The World Health Organization (WHO) continues to work closely with the Ministry of Health (MoH), the Royal Government of Cambodia (RGC) and partners, to prepare for and respond to COVID-19 in Cambodia. Together, the RGC and its partners are working to save lives and protect health while minimizing the social and economic impacts of the new coronavirus.
The COVID-19 pandemic is far from over. COVID-19 remains a serious health security threat in Cambodia and WHO is still concerned about the potential for large scale community transmission. Cambodia has detected and rapidly responded to its initial 122 cases as of 12 May. Of these, 85 cases have been acquired overseas. The remaining cases are linked back to imported cases. There have been no reported deaths due to COVID-19 and no infections in healthcare workers to date. In total, 11,869 tests have been conducted from January up until 7 May.
The core public health response including case detection, isolation, contact tracing and quarantine has been central to Cambodia’s response strategy for stopping transmission and slowing the spread of COVID-19 to date. In addition to universal preventive measures including hand hygiene and cough etiquette, the RGC has also been implementing a number of physical distancing measures. Schools were closed in mid-March, international travel restrictions were implemented in late March and gatherings in entertainment venues such as cinemas and karaoke bars were restricted in early April. The Prime Minister also cancelled the Khmer New Year holiday scheduled for mid-April – one of the largest celebrations of the year amongst Khmer people, and additionally placed restrictions on travel between provinces and districts during this time. The screening and quarantine measures have been introduced in responding to the massive returning migrant workers from Thailand. The quarantine measures have also been implemented for managing any garment workers or company employees taking leave during Khmer New Year. According to the Phnom Penh Capital City Hall, approximately 15,726 garment workers from 672 factories returned to Phnom Penh from the provinces.
Addressing the current COVID-19 situation and planning for future outbreaks
The current response priority is to detect, isolate and treat people who have tested positive for COVID-19, and to trace and manage the follow up of their contacts. WHO and technical partners including the US Centres for Disease Control and Prevention, and the Pasteur Institute in Cambodia, have been working together to support the MoH to trace and manage these contacts around the clock. The surveillance system has adjusted its strategy to conduct “hotspot hunting”, a modified contact tracing approach to focus on high-risk locations where there may be other cases. This has been initiated in neighbourhoods in Phnom Penh, among Cambodian migrant workers returning from Thailand and in the workplaces and residences of garment factory workers. In higher risk settings, mobile units are being set up on site to allow for quick and convenient testing without the need to travel to health facilities. The MoH, with support of WHO and partners, continues to trace all contacts of any confirmed cases and to quarantine them for 14 days to prevent further spread of the virus. This follows WHO guidance for this stage of the outbreak. As of 7 May, 2330 contacts of diagnosed cases have been traced and managed through their quarantine periods.
Although no new confirmed cases have been identified in the past month and there are no current signs of widespread community transmission, this situation could change rapidly, and Cambodia must be ready to respond accordingly. In collaboration and coordination with key partners, WHO is providing technical and operational support to support the MoH to strengthen and enhance their health systems including public health capacities for responding to the current scenario of sporadic cases as well as for a future scenario of widespread community transmission.
There has been good progress in Cambodia’s preparedness efforts. The RGC, with support from WHO and partners, has developed and been implementing the ‘National Master Plan for COVID-19’, informed by the WHO global strategies and the WHO Western Pacific regional action frameworks and various technical guidance. The overall goal of the Cambodia Master Plan for COVID-19 is to control the transmission of COVID-19 and to mitigate health, social and economic impacts of the epidemic in Cambodia. For each of the plan’s nine priority areas, WHO is providing policy advice and technical support to the MoH to respond to the current situation, while at the same time preparing for the possibility of widespread community transmission.
A key objective of the Cambodia Master Plan is to minimize impact through a coordinated, multisectoral response to support public health and broader social and economic measures. Cambodia’s favoured approach, given there are many uncertainties around the virus and its potential trajectory, is to execute risk-based decision-making, anticipating and responding to the rapidly evolving situation, and balancing the consequences of interventions considering the public health risk, and the social and economic impacts of each action.
