COVID-19 are the 20- to 39-year-olds. And that's certainly a group that you would target [for vaccination]."
How a similar scenario would play out in Australia
What
the recent outbreaks in Singapore and Taiwan show is that successful
containment strategies can be thwarted by complacency and a failure to
identify and act quickly to contain quarantine breaches.
It also has lessons for Australia but so too does the country's own previous clusters, experts suggest, as each shows how slippery the coronavirus can be to control once it's gotten out into the community.
The Northern Beaches incident at the end of last year is one recent example of the fragility of Australia's COVID-free status.
To this day, the source of the Northern Beaches incident has not been identified, although once genomic testing revealed it was an overseas strain of the virus, authorities began operating on the belief it came from a recently returned traveller.
All up, an estimated 151 cases were linked to the cluster, which was brought under control by a lockdown over Christmas.
Dr McLaws said if a similar outbreak as Taiwan were to happen in Australia, it probably would take over a month to contain, given that we had fewer cases on the Northern Beaches.
"It took 32 days to control that with a lockdown of an area, although I didn't think it was hard enough locked down over Christmas, and Boxing Day. And then it spread to the west on a train line," she said.
"But eventually they got under control, because of the contact tracing and QR-coding and people wearing masks.
But Dr Fisher said that while Australia could minimise risk by keeping borders closed for now, coronavirus would likely continue to persist at some level globally, even after many people were vaccinated.
"Even if you've got 70 per cent of the population covered, you're still going to get circulating virus and those other 30 per cent are going to be vulnerable to severe disease," he said.
While the Australian government said it expected to keep borders closed until 2022 to avoid more outbreaks and lockdowns, Dr Fisher said there needed to be further clarity about when Australia would open up.
"It's going be a long year for Australia, looking at other countries opening up and tolerating circulating disease," Dr Fisher said.
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