LONDON – Keep calm and carry on, said Britain, the country with the least restrictive coronavirus measures in Europe (before sharply altering course March 16 amid a new “catastrophic” warning about how many people could die). Batten down the hatches, says China, the nation that is not far from declaring total victory over the COVID-19 epidemic that swept its Hubei province. “Test, test, test,” says Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization.
And the United States? Which countries should it look to for guidance about how to combat a disease that’s infected more than 740,000 worldwide and killed over 35,000?
The majority of global public health experts believe that countries need to act quickly and decisively to reduce what Robbert Muggah, a leading Brazil-based risk and security specialist, said “represents the most significant threat to population health and political and economic stability in a generation.” These measures include easy and efficient access to testing and results, rigorous contact tracing, consistent science-based messaging, quarantines and a genuine commitment to clamping down on socializing.
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“If you have a fire on your hands, we all know you have to stamp it out fast,” said Nicholas Chater, a professor of behavioral science at Warwick Business School, in central England. “There’s no point thinking: ‘Well, we don’t want to put it out too soon.'”
But Chater added that while scientists are learning more about COVID-19 every day, publics around the world will need to get used to something they don’t like: uncertainty. “It could be that we can hold this thing back. We just don’t know. No amount of modeling can fix that problem,” he said, noting that, with a vaccine potentially months or more away, scientists need time to understand the virus’s genetics, how it mutates, transmission rates, the viability of cures and the experiences of different countries.
Still, while it may be too early to draw definitive conclusions about how to respond to COVID-19, some countries have taken actions that have appeared to yield results, while others are struggling to contain and combat deepening public health crises.
The Australian government activated its emergency response to COVID-19 on February 27, designating it a global pandemic much earlier than the World Health Organization and any other advanced economy in the Group of Seven nations.
Michael Wallach, a vaccines expert at the University of Technology Sydney, said that this enabled authorities there to quickly release emergency funding and tax breaks, and bought precious time for its hospitals to prepare for a potential flood of patients.
As of March 30, the death toll for the country stands at 17, with more than 4,300 confirmed cases. Everyone traveling to Australia must self-isolate for 14 days, whether or not they have had potential exposure to the new coronavirus.
Prime Minister Scott Morrison has closed Australia’s borders.
Wallach said that Australia’s early labeling of COVID-19 as a pandemic has been helpful for preparedness, but it also brought “early panic,” noting the country was among the first to see consumers stockpile toilet paper.
Prime Minister Boris Johnson has acknowledged that Britain is facing its “greatest public health crisis” in decades. As of March 30, Britain’s outbreak has lagged behind its European counterparts, with more than 19,500 infections and about 1,300 deaths.
Johnson, who himself has tested positive, has conceded that “many loved ones will die.” Yet from the start he has also appeared to pursue a relatively laissez-faire, and controversial, policy based on the idea that, because COVID-19 will spread widely in society, the country’s best bet will be to try to get to “herd” or majority immunity as quickly as possible. The thinking behind this is that it will protect the country in the long term if, as happened with the 1918 Spanish Flu, a highly fatal second wave of infections occurs at some point in the future.
The concept is not only a massive political gamble. Medical experts say evidence to support the theory won’t be available until people who have the disease have recovered and been studied for months. It’s also not clear how long any immunity would last. Infections could reoccur. Late on March 16, Johnson dramatically changed tactics after researchers at Imperial College London projected that around 250,000 people in Britain would die if “chains of transmission” for the virus weren’t immediately slowed or broken.
The British government has now imposed a total lockdown, with only essential trips to supermarkets and for medicine, as well as exercise, permitted.
Germany, France, Spain
Authorities in Germany adopted relatively strict measures early on, including closing all schools and day-care centers and banning gatherings.
Museums, movie theaters, gyms, swimming pools and nightclubs have also been temporarily shuttered. German Chancellor Angela Merkel has also outlawed overnight stays in hotels unless absolutely “necessary and expressly not for tourist purposes.”
The measures introduced by Merkel follow an abrupt about-face for Germany’s leader. For several weeks, she had argued for close coordination with fellow European Union member states to slow the spread of the virus. But amid a fast rise in the number of infections, Merkel closed Germany’s borders with Austria, Switzerland, France, Luxembourg and Denmark. Germany has over 63,000 confirmed cases and 550 deaths, a relatively low figure that public health experts have been at pains to explain. Germany has undertaken a large amount of testing, has a higher-than-average number of critical care beds and is also one of the main European manufacturers of ventilators.