Cambodia has activated national and provincial public health emergency management mechanisms to provide coordinated management of the COVID-19 response. This includes the formation of the National Committee for COVID-19 led directly by the Samdech Prime Minister. The Committee is responsible for setting national policies and strategies for the COVID-19 response; leading the implementation of the strategic plan for the prevention, control and management of COVID-19; and responding to the associated political, economic and social impacts at all levels. In early April the RGC announced the creation of the Inter-Ministerial Committee to Combat COVID-19, headed by the Minister of Health. The same approach, to engage the whole of the government in the fight against COVID-19, is also being replicated at the provincial level led by provincial governors.
Informing the decision-making of these national and provincial committees is the critical function of disease surveillance and risk assessment including use multiple sources of information. WHO has deployed staff to provide technical support on risk assessment and epidemiological surveillance to the MoH. The organization continues to provide technical advice and engagement with both health and non-health sectors on the management of 90,000 Cambodian migrant workers returning from Thailand in recent weeks. The MoH with support from WHO has initiated screening at borders, quarantine for those with symptoms, and follow-up of individuals. Similarly, WHO is working with multiple sectors to support them to manage risk mitigation measures, communications and quarantine among Cambodia’s large numbers of factory workers, and other vulnerable groups.
Building the capacity of health facilities to be able to provide the necessary clinical care is a priority for the MoH and WHO. WHO has provided direct technical support and guidance to health facilities in Phnom Penh and in several provinces in managing the first cases of COVID-19 in Cambodia. WHO and partners have been supporting the MoH in the development of clinical guidelines, including guidance on diagnosis and management of COVID-19, and on infection prevention and control guidelines. As there is much that remains unknown about the virus, access to the latest global evidence and data allows WHO to support the MoH in developing these Cambodia-specific guidelines. WHO and partners have supported the MoH to prepare other key documentation to boost national preparedness, including operational procedures for health facilities for management of suspected/confirmed COVID-19 cases. A training implementation plan is being prepared for the provinces which, at the request of the MoH, will prioritise Pailin, Battambang, Bantey Meanchey, Oddor Meanchey and Koh Kong. The RGC has also taken measures to significantly increase the numbers of hospitals beds available nationally for COVID-19. WHO’s advisory support has helped identify the most effective ways of doing this, from converting hotels into medical facilities, to the development of temporary quarantine facilities and rehabilitation of former hospitals.
Strategies to reduce the level of COVID-19 transmission largely rely on non-pharmaceutical public health measures, as there are currently no vaccines or specific therapeutics available with clear evidence of effectiveness. Non-pharmaceutical public health measures include personal protective equipment, physical distancing, travel-related restrictions and environmental measures. WHO has provided strategic advice and technical support to the RGC to enable them to implement risk-based balanced interventions and develop country-specific messaging, and to identify and use the most appropriate platforms to engage communities with clear and actionable advice. The newly developed Messaging Matrix includes messages regarding the risk the virus poses, preventative measures that people can take and reducing COVID-19 related stigma. These resources can empower every person in Cambodia to be clear on the risks and take actionable, preventive measures to play a role in fighting the disease. The action of every Cambodian will be crucial if efforts are to succeed in tackling COVID-19 and minimizing its impact on Cambodia.
Responding in Solidarity
In addition to the health response supported by WHO, the entire United Nations (UN) System in Cambodia is also fully committed and has taken action to support the RGC in its COVID-19 preparedness and response through the UN Framework for the immediate socio-economic response to COVID-19. This commitment reflects the gravity of the challenge. In the UN Country Team, WHO serves as the COVID-19 Technical Lead Agency for health response, providing strategic and technical advice, and coordinating the international health response among the UN agencies. All UN agencies in Cambodia have considered how they can best support the Royal Government of Cambodia in responding to COVID-19. The broader UN system is also considering the secondary impacts of the outbreak, and several agencies are contributing specific sectoral support complementary to the Master Plan.
