COVID in Cambodia

I was in Cambodia at the start of the pandemic, and I’ve been in the UK for three months now (as well as watching the two countries from afar). Therefore, I have a fairly good idea of what the response has been in both countries. I keep getting asked, “What is the COVID situation like in Cambodia?” I think the expected response is that it has been terrible, hospitals have been overrun, people are dead on the streets and there is no Cambodia for me to go back to.

This is not the case. Recently, there has been an outbreak of COVID cases in Phnom Penh. My dad told me he think the situation was about to get serious as about 300 people were found with it. I had to tell him that the figure was for the year. As of Wednesday 6th January, Cambodia has had 382 cases and 0 deaths. (The UK has had over 7000 times that amount; the US has had around 55,000 times that, for a little perspective.)

So why is it that Cambodia has not had as many cases? Or is it that COVID is actually rampant in the country and just not being reported? In the first few months I thought that might have been the case. Apparently, the British government did too, as it took until October for the country to be put on the safe corridors list. However, after a few months since we were first aware of the virus, the expected signs of an outbreak were absent. First, there was no massive uptick in funerals. Seeing as funerals are outdoors and very loud, it’d be hard to miss a pandemic. Also, there were no overwhelmed hospitals. I ended up going to various hospitals during the pandemic (mainly to visit newly born babies and their parents). They were mostly empty. The missionary community, working in vulnerable, poor areas and having networks throughout the country, heard nothing out of the ordinary. (Well, there were rumours, of course, but that didn’t reflect the actual truth.)

So, why is the situation so different in Cambodia than in the UK?

Closing schools and other public buildings

A single case of COVID-19 was discovered in Siem Reap, a tourist city towards the north of the country. Within days (or even hours), every school in the city was closed, as were cinemas, karaoke bars, sports centres and gyms. Again, after a case was discovered in Phnom Penh, all the schools in the country were closed. In this case, it was the headteacher of an international school who had just come back from a conference who had the virus. The entire school was disinfected and shut off from being accessed.

When a November community outbreak occurred, any affected business or public building (including a whole governmental department) was closed. Aeon 1, one of the largest malls in the city, was shut. Two clothing stores were closed. These have all since been reopened after being thoroughly cleaned.

Schools have been intermittently closed and reopened throughout the year. Private schools were some of the first to fully open. In order to do so, they had to pass an inspection by the Ministry of Education. The minister himself visited HOPE school and gave various recommendations. Hun Sen, the Prime Minister, essentially said that what happens in schools happens in the community.

Rapid tracing

When the few community outbreaks have occurred, the individuals involved are extensively interviewed. Their movements are traced and everyone that seemed to be in contact with them are tested. When the November community outbreak occurred, hundreds of people were tested. There were also hundreds of tests done in response to the visit by an infected Hungarian minister. As a result, the outbreaks are usually contained relatively quickly.

This was not done through a world-beating app or other system. Nor was it done on an Excel spreadsheet. It was done in person, using the tradition methods, and has been relatively effective.

Quarantining and closed borders

Once a positive case is detected, the person is immediately hospitalised. This possibly accounts for the low death rate as well. At about 1%, you could have expected that around 3 people of the 382 people infected to have died. Obviously, it’s slightly more complex than that, as many of those who had it were travelling into the country and therefore fit enough to travel. This means they were unlikely to be elderly. In many cases, people around those who tested positive, such as family or colleagues were forced to quarantine.

Cambodia also shut its borders to various countries and cities for a few months. (Surprisingly, UK and China were not on the list. This may be due to the importance of the countries in terms of trade. I’m looking at you, Marks and Spencers.) The land borders between Thailand, Vietnam and Laos were completely shut for months.

When the borders did finally open, quarantining and testing measures were extensive. You had to be tested before you flew, once you arrived and fourteen days later. After that, you had the all clear. Initially, if anyone on your plane tested positive, you had to be quarantined in a hotel. Otherwise you’d quarantine at home. However, as someone breached the at-home quarantine, everyone who arrives in the country has to quarantine in a hotel (unless you’re a dignitary).

Cultural aspects

South-East Asia is well known for its mask wearing. It’s something that has been seen as a practical part of life. You might wear a mask because the roads are dusty, or you have a cold. So, when the news stories started in January, masks were seen everywhere. This wasn’t seen as oppressive or a breach of human rights.

Ready to go!

Another important factor in Cambodia is the amount of fear of the virus. Cambodia is well aware of its limited health infrastructure, its poverty and the vulnerability of its citizens. Therefore, the fear of the virus is high. When only a few cases had been reported, people were terrified of it. One impact of this is that alcohol gel, face masks and even visors were in the shops pretty much instantly. You could get them at bookstores, stalls on the side of the street and at the entrance to malls. The amount of PPE available was actually quite extreme, especially considering that the NHS had a shortage. The UK did actually end up buying PPE from Cambodia, which wasn’t a surprise.

Businesses were very proactive too. Many shops or restaurants put perspex screens up in front of the counters, as well as implementing temperature checks for customers as they entered (which is how the community outbreak was discovered), cleaning shopping trolleys, adjusting seating. A lot of businesses chose to shut during the first months and use it as an opportunity for refurbishments and training. A lot of this was not mandated, but strongly advised. Many businesses went above and beyond what was actually required of them.

There are other cultural aspects that have perhaps prevented the spread of COVID-19. Cambodians love to be outside. Celebrations such as weddings and funerals are outside in tents. People tend to eat outside if they can. Even if they are inside, the doors and windows are probably open, providing ventilation. During the rainy season, this is less frequent. However, the outbreaks coincided, fortunately, when the rains were less common. (In fact, during the first four months of 2020 it rained about five times in total.) A lot of shopping is done in outside markets, again mitigating against the spread of the virus in closed spaces.

The cost

There has, of course, been a huge cost due to the pandemic. The economy heavily depends on tourism, especially in Siem Reap. A lot of businesses have been decimated as a result. The informal economy of tuk tuk drivers, market vendors, souvenir sellers, tour guides has also been heavily impacted. Students have missed out on months of face-to-face schooling.

The government has been criticised, of course. A lot of the measures seemed unwarranted an oppressive. In order to prevent further community transmission, names were published of those infected. Also, misinformation via Facebook and social media has been cracked-down on . A lot of human rights watchdogs and charities have been critical of these moves.

However, it could easily be argued that the most important human right is the right to life, which Cambodia has secured for its citizens through its stringent measures. The quick, decisive (albeit excessive in some people’s opinion) actions are in stark contrast to that of the UK. The UK, a year in, is finally suggesting the restriction of entry at its borders and tighter quarantine measures. That horse may have bolted long ago. Furthermore, only this week have schools been declared a vector of transmission by the British government.

It is possibly Cambodia’s vulnerability and humility that has protected it so far. There has always been a realisation that the pandemic will cause huge problems for the country in many ways, but mostly through a significant death toll if it was allowed to spread. The Cambodians are a resilient people and I am confident the country will recover. Like most Cambodians, however, I am still cautious and apprehensive about what the pandemic could mean, especially if an outbreak did occur.

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