Lessons from the global response to COVID-19

April 29, 2020

With more than three million confirmed cases of coronavirus (COVID-19) around the world, including at least 200,000 deaths, this global pandemic is forcing health systems, in large and small countries, to dramatically change the way they deliver services.

As Victoria plans for the next stage of its response to COVID-19, the VHA has taken the opportunity to review how other countries have approached the pandemic – uncovering interesting case studies and discovering lessons for Victoria.

Although there have been 89 deaths linked to COVID-19 in Australia, the threat appears to have been curtailed; the ‘curve has been flattened’ across the country with a dramatically reduced daily rate of new cases. This has been achieved, so far, through a focus on suppression to ensure COVID-19 demand did not exceed health system capacity.

Image source: Twitter @ChannelNewsAsia

Singapore | 14,951 cases, 14 deaths

Singapore was an early exemplar, lauded for its ability to control the pandemic.

Using hospitals to slow the spread

Unlike Australia, people with mild symptoms were hospitalised rather than self-isolating at home. This move reduced community transmission and helped the city-state respond to the pandemic. This is a possible route for Victoria, especially with the anticipated surge on the health system not yet materialising.

Beware of the second wave

While a strong focus on tracing avoided lockdowns, Singapore’s initial response has been undermined by a second wave, largely concentrated on migrant workers. The lack of lockdown was only viable while infections from overseas were kept out, and new potential cases were detected and dealt with quickly. Singapore has since moved to a more traditional lockdown showing that while testing can enable greater freedom, vigilance is still required to limit resurgence, especially among more vulnerable populations.

Image source: Twitter @Sweden.SE

Sweden | 19,621 cases, 2,355 deaths

While Sweden has taken the most atypical response to the pandemic, it is still not clear whether this has helped or hindered the country’s ability to respond to COVID-19.

A reliance on social responsibility

Sweden’s idiosyncratic culture, developed over many years, has meant a focus on individual responsibility with minimal government intervention covering the closure of schools and universities, banning of gatherings of more than 50 people, and encouraging people aged over 70, and those who feel ill, to stay home. Bars and restaurants have remained open. As well as keeping the economy and society functioning, the focus on individual responsibility was aimed at ensuring a longer period of compliance from citizens compared to mandated lockdowns. This is something for other locations to consider as they ease restrictions.

Social distancing not enough, particularly for the most vulnerable

More than half of the country’s COVID-19 deaths have occurred in aged care homes. While ill people have been encouraged to stay at home, the lack of enforcement has likely impacted the most vulnerable. As Victoria moves into a new phase, it is important to remember a lack of enforcement could impact our most vulnerable members of the community.

Image source: Twitter @RLHOPS

UK | 161,000 cases, 21,678 deaths

The UK’s struggle to control the pandemic has been linked to poor communication.

Clear communication is critical

Testing was poorly communicated in the UK. Following intensive community testing, these measures became heavily restricted, focusing on hospitalised patients. This change occurred as the virus outpaced the capacity to test and trace, which required changes to ensure the health system was ready. These changes were not effectively communicated, with limited testing becoming a major issue.

The importance of scalability in health systems

The crisis has highlighted the ability of the NHS to scale to meet demand. A national recruitment campaign saw 4,500 recently retired professionals return to work alongside half a million volunteers. Doctors from across all specialities have been redeployed and staff rotas and wards have been redesigned to accommodate the anticipated surge in patients, with a 4,000-bed hospital created in the ExCel Centre in London. While Victoria has not yet experienced a demand surge on its health system, the UK experience demonstrates the value in maintaining a scalable health system.

Image source: Twitter @GovernmentZA

South Africa | 4,996 cases, 93 deaths

South Africa has had the strongest response to COVID-19 on the African continent, but this may be curtailed as it deals the reality of lockdowns.

Testing over social distancing

An extensive testing regime has been implemented to stop the spread before it could take hold. The approach draws on South Africa’s considerable experience fighting other infectious diseases, its extensive network of community health workers, and recognises that social distancing is not always practicable in dense, poor neighbourhoods. The focus on testing over social distancing could be a tactic Victoria considers to ensure more vulnerable populations are not impacted.

Forced to open up

While South Africa implemented immediate measures to curtail the pandemic, the response will require a multi-year approach. The lead of the public health sub-committee, which advises South Africa’s decision-makers, has told the public: ‘We are not returning to normal for the next two to three years’. South Africa is preparing for waves of the pandemic over the next few years, with lockdowns potentially becoming a regular part of life. While the economic impact of the lockdown continues to be felt in Australia, South Africa’s example demonstrates that lockdown measures do have to end or cause worse social and economic outcomes.

Image source: Twitter @BBCWorld

South Korea | 10,752 cases, 244 deaths

While South Korea initially struggled to contain COVID-19, they are now a leading example on how to contain COVID-19 and embrace a ‘new normal’.

Transparency key to tracing

Due to its digitalised society, the South Korean Government has been able to easily trace the movement of diagnosed cases, using CCTV footage to help identify potential contacts. Those in close contact with the infected are asked to get tested, while indirect contacts are ordered to self-quarantine for fourteen days. Their tracing ability relies on transparency, with the South Korean Government keeping people informed and texting citizens when a case of COVID-19 is discovered nearby. This approach has meant South Korea has, so far, avoided a second wave, maintaining its processes, and finding an equilibrium its population can manage.

Learning from the past

South Korea’s response is heavily based on its experiences with the 2009 ‘swine flu’ and the 2015 MERS [Middle East respiratory syndrome] outbreaks. These outbreaks prompted changes, especially in relation to early testing and detection. Key lessons from the 2015 MERS outbreak facilitated the development of rapid responses such as drive-through testing that reduces testing time and protects medical staff. By conducting nearly 15,000 tests per day, health officials have been able to screen some 250,000 people, about one in every 200 South Koreans, since January. Victoria must use its experience of COVID-19 to prepare for the next pandemic.