In our globalized world, it is disconcerting that so few lessons have been learned in the first weeks of each country’s epidemic, when the chances of containing and stopping the virus were highest. The focus is now on flattening the curve, or slowing the spread of the virus, to keep the death toll from climbing further.
As much of the rumor in the world is gradually lifting blockages, there are still lessons to be learned from these four places that have done it right. Here are 12 of those lessons.
But Taiwan, with a population of around 24 million, has recorded just over 390 cases and six deaths, and yesterday it did not report any new cases. It succeeded in doing so without putting in place severe restrictions, such as closures or closings of schools and nurseries.
In terms of the death toll, at least Taiwan doesn’t even have a lot of flattening, plus a line with a few stiff steps.
Compare that to the United States – now the hardest hit nation in the world, at least in raw numbers – which killed at least 26,000 people. Even taking into account the size of the population, a level of success like that of Taiwan could have meant only 83 deaths in the United States.
Although Taiwan has high quality universal health care, its success lies in its preparation, speed, central command and rigorous contact seeking.
Lesson # 1: Get ready
Taiwan’s preparation came in large part from some hard-learned lessons from the severe acute respiratory syndrome (SARS) epidemic in 2003, which killed 181 people on the island.
As a result, the island has set up a central command center specializing in epidemics, which could be activated to coordinate an intervention in the event of an epidemic. As a sign of Taiwan’s desire to get ahead of the coronavirus, the center was activated on January 20, a day before the island even confirmed its first infection.
Because its authority was already established, the center was able to implement strict measures without being slowed down by lengthy political processes. He implemented more than 120 actions in three weeks, according to a list published by the Journal of the American Medical Association (JAMA). This list alone could serve as a manual on what to do exactly during an epidemic.
Lesson # 2: Be Fast
Taiwan’s action came long before her first Covid-19 infection was confirmed on January 21. Three weeks earlier, a few days after the first case reported by China to the World Health Organization (WHO), the Taiwanese authorities began to board and inspect passengers for symptoms of fever and pneumonia on flights from Wuhan, the original epicenter of the virus in China. The island issued a travel alert for Wuhan on January 20, and two days later, still with only one case, officials began to inform the public during daily briefings.
A week after its first case, Taiwan began electronic surveillance of people quarantined via government-issued mobile phones, and announced travel and entry restrictions, mainly targeting the Chinese province of Hubei, of which Wuhan is the capital. Almost every day after the end of February, the government has implemented new measures to keep the virus at bay.
Taiwan had only 329 cases when it imposed strict social distancing measures on April 1. In comparison, there were already 335 deaths and more than 3000 cases on March 20, when Prime Minister Boris Johnson announced the closure of pubs and restaurants, and most children would be removed from schools and nurseries. And since the UK does not do large-scale testing, the actual number of infections would be much higher than official figures show.
Lesson 3: testing, monitoring and quarantine
Authorities carried out extensive tests and traced the contacts of the infected, quarantining them all. He proactively tested everyone from cruise ships and even re-tested those diagnosed with influenza or pneumonia to make sure they were not misdiagnosed and were infected with coronavirus.
Lesson # 4: Using Data and Technology
“A coordinated response from the government with the full cooperation of its citizens [was] combined with the use of big data and technology, “Jason Wang, associate professor of pediatrics at Stanford Medicine, told CNN. Wang also studied public health policy and co-authored the JAMA report on Taiwan’s response.
Taiwan has merged national health insurance data with the customs and immigration databases to create real-time alerts to help identify vulnerable populations.
“A good health data system helps monitor the spread of the disease and allows for its early detection. When someone visits a doctor for respiratory symptoms, the national health insurance database will have a record. It’s easier to track epidemic clusters, “said Wang.
Taiwan used mandatory online reports and registrations for 14 days after the travel restrictions. He also used a “digital fence” for nearly 55,000 people under quarantine at home, where alarms would sound if a quarantined person moved too far from his home. Technical surveillance methods used in Taiwan and other governments have raised concerns about confidentiality among civil society groups.
Getting a coronavirus test in many countries can be almost impossible unless you are already very sick. This is not the case in Iceland, where anyone who wants to take a test gets one. Widespread testing has been crucial to the low number of infections and deaths in the country, officials said. Only around 1,700 people were infected in Iceland and only eight died.
Lesson 5: Be aggressive
Iceland’s response to the coronavirus has not been particularly innovative. It’s just meticulous and fast. As in Taiwan, its speed means that it should not have been too restrictive – people can always meet in groups of up to 20, if they stay within two meters of each other. While universities are closed, schools and nurseries are still open, allowing more parents to work.