Cambodia has managed the first phase of COVID-19 effectively under the leadership of the RGC, especially MoH. Despite these significant achievements, much more remains to be done if the country is to be prepared for further outbreaks and community transmission. Surveillance and laboratory capacity will be further expanded, reflecting the RGC’s proposals in the Master Plan to build on the rapid progress already achieved. Similarly, following the establishment of health services at hospitals for COVID-19, there is a need to scale up the readiness of the entire health system for COVID-19 in the event of widespread community transmission, especially at health centres and in the private sector. There is also a need to provide greater support at provincial level to health services – WHO is coordinating partners to provide support to the MoH to do this. WHO’s support going forward will incorporate recommendations from the International Health Regulations (2005) Emergency Committee who held their third meeting on the coronavirus outbreak on 30 April; more information on their recommendations can be accessed here. WHO is also continuing to provide support to the MoH to sustain routine essential health services to ensure they continue to function even as the country focuses on COVID-19. Examples include malaria elimination, routine immunisation services and measles outbreak response, HIV/AIDs and TB treatment, material and child health, and NCD management.
The Inter-Ministerial Committee to Combat COVID-19 and the United Nations Country Team (UNCT) met on 30 April to review progress in implementing the Cambodia Master Plan on COVID-19 and identify future priorities including key areas with possible UN support in the health response, as well as the social and economic response. The future priorities which are complementary to the priority areas in the Master Plan, include:
- Update and continue implementing the Cambodia Master Plan to fight against COVID-19
- Make the core public health system even stronger
- Plan for introducing, easing and lifting public health and social measures including physical distancing.
- Update and test the Cambodia pandemic response plan,
- Continue strengthening health care system readiness for pandemic response
- Build on existing efforts to mitigate the socio-economic impacts of COVID-19.
- Protect vulnerable populations from COVID-19 through a multi-sectoral approach
- Strengthen local government leadership and coordination, resource investment and operational capacities
- Strengthen risk communication, and identify and implement local solutions through community engagement in fighting against COVID-19
WHO and the UN Country Team are committed to intensifying support to Cambodia’s COVID-19 preparedness and response. As a united front, they will support future preparedness to prevent transmission and respond to cases, prepare for and manage a widespread outbreak if it occurs, mitigate the social and economic impacts of COVID-19 and coordinate resource mobilization and technical support to Cambodia.
Given the current stage of the COVID-19 transmission, it is essential that Cambodia must be proactive in balancing public health considerations with social and economic impacts in the context of a return to ‘normal’. It is natural that people will want to return to their normal lives. But as Dr Li Ailan, WHO Representative to Cambodia, recently stated “the COVID-19 pandemic is far from over and the COVID-19 risk to Cambodia persist. We must be vigilant, we must be a new normal, and we must be ready for emergency response in the future”.
Universal preventive measures such as hand hygiene, cough etiquette and physical distancing should be part of everyday life, at home, at work, and at school. Individuals must protect themselves, their families and their communities. Businesses must adopt new ways of working. The new way of living will mean constantly evaluating risks and tactics as the epidemic evolves. It will require that everyone acts with solidarity, vigilance and patience.
To win this evolving battle, Cambodia must continue to act together as one in solidarity. While there is no new cases reported since 11 April 2020, the whole Government must continue to work together to support the health sector preparedness and response, whilst maintaining the essential services and adjust social measures that allow Cambodia to function. Each and every person will also need to play their role. Communities must be empowered with the knowledge and skills they need to play their part in this struggle.
Together with the international community, WHO stands ready to continue to support Cambodia in these historic efforts.
WHO advice for the public
WHO’s recommendations for the general public to reduce exposure to, and transmission of, a range of illnesses is to follow standard hygiene precautions, including regular hand hygiene, covering mouth and nose when coughing and sneezing and avoiding close contact with anyone showing symptoms of respiratory illness such as coughing and sneezing.
The MOH will continue to keep the public informed of developments via the MOH website www.cdcmoh.gov.kh and social media where relevant health education materials can also be downloaded.
For WHO updates, please visit www.who.int/emergencies/diseases/novel-coronavirus-2019.