The majority of countries have introduced at least some nation-wide measures aimed at containing the spread of the novel coronavirus pandemic. The measures include stopping/limiting international and domestic movement, closing educational facilities, banning public gatherings or announcing quarantine, to name a few.
You may also like: COVID-19: Quarantine Measures, Laws and Limits
As ISGlobal puts it, “each country has responded – or is responding – to the same threat with different measures and/or with different timing.” This results in differences in the epidemiological curve and in the societal and economic costs. At the same time some experts warn that nations have different reporting standards, different approaches to testing, and different approaches to tracing cases, all of which makes comparisons between them dangerously misleading. "Data is useful, but I think the most important thing is looking at the experience in other countries," said Nick Chater, a professor of behavioural science at Warwick Business School, in an interview.
In any case,
proper assessment of the effectiveness of introduced measures needs time, so
for now the best examples would be places with early outbreaks – China, Taiwan,
Singapore and such.
China
81,961 confirmed cases, 3,293 deaths
China’s
approach included early lockdown and strict quarantine; severe restrictions on
international and domestic travel; use of health QR codes for permissions to move around a
city; frequent building and street sterilisation; testing, admitting and treatment
of all patients; and isolating suspected cases. The advantages of these were cooperation (even
if enforced), unburdening and rapid increase in the capacity of the health
system (eg with ‘panic building’ of hospitals). These early and drastic measures helped to delay the spread of the virus from Hubei to
other provinces.
This is
confirmed, for example, in an analysis by a global consortium of
researchers, led by the University of Oxford and Northeastern University, which
showed that human mobility played its role in the COVID-19 spread in China,
especially at the early stage. The
implementation of travel
restrictions resulted in the decrease in
this correlation and a much flatter epidemiological curve in most locations. At that point, the authors say, public health
response to curtail local transmission (eg through testing, tracing and
isolation) was most effective. The study emphasises that social distancing
works – if not immediately.
South Korea
9,241 confirmed cases, 131 deaths
Here
the strategy has relied on active, free and massive screening (including
drive-through tests) for symptomatic individuals, case contacts and travellers.
Schools have been closed, working remotely is recommended, and large gatherings
are banned. Mask wearing, sanitiser use and thermal screening in buildings are widespread.
Notably, there have been neither lockdowns nor restriction to movement.
The
UNDP Seoul Policy Centre has reviewedsome
outbreak-related practices in South Korea. Among these are disclosure of real-time information on
COVID-19 by the government via dedicated websites, mass media,
phone messages and mobile apps. Also, as of 19 March there were approximately 85 drive-through testing
stations, and nearly 20,000 people are tested every day – more tests
per head of population than anywhere else.
People under compulsory self-quarantine (eg those
awaiting the test results) are monitored through an app by government and
police, and violators are punished. Only people with severe symptoms are
hospitalised, the rest being sent home.
Private
sector companies actively participate in disseminating and collecting virus-related
information, which includes data on confirmed coronavirus patients, along
with the patient's nationality, gender, age, which places the patient has
visited,and how close citizens are to these patients.
Telecom
companies are providing the government with mobile data to monitor the movement
of COVID-19 patients.
All
of the above allow for more accurate estimations and efficient misinformation
and panic management. This strategy also facilitates cluster
identification and rapid self-quarantine, notes ISGlobal in their analysis.
Hong Kong, Singapore, Japan
Hong Kong: 454 confirmed cases, 4 deaths
Singapore: 631 confirmed cases, 2 deaths
Japan: 1,291 confirmed cases, 45 deaths
A study on resilience of systems in Hong Kong, Singapore and Japan has shown that containment
strategies there seem so far to have prevented widespread community
transmission. In these three countries surveillance systems were readjusted to
identify potential cases and their contacts, diagnostic tests were developed early
on, and laboratory testing capacity was increased.
Different
strategies were used to selectively control travellers entering these locations,
from partial entry restrictions (Singapore, Japan) to mandatory 14-day quarantine
(Hong Kong) of non-local visitors. Intragovernmental coordination was improved
based on the previous experiences during SARS and H5N1 outbreaks.
In all
locations, all direct costs for treating patients are covered by the
governments, appropriate training and adherence to infection prevention and
control measures are practiced in hospitals.
Another
advantage is the comprehensive management of information systems, especially in
Singapore, where regular meetings between regional health system managers,
hospital leaders, and the Ministry of Health are held and information is
disseminated via mainstream media, online messengers and websites.
