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October 14, 2020

Rising global cases and deaths, WHO website, Oct. 14, 2020

The fall headlines proclaim it. COVID-19 cases are rising worldwide. But not everywhere. Why are some countries able to keep their numbers down? What are the success stories? Comparisons are tricky because there are so many variables, but we can make a few general observations. It helps to be a relatively small country. It helps to be an island. But these are not guarantees. Most of all, it helps to mobilize quickly. Countries which have seen epidemics before know this.

Pakistan, for example, is neither small nor an island, but they were working hard to eradicate polio when COVID-19 came along. Trained community health workers were already in the field working on contact tracing, tracking, and health care. With a 220 million population, Pakistan’s COVID cases peaked in June, went down and have not gone back up. They responded quickly with masks, social distancing, and awareness campaigns. The government passed a $7 billion relief package to help day workers, low-income families, and small businesses. To preserve the economy, they limited lockdowns to selected hot spots. Schools closed in March, but opened again in September (with masks).

Taiwan, experienced the SARS epidemic in 2003. SARS is a similar coronavirus, more deadly, but easier to trace than COVID because the only people who transmitted it had symptoms. When the new coronavirus was reported in Wuhan, Taiwan activated its CECC (Central Epidemic Control Center) to bring public agencies together in a coordinated response. With 23 million people they have had only 7 deaths and just one case with local transmission since April.

Taiwan’s response included: Quick travel bans, early mask requirements, hand washing, and daily briefings. Life there is fairly normal now and they are working toward increasing travel safely by requiring testing and reducing quarantines. Even with cases under control, a country needs active travel connections to restore its economy.

New Zealand is also working toward restoring travel, since its cases peaked in April, went down and stayed down. With five million people, they have had no positive cases since an outbreak in August which was immediately traced and controlled. They acted quickly and used aggressive contact tracing, including the use of a tracer app which helped people track their own movements so that tracing could be quickly done if needed. Masks are still required on public transport and when you cannot distance.

New Zealand imposed a unique system of isolation and quarantine. Travelers and returnees are quarantined in designated hotels for 14 days. People with exposure to COVID or with symptoms are isolated separately. There has been some resistance, but it does prevent new cases. Like Taiwan, however, restricting travel has severe economic and social consequences and can only be a temporary measure.

The October 12 article in The Atlantic (link below) describes similar success stories in Indonesia, Australia, Japan, South Korea, and Vietnam. Measures were similar, but with some variations. Japan found that simply opening a window and a door improved ventilation enough to reduce virus spread in classrooms. South Korea did not have widespread lockdowns, but mask-wearing was universal. Australia was quick to form a national cabinet of the prime minister and the leaders of each state and territory to coordinate responses. They did not require masks at first, but later made them mandatory in states where active spread was occurring.

Every country has a different story, but there are some common elements. Coordinate administrative units with a national plan. Act quickly. Raise awareness in every part of the community. Communicate openly and often. Use masks, hand washing, and distancing to prevent spread. Trace contacts and restrict travel. Use targeted lockdowns in hot spots as needed.

What about Europe?

Europe and the UK experienced a first wave in the spring, began to open up in the summer, and are showing a second wave right now. Lockdowns and restrictions are being brought back.

Sweden has had a controversial and often misunderstood approach. I urge you to read the articles below, follow up with your own research, and draw your own conclusions.

United States total cases, 7-day moving average, CDC https://covid.cdc.gov/covid-data-tracker/#trends_dailytrendscases

As for the United States, we’ve had a first peak in April and a second higher peak in late July and are now going up again. Whether this constitutes a “second wave” is a moot point, since we never really went completely down. Highs and lows vary considerably around the country, however, so individual states and communities have had very different experiences.

About these graphs:

I owe the small graphs to a nonprofit organization called EndCoronavirus at https://www.endcoronavirus.org/countries . They do a good job of explaining the use of normalized graphs and a 7-day rolling average to facilitate comparisons. Increases and decreases in cases are real even with the knowledge that every individual test is not perfectly accurate. I encourage you to look at their excellent website which has plenty of additional food for thought on this topic.

“SOME ARE WINNING – SOME ARE NOT,” End Coronavirus.org. https://www.endcoronavirus.org/countries

Successful Countries:

“New Zealand Declares Victory Over Coronavirus Again, Lifts Auckland Restrictions,” NPR, Oct. 7, 2020. https://www.npr.org/sections/coronavirus-live-updates/2020/10/07/921171807/new-zealand-declares-victory-over-coronavirus-again-lifts-auckland-restrictions

“4 ways Australia’s coronavirus response was a triumph, and 4 ways it fell short,” The Conversation, June 3, 2020. https://theconversation.com/4-ways-australias-coronavirus-response-was-a-triumph-and-4-ways-it-fell-short-139845

“Australia’s about-face on masks and Covid-19: why our health advice was late to the party,” The Guardian, July 21, 2020. https://www.theguardian.com/australia-news/2020/jul/22/australias-about-face-on-masks-and-covid-19-why-our-health-advice-was-late-to-the-party

“Taiwan led the world in closing down for Covid-19, now it wants to do the same with opening back up,” CNN Travel, Oct. 7, 2020. https://www.npr.org/sections/coronavirus-live-updates/2020/10/07/921171807/new-zealand-declares-victory-over-coronavirus-again-lifts-auckland-restrictions

“Pakistan’s fight against COVID-19: A success story?” CGTN, Sept. 16, 2020. https://news.cgtn.com/news/2020-09-16/Pakistan-s-fight-against-COVID-19-A-success-story–TPi9CHkXbq/index.html

“How to Keep a Fall Surge From Becoming a Winter Catastrophe: What we can learn from other countries to avoid the worst-case scenario,” The Atlantic, Oct. 12, 2020. https://www.theatlantic.com/ideas/archive/2020/10/how-keep-fall-surge-becoming-winter-catastrophe/616674/

Sweden

“Pandemic Exposes Holes in Sweden’s Generous Social Welfare State,” The New York Times, Oct. 8, 2020. https://www.nytimes.com/2020/10/08/business/coronavirus-sweden-social-welfare.html

“The Swedish COVID-19 Response Is a Disaster. It Shouldn’t Be a Model for the Rest of the World,” Time, October 14, 2020. https://time.com/5899432/sweden-coronovirus-disaster/

Why am I doing this?

The coronavirus pandemic will be indelibly written on our memories just as the Great Depression or the Battle of Britain left their mark on past generations. It is my intention to journal the pandemic experience from three perspectives: as a retired medical technologist, a historian (Ph.D., 2014), and an ordinary person living through an extraordinary crisis.

You are on History’s Edge.

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