Anushree – Year 9 Student
Editor’s note: Talented student Anushree, now in Year 10, recently undertook extensive research into the wide-ranging strategies implemented by nations around the world as they attempted to control the coronavirus pandemic in its early stages. The pandemic has evolved since this article was originally written and the statistics have therefore changed; however, the key points still hold true in relation to Anushree’s careful evaluation of the response strategies outlined. CPD
Featured image: Coronavirus graphic. (Pixabay.com: free for commercial use.)
About the Pandemic
Coronavirus (COVID-19) is a highly infectious, respiratory disease which originated from the virus SARS-CoV-2. Whilst most of the symptoms are like that of the common cold (fever, cough, fatigue, and loss of taste or smell), the disease has proven to be fatal to those who are elderly, pregnant, with underlying comorbidities or have a weakened immune system. The WHO declared it a pandemic (global emergency) on 11th March 2020, which essentially led to most of the world going into lockdown and the global economy coming to a standstill.
Whilst there are many theories as to how coronavirus originated, the most likely possibility is that it has zoonotic origin from bats that were traded at the Huanan Seafood Wholesale Market in Wuhan. They were then used in the production of traditional Chinese medicines and formed part of the Chinese’s’ diets.
Wuhan, a city of population about 11 million people, became the first region to become infected by the coronavirus, having over 50,000 cases, most of which were in the Hubei province.
As soon as the coronavirus was discovered in the city, Wuhan immediately went into lockdown on the 20th January 2020, stopping all transport routes into and out of the city to help contain the virus. About 80% of all China coronavirus cases were recorded in the city. 14 other cities in China went into lockdown four days later, with over 50 million people now restricted.
On February 20th, schools, offices, businesses and factories were also closed in China, hence meaning that the economic activity and daily life were now on hold.
To provide medical care for this surge in cases in Wuhan, the Chinese government built a 1,000 bed hospital in a record 10 days, which was operational on 5th February, 2020.
This rigorous approach by the government proved to be successful.
Wuhan lifted its lockdown on April 8th, after approximately two months of isolation, shortly after the rest of China. It was left in an economic crisis, with a GDP forecast revised to 6.8% since 2010.
China’s successful lockdown and strict quarantine measures had provided time and a foundation for which other countries could prepare themselves for the coronavirus.
The first country in Europe to go into lockdown due to Coronavirus was Italy, by trying to contain the spread of the infection in the region of Lombardy. The Prime Minister, Giuseppe Conte, enforced a lockdown on 9 March 2020, closing off most of Northern Italy. People were only allowed to leave their homes for essential supplies and travel. This resulted in approx. 60 million people being quarantined. Like China’s measures, after a spike of 6,557 cases on the 21st March, Italy’s cases began to decline, the country exiting lockdown two months later.
Germany have been incredibly vigilant and focused actions to combat the spread of COVID-19. Ever since the pandemic began, the German government followed the policy of contact tracing, testing and isolation, backed by a robust pre-existing healthcare system. National lockdown measures were strictly enforced, aided by public compliance. It was one of the few countries who prevented huge economic downtrend. Unlike most countries, Germany’s healthcare systems were also able to cope with the huge demands for critical care beds, PPE supplies and testing kits. Carrying out approx. 500,000 tests a week, it was one of the most effective strategies to reduce the spread of coronavirus. However, there has been debate over whether Germany were too quick to lift their lockdown: cases have recently surged following the opening of its borders and social distancing measures being relaxed.
Sweden have been following the advice of their chief epidemiologist. However, unlike the rest of Europe, the people have the choice to go into self-imposed isolation and lockdown, or not. From the statistics, we can see that this is a risky choice. Sweden currently has 65,137 coronavirus cases, which is marginally less than the UK, which just beginning to ease restrictions. The question naturally arises, therefore, whether a national lockdown would have lowered Sweden’s cases or not.
Why were some responses better coordinated than others?
South Korea’s coronavirus pandemic was between late February and early March, during which cases were escalating into thousands; at its peak, 909 new cases were recorded in just one day. However, in the next week the cases halved, and continued to decrease at a rapid rate.
South Korea once reported 64 new cases during the time when Europe was reporting several thousand daily.
How have they done this?
Lockdown measures were superimposed almost immediately after cases increased in China. This was backed with thousands of “walk-in” testing centers, use of technology for collecting credit card history, location data from mobile operators for widespread location, contact tracing and testing. As a result, the R rate (the virus reproduction number) dropped to and was maintained at 0.1. The head of the WHO, Dr. Tedros Adhanom Ghebreyesus stressed the importance to “apply lessons learned in South Korea” elsewhere to help control the transmission of COVID-19.
On March 21st, India imposed an initial seven weeks lockdown. Whilst cases in India are at presently record high, the main caseload is restricted to eight regions and cities, such as Chennai and Bangalore, and states like Kerala have managed to limit the spread of COVID-19 though the implementation of widespread contact tracing and testing. The steroid Dexamethasone that has been found by Oxford University to reduce death rates among patients by 1/3 is widely available in the country and has already been used to treat those with the disease. However, the main reason that coronavirus cases are on the rise in cities such as Delhi is mainly due to poor, overcrowded and unsanitary living conditions, political divisions and lack of access to healthcare. Furthermore, due to the sheer size and population of the country, the number of cases and deaths cannot be monitored effectively. That poses a problem for the government, who are now questioning when they can begin to reopen India’s economy.
