TABLE 3.

Describing selected Indicators and domains of public health policy response (Switzerland, Spain, Iran and Pakistan, January–July 2020).

Domain of response	Switzerland	Spain	Iran	Pakistan
Governance
Coordination mechanism created	Legislation in place before the pandemic. The epidemics act “EpiA” clarifies the work-sharing and other coordination aspects between confederation and cantons during a crisis	The Inter-territorial Council of the National Health System, which is the government body of the health system, laid ground for the collaboration between the national and regional health authorities	In February 19,, the National Covid-19 Committee (NCC) led by the minister of health and medical education was established to achieve maximum coordination and inter-sectoral cooperation/Establishing a joint committee (the scientific sub-committee of the NCC) consisting of some deputies of the Ministry of Health and members of the parliamentary health commission	A multi-sectoral response was designed through the creation of the National Coordinating Council (NCC) to manage the epidemic in March 13. The NCC was headed by the Prime Minister alongside representatives from all relevant ministries. Subsequently, on March 27 the National Command and Operations Center (NCOC) was established, this civil-military constellation proved to be critical in fast-tracking logistics, information gathering, real‐time reporting and “smart” lockdowns
Level of decentralization in COVID response in the health sector	Policy-making in Switzerland is usually decentralized. Health care is mostly organized in cantonal level. During an epidemic, the epidemics act “EpiA”, allows the transfer of decision-making from sub-national to national levels through escalating steps from “normal”, over “special” to “extraordinary situation”	The state of alarm was declared on March 14, this conferred to the central Government full responsibility for implementing measures for COVID-19 crisis. Regional administrations retain operational management of health services	General regulations have been passed by the national committee, while provincial committees are obliged to pass specific regulations based on provinces’ situation in line with national committee regulations. National committee also announced the need for continuous monitoring and control over the measures of the provinces	The response initially in February and March was decentralized, as the provinces were independent. But after NCOC was established on March 27 the response was mainly central
Finance
Introducing emergency legislation to finance response to COVD-19. Briefly describe source, e.g. mobilized emergency reserve funds; reallocated from other budget lines; etc.	In 2020. mobilized estimated CHF 70 to 80 billion from high level of liquidity but also incurrence of debt	A Royal decree approved on March 12 2020 to implement measures that allow exceptional mobilization of structural and contingency funds; Release of extra funds to support the education sector for COVID-19 crisis	Mobilizing $1,127,770,000 from the National Development Fund; allocating $176,229,885 by the government to the country’s health system; $62,362,297 foreign financial facilities to fight Corona; etc.	The initial shortage of health commodities and medical equipment in April and May was addressed by the disbursement of more than six billion Pakistani rupees (PKR) (US$ 37M) to buy equipment, ventilators and to upgrade hospital facilities. Additionally, state banks provided low-interest loans to hospitals to improve their case management capacity
Human resources
Mobilizing and repurposing health workforce (e.g. reserves, retired staff, staff from other specializations, trained students, etc.)	National level: Non-emergency procedures have been prohibited March 21 - April 27, 2020. Other mobilization was organized largely on a cantonal or even hospital level. Cantons can request private institutions to provide their resources for COVID-19 support	Regulation to adopt measures for human resources management during the covid19 crisis. Some Autonomous Communities implemented measures to mobilize the health workforce to cope with the crisis	Reserving 5%–10% nursing staff from other wards of the hospitals for COVID-19 wards; Recruiting individuals who have capability for nursing, (i.e retirees, unemployed nurses, volunteers and interns); Invite nursing professionals, faculty members and post-graduate nursing students to counsel people via the 4030 hotline	A shortage of trained professionals in critical care units was observed in the beginning of the pandemic. Training programs were launched for health care staff
Information systems
Media briefing intervals	Media releases/press conferences are done at irregular intervals, but several times a week. Special press conferences with specific topics (e.g. sport) are released additionally	From February, the Government released the latest update on the pandemic evolution and the implementation of different measures and policies, at daily press conferences	From February, ministry of health published daily reports of covid-19 statistics including new/total cases, deaths and laboratory tests	Daily media briefings by NCOC started in April and continued for a long time
Medical technologies and pharmaceuticals
Ensuring emergency mechanisms are in place for procurement and registration of medicines and health technologies	In General, the supply of essential medical products is organized in COVID-19 Ordinances 2/3. Some selected smaller scale measures: i) Procurement can be done on a federal level via the military; ii) exceptions are made concerning legal requirements of medical products; iii) essential medicines are given out only in limited amounts; iv) mandatory reporting of ICU availabilities, PPE stocks etc.	There were mechanisms in place but they did not ensure the access to specific health technologies and PPEs	Due to economic pressures from sanctions and the ban on foreign exchange transactions, the possibility of importing medicines and health equipment was minimized. Therefore, the country developed and implemented mechanisms to encourage Iranian companies and factories to increase domestic production lines and achieve self-sufficiency	The NCOC provided vital PPE, oxygen supply systems and established COVID-19 care and treatment centers through National Disaster Management Authority
Service delivery
Identification of cases
Contact tracing	Contact tracing done by the cantons. Contact tracing app “SwissCovid app” piloted in June 2020	The contact tracing protocol classified “close contacts” or as possible, probable or confirmed cases; On May 9, the MoH published new guidelines for early detection of cases and contact tracing. Tracing workers would track down people who were closer than 2 m and for more than 15 min to suspected or confirmed cases	A mobile app (mask app) was developed for this purpose. But it was not widely used	Contact tracing conducted by rapid response team, including primary healthcare doctors, nurses and paramedics
