COVID19 IN SOUTHEAST ASIA

A lot of people are making predictions about the future of travel. Honestly, I don’t think anyone can know for sure what is going to happen after the coronavirus is under control. We can’t even be sure there will be a vaccine in the near future. Even if there is one, it’ll take a long time to both manufacture and distribute enough vaccines to everyone on the planet.

The good news is that as of June 28, 2020, most countries in Southeast Asia have been effective at lowering the transmission rate of the disease particularly Vietnam, Laos, Cambodia, Thailand, Malaysia, and Myanmar. They’ve done this through mandatory face masks, physical distancing, and in some cases shutting down the economy. You can visit Dr. John Campbell’s YouTube channel on the coronavirus where he discusses the reasons behind Southeast Asia’s effective response.

You can check out how many cases are in each country in the world on Worldometer. 

Currently, most countries in Southeast Asia are closed to foreign nationals. The ones that are opening up (Cambodia) have certain restrictions placed on people entering the country.

If you do decide to travel to any of these countries when they open, you should take extra precautions to avoid getting sick even for illnesses not related to COVID19. Do anything you can to keep your immune system strong.

3 Most Common Health Issues in Southeast Asia

There are three main health issues you should be aware of when traveling in Southeast Asia: diseases from mosquitos, diseases from contaminated water and food, and rabies.

1. Diseases from Mosquitos

There are three main mosquito-borne diseases that you need to worry about in Southeast Asia:

Malaria: Malaria still exists in some parts of Southeast Asia. It’s a serious and fatal disease that if left untreated can result in death. People who have malaria usually experience high fevers, chills, and flu-like symptoms.

Dengue Fever: Dengue is a very common mosquito-borne disease found in Southeast Asia. Symptoms can be mind to severe. They include body aches, nausea, rash, and vomiting.

Zikka: Zikka is less common than malaria and dengue, but it can be found in Southeast Asia. It’s mainly serious if you are pregnant.

2. Diseases from Contaminated Water and Food

Of all the diseases you can get in Southeast Asia, I am always most worried about getting sick from contaminated water and food. Some common illnesses that you can get include typhoid, cholera, giardia, dysentery, E coli and other nasty illnesses. However, you’ll often see these illnesses referred to as traveler’s diarrhea.

How do you get these illnesses exactly? The main thing is that you consume something that contains feces. You can do this in a number of ways:

• Consuming contaminated water or ice
• Eating raw fruits and vegetables that have been washed in contaminated water or prepared by someone who didn’t wash his or her hands after going to the bathroom.
• Consuming foods that haven’t been cooked long enough
• Touching a surface that has been contaminated with feces and then putting your hands in your mouth or touching food that you later consume.

The most common symptoms along with diarrhea include cramps, nausea, vomiting, and fever. It can take several days and even several weeks for symptoms to clear up. One of the biggest problems with traveler’s diarrhea is that you can become dehydrated easily, which can lead to further complications.

It’s hard to know when you might have contracted the illness since it usually takes one to three weeks to get ill after becoming infected.

How to treat illnesses caused by contaminated food and water?

• Drink lots of water so that you stay hydrated
• Eat bland foods like bananas, yogurt, rice, toast, and salted crackers
• Only take Immodium if you need to take a long bus or boat ride and it will be difficult to get to a toilet quickly.
• Only take antibiotics if it’s really severe. I know that taking antibiotics is controversial, so speak to a health care professional about it. Id did get a round of antibiotics from a travel clinic before my trip to Myanmar. I took them when I had diarrhea and couldn’t hold down any food for days. I got better the next day. 

Some of the island destinations like in the Philippines (El Nido) suffer from contaminated water and thus become particular hot spots for water-borne illnesses.

3. Rabies

Rabies is a fatal disease that affects the central nervous system. It continues to be a problem in many countries in Southeast Asia. Myanmar is considered to be a high-risk country for rabies. Bali is another place where rabies has become a problem.

In Southeast Asia, rabies is often found in stray dogs.  You can also get rabies from wild monkeys. I know many people who have been bitten while traveling in Southeast Asia either from a dog or a monkey. All of them got treated while in the country.

