A majority of countries have implemented a lockdown in an attempt to reduce the spread of the coronavirus and combat the growing number of infected people. Prior to the coronavirus being declared a pandemic by WHO, there was a clear patter in terms of people’s response to the spread of the virus although there were signs that the threat was making its way across the globe. Denial, ignorance and fumbling are but a few.
It is surprising that little to no lessons were learned in the early weeks of each country’s outbreak, when the chances of containing and stopping the spread of the coronavirus were highest. Currently, the global focus is on slowing the spread of the coronavirus to keep death tolls from climbing further. As much of the world mulls gradually lifting lockdowns, there are still lessons to be learned from these four nations that got it right. Here are 12 of those lessons.
In many countries, it isn’t commonplace to get a coronavirus test unless you’re already very ill. This is different in Iceland where anyone who wants a test can get one. Authorities in Iceland have reported that widespread testing has been crucial to the country’s low number of infections and deaths. Only around 1,700 people have been infected in Iceland, and only 9 have died.
Lesson 1: Be Aggressive
Iceland’s response to the coronavirus has been meticulous and quick rather than innovative. The benefit of this is that it hasn’t had to be too restrictive — people can still meet in groups of up to 20, if they stay two meters away from each other. While universities are closed, schools and nurseries are still open, allowing more parents to work.
In a conversation with CNN, Iceland’s chief epidemiologist Thorolfur Gudnason said that “From the beginning, since we diagnosed our first case, we worked according to our plan. Our plan was to be aggressive in detecting and diagnosing individuals, putting them into isolation, and to be very aggressive in our contact tracing. We used the police force and the healthcare system to sit down and contact trace every newly diagnosed case. We are finding that above 60% of new cases are in people already quarantined. So that showed that contact tracing and quarantining contacts was a good move for us,” Gudnason said.
Lesson 2: Involve the private sector
Iceland have designed testing procedures early and expects to have tested 10% of its population by the end of this week. The designed test were done via a public-private partnership between the National University Hospital of Iceland and biotech company deCODE Genetics. The biotech company has already become a valuable laboratory for the world to learn more about the novel virus. It has been recently discovered that 50% of the people who tested positive in a lab in Iceland showed no symptoms at all. This has prompted other countries to take firmer action through social distancing, as it has been realised that preventing the spread of the coronavirus will be more challenging than initially thought.
CEO and director of deCODE Geneticsm, Kári Stefánsson, told CNN that as of Monday, 528 mutations of the coronavirus have been found during mass testing in the community. These mutations could give insight to how lethal the virus becomes and offers important data to the world to better understand how it operates.
Lesson 3: Act preventatively
Speed has been emphasised as a power tool by the Icelandic Health Minister Svandís Svavarsdóttir. He says that the approach to defeating the virus is to stay ahead of the curve. Iceland appears to have done just that. After just six imported cases were confirmed on March 3, Iceland immediately issued quarantine measures for all travellers returning from Italy. Additionally, it increased travel restrictions in the following weeks. Three days later, the National Police Commissioner declared a state of emergency when the first two community-transmitted infections were confirmed. This sent a signal to government bodies to improve their preparedness.
On March 13, Iceland closed universities and junior colleges and banned gatherings of more than 100 people on March 16, when it had 61 confirmed cases without a casualty. Three days later, all Icelandic residents that entered the country were required to go into 14 days of quarantine, regardless of where they were traveling from. 21 days after the first confirmed case and the beginning of the restrictions, Iceland reported its first death. That same day, authorities banned gatherings of above 20 people and shut down public amenities, such as bars, swimming pools, museums and gyms.
Lesson 4: Utilise technology, but respect privacy
An app for people to help track the spread of the virus was developed by Icelandic officials. It creates a log of the places the user has been too. Users are not obliged to share that data with authorities — but many do as it helps contact-tracing teams work out who may have been put at risk. In comparison to another country with an app initiative for combating the coronavirus, the UK’s response has been slow. A government-supported app is now in the works and weeks away from launching.
Taiwan’s outbreak could have been disastrous given that it sits just 180 kilometres (110 miles) off the coast of mainland China. By the end of January, the island was estimated to have had the second-highest number of cases in the world, according to Johns Hopkins University. However, with a population of around 24 million people, Taiwan has recorded just over 390 cases and six deaths. It has managed to do so without implementing sever restrictions like lockdowns or school and nursery closures. Although Taiwan has high-quality universal health care, its success lies in its level of preparedness, speed, central command and rigorous contact tracing.
