Table 1.
A select list of nations that highlight approaches that nations took to manage C19.
| Country | Measures | References |
|---|---|---|
| Australia | Australia’s early physical distancing measures, stable political system, stable wealth, and geographic isolation may have contributed to its relative success in managing the C19 pandemic. Widespread public support for physical distancing measures and the government’s financial support for individuals and businesses afflicted by the pandemic meant that these measures could be quickly put in place. On the other hand, confused and inconsistent communication, especially in the early stages of the pandemic, detracted from government efforts to manage its response. The pandemic exacerbated existing social inequalities, highlighted by racism and dependence on import industries. Measures to reduce social inequality through secure employment are likely to be juxtaposed against measures to contain the costs of employment in forthcoming policy debates. The impact of the withdrawal of job placement schemes while unemployment remains high will likely exacerbate social inequality. The Australian health system’s response to C19 attempted to manage the spread and increase due to its limited number of intensive care unit beds across the continent nation, and the limited supply of ventilators, masks, and personal protective equipment (PPE). New skills and ways of working were required within the health system: these included contact tracing, telehealth, and leveraging resources from the private hospital and health sector. The Australian Therapeutic Goods Administration instituted procedures for rapid deployment of a range of medical devices used in the treatment of the disease, including ventilators and point-of-care testing kits, and increasing the availability of PPE. | [9,10,11] |
| Belarus | Government authorities initially denied the virus was a public health hazard. Later, they announced that drinking vodka and working in the fields offered protection from C19. Due to its official rejection of the pandemic, Belarus did not impose any quarantine measures, did not restrict cultural activities, events, or the retail industry, and instead operated on a campaign to ignore the existence of the SARS-CoV-2 virus. Although geographically isolated and distant from pandemic epicenters in western Europe, C19 finally reached Belarus, forcing measures for self-quarantine, social distancing, mask-wearing, and avoiding shops and public gatherings. | [10] |
| Brazil | The C19 pandemic created hardships for developing countries such as Brazil. From January to March 2020, the pandemic reached crisis proportions that exacerbated political, social, and economic problems. However, Brazil also reaffirmed its leadership and coordination capacity, especially in fiscal and economic measures, while the number of healthcare jobs decreased. In large part, healthcare workers were supplied with the necessary PPE following WHO recommendations. However, most healthcare workers did not receive proper training for treating patients suspected of coronavirus infection. Physicians and nurses were overworked and suffered fatigue. Many healthcare workers reported difficulty sleeping as a result of pandemic stress and workplace fatigue. | [12,13] |
| California | As a case example of a state in the U.S. where it is difficult to oversee a federal role, following the establishment of Critical Care Services and public health guidelines, C19 patients received better care, and mortality dropped to 0.008%. The public health guidelines involved social distancing, hygiene education, widespread C19 testing, acquiring a substantial inventory of ventilators, PPE for healthcare workers, and ample therapeutic drugs and pharmaceutical supplies. The expansion of resources, including ICU capacity, trained staff (mainly physicians, physician assistants, nurses, and respiratory therapists), and supplies expanded from 20% to 100% in the contingency and upwards of 200% during the peaks of the C19 crisis. | [3] |
| China | China responded rapidly and effectively to contain the virus within the Wuhan province where the outbreak began and quickly recovered due to social contact restrictions that were strictly observed. The success was achieved by rapid establishment of lockdowns and construction of modular hospitals, use of state-of-the-art equipment for population-level diagnostics, recruitment of the best health workers, systematic population screening with testing and isolation, prevention of nosocomial transmission, the development of two vaccines, and subsequent administration of an unparalleled vaccine campaign. | [14,15] |
| Finland | Finland was the only country to initiate a hybrid strategy to control the C19 spread by shifting from large-scale restrictive measures to more targeted pandemic management measures. Border entry restrictions excluded outside visitors, while Finnish citizens were required to remain in a 2-week quarantine upon re-entry. Non-essential retail operations were closed, while essential retail was allowed (e.g., grocers and pharmacies). Educational institutions suspended on-site activities. The public health institutions and small businesses were financially supported to relieve economic consequences; consulting services that support health care and business were developed. | [10] |