You can get rabies if a rabid animal bites or scratches you or licks an open wound AND you don’t get treatment before symptoms appear. The incubation period can be from 3 to 12 weeks, but can also take 5 days to 2 years. The closer the bite is to the brain, the quicker symptoms will appear. If you don’t get the necessary treatments after being bitten by a rabid animal, you will die.

What to do if you get bit or scratched by an animal and you don’t know whether the animal has been vaccinated:

• Wash the wound immediately for 15 minutes with soapy water, providone iodine, or detergent to reduce the number of viral particles.
• Get a dose of rabies immune globulin as soon as possible
• Get a series of rabies vaccines that you’ll need to take over the next 2 to 4 weeks as soon as possible

You can read more information about rabies on the CDC website.

The CDC recommends getting a vaccine if you’re traveling to Southeast Asia for a long time or if you are doing a lot of outdoor activities like hiking, camping, etc.

Tips to Help You Avoid Getting Sick in Southeast Asia

1. Get Travel Insurance that covers COVID19

This first tip is actually not going to help you AVOID getting sick in Southeast Asia. But it will help if you get seriously ill and you need to spend a long time in the hospital. Insurance is going to especially help you now during COVID19. Just make sure that your insurance covers the coronavirus and/or pandemics.

The best thing about Southeast Asia is that seeing or doctor for minor ailments is not expensive. In fact, I visited the doctor four times when I was in the Philippines and each time, it cost me US$20 – $40, less than my deductible.

However, accidents happen and you should always be prepared.

Insurance companies are undergoing a lot of changes since the beginning of the pandemic. What was true in the past may not be true in the future.

I used Safety Wing when I was traveling earlier this year. Their insurance was really affordable even though I was over 40 (under US$100 a month) at the time. I was also able to pay month-to-month. Most insurance companies for long-term travel make you pay for a year-long policy. However, they wouldn’t cover me when I was in Malaysia because the country was under a level 4 travel warning from the CDC.

Safety Wing now has a pricier policy that covers pandemics and COVID19 regardless of the CDC’s warning system. You need to purchase a whole year’s coverage and the cost is double their old policy.

Another popular travel insurance company is World Nomads.

2. Get Vaccinated

Probably the best way to avoid getting sick in Southeast Asia is to get vaccinated. Vaccines can protect you from getting sick from contaminated water and food, rabid animals, and mosquitos with malaria.

In order to know what vaccines to get is to BOTH visit your country’s public health department website (CDC and NHS) AND get one-on-one advice from a travel clinic. 

According to the CDC, there are three types of vaccines that you should consider getting:

• ROUTINE VACCINES – These are vaccines that should be current. These include your Tdap (Tetanus, diphtheria, and pertussis) every 10 years; MMR – Measles, Mumps, and Rubella; Varicella – Chickenpox; and a yearly flu vaccine. The CDC has a chart of which routine vaccines to get.
• RECOMMENDED VACCINES – These are vaccines that are not required for entry into a country but the CDC recommends that travelers get them.  The CDC usually says most travelers should get typhoid (contaminated food or water) and Hepatitis A (contaminated food or water) vaccines. Other possible vaccines depending on your activities, destinations, and length of stay include Japanese Encephalitis, Hepatitis B, rabies, and malaria.
• REQUIRED VACCINES – These are vaccines that some countries require you to have in order to enter. The most common one is the Yellow Fever Vaccine. If you’ve just been in a country with yellow fever such as Peru, you’ll need to show that you have the vaccine in order to enter a country.

You’ll want to start getting your vaccines several months before your trip because some require more than one dose spread apart over weeks or months.

Do your own research before visiting a travel clinic and have an idea which parts of the country you’re planning to visit. 

When I was going to Myanmar, I researched the location of malaria outbreaks, so I knew that it was just in the western part of the country and not in the more touristy area around Bagan. However, when I went to see a doctor at my local travel clinic for immunizations for my trip, she said I needed to take malaria pills for the whole country. I challenged her on this point, and after reading the fine print on the CDC website, she agreed with me. Don’t rely on health care professionals to know specific information for every country.