New Zealand’s amazing ratio of 1,489 cases to a population of 5 million since 7th May showed that its strategy to combat coronavirus was very effective. Its structured response was similar to both China and South Korea; aggressive and intense restriction and a total shutdown of the economy. New Zealand’s borders were shut and citizens were only allowed to leave home for medical emergencies or food supplies.
Policy makers, led by Prime Minister Jacinda Ardern, meticulously analyzed the global spread of the virus and began acting early and immediately. From what we have now seen, this seems to be the safest and most operative method that hinders transmission. On May 4th, New Zealand recorded 0 new cases of coronavirus. It is a relief to many New Zealanders that they have not had to face the same pandemic as many other nations.
South America – Peru
Most of South America was slow to go into lockdown, due to unwarranted complacency by government officials. Many believed it to be a “rich people’s disease”, which only affected the wealthy in Europe. Therefore, when the first case in all territories was identified on the 3rd of April, the countries were slow to establish and enforce their lockdowns. This is perhaps one of the reasons as to why Brazil (1.1 million recorded cases) and Peru (264,689 recorded cases) have such high numbers.
Another reason is also high poverty rates in both areas. For example, around 6,765,000 people in Peru are [living] below the poverty line, meaning that they are much more vulnerable to catching and transmitting the disease. Peru is also famously known for its foreign market and tourism industry, which is also factor into the country’s high rate of infection.
It is obvious to recognize that those who enforced measures immediately and stringently managed to control the rate of transmission of the virus. However, LICs (such as Peru) are faced with the inevitable disadvantage of high poverty rates, poor sanitation and pre-pandemic high unemployment rates.
It is not only LICs who have suffered. Developed nations such as the USA have over 2.59 million recorded cases, with overwhelming effects on the healthcare system and economy with almost 2.1 million people filing for unemployment. Many critics believe that the USA would have escaped its current predicament had it not been for the Presidency’s leniency. For instance, President Donald Trump once quoted at the start of the pandemic: “The 15 [cases] within a couple of days is going to be down to close to zero”.
How effective has the UK response been?
The first confirmed case in the UK was on 31st January. There have been 311,151 total confirmed cases as of this week. The UK lockdown was imposed on 23rd March, with permission to leave the house only for essential work, one form of exercise a day, and shopping for essential goods. All forms of transport were stopped, causing devastating impacts in particular to the UK hospitality and aviation industry (with revenue dropped by 80%), which had to furlough most of its employees or in worst cases, fire them. Now, restrictions are slowly being eased in accordance to the government’s five key stages being met. The UK has had one of the longest lockdowns in the world with the sixth highest death rate.
A primary cause of increased number of deaths appeared to be due to the initial inadequate preparedness for pandemic response, such as availability of PPEs and delayed testing. Many healthcare workers around the country had to reuse old aprons and wear flimsy surgical masks for approximately 9 hours continuously. The relative lack of healthcare staff who work with COVID-19 patients also meant that they had to work for longer hours and frequent shifts in trying conditions; correspondingly, many have experienced emotional instability, such as Post Traumatic Stress Disorder, due to these periods of overwork and constant exposure to an environment of death and illness.
The government was also sluggish to enforce travel restrictions and close the borders; something which many say could have shortened the UK lockdown and saved many lives. The same scenario is also depicted in the 7,000 UK care homes, which were initially neglected until the number of deaths in this setting began to escalate.
Nevertheless, the UK citizens have been compliant in the way in which they have responded to the lockdown. With lockdown measures being imposed on March 23rd, it is only until recently that COVID-19 caseload has started to reduce after the peak, and whilst many have been eager to return to life’s former normality, they have all obeyed the government’s strict cautioning and following of the medical advice.
Ways in which the transmission of the virus can be broken and the importance of lowering the R number was clearly conveyed to the public. The government formulated and effectively communicated simple but necessary and effective steps such as: social distancing (staying 2 meters away from person around you) frequent handwashing for at least 20 seconds; use of hand sanitizer; avoiding touching nose, mouth and eyes; use of facemasks when outdoors; avoiding unnecessary travel; the gradual opening of lockdown and other recreational activities, including sporting events such as Premiership football league. There were daily updates and press briefings by ministers on the situation which revealed how the UK was coping with the virus. For instance, perhaps the five pillars of testing commanded public cooperation and patience; the government’s democratic method of asking experts and being guided by scientific advice, analyzing data and listening to critics; and very little politicization of the event ultimately managed to maintain public morale.
The UK furlough scheme was an ingenious agenda that provided a much-needed income to many in the UK who were under financial insecurity and fear of unemployment. However, inevitably it could not provide an income for everyone. Retail giants such as Debenhams have now permanently disappeared off the market due to a financial deficit.
Another incredible feat performed was the establishment of NHS Nightingale Hospital in London in a record 12 days and subsequently in other parts of UK to increase NHS capacity for treatment of coronavirus patients. This ensured that the NHS had the capacity to care for the sick, and that they were not overwhelmed. The government achieved their target of increased testing capacity to 100,000 tests per day on 1st May.
Perhaps one of the UK’s current biggest challenges is the implementation of widespread testing and contact tracing. An app was trialed in the Isle of Wight to see if this could be a way in which contact tracing was going to be installed in the rest of UK; unfortunately, it was unsuccessful. It would be beneficial for the UK to collaborate with countries like South Korea and New Zealand to try to achieve their goal of contact tracing and mass testing. This should help in predicting and managing cases should there be second peak in COVID-related cases.