The COVID-19 pandemic has elicited a global response, unlike anything we’ve seen before. There are still no clear and definitive answers for how best to overcome the novel pandemic; the answers are constantly evolving and success is in part dependent on an individual country’s context and capacity.
However, amid some distressing trends, there are countries that are battling the virus more effectively than others. Squashing rapid infection rates, numbers of new cases in decline and serving as models to follow. As noted in Development Works Changemaker’s blog ‘Evidence-Based Responses to the Coronavirus Chaos’ emergent evidence is being used to craft South Africa’s response to the Coronavirus crisis and this is a promising approach in tackling the virus.
While more and more evidence is continuously gathered by the world and sector experts, we can potentially learn from other countries’ best practices as we deal with a fast-changing complex issue.
The practices listed below may already be implemented in South Africa or may not necessarily be applicable or possible in South Africa’s context. But they can still serve as thinking points and catalysts for other possible solutions.
As of 21 April 2020, Taiwan’s number of COVID-19 infections sits below 450, a low number despite the country’s close proximity to China where the virus first originated. Experts believe that quick preparation and early intervention has helped spare Taiwan from facing the uncontrollable spread of the virus.
The lessons learned by Taiwan during the SARS epidemic in 2003 is reportedly one key reason that the country has been more prepared for the virus than many other countries. Taiwan was quick to respond by introducing travel bans soon after COVID cases began to rise in mainland China.
Taiwan took action earlier than most others; it was quick to first screen arrivals from China before closing its borders altogether and to initiate strict quarantine, health monitoring and contact tracing.
Private businesses and apartment communities have also started body-temperature monitoring and disinfection steps in a public area that have helped supplement government efforts. The joint efforts of government and private companies—a partnership deemed “Team Taiwan” have also enabled the country to donate supplies to countries hard hit by the pandemic.
Importantly, Taiwan tackled the impending challenge of shortages in personal protective equipment (PPE) early. Taiwan predicted high demand for masks as early as late January, thus the government already began rationing the existing supply of masks then, and implemented a policy that citizens buy a specific number of masks from designated drug stores on a weekly basis.
Reportedly, the policy has been replicated in other countries including South Korea (another well-performing country in managing COVID) and France. Further, Taiwan invested approximately $6.8 million to create 60 new mask production lines, increasing the country’s daily mask production from 1.8 million to 8 million masks, an action now called “Taiwan’s Mask Miracle.” The wearing of face masks quickly became routine as early as January in many areas.
The government has also been using data technology. It integrated the national health insurance database with its immigration and customs database. By merging the databases, it was possible to gather citizen’s 14-day travel history and ask those who visited high-risk areas to self-isolate.
It also helps medical workers identify and trace suspected and high-risk cases, including the whereabouts of individuals in quarantine. The Taiwanese government can track citizens through their phones, allowing them to ensure that individuals are adhering to the mandatory 14-day quarantine and are not violating the quarantine rules.
The government has also been making efforts to support those in quarantine, including delivering basic supplies (food or books) and implementing a welfare programme that provides a $30 daily allowance to those undergoing two-weeks or quarantine. Experts suggest that this gives Taiwanese citizens greater incentive to report their symptoms honestly.
Over the past few decades, Taiwan has also invested in its biomedical research. This capacity has now been leveraged by way of working on a mass-produced rapid diagnostic test for COVID-19 that can reduce the diagnostic time frame to as little as 20 minutes. Should this be rolled out, it will be a game-changer in improving the number of individuals tested and immediately placed in quarantine before the virus can spread further.
While for many it is not entirely clear why more countries and the global health community did not follow Taiwan’s lead in early 2020, some of pointed out that it is likely due Taiwan not a member of the World Health Organisation (WHO).
The island nation has been shut out from a number of international fora including the WHO as a result of Beijing’s geopolitical agenda to assert its “One China” policy against Taiwan’s President Tsai Ing-Wen’s mandate to assert democracy. Had Taiwan had more of a presence and a voice on this global platform, potentially many lives could have been spared.
South Korea is another nation standing strong in the face of the pandemic, taking action decisively and quickly. It was one of the first Asian countries to follow China’s lead in implementing widespread containment measures.
Comprehensive and innovative protective measures
According to experts, the country has some of the most comprehensive and innovative protective measures in place and is why the number of new infections have slowed down. Even in the absence of stricter measures like lockdowns seen elsewhere. With the exception of closing schools and imposing a curfew in some cities.
The country’s testing campaign and intensive contact tracing have helped slow the spread of coronavirus. The country acted early and reportedly has the most extensive, widespread and well-organised COVID testing program in the world, combining this with substantial efforts to quarantine infected individuals and trace and quarantine those they’ve been in contact with and potentially infected.
