What can we learn from the global response to the coronavirus pandemic?
South Korea has tested 295,000 people while India has reportedly only tested 17,000 as of March 22.
Last week, the director-general of the WHO, Dr Tedros Adhanom Ghebreyesus had a simple message for containing the spread of COVID-19 . “Test, test, test”, he said, noting that health systems cannot “fight a fire blindfolded”.
South Korea, which has been lauded for its preparedness and response to the pandemic, has aggressively tested its population for the virus. Over 295,000 tests have been conducted, covering 5,000 people per million citizens. Initially uncovering carriers helped ‘flatten the curve’ of infections - the rate of transmission was lowered so that hospitals were not overwhelmed and the response frantic.
Other countries such as Hong Kong, Taiwan, Singapore and Japan have also unleashed a slew of measures that have not let the epidemic get out of hand - despite dense populations, having a strong connection with China, and an older demographic as well.
This also begs the question of what went wrong in Italy, and what other countries can learn from their response. While there are no straightforward answers, and the nature of epidemics is unpredictable and it is therefore unfair to point out Italy, there are some hard-earned lessons that have emerged from the Italian outbreak.
How did it get so bad in Italy?
Italy has seen close to 59,200 cases and nearly 5,500 deaths so far, with a concerning rise in mortality over the weekend. It now far exceeds the death toll in China.
Experts have pointed at Italy’s old population; 23% of the population is over 65 and the median age is 67. About 87% of the deaths have been people over the age of 70. For comparison, the median age in China is 46 and in India, it is around 27. Studies have shown that the disease is more dangerous for those who are older; those who are older and have underlying conditions such as diabetes or heart problems are especially vulnerable.
But these are uncontrollable factors. Blame has also been put on Italy’s haphazard containment measures. While it was the first European country to ban flights from China, the government sent mixed signals to people about the seriousness of the disease. Containment orders in the North — where the majority of cases are — were issued but not implemented strictly. People were still able to move around freely. By the time officials realized community transmission had started, it was too late and the epidemic had gained a foothold.
There are contrasts within the country. The town of Vo has seen a steady decline in cases - officials there have said it is because of aggressive testing and the fact that they were able to track even those with mild symptoms.
However, Italy still insists that it tested thoroughly. Given this, what are some other steps that can be taken to limit an outbreak?
Stricter travel controls
Italy lost vital time initially by not clamping down hard enough and restricting travel within infected districts and failing to keep a track on cases.
Singapore responded differently. Strict travel controls were in place from the beginning and there was extensive data collected on those who had tested positive - the list of potential contacts was made, they were notified and any events that they were to attend were cancelled. Such prophylactic measures played a big role in flattening the curve.
Enforcing a lockdown
Another lesson to be taken is to implement a lockdown promptly, before the signs of community transmission are noted. While Italy did go on lockdown eventually, some people still flouted the restrictions and went about their business without facing any charges. Comparatively, all affected districts have been put under lockdown in India as of 23rd March while there is no sign of community transmission. Whether it will be enforced well is to be seen.
The US initially had a huge issue sending out diagnostic test kits to test widely for the virus - even now there is a shortage in the country.
Hong Kong, Japan and Singapore expediently developed their own test kits to get mass testing underway. While Italy hasn’t been particularly bad in testing its population, our own country may have initially been. South Korea has tested 295,000 people while India has reportedly only tested 17,000 as of March 22. If India is to get ahead of the curve, testing needs to be done more extensively.
These are small points that are indicative of a country’s overall health system. India needs to dedicate more resources to strengthen its healthcare infrastructure as well as take lessons wherever we can get them; an ineffective public health system right now could have disastrous long term effects.
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