| France | Following the well-publicized case explosions in Italy and Spain, and despite it being a foreseeable event, France failed to advance stocks of medical supplies, PPE, and tests for SARS-CoV-2 detection. As cases mounted, the government enacted measures to restrict public gatherings, and the operations of restaurants, shops, schools, and non-essential activities; however, the government funded essential activities, focusing on supporting the healthcare system. | [10] |
| Hungary | In March 2020, authorities declared a state of emergency and adopted a law to enact restrictions without the oversight of the parliament. Government communication with citizens was inadequate, and therefore heavily criticized by the population, leading to non-compliance by the citizenry. Financial measures were created to support businesses and entrepreneurships by tax abatements and accelerated VAT refunds as a means to ameliorate the economic impact of restrictions. | [10,16,17] |
| Iceland | The primary healthcare in Iceland managed to accomplish its role as a first-line gatekeeper and was able to change its strategy swiftly in an effort to deal with C19. At the same time, traditional maternity and well-child care was preserved. The use of primary healthcare for non-C19-related issues decreased, indicating substantial flexibility in the organization. Iceland has been lauded for its approach to handling the virus, which has led the way in terms of the gathering of scientific evidence and its implementation in policies. Iceland has used the resources of deCODE, a private sector genetics firm located in Reykjavík, in tandem with the public health services to track the health of every individual in Iceland who has tested positive for the virus and, uniquely to this nation, sequenced the genetic material of each viral isolate and screened more than half of the nation’s population for infection. This information has informed the recommendations of the chief epidemiologist in Iceland concerning border controls and domestic restrictions. |
[18,19] |
| India | An ill-equipped infrastructure and anemic pool of public healthcare professionals led to major failures to slow the C19 spread. Lockdown periods were extended, and measures were taken to equip care centers with C19 facilities, increase the ranks of trained healthcare professionals, and provide the population with PPE. | [20,21] |
| Italy | Initially one of the most affected countries in the world in early 2020, Italy altered strategies to focus on reorganizing medical departments and supplementing intensive care beds, closing/blocking activities considered non-essential, financially supporting businesses, and creating isolation areas that reduced risks to healthcare staff. | [22] |
| Japan | The Japanese understood the importance of self-quarantine, the telemedicine services worked intensely, being useful to people who could be treated at home, the medical staff understood and respected the rules of protection. | [23] |
| New Zealand | New Zealand adopted a set of non-pharmaceutical interventions aiming to bring C19 incidence to zero. The transmission chains were spread out across the country, with the highest incidence in popular tourist areas, and large transmission events such as weddings led to transmission chains containing multiple age groups. The reconstruction of detailed epidemiological links is paramount to improving understanding of the spread of SARS-CoV-2 and keeping close surveillance on settings with a high risk of transmission. | [24] |
| Pakistan | The containment measures included self-isolation, social distancing, restricting public gatherings, supplementing public health facilities and staff, concentrating human resources on areas treating patients with C19, providing necessary resources and equipment, and mental and economic support for the population. | [25] |
| Romania | A disorganized and under-funded healthcare infrastructure coupled with poor organization by government authorities caused serious failures to address public health and led to a widespread and rapid outbreak. A lack of medical professionals trained in infectious diseases created a massive shortfall in C19 patient care. Once a State-of-Emergency was declared, non-specialist physicians and healthcare workers were deployed to staff C19 sectors. As a result, healthcare workers came in regular contact with a large number of C19 patients, which magnified contamination risks and further strained the healthcare infrastructure. Health-care workers were not provided sufficient Personal Protective Equipment (PPE) and worked overtime without adequate rest, which led to declines in performance from illness, stress, and fatigue, which essentially broke the healthcare system. As in other nations, non-C19 patient care needs were reclassified and thereby canceled or postponed, further complicating the public health situation. | [26,27,28] |
| Russia | Russia initially denied the severity of SARS-CoV-2. The government sent aid to other areas affected earlier in the pandemic (e.g., Italy and Serbia). Subsequently, as Russia faced its own C19 outbreak, they ran out of necessary supplies to combat contagion spread. Soon thereafter, Russia closed its borders, first to China, and then to all foreigners, but throughout it appeared more concerned with financial stability than the public health crisis. | [29] |
