The CoviD-19 saga: What makes a Good Pandemic Response (pt. 1)

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The world has, throughout history, been bombarded by various pandemics. Smallpox, Influenza and the Black Plague are but a few of these infamous invisible enemies that were so significantly devastating they managed to burn through a percentage of the world’s population at the time they were active. Science, medicine and healthcare have since advanced to counter these threats.

With annual developments, humanity has managed to stand up time and time again against the overwhelming odds of these attacks.

But as our global dominion is tied to these diseases, who is to say they won’t come back?

The risk of a pandemic was warned as a known and incoming threat (link to Pandemic History article). There had been various guidelines laid out by top health authorities of the world in case a disease with pandemic level threats will rise again.

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These guides stem from what we’ve learned about facing these invisible enemies in the past. The world has been anticipating for a comeback from a list of candidates capable of global infection. Would it be a newer better virus strain or multi-drug resistant bacteria?

Alas, it came in the form of a novel coronavirus named SARS-CoV-2 and it has been running around the globe since the start of 2020, causing what is dubbed as the great lockdown. Historical, shocking, yes but only if we’d listened, we actually saw this coming.

The Centers for Disease Control and Prevention and the World Health Organization have provided pandemic response strategies even before the SARS-CoV-2’s attack. These act as a template and the measures are supposed to be updated and built upon as needed.

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Some general recommendations of actions that should be undertaken include, but not limited to, planning and coordination, situation monitoring and assessment, reduction or if possible elimination, continuity of health care provision and communication.

Various media and health care authorities collated studies by looking at responses by various countries.  They agree that these are among the effective responses.
Various media and health care authorities collated studies by looking at responses by various countries. They agree that these are among the effective responses.

Health care authorities have since built on this guidelines due to the nature of the CoviD-19 pandemic, which includes specifying the things to prepare such as laboratories and doubling down on healthcare necessities, increased surveillance (which leads to contact tracing and mass testing) and guidelines for when and where to issue lockdowns or various policies for mass gatherings.

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In retrospect, the guidelines can be summed up as Investment in Science and Healthcare, pooling resources into Science and Healthcare if not done prior, effective communication strategies in order to properly convey policies such as Lockdowns, mass testing and contact tracing – then when successful control has been attained, subsequent plans should include further support for research and treatment of those affected, continued maintenance on stopping the spread and maintaining the healthy community (this includes humanitarian aid throughout the duration of the lockdowns), continued surveillance and communication on policies that might change depending on the nature of the disease, and setting up the society for the future.

There is no definite objective measure to judge the success (or failure) of a countries’ response, since a lot of factors may come into play, including geography, population number, people above or below poverty line, resources, alliances, enemies, ongoing wars and calamities in the country, etc. But although there can be no objective conclusion (yet) if a country’s response is good or bad, it’s not to say that it can’t be felt. For example, good surveillance (mass testing, contact tracing) would give a country better data on cases per day, deaths, and recoveries and it will be lead to better assumptions on how good (or bad) a countries’ policies are.

It is generally accepted that a determinant of a successful response is a continued or increasing amount of surveillance while new cases and deaths per day decreases until preferably zero (and sustained that way).

Various media and health care authorities collated studies by looking at responses by various countries. They agree that these are among the less effective responses in curbing the spread of the virus.
Various media and health care authorities collated studies by looking at responses by various countries. They agree that these are among the less effective responses in curbing the spread of the virus.

There are a lot of factors to consider, though, as there are countries that cannot afford better surveillance but does not automatically have a bad response, while countries who arguably could afford better surveillance yet don’t see this as a priority, or is slow in implementing it could easily be labelled a bad response.

Various media have cited many countries that they deem “best” in organizing epidemic controls and most of the reports are unanimous in saying Vietnam, Taiwan, South Korea and Singapore in Asia. By observation, these countries have clocked in recovery numbers that don’t stray too far from the amount of cases. They also have very few deaths (Taiwan at seven deaths and Vietnam at 0 so far)

With these in mind we can safely make assumptions that policies made by these countries are executed better since policies worldwide are quite similar because of known guidelines by Global Health authorities. The only difference is when and how strict the policies are implemented, which can be seen compiled and updated in Our World in Data website “Policy Responses to the Coronavirus Pandemic” by Hannah Ritchie and co-authors, which tracks global data on government policies published and managed by researchers at the Blavatnik School of Government at the University of Oxford.