3. Protect Yourself Against Respiratory Illnesses

COVID19 is a respiratory illness. However, there are other respiratory illnesses that you can get like bronchitis and the flu. You’ll want to take extra precautions to protect yourself against any respiratory illnesses.

Based on the suggestions by the CDC, here’s what I’m going to do when I travel:

• Wear a mask
• Wash hands with soap – so many people (travelers and locals in Southeast Asia) don’t wash their hands after going to the bathroom;
• Use hand sanitizer
• Avoid staying in dorm rooms
• Keep a physical distance from others of at least 2 meters (6 feet)
• If eating in restaurants, eat outside or do takeaway or get food from grocery stores and markets
• Pack an oximeter, thermometer, and pain medicine
• Pack vitamins to boost your immune system

4. Protect Yourself Against Mosquitoes

Since mosquitos that carry dengue fever are so common in Southeast Asia and malaria exists in certain parts, you’ll want to protect yourself against these buggers.

Mosquitos with dengue are found in urban areas during the day and malaria are found in rural areas between dusk and dawn.

Here are some of the things I do:

MOSQUITO REPELLANT: I always bring mosquito repellent with at least 30% DEET with me on every trip. Getting DEET that’s higher than 30% doesn’t protect you more; it just lasts longer.

For a month-long trip, I usually bring 2 small bottles of repellent: one spray and one lotion.

My favorite brands are Ben’s 100% DEET Mosquito, Tick and Insect Repellent spray and Ultrathon insect repellent lotion.

WebMD has a list of suggested mosquito repellants.

CLOTHING: In the evenings, I wear pants and shoes with socks. When I’m sitting at a table, I will sometimes tuck my pant legs into my socks. Mosquitoes seem to love my ankles, my elbows, under my knees, and the back of my legs. I also spray it on the outside of my pants and shoes. You can read more here on how to properly apply mosquito repellent. 

MOSQUITO COILS: When you’re at a restaurant, ask if they can put mosquito coils under or next to your table. Mosquitos seem to love to hang out under tables.

PROTECTING YOUR ROOM: In Southeast Asia, you’ll often find that hotels and hostels don’t have screens on windows. Air conditioning generally keeps mosquitoes away. You won’t need a mosquito net then. A fan can also help keep mosquitos away, but it’s not as effective as an air conditioner. If you don’t have air conditioning, use a mosquito net. And make sure the net is tucked under your mattress and all around your mattress.

MALARIA PILLS: In order to avoid getting malaria, take malaria pills. Make sure you visit a travel clinic before your trip to get the appropriate kind.

MOSQUITO BITES: Whenever I get mosquito bites, I put hydrocortisone cream on them to stop them from itching.

5. Don’t Drink the Tap Water 

Some parts of Southeast Asia have serious issues with their water supply. This is especially true on very touristy islands such as Palawan in the Philippines where over-tourism has pushed the sewage system to its limit.

To avoid getting sick with dysentery or giardia, NEVER ever drink the tap water in Southeast Asia. Singapore is an exception. Buy either bottled water or use filtered water.

The good news is that if you stay in hostels, there are usually water dispensers for guests to use to refill their water bottles.

You can bring your own water bottle to Southeast Asia. A lot of people recommend Life Straw water bottles. They supposedly filter out bacteria and protozoa but they don’t filter out viruses.

I bought a Grayl Geopress Water Purifier with me to the Philippines. It will actually filter out all viruses, bacteria, and protozoa. It will also filter out pesticides, chemicals, heavy metals, and microplastics. Then you can drink from any freshwater source, including from the faucet in your hotel room.

6. Don’t Brush Your Teeth With Tap Water

I used to always brush my teeth with tap water when I traveled. I was just too lazy to use bottled water. I don’t think I’m alone in doing this way either. But I would get traveler’s diarrhea every time I traveled to Southeast Asia.

Then I read the horror stories of people getting sick in El Nido in the Philippines, and I vowed that on my trip there I would NOT brush my teeth with tap water. And I didn’t. I either filled up my water bottle from a water dispenser or used my Grayl Geopress Water Purifier. And I never had diarrhea or got a stomach bug during my two months traveling around the country. I’m a convert now! I will never use tap water when I brush my teeth. 