French President Emmanuel Macron has also strongly limited movement in France. Only trips to the doctor and to food stores will be allowed. Macron also delayed elections. As of March 30, France had more than 40,174 cases of the virus, including 2,606 deaths. Spain, the most virus-infected nation after Italy and the U.S., has taken similar actions to France. It has more than 85,000 cases and 7,300 fatalities.
More than 4,300 people have been diagnosed in Israel, with the number quickly rising. Prime Minister Benjamin Netanyahu has closed Israel’s borders to all foreigners.
On March 17, Netanyahu announced that the country’s highly secretive Shin Bet internal security service would soon begin deploying its highly sophisticated counter-terrorism technology to help curb the spread of COVID-19 in Israel.
The agency’s capabilities are normally used to track Palestinian militants.
In a statement, Shin Bet head Nadav Argaman acknowledged that using these digital tools to keep track of sick Israeli citizens deviates from the agency’s typical operations, but he said the goal was still in line with its overall mission of “saving lives.”
Netanyahu said the technology had never been used before on civilians and would involve a certain degree of violation of privacy. He approved its use for 30 days.
Netanyahu is self-isolating after a member of his staff tested positive.
Unlike its Scandinavian neighbors, Denmark and Norway, which have placed extensive restrictions on their borders and imposed broad-based lockdowns to stem the outbreak, Sweden has only closed some schools and largely kept restaurants and shops open.
It’s a strategy that appears similar to Britain’s, before Johnson did an abrupt about-face amid spiraling infections. As of March 30, Sweden recorded more than 4,000 cases and 146 deaths, compared to Denmark’s 2,555 cases and 77 deaths, and Norway’s 4,300 cases and 31 deaths. Denmark and Norway have similar populations of around 5 million; Sweden’s is twice that.
“Sweden has gone mostly for voluntary measures because that’s how we’re used to working,” said Anders Tegnell, an epidemiologist from Sweden’s Public Health Agency, in a CNBC interview on March 30.
“And we have a long tradition that it works rather well.”
Iran’s authorities for days denied the risk the outbreak posed even as a high number of its lawmakers have fallen ill with the disease and it has also not spared top officials, including Iran’s senior vice-president, Cabinet ministers, Revolutionary Guard members, health ministry officials and close aides to Supreme Leader Ayatollah Ali Khamenei.
The virus has killed 2,750 people amid over 42,000 cases, according to Iran’s health ministry, although there are concerns the country may be either underreporting infections or simply not know the scale of its outbreak. Years of western sanctions have puts its health system under extreme strain and officials have been slow to enforce quarantines in some areas.
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Khamenei has issued a religious ruling, or fatwa, prohibiting “unnecessary” travel after earlier warning Iranians that “millions” could die if they don’t start heeding travel restrictions and public health guidance, such as staying away from religious shrines.
Sources in Iran told USA TODAY that people in Iran have still been widely going about their business in public despite calls from the authorities for people to stay home.
Italy is only behind the U.S. as the epicenter of COVID-19, according to the World Health Organization. It has almost 98,000 infections and more than 11,000 deaths, the majority of them in its wealthy northern regions, where there are world-class hospitals.
Intensive care beds and ventilators are in such short supply in some areas that the Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care has drawn up guidelines for doctors about how to manage the crisis if the outbreak intensifies. Among the considerations: prioritizing treatment for those under the age of 80 who don’t have any “co-morbidities” – underlying health conditions. With too many patients to care for, many needing life support machines, medical staff would need to effectively choose who lives and who dies. It’s a form of triage medicine usually only seen in wartime.
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Italy has imposed a near-total lockdown on its citizens, with only supermarkets and drug stores open to the public. There are curfews and travel restrictions and its normally bustling piazzas and squares and historic sites are virtually empty.
It’s too soon to tell if Italy’s severe measures are working, although the rate of infections appears to be stabilizing.
In mid-March, an Italian citizen named Giovanni Locatelli shared Facebook footage comparing a Lombardy newspaper’s obituary section on Feb. 9, when it took up just one page, to a copy on March 13, when 10 pages were needed to commemorate the dead.
Few countries battling the virus have been as successful as Singapore.
It has 879 cases and just 3 deaths and its rate of recoveries has outpaced infections.
According to Michael Merson, director of the SingHealth Duke-NUS Global Health Institute and the Wolfgang Joklik Professor of Global Health at Duke University, the country has a number of factors that are hard to replicate: an excellent health system; strict virus testing, tracing and containment programs; a small population; and citizens who are largely accepting of what the government orders to them to do.
“There’s strong government leadership, but also trust in the government,” said Merson, who used to run the World Health Organization’s anti-AIDS program. “Every time a case is identified there is a very strong action plan to identify contacts. It’s also very good at promoting hand-washing and keeping people at a safe distance from one another.”