A country’s policies and CoViD-19 cases (new cases, deaths, recoveries etc) can now be grouped together and can be compared and contrasted to other countries. The more similar a country is in terms of government, economy, location the better their responses can be deduced on which one is successful (for example, Philippines and Vietnam which are both considered developing countries with fairly similar global economic standing and are both members of ASEAN).

This can now be a basis in determining which countries have the best responses which we will tackle in the following examples

Early Lockdowns vs Late Lockdowns

Pandemics are economically painful, but countries that are willing to sacrifice their economies and decide to implement public health solutions as early as possible such as lockdowns, massive screening and contact tracing measures fared well, as is most clearly seen in Vietnam and Singapore during the first wave. Countries who made decisions based on medical and scientific evidence — deferring to their public health and medical officials — have come out on top, while leaders who made their public health decisions based on short-term economic and political calculations lost very valuable time and in a pandemic with exponential growth, every day matters.

Softening lockdowns and re-openings are also an issue for judgment. Some countries who claimed they have controlled and prematurely eased their lockdowns experienced by a second wave. It is necessary to note that guidelines have stated these risks, but if a country is certain of controlling the pandemic, perhaps the easiest to compare and contrast are when these countries issued lockdowns. Countries who closed borders as early as January are opening or planning to reopen soon. The Philippines, which closed borders more than two months later, has arguably not controlled its first wave yet.

Communication of policies and strict compliance to Surveillance

Countries with governments that communicated with their public in a transparent manner tended to quickly win confidence. The governments that admitted the problem, communicated risks, outlined effective mitigation efforts, and spoke with one voice, have fared much better. A leader’s speech should always be made to draw in more public trust than public ire, since greater trust leads to greater compliance when it came to wearing face masks, social distancing, and self-isolation. People will be more than willing to compromise and sacrifice if they are assured and made to understand the threat that is in their doorsteps. Policies that were usually spoken and interpreted differently by multiple speakers (including downplaying the threat) have publicly reversed policies or changed policies too frequently have obviously less favorable outcomes for public compliance and the repercussions are shown.

Preparedness and strengthening of the Health and Sciences Sector

Epidemiologists, virologists, people in science and healthcare have been warning about a major pandemic that is fairly lethal, quickly transmissible and can leap from animals and humans. This is both knowable and known, with multiple researches supporting it and subsequent guidelines from Health authorities alluding to it – so unsurprisingly, we are living in it now. Countries that stockpiled PPE, maintained public health centered infrastructures and made sufficient investments in their health and science departments have fared better. Countries with years of neglect to their science and health sectors have fared poorly.

There is an age-old saying that goes: “An ounce of prevention is better than a pound cure.” Vietnam’s Medical sector is not as advanced as Philippines or Indonesia, yet they have good public health measures – testing, contact tracing and thermometers are really cheap compared to ICUs and Ventilators.

Singapore on the other hand, while having first world hospitals and infrastructures and optimum first wave response, was hampered by their second wave because of their 300,000 migrant workers (which are responsible for their first world hospitals in the first place). Just a reminder that public health is determined by the least common denominator. If the poorest and most marginalized within a society are not protected then no one is. That is a lesson that all governments need to take to heart.

Thailand, in spite of its political leaders, have a good public health system. According the Global Health Security Index (GHS), Thailand is an “an Exemplar” and an “international leader in health security.” This is because world class hospitals and a nationwide network of provincial and district hospitals can be seen in Thailand. Philippines on other hand, despite having the best Nursing and Medical Schools, the country has ironically a starved public health system. Many of its medical professionals work abroad – and a lot who are left contribute more or less 20% to the overall infected cases in the country with numbers rising according to the DOH.

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