I also think with COVID19, you need to do everything possible to keep your immune system strong. Don’t compromise it by using contaminated water to brush your teeth with. 

7. Be Careful What You Eat

One of the best ways to avoid getting sick in Southeast Asia is by being careful with what you eat. As mentioned earlier, illnesses related to contaminated water and food are very common in Southeast Asia. Eating these foods can lead to traveler’s diarrhea and other symptoms.

Here’s what you can do to avoid getting sick:

• Eat street food that’s been cooked in front of you; if you see food that’s been laying out, avoid it.
• Avoid raw vegetables like salads – You don’t know if they’ve been washed in clean water or not and you don’t know if the person handling the food washed their hands after going to the bathroom
• Avoid eating peeled fruit – You don’t know if it was washed in contaminated water or if the food handler washed his or her hands after using the toilet.
• Avoid ice in drinks as you don’t know what kind of water the ice comes from.
• When choosing where to eat, look for a place that’s packed with locals. These people know what’s best. 
• Make sure the meat you eat has been cooked thoroughly.
• Don’t assume that the food in your hotel is automatically going to be uncontaminated.
• Wash your hands frequently with soap and water especially after using the toilet. Carry hand sanitizer with you in case there is no soap and water.

8. Protect Your Skin

When you’re in Southeast Asia, you’ll be spending most of your time outdoors, so you’ll need protection for your skin against sunburn.

Make sure to bring sunscreen with you that is at least a 30SPF.

I usually bring Neutrogena for my face and Banana Boat for the rest of my body.

If you forget to bring sunscreen or run out of the one you brought, don’t freak out. You can buy sunscreen (including Banana Boat) in touristy areas in Southeast Asia. However, prices tend to be high. Shop around. I noticed that prices vary from shop to shop.

A lot of people get sunburned because they apply sunscreen wrong. It’s crucial to put sunscreen on 30 minutes before being in the sun, which is also beneficial for the coral. Reapply every 90 minutes. It’s so easy to forget this last part. Don’t underestimate the sun in Southeast Asia.

In case you do get burned, make sure you have aloe vera gel with you. It contains vitamin E, and can help heal your skin.

9. Avoid Heat-Related Illnesses

One of my worst experiences in Cambodia was the time I stayed out in the sun too long and got heat exhaustion. I don’t think I’ve ever had a headache that bad before. I’m not alone. I’ve met countless travelers who’ve gotten sick from lying on the beach too long. 

The CDC has a great explanation of the different kinds of heat-related illnesses that you can get. Here is a brief overview of the most common ones for Southeast Asia:

• Heat exhaustion: Symptoms include heavy sweating, cold, pale, and clammy skin, fast, week pulse, headache, nausea, vomiting, dizziness, fainting, feeling weak
• Heat Stroke: This is more serious and requires immediate medical attention; symptoms include high body temperature, hot, red, dry or damp skin, fast, strong pulse, headache, nausea, vomiting, dizziness, losing consciousness
• Heat Rash: read clusters of small blisters that look like pimples on the skin

Here are some things you can do to avoid getting heat exhaustion and heat stroke:

• Wear sunscreen – It’ll help cool down your skin and thus cool down your body temperature
• Take breaks from the sun and spend time in the shade – If you’re in a city like Singapore or Bangkok, take breaks indoors at cafes, restaurants, or museums; if you’re at the beach, move into the shade or stop by a restaurant or café to eat or drink.
• Drink lots of water and less alcohol and coffee
• Don’t push yourself and do too much when you first arrive. It takes time to acclimate yourself to the heat and humidity of Southeast Asia if you come from countries with milder climates.
• If you’re feeling weak, rehydrate with something like Gatorade.

10. Wear Good Shoes

If I could go back in time and give my younger self one piece of advice, I would tell her to always wear good shoes. I learned this the hard way when I was in Japan a few years ago and ended up in the emergency room with an infected blister because of plantar fasciitis and bunions.

You’re going to be doing a lot of walking when you’re in Asia (20,000 steps a day), so you’re going to need good shoes.