As an example, in March 2020, South Korea was conducting approximately 5200 tests per million citizens. In comparison to the United States, which had only conducted 74 tests per million citizens. The United States is one of the most infected nations globally with no trends of decline in sight.
Preparation is key
Similar to Taiwan’s lessons learned during the SARS epidemic, South Korea also learned the significant importance of preparedness from the outbreak of Middle East Respiratory Syndrome (MERS). Which saw the tracing, testing and quarantining of nearly 17,000 people and a negatively impacted economy.
The MERS experience revealed the major importance of testing to control any viral and fast-spreading epidemic and helped the country to improve hospital infection prevention and control. The experience led South Korea to use testing as a key in its coronavirus strategy, and it became a measure that seems to have set the country’s projections apart from others.
Information and communications technology
Another key to South Korea’s success is its use of information and communications technology. Since the MERS outbreak, legislation was implemented that allowed the South Korean government to collect mobile phone, credit card and other data from individuals who test positive in order to determine their recent whereabouts and therefore allowing others to determine if they may have come into contact with an infected individual.
Government has also rolled out several smartphone apps that track quarantined individuals, gather data on their symptoms, send emergency texts about spikes in infections in the area, facilitate telemedicine, update on the number and type of masks available, and allow citizens to monitor their own symptoms and contact a doctor if needed.
In addition to contact tracing, technology has also helped the country to test widely and quickly share information with the public about the virus. Including how many people were infected in each geographic area and city in real-time.
Data literacy is essential during these uncertain times.
Commercial test kits
When news of the virus emerged in China, South Korea quickly worked to develop its tests and cooperated with manufacturers to develop commercial test kits. The first test was approved in early February when the country had only a few cases.
Other actions include a local monitoring team calling quarantined patients twice a day to check up on symptoms and ensure that the rules of quarantine are not violated. Those who violate quarantine face up to $2500 fines.
The country took an all-government strategy. The Prime Minister developed a task force of all government ministries as well as all regional and city governments; the approach ensured that different regions shared doctors and opened their hospitals to each other’s patients when resources ran low.
The Foreign Minister also noted that being transparent and open with the public helped secure the people’s trust. “The key to our success has been absolute transparency with the public – sharing every detail of how this virus is evolving, how it is spreading and what the government is doing about it, warts and all.”
One interesting measure South Korea takes is offering drive-through testing stations nationwide, an idea that has now been duplicated in the United States, Canada, and the United Kingdom.
Another novel concept employed is public “phone booths” used by a Seoul hospital for COVID-19 testing, providing easy access and quick testing for those concerned that they may have the virus.
On one side of the glass, the patient picks up a handset to have a consultation with a hospital worker connected on the other side of the glass. The health worker then puts their arms into rubber gloves embedded in the booth to swab a sample from the patient, and thereafter the booth is quickly disinfected for the next patient. In total, it is a seven-minute exam, allowing the hospital to test almost 10 times more than it could previously.
While the numbers evident thus far have certainly been promising for the country, whether South Korea’s success will be sustained is unclear, as reportedly new clusters are beginning to appear.
The countries discussed above are well-resourced and are therefore well-positioned to make the more difficult decisions to mitigate the spread of coronavirus but concurrently negatively impact the economy. So what about countries that are poorer and developing?
Selective and proactive
One success story is Vietnam, which has shown how the virus can be contained with limited resources. While Vietnam’s neighbours Taiwan and South Korea possess the financial resources for mass testing, Vietnam is driving selective but proactive prevention, deeming the country’s model to be an effective low-cost model.
As of 17 April, the country only had 268 confirmed cases (97 active and 171 recovered) with no deaths; an impressive containment given that the country shares a border with China where the virus originated.
Vietnam prepared aggressively for the virus before its first case was identified and the country’s success in fighting the virus has largely been attributed to its proactive and rapid action. The country’s early anti-COVID-19 measures included issuing urgent dispatches on outbreak prevention to government agencies, hospitals and clinics in January; and organising a National Steering Committee on Epidemic Prevention when the first case was identified.
There were also common policy actions including cancelling of all foreign flights and foreign entry (with any returning citizens subjected to medical checks and compulsory 14-day self-isolation), extensive contact tracing and expanding production of medical supplies.
Since the first case was recorded, Vietnam limited movements where necessary, striking a balanced approach between overt caution with precision and fighting the virus and maintaining open economic policies:
Schools were closed after the lunar New Year (with schools gradually adopting online teaching). High-risk villages and communes were initially locked down and the risks contained by enforcing checkpoints in and out of the localities and developing local medical facilities for testing and treatment.