| Spain | In the beginning, testing was not provided to health workers that had been exposed to patients with C19, resulting not only in dangerous conditions for workers themselves and the people in close contact with them but also for other patients hospitalized for conditions not related to the C19. Another consequence of the lack of testing was the possible underreporting of cases, resulting in overestimated mortality rates being reported due to the lack of certainty on the real number of positive cases of C19 in Spain. Finally, the lack of surveillance and case detection potentially caused the further spread of the disease, as many of the unidentified cases did not follow recommended isolation measures. Overall, the lack of testing resulted in a symptom-based strategy to control the disease, which was unlikely to succeed at stopping disease transmission due to the characteristics of SARS-CoV2, which had been reported to cause a high proportion of asymptomatic and mild cases. In addition to the consequences seen in the healthcare sector, government interventions also had severe impacts on the public. These impacts included the economic recession generated by confinement measures that caused an unprecedented situation which is predicted to have multiple short and long-term effects on the Spanish economy. Additionally, psychological consequences occurred due to the restricted freedom, decreased social contact, and persistent insecurities caused by the health threat and the control measures; children, adolescents, and young adults are particularly vulnerable to these consequences given the important role of socialization. The outbreak has had a severe social impact; senior citizens, children, and women at risk of violence, families, and individuals at risk of poverty, migrants, socially excluded groups, and people with low-paying or informal jobs are some of the groups that have been severely affected by the psychological, economic, social and health consequences of the pandemic and the measures to control the spread of the outbreak, aggravating the existing inequalities across the population. To be able to meet the needs of the epidemic, health professionals decreased their regular activities at the hospital to focus all their working capacity on tackling the C19 crisis, decreasing the capacity of non-urgent and specialized medical services. | [30] |
| Sweden | Based on advice from the national epidemiologist, the government elected few social restrictions except for border controls. Instead, it opted for a herd immunity approach to achieve seroconversion. It is unclear if this approach succeeded, although the mortality rate remains below 1%, while still higher than other Scandinavian nations with Norway the lowest by a factor of 10. | [31] |
| Switzerland | Medical resources were strengthened by public-private partnerships that increased isolated treatment areas for C19, separate from other patients; supplementation efforts were extended to aid medical staff and increase availability of medicines that enhanced patient care. | [22] |
| Taiwan | The containment of SARS-CoV-2 dissemination was very effective and the population infection rate stopped at the level of hardly more than 0.6 percent. Strict border control and the effectiveness of contamination programs have isolated the pandemic in a few local niduses, mainly in Taipei and Taoyuan. | [21] |
| United Kingdom | As the number of cases rose rapidly, government measures focused on patient care and providing medicine, such as PPE, ventilators, and intensive care units. Although a lockdown was enacted in March 2020 and was viewed with some skepticism, the measure came late as cases continued to rise and overwhelm the healthcare system. Researchers and physicians collaborated in drug discovery to develop the Oxford–AstraZeneca C19 vaccine. | [32] |
| United States | Although access to information is high, the government lost touch with the population during the pandemic, and disinformation caused mistrust in public health authorities and advocates of protective measures such as vaccination campaigns. Much of the population grew fatigued over mandates and contradictory statements regarding C19, polarizing the people into two fractions, one of which ignored mandates of quarantine or public distancing. The most common systemic problems worsened during the pandemic, as inadequate supplies and an ineffective distribution system led to increased community spread. Perhaps the greatest failure of the U.S. at the onset of the pandemic was the delayed restrictions on international travel, which allowed individuals afflicted with C19 entry into international airports, notably in Seattle and New York. | [33,34] |
| Ukraine | The healthcare system was unprepared and therefore overwhelmed. Authorities were forced to adopt a pandemic response and instituted a quarantine on 12 March 2020, eight days after the first case was documented. The government appealed to the private sector entrepreneurs and businesses for monetary assistance in managing the economic and public health crisis. This internal aid provided the necessary equipment and PPE and supported healthcare facilities. After restrictions were lifted, widespread adoption of masks was put in place, public events were restricted, and the over 60 populations were advised to isolate themselves from public exposure. The government facilitated and supported small businesses, cut interest rates, and substantially increased the health sector budget. | [10] |
| Vietnam | A number of countries in East and Southeast Asia managed C19 spread quite effectively, notably by promoting hygienic practices to prevent spread, specifically personal hygiene, and food and water hygiene. | [35] |
Included here are island nations, which due to their geography, were better able to implement containment protocols. Sweden is also included as a notable nation that rejected social control measures taken by the majority of nations in an attempt to achieve herd immunity.