			All people in contact with cases should be screened within 14 days after contact
Screening on entry	Since March 13, travel from “risk countries” (neighboring Italy at the time) was restricted. This list was slowly expanded. On May 11, first travel restrictions were relaxed. Since June 2020, passengers from “risk countries” could have their temperature measured. From July 2020, travelers from “risk countries” need to quarantine for 10 days	Initially, after the detection of the first imported case on January 31, public health interventions were activated to detect cases coming from China; In March, travel bans were imposed from Italy and cruises from any origin; In May land borders closure measures were implemented	Inbound travelers from abroad were required to fill out an entry form/Prohibition of passenger entry into the aircraft without a mask/Screening before exist/airport public places disinfection, including terminals and aircraft/Develop a special procedure for protecting flight controllers/flight restriction	Initially screening only applied to travelers from China. Then extended to the pilgrims from Iran who were quarantined at Taftan border
Preventive measures
Quarantine/home isolation of COVID-19 patients	Isolation of positive cases for 10 days	Cases with symptoms were isolated at home and followed up by a PHC team, or hospitalized if needed	Compulsory quarantine of infected people was approved by the NCC, its implementation was not monitored	Quarantine facilities were established in major cities in the early phases
Quarantine/home isolation of suspected cases and contacts of confirmed patients	Quarantine of close contacts of positive cases for 10 days	Initially, suspicious cases were isolated on arrival, and potential contacts investigated. During the state of alarm, symptomatic cases were isolated at home and potential contacts further investigated.	All people in contact with cases should be screened within 14 days after contact	Quarantine facilities were established in major cities in the early phases
Announcements of preventive activities (personal hygiene)	Public information campaign updated with new rules and recommendations (e.g., hand washing) at different intervals	Personal hygiene, physical distance and indoor preventive and hygienic measures	Personal hygiene protocols were recommended	After NCOC took the control national strategy for communication was developed
			Since July 5 wearing face mask became mandatory in public places
Physical distancing	Initially 2 m, scaled back to 1.5 m	When the first community outbreak was declared, progressive physical distancing measures were implemented. After the state of alarm declaration, citizens were required to stay at home and use public roads just when carrying out specific activities	It was recommended but not mandatory	All preventive measures were communicated but not strictly followed
			Eid al-Fitr prayers was held outdoors of mosques
			Introducing staggered office hours
Restrictions on congregation	Congregations banned at various levels of stringency, e.g. prohibiting gatherings of more than five people	On March 10, sports events were limited to closed doors and, in regions with community transmission, events with more than 1000 people were banned. When the state of alarm started, citizens were required to stay at home and congregation was not allowed	Issuance of regulations by the government regarding restrictions on gatherings in high risk areas	Non-essential services such as educational institutions, government offices, markets, business centers, parks, etc., were closed
Closure of schools and other teaching facilities	Schools on all levels closed for 2 months. Step-wise reopening (Secondary level II, tertiary level and further education last), shift of decisions to cantons	Schools and universities were closed, first in the regions with community transmission, followed by application country-wide on March 12th. When the de-escalation plan started to be implemented, during the state of alarm, educational centers could open under particular circumstances	In the metropolis of Tehran and other red-zone cities: Closure of all universities, seminaries, educational centers, and libraries (the NCC scientific committee has classified the country into five zones according to the COVID-19 situation in each city: red, orange, yellow, blue, and white. In this classification, white zone is where no new COVID-19 cases are found, and the red zones are the cities with the most infected cities)	In March all the educational institutions, were closed to reduce the spread of COVID‐19
Closure of bars, restaurants, sports venues	Fully closed for 2 months, afterwards opening with restrictions (e.g. four people per table)	During the first months of state of alarm, hotels and restaurants had to close, except if they had been recruited to serve healthcare workers or truck drivers. In May, during the de-escalation plan, bars and restaurants in some regions could open with some restrictions. Professional sports competitions were allowed behind closed doors	Fully closed in red-zone cities. Re-opening with restrictions in lower risk zones	Fully closed during lockdown, afterwards opening with restrictions in lower risk areas
Lockdown	Not considered	Total lockdown started on March 14 and was progressively scaled back (with the de-escalation plan) until June 21	Lockdown was in place including closing businesses and government offices and inter-city and inter-province travel bans. Later, using a color coded scale, cities were classified into blue, yellow, orange, and red zones based on the COVID-19 infection rate. In red cities, only essential services were allowed to open. Inter-city travel was banned	After the low compliance with the initial decision on national lockdown for 2–3 months, prime minister ordered to reopen the economy and move to a strategy of contact tracing and “smart lockdown” in areas with high positivity ration
			Blue was the lowest threat with minimum restrictions
Border closure/Travel restriction	Closure of borders/travel restrictions and stepwise reopening (first neighboring countries, Schengen area, then other countries)	Closure of borders/travel restrictions and stepwise reopening (first neighboring countries, Schengen area, then other countries)	Partial closure of borders/travel restrictions and stepwise reopening	Initially only china but later included other countries. Since March 2020, Pakistan suspended domestic and international flight operations and reopened the borders in stepwise manner