A study conducted in a simulated Singapore setting has shown that efforts
to contain the spread of COVID-19, such as quarantining infected people and
their family members, closing schools plus quarantine and adopting workplace
distancing plus quarantine, “in that order,” can facilitate the reduction in the
number of cases.
Taiwan
252 confirmed cases, 2 deaths
Taiwan has
been another example of an efficient coronavirus
strategy. Home to nearly 23 million people, it was expected to have the second
highest number of COVID-19 cases due to its proximity to and close ties with
China.
But it had
learned from the SARS outbreak, when the National Health Command
Centre (NHCC) was created as part of a disaster management centre. The Central
Epidemic Command Centre (part of NHCC) introduced a number of immediate measures, eg inspecting
plane passengers coming from Wuhan starting from 31 December (when pneumonia
cases were announced) and banning entry for Wuhan residents on 23 January (when
the province was locked out).
Other
measures included case identification (using new data and technology),
quarantine of suspicious cases, proactive case finding and resource allocation,
among others. Taiwan’s government stopped exports of surgical face masks on 24 January
and took charge over pricing and distribution. Local companies were asked to
step up production. The government also claimed a stockpile of surgical and N95
masks (which have been divided between the public, medical and industrial
sectors) and 1,100 negative-pressure isolation rooms.
Patients
with severe respiratory symptoms were proactively identified (based on
information from the National Health Insurance database), citizens were asked to report
suspicious symptoms or cases via a hotline number. The authorities track down infected persons and map the cases while residents’ 14-day travel history is integrated with their health
insurance card data. Educating the public about the coronavirus-associated
risks and precautions has also been instrumental.
Third Wave
Despite their successes in containing the outbreaks, all these countries are now facing the ‘third wave’ of mostly imported cases and introducing new restrictions.
In Hong Kong
the number of confirmed cases has almost doubled in the past week, which has led to
new entry and transit bans, compulsory quarantine, renewal of remote work in
the public sector (with private companies following suit), with a possibility
of a comprehensive shutdown of businesses.
In Singapore
almost 80% of new COVID-19 cases over the past days were imported. The country has banned entry and
transit for all short-term visitors and there is compulsory two-week quarantine
for residents returning from abroad. Similar measures have been introduced in Taiwan.
When it
comes to the pandemic, all these countries are said to be weeks, if not months, ahead of
Europe and North America. The latter two have been slow to introduce
restrictions, which first seemed to have lower societal and economic cost, but
now are left vulnerable to the rapidly worsening crises. With lockdowns in place from
mid-March, it is still too early to tell if their strategies prove to be
efficient.
At a media
briefing on 25 March, the World Health Organization’s Director General Tedros Adhanom Ghebreyesus indirectly expressed similar
concerns. He called the “unprecedented measures” introduced around the world in the context of
the novel coronavirus outbreak, “buying time,” and urged all the countries “to
attack the virus,” enabling “the more precise and targeted measures that are
needed to stop transmission and save lives.”
In this
context, WHO recommends six key actions:
- Expanding, training and deploying healthcare and public health workforce.
- Implementing a system to find every suspected case at community level.
- Ramping up the production, capacity and availability of testing.
- Identifying, adapting and equipping facilities to treat and isolate patients.
- Developing a clear plan and process to quarantine contacts.
- Refocusing on suppressing and controlling COVID-19.
According to
the Director General, these will help to suppress and stop transmission, “so
that when restrictions are lifted, the virus doesn’t resurge.”
At the same time, Matthew Jackson, the William D. Eberle
Professor of Economics in Stanford’s School of Humanities of Sciences, said in an
interview that the current efforts, both on national and global levels,
lack coordination, which “may end up being very costly for the world.” He noted
that while one area was slowing the virus down and getting it under control, it
was growing somewhere else. “Once it is under control in the first area, it can
return from another area.”
As of 26 March, there were 462,684 confirmed COVID-19 cases in the world, with 20,834 deaths.
Note: all data (except for Hong Kong and Taiwan) on the number of confirmed cases and fatalities come from the WHO Situation Report #66 (26 March). The latest reports can be found here.
If you want to share your experience and perspective on COVID-19, please do.
If your company is interested in engaging with our COVID-19 community, please send us anemail.
Image
credit: Mx. Granger – Own work, CC0, Wikimedia
Commons