The country was placed under limited lockdown effective April 1, which mandated self-isolation nationally, banning of all gatherings, closing borders and implementing a quarantine policy.
Further, by proactively providing information to the public and being transparent, the Vietnamese government gained the confidence of its people and is viewed by the public as an effective source of communication leadership.
The Ministry of Health launched a website to share coronavirus-related information and just before the WHO declared COVID-19 a global pandemic, they launched the health declaration mobile application NCOVI to help citizens report their symptoms and follow the contact tracing operation. Both platforms not only ease the medical process but also share accurate information rapidly and squash misinformation and fake news.
While the above-mentioned responses have certainly played a role in containing the spread of the virus, reportedly a key underlying factor is the government’s mobilisation of nationalism. Vietnam has also leveraged its culture of surveillance to encourage citizens to report if they see any rule-breaking and have police administer fines to those who spread misinformation and fake news.
The government reportedly framed the virus as a foreign enemy and called the nation to come together to defeat it, mirroring the country’s history being long-threatened by foreign attackers. Additionally, with large and well-organised military and security services, the country has been in a position to act decisively and swiftly.
New Zealand has been showing an effective fight against the virus which has also been attributed to early and decisive action taken by the government. The country identified its first case in February, and by early April, more citizens were found to be recovering than be infected, indicating a decline of the virus.
Reportedly, the heart of New Zealand’s success has been due to a strategy including;
1) travel restrictions before any cases were detected in-country, including restricted access by those returning from mainland China, all international visitors self-isolating for 14 days, and finally fully closed borders to international visitors;
2) the government pushing early for a level 4 lockdown for at least four weeks, that has seen the shutdown of schools and non-essential jobs and services and prohibiting of many outdoor activities;
3) New Zealanders, including immigrants, have received recurring payments from the government to make it easier for individuals to stop working;
4) having scientific input into the policymaking process; and
5) a Prime Minister who reportedly is a good communicator, the public have trust in her and therefore are more inclined to follow instructions.
It is reported that if New Zealand’s current trends continue, the country will be set to reopen its society quicker than Europe or the United States. Experts report that the early and strict mitigation efforts, very good adherence by New Zealanders to the rules, and widespread testing have prevented an outbreak of the likes elsewhere.
As such, because there has been little evidence of community transmission, there have not been unmanageable numbers of patients overwhelming the healthcare system, making it easier to treat patients and ensure they see a full recovery.
Australia has shown similar effectiveness to its neighbour New Zealand by implementing early mitigation actions.
As early as January, Australia began limiting incoming travel from Wuhan, China where the virus first originated. In late January, the country recorded its first case, and within days the country recorded nine cases and initiated a mandatory two-week quarantine for those entering the country from China.
The Australian government initiated its emergency response to COVID-19 in late February, marking it a global pandemic earlier than the WHO; this enables the government to rapidly launch emergency funding and tax breaks and allowed hospitals to prepare for the wave of patients early on.
By mid-March, all travellers arriving in or returning to Australia were instructed to self-isolate for 14 days. The Prime Minister also restricted public gatherings to maximum two people by the end of March, and that individuals would only be allowed to leave isolation for essential shopping, medical reasons, exercise, or work.
Australia also rapidly expanded testing and implemented contact tracing measures to mitigate further viral spread.
The Road Ahead
There are several other countries not discussed here that are showing successes including Iceland, Croatia and India and provide further support for the lessons highlighted above. There are also numerous countries struggling to keep their heads above water in fighting the virus, including Italy, Spain and the United States. These countries provide their own lessons on what poor responses look like.
The country cases presented in this article have highlighted key acts and strategies in fighting the virus effectively; including quick preparation; early intervention; government support and welfare; leveraging technology for early detection, tracking cases, share of up-to-date information and shut down fake news; contact tracing; widespread testing and quick test turnaround times for early detection and treatment; case isolation and investment in a research capacity.
It should be noted however that the circumstances change every day globally and the success rates of some countries have changed. Early success does not necessarily guarantee against a resurgence later.
For example, Singapore was initially reported as a model country that vigorously undertook contact tracing, shut borders and implemented free testing and treatment for residents, while business remained open and a sense of normalcy was maintained. However, in recent days the country has seen its caseload doubled and has exceeded 9000 cases.
As such, while the countries described above can certainly provide key lessons in the interim as our world leaders and sector experts navigate the novel coronavirus, things are always subject to change and only time will tell which countries are able to completely eradicate the virus.
Each country can only work towards using the most up-to-date evidence and advice to inform their actions and policies, while considering the nature of their very unique contexts before making rash decisions that could provide an effective band-aid in the short-term, but frightening consequences in the long term.
By Jenna Joffe