I no longer wear fashionable shoes when I travel (or even when I’m back home at work or out and about). I only wear my Brooks Andrenaline GTS 20 running shoes.

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These are amazing shoes–so comfortable. They’ve got a really wide front toe box. Perfect for anyone suffering from bunions and plantar fasciitis. And they’re supper supportive and cushiony, which is essential if you have plantar fasciitiis and bunions.

You can read more about these shoes and another pair that I love in my post on best travel shoes for plantar fasciitis and bunions. 

11. Bring Water Shoes

Water shoes are a MUST to have when visiting the beaches and going on island-hopping tours in Southeast Asia. You’ll find that the shallow areas of water are filled with rocks and other sharp objects. It’s easy to stub your toe or cut yourself. Water shoes will also protect your feet when climbing on and off and over boats when you’re on island hopping tours. I met someone who broke her toe while on an island hopping tour.

Water shoes will also protect your feet from hookworms found on beaches. I met another traveler who got a worm in his foot on Malapascua Island. You can read up about how you can get a hookworm by walking barefoot on beaches. 

12. Put Together a First-Aid Kit

Rick Steves says that you don’t need to add extra weight to your backpack by including a first-aid kit when traveling to Europe. THIS is NOT true for traveling in Southeast Asia. it’s sometimes hard to find medicine that is equal in strength and efficacy to what you’re used to back home, so if you really want to avoid getting sick in Southeast Asia it’s essential that you leave for your trip prepared.

First of all, have a good case to put your medicines and other preventive measures in. I bought this simple clear one from Amazon. I can easily see from the outside what’s in it.

Here is what I carry with me to stay healthy:

Here is what I brought with me on my last trip to the Philippines:

• Sunscreen for face and body
• Aloe vera gel for sunburn
• Mosquito repellent (spray and lotion)
• Hydrocortisone cream for insect bites and rashes – sometimes you can get sandfly bites at beaches
• Pain relief medicine – bring an anti-inflammatory drug like Aleve or Advil and acetaminophen like Tylenol since some illnesses like malaria react negatively to anti-inflammatory medicines.
• Multi-vitamins
• Bandaids – Bring more than enough because the ones in most Southeast Asian countries are scrawny and never seem to stay on – bring regular size and large  size
• Neosporin – antibiotic cream for infections
• Antiseptic for cleaning wounds
• Immodium – I take only if finding a bathroom quickly will be difficult such as on long bus and boat rides; make sure to get the smallest pack because they generally expire before one uses them all; check for an expiration date that is the furthest out possible
• Cold tablets
• Cough suppressants (cough drops)
• Contact lens cleaning solution (can be hard to find in smaller towns)
• small pair of scissors
• tweezers
• Zicam
• Cotton swabs (Q-tips)
• Mini icepack (My right knee swells up like a balloon after walking for a long time)
• Extra pair of glasses plus your eyeglass prescription
• Prescription medication – kept in the original container

Here is what else I would bring the next time I travel anywhere:

• Oximeter – A small oxygen reader to check to see that you have enough oxygen; necessary for COVID19
• Thermometer – another necessary item for COVID19
• Debrox – earwax remover drops – My ears kept on getting plugged up in the Philippines and their medicine only made my ears worse
• Face mask to protect against COVID19
• Vitamins: Vitamin C, Vitamin D, Fish oil, and Zinc; research has shown that these vitamins can boost your immune system. A strong immune system is needed to fight off COVID19

This next item might be a bit controversial. I also go to my travel clinic and get antibiotics for travelers’ diarrhea. It was recommended to me by the last travel doctor I went to and it’s recommended by the CDC. I only take them if I’m really, really sick.

Since I am not a health care professional, much of what is written here comes from research that I’ve done. I’ve included links to the original source.

I’ve also based some of this information (wearing good shoes and water shoes) on my own experience. I’ve gotten sick and injured countless times, so I have an idea of what can help you avoid getting sick in Southeast Asia. I know that buying water shoes in the Philippine was the best thing I could have done. I know that having

Many of these tips can be used for travel anywhere in the world as well.

If you have any questions or comments about what I wrote, please leave a comment at the bottom of this post.

Happy and safe travels!