“From the start, since we diagnosed our first case, we have worked according to our plan. Our plan was to be aggressive in detecting and diagnosing individuals, to put them in solitary confinement, and to be very aggressive in our search for contacts. We used police force and the health care system to sit down and contact the traces of each newly diagnosed case, “chief epidemiologist Thorolfur Gudnason told CNN.
“We note that more than 60% of new cases concern people already in quarantine. So it showed that tracing contacts and quarantining contacts was good for us, ”said Gudnason.
Lesson 6: Involving the private sector
As part of a public-private partnership between the National University Hospital of Iceland and the biotechnology company DeCODE Genetics, Iceland designed tests early and plans to have tested 10% of its population by the end of this week. It aims to test just about everyone and has already become a valuable laboratory for the whole world to learn more about the new virus.
Recent revelations that 50% of people tested positive in a laboratory in Iceland have shown no symptoms, for example, have prompted other countries to take stronger action through social distancing as they begin to realize that preventing the spread of the virus will be more difficult than expected.
Kári Stefánsson, CEO and director of deCODE Geneticsm, told CNN that on Monday he found 528 mutations in the coronavirus in mass tests in the community. These mutations could provide insight into how the virus becomes deadly and provide important data to the world to better understand how it works.
Lesson 7: Take preventive action
Icelandic Health Minister Svandís Svavarsdóttir stressed speed as a powerful tool, saying the approach is to stay “ahead of the curve”. The country seems to have done just that. After only six imported cases were confirmed on March 3, Iceland immediately issued quarantine measures for all travelers returning from Italy and increased travel restrictions in the following weeks.
The national police commissioner declared a state of emergency on March 6, when the first two infections transmitted by the community were confirmed. This sent a signal to government agencies to improve their preparedness, but it kept public gatherings as they were, only warning the vulnerable to stay away from crowded places.
The country closed universities and colleges on March 13 and banned gatherings of more than 100 people on March 16, when there were only 61 confirmed cases and not a single death.
Three days later, all Icelandic residents who entered the country had to undergo 14 days of quarantine, regardless of their place of departure.
It was only after all these actions that Iceland’s first death was reported on March 24. On the same day, the authorities prohibited gatherings of more than 20 people and closed public facilities, such as bars, swimming pools, museums and gymnasiums.
Lesson # 8: Use Technology, But Respect Privacy
As in Taiwan, the Icelandic authorities have also made available an application to download to help map the spread of the virus. It creates a log of the user’s location. Users do not have to share this data with authorities – but many do so to help contact tracing teams determine who may have been at risk.
In comparison, the UK’s response has been slow. A government-supported application is under development and a few weeks before launch. As it lags behind in testing, it only considers public-private partnerships.
Significantly, South Korea reported its first case of coronavirus around the same time as in the United States and the United Kingdom. South Korea confirms about 30 new cases a day, while in the United Kingdom it is around 5,000 and in the United States it is over 20,000.
The way each country tests varies, but their death rates in the population contrast just as dramatically. Less than one in 100,000 people in the South Korean population has died from the virus, while in the UK it is around 18 people. It’s almost eight in 100,000 people in the United States, according to JHU data.
Lesson 9: You Can Take a Driving Test
South Korea’s success is largely due to its tests, according to Dr. Eom Joong Sik of the Gil Medical Center near Seoul. Eom treats patients with coronavirus in hospitals and sits on a committee that advises the government on its response.
“Early diagnosis, early quarantine and early treatment are essential,” he told CNN.
“Since the first patient was confirmed, setting up over 500 screening clinics across the country, we have screened suspect cases and performed tests, and we have worked hard to develop and maintain a system to perform numerous tests. with a small workforce over a short period, “” he said.
The country has also innovated in its tests. Eom’s advisory team had hundreds of service cabs behind the wheel, just like at a McDonald’s, set up across the country to offer tests that were largely free, fast, and performed by staff at a safe distance. The United States has since replicated this model in some states.
On March 16, WHO called on governments around the world to “test, test, test.” South Korea has been doing this for weeks now and has tested more than 500,000 people to date, among the highest in the world per capita.
Many countries struggle to perform thousands of tests every day. It is so difficult to get tested in the UK, for example, that people are turning to mail order kits, in an industry that is not yet regulated by government.
South Korea also reacted quickly, implementing quarantine and screening measures for people arriving from Wuhan on January 3, more than two weeks before the country’s first infection was even confirmed. Authorities deployed a series of travel restrictions over the following weeks.
South Korea was also rigorous in its search for contacts, although it could easily have done so when it realized that a large number of cases could be traced in a single religious group in the city of Daegu, which which made it easier to find contacts and gave the authorities a specific area. to perform intensive testing.