Lesson 5: Be quick
Taiwan’s action came well before its first Covid-19 infection was confirmed on January 21. Three weeks prior, within days of China’s first reported case to the World Health Organization (WHO), Taiwanese officials began boarding and inspecting passengers for fever and pneumonia symptoms on flights from Wuhan, the original epicenter of the virus in China. A travel alert for Wuhan was issued on January 20th and two days later, still with just a single case, officials began updating the public in daily briefings.
Taiwan began electronic monitoring of quarantined individuals via government-issued cell phones, and announced travel and entry restrictions a week after its first case. The Taiwanese government implemented new measures to keep the virus at bay just about every day until the end of February.
Taiwan had only 329 cases when it imposed strict social distancing measures on April 1. In comparison to the UK, there were already 335 deaths and more than 3,000 cases on March 20, when Prime Minister Boris Johnson announced that pubs and restaurants were to close, and that most children would be pulled from schools and nurseries.
Lesson 6: Be prepared
Taiwan’s preparedness came largely from hard-learned lessons from the Severe Acute Respiratory Syndrome (SARS) outbreak which killed 181 people in 2003. In response to that outbreak, Taiwan established a specialised Central Epidemic Command Center, which could be activated to coordinate a response in the event of an outbreak. In an attempt to get ahead of the coronavirus, the centre was activated on January 20, a day before the island even confirmed its first infection.
The centre was able to implement stringent measures without being slowed down by lengthy political processes. It put more than 120 action items into place within three weeks, according to a list published by the Journal of the American Medical Association (JAMA). That list alone could serve as a manual on exactly what to do during an outbreak.
Lesson 7: Test, trace and quarantine
Authorities carried out widespread testing and contract tracing. All individuals were placed under quarantine. It proactively tested anyone who got off cruise ships and even retested people diagnosed with influenza or pneumonia, to make sure they hadn’t been misdiagnosed and were infected with the coronavirus.
South Korea reported its first coronavirus case at around the same time as the US and UK. South Korea is confirming around 30 new cases a day, while in the UK it’s around 5,000, and the US it’s more than 20,000. Each country’s way of testing varies, but their death rates among the population contrast just as dramatically. Fewer than one in every 100,000 people in South Korea’s population have died from the virus, while in the UK it’s around 18. In the US, it’s almost eight in every 100,000 per Johns Hopkins University data.
Lesson 8: You can drive-through test
According to Dr. Eom Joong Sik from the Gil Medical Center near Seoul, South Korea’s success has been largely down to its testing. Dr. Eom is treating coronavirus patients in hospital and he sits on a committee that advises the government on how to respond to the coronavirus. “Early diagnosis, early quarantine and early treatment are key,” he told CNN. “Since the first patient was confirmed, by installing more than 500 screening clinics all over the country, we sorted suspected cases and conducted tests, and we have worked hard to develop and maintain a system to conduct many tests with a small workforce over a short period of time,” he added.
The country has also been innovative in how it tests. Dr. Eom’s advisory team created hundreds of drive-through booths, similar to the ones at McDonald’s, across the country to offer tests that were largely free, quick and done by staff at a safe distance. The US has since replicated that model in some states.
On March 16, the WHO called on governments of the world to “test, test, test.” South Korea had already been testing and has to date tested over 500,000 people.
Many countries are struggling to carry out thousands of tests each day. South Korea was quick to move, implementing quarantining 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 rolled out a series of travel restrictions over the weeks after. South Korea has also been rigorous in its contact tracing, though it was able to do that easily after realising a large number of cases could be traced to one religious group in the city of Daegu. This gave authorities a specific area to carry out intensive testing.
Dr Eom said “By carrying out tests on all members of the congregation and diagnosing even infected people without symptoms, the government carried out quarantine and treatment side by side.” Once Daegu was established as the epicenter, authorities were ready with the ability and political will to test broadly, to trace contacts of people infected, and to quarantine them to try and contain the virus before it became a case of mitigating wide scale death, as is now the case in much of Europe and the US.
Lesson 9: Learn from the past
South Korea was able to move quickly because it had experienced an outbreak of such sort in the Middle East Respiratory Syndrome in 2015, when it recorded 186 cases and 38 deaths. This made it the worst-impacted country outside the Middle East.
As such, the political will needed to enforce measures during the coronavirus outbreak wasn’t a problem and there was good coordination between the central government and the provinces. It also helped that South Korea is one of the most technologically innovative countries in the world. Much of life there is already conducted online, so developing and enforcing the use of an app to monitor people in quarantine wasn’t too difficult, though activists there too have warned of invasion of privacy.