Merson said Singapore has allowed businesses and some universities to stay open but with very strict guidelines about the size of gatherings (25 or under). “They take prudent steps at prevention, but they haven’t entirely shut the country down. They also have experience with SARS (severe acute respiratory syndrome, a much more deadly virus), which has given them some confidence with how to deal with coronavirus,” he said.
Still, worryingly, Singapore reported 35 news cases on March 30, the highest number it has reported in a single day.
It has now imposed 14-day quarantines for all arrivals into the country.
Most of South Korea’s infections are linked to a quasi-Christian sect.
But the Asian country has still become one of the countries hardest-hit by COVID-19 outside China, with more than 9,660 infections and at least 158 deaths.
It has also put in place a rigorous screening program, with more than 200,000 people tested, about 1 in every 250 people. Testing is fast (about 10 minutes) and free (the government pays) and the results are usually sent by text within 24 hours.
South Korea was also among the first countries to roll out a drive-through testing center and it has a well-functioning virus-contact-tracing system.
South Korea, like Singapore, Taiwan and Hong Kong, is one of a number of places in Asia where authorities have appeared to have had some success “flattening the curve,” or potentially spreading out the number of its coronavirus cases over a longer period so that health systems can have time to mitigate the impact of the disease.
But Merson said that it’s not clear how long countries can continue to “flatten the curve” and if COVID-19 will only roar back once current control measures are phased out.
“We need to watch closely what happens in China,” he said, referring to its decision to start phasing in school openings and restart factories and businesses in some areas.
Despite receiving early criticism for trying to cover up the outbreak, China has been able to turn the tide of an infection that is now rapidly spreading through the global population. It reported fewer than 31 new infections and 4 deaths on March 30, bringing its total number of cases to 81, 470, of which more than 75,700 patients have recovered.
China enacted sweeping measures that forced people inside for weeks, banned all forms of public gatherings and mobilized almost 20,000 medical staff from all over the country to Hubei. At the virus’s peak, 120 million school kids were taught online.
Huiyao Wang, a senior adviser to China’s government, told USA TODAY in a phone interview from Beijing that the U.S. and other western nations need to do even more to combat COVID-19 than they are doing now, including more harsh restrictions.
“I worry that the economic impact may now cause more casualties than the virus itself,” he said, adding that the during the worst of the outbreak authorities in China visited every single household in the affected areas, meticulously took temperatures and isolated the sick in large stadiums and other venues for observation and treatment.
“I understand that some of the Chinese experience can’t be transferred, but since we have been dealing with this for months now they should take our advice,” he said. referring to what he described as little high-level contact between the Trump administration and President Xi Jinping’s government over the pandemic.
In fact, relations have appeared frosty in recent days.
U.S. Secretary of State Mike Pompeo has accused China of spreading “disinformation and outlandish rumors” and needed to stop blaming the U.S. for the spread of the disease first detected in China. Pompeo’s comments followed a false suggestion on Twitter from Chinese foreign ministry spokesman Zhao Lijian, shared and retweeted by other Chinese diplomats, that COVID-19 may have originated with the U.S. Army.
“We can help with how to build temporary hospitals, we can transfer some of our technology,” said Huiyao Wang. “Let’s have an online summit right now.”
President Donald Trump has enacted federal guidance about social distancing and cities and towns across the U.S. have already closed schools, restaurants, sports stadiums, entertainment venues.
Trump has urged Americans to refrain from gathering in groups of more than ten people to stem the spread of the virus. He has also declared a national emergency unleashing billions of dollars as part of a raft of measures aimed at bringing a roiling public health crisis – and a growing economic and financial one – under control. Trump has signed a $2 trillion coronavirus economic stimulus package.
Trump now appears to be taking COVID-19 seriously.
“If everyone makes this change or these critical changes and sacrifices now, we will rally together as one nation and we will defeat the virus, and we are going to have a big celebration all together. With several weeks of focused action, we can turn the corner and turn it quickly,” he said in a news briefing on March 16. “A lot of progress has been made.”
He has also said he hopes the U.S. will see a peak in cases by Easter.
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However, Trump continues to reject suggestions his administration could have taken action earlier, such as seeing that more testing was available, to ward off COVID-19’s threat to Americans and his earlier public comments on the matter are littered with attempts to downplay the crisis.
“We have it totally under control. It’s one person coming in from China, and we have it under control,” he said during an a TV interview from Davos, Switzerland, on Jan. 22, just a day after the CDC reported the first travel-related case in the country.