“By testing everyone in the congregation and even diagnosing infected people without symptoms, the government has done quarantine and treatment side by side,” said Eom.
Once Daegu was established as an epicenter, the authorities were ready with the capacity and political will to test extensively, track down and quarantine the contacts of infected people to try to contain the virus before it becomes a large-scale case of death mitigation, as is now the case in much of Europe and the United States.
Lesson 10: Learn from the past
South Korea was able to move quickly because, like Taiwan and many other Asian countries, it had already been burned. South Korea has been largely unaffected by the SARS epidemic, reporting only three cases and no deaths. But he was caught off guard by Middle East respiratory syndrome in 2015, when he recorded 186 cases and 38 deaths, making him the most affected country outside the Middle East.
The political will to enforce the measures during the coronavirus epidemic was therefore not a problem and there was good coordination between the central government and the provinces.
It has also helped South Korea to be one of the most technologically innovative countries in the world. Much of life is already done online, so it was not too difficult to develop and apply the use of an app to monitor quarantined people.
It has also helped South Korea to be one of the most technologically innovative countries in the world. Much of life is already done online, so developing and enforcing the use of an app to monitor quarantined people was not too difficult, although activists there also warned against invasion of privacy.
The case of Germany is a little different. The country has not really been able to keep the number of infections at bay much better than some of the hardest hit countries. It currently has more than 132,000 confirmed infections, the fifth largest in the world, according to JHU.
But Germany has managed to keep the death rate in its population relatively low. More than 3,400 people have died from the virus in Germany, or about four in 100,000 across the country. It is well below the 35 Italians and 18 British.
Lesson 11: Test more as restrictions go down
Germany’s success has also been its mass testing, but its well-endowed universal health system has also played a major role, according to Martin Stürmer, a virologist who runs IMD Labor in Frankfurt, one of the laboratories performing tests. Germany has also appealed to the private sector to ensure that enough tests are carried out.
“From the start, Germany has not required one or two or three central laboratories to do all the tests. Many private companies were involved, so we were able to do 100,000 tests a day, ”Stürmer told CNN.
“Some countries have done it even better than Germany to control infections, but what is very important are the general tests, where we were able to see what was going on in our population. Only with mass testing can you identify people who might be infected. “
Like Taiwan, South Korea and Iceland, Germany developed a test for the coronavirus and prepared a large number of kits early, long before the country even reported its first death.
While German Chancellor Angela Merkel announced on Wednesday that the country will begin gradually reducing its lockdown, the country plans to carry out more tests, in case the increased contact leads to a second wave of infections. Like many countries, it will also test for antibodies to try to determine who in the community can be immune to the virus.
The death toll in Germany has remained relatively low, in part because the coronavirus has infiltrated the country, mainly among young people. Many had visited Italy or Austria on ski trips.
The authorities were able to test people returning to Germany from these ski resorts and find their contacts for the tests as well. Most of these people were young, and even today the largest age group in terms of infections is 35 to 59, followed by 15 to 34. The virus is more deadly in older people around the world.
But as community infections spread in the country, Stürmer fears that more elderly people will die in the coming weeks and that the death rate will increase in the country.
Lesson 12: Building the capacity of hospitals
Germany ranks 18th in the world in terms of access to quality health care, according to an index published by The Lancet, above the United Kingdom in 23rd and the United States in 29th. But these clues tell us a lot. Italy, for example, ranks ninth and the country has also done rigorous testing, but it has the second highest number of deaths per capita in the world, after Spain.
In this situation, the difference seems to be the enormous capacity of the German healthcare system. Germany is expected to need around 12,000 beds at the height of this outbreak mid-month, according to projections by the Institute for Health Metrics and Evaluation. It has more than 147,000, more than 10 times its needs.
In contrast, the United States has about 94,000 beds, or about 15,000 beds below their needs. Germany has more spare beds in intensive care units than Italy overall.
In fact, the German healthcare system has such capacity, its hospitals are now treating people for coronaviruses from Italy, Spain and France.
Authorities were able to bring people with even moderate symptoms to hospital long before their conditions worsened, which led some experts to wonder if people were treated early, put on a respirator before their condition improved. getting worse, for example, improves their chances of survival.
“Germany is not in a situation where the healthcare system is overloaded, as you see in Italy, where they have to decide whether to treat a patient or not. We don’t have that, “said Stürmer.
All data on the number of cases and the number of deaths were obtained from Johns Hopkins University on April 15 at 2 a.m. AND.
CNN’s James Griffiths, Sharif Paget, Maija-Liisa Ehlinger, Sophie Jeong, Stephanie Halasz and Gabrielle Smith contributed to this report.