COVID-19 pandemic has highlighted the centrality of health in development and put into focus the country’s health systems in place. As the cases all over the world continue to rise and Europe and the USA become the new epicenter, doctors and health workers all over the world are keeping a close watch on possible cures and best practices to manage the disease.
Italy, with one of the largest number of cases and deaths, has been the worst hit, even though it has one of the world’s best public health systems. It is believed that Italy’s lockdown was announced too late and a lot of people escaped the red zone to spread the virus all over the country. UK’s NHS has been struggling under the load and has advised people to stay at home and asked people not to visit places like hospitals or GP surgery if they fell ill due to any other issue. Their coronavirus helpline also advises staying at home unless emergency. The USA with its private health care began testing very late and as a result, now has the highest number of cases (over 100,000). Furthermore, they are struggling with the scarcity of drugs, medical supplies, protective gear for health workers.
Amongst the European countries, Germany has reported a very low mortality rate due to COVID at 0.6 percent (the mortality rate in China is 4 percent, 10.1 percent in Italy, 7.4 percent in Spain, 5.3 percent in France and 4.9 percent in the UK.) This is mainly been attributed to extensive testing being done by Germany – as many as 120,000 people a week. Plus, Germany has excellent intensive care, the young average age of infection and a severe lockdown in place.
South Korea has also done massive testing. It initially saw a huge surge in cases –over 9000, however, these were quickly controlled. They famously set up no-contact drive-through clinics with quick results, followed by strict quarantines.
South Korea’s experience shows that diagnostic capacity at scale is key to epidemic control along with contact tracing and case isolation.
This model has been seen in other Southeast Asian countries as well. Japan, with more than double South Korea’s population, has recorded a fraction of the cases and while it hasn’t been testing as widely as South Korea, it appears to have fended off significant community transmission by quickly investigating any flare-ups of cases, identifying who exactly is infected and then monitoring their contacts.
Singapore has been particularly efficient and despite an initial surge in cases, has recorded zero deaths. It has highly effective contact tracing teams and is very liberal with testing. Communication regarding information is efficient and transparent.
Elsewhere, Israel (more than 3000 cases) mobilized quickly with lockdowns and quarantine centers, however, it has been facing resistance from ultra-Orthodox
Jewish community who live in communal lifestyles and have faced the biggest outbreaks.
The outbreak has been late to arrive in Africa and Latin America. Kenya has seen 38 cases and one death – they are already on lockdown. Things have been serious in the Democratic Republic of Congo who is just coming off an Ebola outbreak. The region also has dozens of armed groups and millions of displaced people.
Cuba has emerged as exceptional in its response. Cuba has been long credited with one of the best health systems and the doctor to patient ratio. In fact, medical workers and doctors from Cuba are now going around the world as front line responders. Brazil’s strategy has been different where the President has been against the all-out social isolation and business shutdowns believing that it causes economic devastation worse than the disease. This has placed him at odds with scientists and medical professionals in his country.
The approach can be compared to Sweden – they have not closed their borders or schools and non-essential businesses and gatherings of two or more people continue – even though the government has recommended working from home if possible and avoiding non-essential travel. Overseen by country’s Public Health Agency it is trusting the people to adopt voluntary measures to delay the spread.
Epidemiologists both within and outside have criticized this more relaxed approach, especially since it has reported more than 300 cases and more than 30 deaths. Its Scandinavian neighbors Norway and Denmark, on the other hand, have closed their borders, restaurants and ski slopes and told all students to stay at home for the month.
India with its already extremely poor health systems, negligible surveillance and hardly any epidemic control plan are most vulnerable given the size and density of its population. It has imposed a 21-day lockdown, albeit it been seen as rather late in the day, and it is believed that cases being reported are a major underestimate due to low testing rates.
Moreover, poorly executed lockdown with little notice has put lakhs of migrant workers and daily wage earners on the road who are traveling hundreds of kilometers to reach their village. Deaths due to hunger and exhaustion have already started and another tragedy is underway. Moreover, large congregations of poor workers and their families trying to board a few buses available have defeated the purpose of social and physical distancing that the lockdown was trying to achieve.
As COVID cases continue to rise countries will have to draw out a strategy that will test the limits of their public health systems, citizen’s awareness and engagements and economic fallout. COVID crisis has shown the global nature of pathogens, the increasingly interconnected world that we inhabit and how investments in public health are being central to the strength of the nation.