In the face of the pandemic, we are not all equal. As an individual, but also as a citizen residing in a particular country. This editorial address the second point: the strategies and measures put in place by the different governments of different countries, but also the habits and customs of the different population, both of which play a significant determining role in addressing the crisis. Here is a benchmark of the “good students” who have made it as difficult as possible for the virus to spread, and whose policies have proved effective to date (1). This is not an exhaustive analysis – the situation develops and changes by the hour –but it serves as a good indicator of where we are at this moment.
Respect for hygiene rules
Sometimes coincidences appear to be fatal. At the end of February, the IFOP polling institute released a survey showing that the French had a difficulty with hygiene. One of the most striking results being that “only 3 out of 4 French people (76%) undertake full bathing and grooming every day” (2). The hygiene of the population of a country is one of the first factors of resilience in the face of the spread of a virus.
A study by Haris Interactive in Malaysia has shown that Malaysians’ awareness of the danger of the pandemic has led Malaysians to wash their hands more – a change in behavior that affects more than 76% of the population (3). It would be interesting to have a comparative study showing the impact of this factor depending on the country, but we can already imagine that it can play an important role in terms of prevention (4).
Wearing a mask
The shortage of masks will undoubtedly be included in the health scandals of a country like France. On the contrary, the respect of this prophylactic constraint will have been beneficial for some countries. In Asia, this precaution is seen as essential for collective interest and in particular in a country like South Korea, for example. Le Figaro explains in the article headlined “Coronavirus: in South Korea”, that everyone has been wearing a mask since February (5). A Korean woman explains that “People who do not wear a mask in the metro or in the street are frowned upon. You have to wear a mask so as not to contaminate others”. Recall that this country was one of the very first hit by the pandemic after China, as Philippe Lacoude reported on our website: “The situation is now serious in South Korea, which initially took things lightly. With nearly 3,736 cases confirmed on March 1, 2020”. It is all the more striking to see that South Korea is today cited as an example by many scientific commentators, for its good management of the crisis (6).
Anticipating the crisis “at the right time”
Some governments have been able to anticipate the crisis better than others, taking restrictive but necessary measures, which have turned out to be beneficial for their country. This is the case of Georgia, for example, which limited travel as early as January 28, long before other European countries. That decision – an early and decisive action that was praised by the WHO – taken by the Georgian Prime Minister Georgi Gakharia was followed by others such as the early cancellation of major sporting and cultural events (7). Georgia also closed ski resorts, restaurants and bars, All of these actions were taken when very few people were infected. Measures to cushion the economy immediately followed and an economic rescue plan was launched (tax deferrals, loans guaranteed by the government, VAT refunds…). A dedicated website was set up by the government to communicate directly with citizens in real time (8). As Gabriel Wacksman for European Scientist points out, this ability of governments to anticipate the pandemic, and then act decisively, is fundamental and even more appreciable when it comes from a small country.
Wearing the mask made the difference in South Korea, but we another key element is the ability to massively test the population. So, as Eric Van Vaerenberg reminded us on our site, this country made more than 15,000 tests a day. Today, everyone is convinced that massive testing is the solution. WHO has also called for widespread testing. In Europe, Germany (9) performs more than 500,000 tests per week (10). In Romania, there has been talk of testing “the entire population of Bucharest”, or 1.8 million inhabitants (around 10% of the country’s population). In the case of COVID-19, the advantage of the tests is that they make it possible to detect people who are infected without showing symptoms and who can therefore take appropriate action.
To distance oneself socially
This precaution can be applied by each individual without constraint and by exercising his full responsibility as soon as he is informed of the risk that he makes others run or of the risk that he may run in their presence. But the fact is that in the case of COVID-19, individuals are not necessarily aware of the fact of being infected and therefore of being vectors of contagion.
Countries like Taiwan and Singapore have stood out for the establishment of Contact Tracing, which is very well explained in the infographic produced by the Swiss epidemiologist Marcel Salathé (11). The general idea being to identify and confine the contaminated people as quickly as possible and in a non-targeted manner.
Singapore was also noted for the crackdown put in place for failure to follow established rules for social distancing: those who do not follow these rules are now at risk of imprisonment (12). Measures that seem to prove their great effectiveness, because even if these two countries are close to China (13), the number of cases seems extremely low.
The key question: How to NOT be in lockdown for months?
Barring pharmaceutical breakthroughs, I currently don’t see a responsible exit strategy without testing, contacting tracing, and isolation. https://t.co/QcV1e7ADiD
— Marcel Salathé (@marcelsalathe) March 26, 2020
While some will blame China (14) for having hidden the pandemic for longer than necessary, it is undeniable that the use by this country of advanced technologies has played a fundamental role in the fight against the pandemic and the search for an exit route. Eric van Vaerenbergh, already quoted, makes a complete list of the panoply of technological solutions deployed by China to detect and monitor individuals infected with the virus. The facial recognition company Megvii, installed a prototype temperature measurement system using facial recognition in a district of Beijing; infrared cameras to measure body temperature in public places; voice recognition assistants capable of handling 200 telephone calls in five minutes and assisting hospitals in their screening tasks; applications to check if you have been in contact with a patient, facial recognition, and so on. To this must be added that China is now equipped with advanced medical equipment. One is amazed by the Health Code project, a QR code useful a pass for all our daily activities as explained by Marc Rameaux for our site.
Generalized confinement / “Lockdown”
This measure is undoubtedly the last resort in terms of action. As we know, faced with the emergency, many countries have used it, starting with China. Wuhan took very strict containment measures on January 23, 2020, and 15 other Chinese cities followed. In Europe, Italy was the first country to use it, followed by France. It is difficult to say whether this measure is beneficial for a particular country, because it is applied differently in each country and is not necessarily followed with the same discipline everywhere. Finally, it should be noted that this last resort even if it seems to have been more or less adopted by all countries, has catastrophic economic and socioeconomic consequences. However, when we reach stage three of the pandemic, this strategy seems to show its effectiveness to reverse the curve.
A reactive hospital infrastructure
Here is the final criterion, which is difficult to judge. However, we can rely on the data provided by worldometers (15), which compares the efficiency of healthcare systems. At the top we find Israel with 5 deaths for 2495 cases, which is a fatality rate of 0.2%; Norway with 14 deaths for 3,191 cases, or 0.2%; Australia with 13 deaths for 2,799, or 0.5%, and the rare countries such as Georgia, with no deaths at all so far.
As this short guide demonstrates, the best prepared country would be the one that ticks all of these boxes and scrupulously applies all effective measures…. This analysis shows above all that everything – absolutely everything – is important: governments who know how to take the right measures at the right time, but also citizens who have appropriate customs and are willing to take responsibility in the face of the pandemic.
Lessons to consider for the future!
(1) Based on information from the following website https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6
(4) On the date of publications, Malaysia has confirmed 3116 cases, of which 50 fatalities.
(6) On the date of publication, South Korea has confirmed 9976 cases and 169 fatalities.
(7) Of note: 4000 Georgian citizens trapped overseas were brought home immediately by the government.
(8) On the date of publication, Georgia has confirmed 130 cases of COVID-infections, and no fatalities.
(9) On the date of publication, Germany has confirmed 77 981 cases and 931 fatalities.
(13) On the date of publication, Singapore has confirmed 1000 cases and 4 fatalities, whereas in Taiwan the numbers are 338 and 5 respectively.
(14) On the date of publication, China has confirmed 82 394 cases and 3 322 fatalities.