To get a more accurate picture of the global pandemic response, we chose five countries – China, Italy, the United States, India and Brazil, to represent the worst-hit countries in Asia, Europe, North America, and emerging developing economies respectively. In addition to geographical representations, China, India, and Brazil in particular can offer lessons learned in coping with COVID among the large or dense population; whilst the United States and Italy can offer lessons learned in treating data privacy and elderly population.
Figure 1 shows a comparison between daily new confirmed COVID-19 cases V.S. daily new confirmed COVID-19 deaths among these countries. Italy and the United States were particularly hard hit. Even though all three countries have taken similar quarantine measures ranging from two to four or even more weeks, the rapid increase in the number of new contractions has been common in Brazil, the United States, and Italy. While the number of COVID-19 deaths remain high in the United States, Brazil, and India, Italy has had a drastic increase since the ralatively peaceful summer monthshas.
COVID-19 broke out in Wuhan city, China and spread rapidly across the country at the beginning of 2020. Wuhan has been known as the "Chicago of China" for its role as a business hub throughout the nation's modern history with high population mobility. Aggravated by high mobility, the coronavirus spreaded from Wuhan to the rest of Mainland China within one month. Since Professor Zhong Nanshan, distinguished Chinese pulmonologist confirmed the human-to-human transmissibility of 2019‐nCoV on January 21, the national government has decisively a quarantine for Wuhan, with additional measures in: case detection with immediate isolation, contact tracing, and medical observation, increase in medical resource supply (transforming stadiums, hotels and schools into hospitals for centralized quarantine). By March 18, the government reported zero new confirmed cases in Hubei Province. Since then, China has entered a phase referred to as normalized prevention and control. Yet COVID-19 has been a recurrent risk. On June 13, 36 confirmed new COVID cases emerged at the Xinfadi wholesale market in Beijing. For this regional outbreak, the local government responded swiftly with large-scale PCR tests and epidemiological investigation. China’s current localized approach to pandemic control has showcased the the principle of timely detection, rapid disposal, precise control and effective treatment.
Italy was the first developed country in which COVID-19 reached a major outbreak outside of China. In Italy, unfortunately there was a long gap between the first diagnose confirmed on January 31 to the first death reported on February 21, which gave the coronavirus the chance to transmit widely across the country. On March 8, the Italian Government implemented extraordinary measures to limit COVID transmission, including travel restrictions in the Lombardy region, as well as a quasi nation-wide lockdown. Additional efforts include the closure of schools, universities and many services including theaters, cinemas, and pubs. Public transportation was highly restricted, all sports events and religious ceremonies were suspended.[20, 21] Italy experienced the month of March with appallingly high fatality. The deadliest day from Coronavirus was March 27, in which 969 people died. After a prolonged and persistent quarantine, The Italian health system became relatively in control of COVID-19 since May. By June 2, Italy reopened its borders to tourists. At the moment (end of October), a sharp increase of new confirmed cases has again been recorded in the country.
The Unite States, Brazil and India became the top three countries respectively for having the highest confirmed COVID-19 cases as of August 7. The United States is worst hit by the second wave of COVID contractions. The first case of COVID-19 was announced on January 20, 2020, in Washington State. The state of New York quickly became the epicenter with the majority of cases and deaths reported in New York City. The country suspended all entry of immigrants and non-immigrants to high-risk zones and set up quarantine stations 18 major ports of entry, hoping to halt the spread of the virus.[23, 24] By April 11, The United States surpassed Italy and became the country with the highest number of confirmed COVID deaths in the world. As of August 7, The United States has exceeded 160,000 coronavirus deaths as more than 60,000 new cases are detected on this day alone across more than 12 states. Compared to other countries, the United States has taken fewer countermeasures: city/region-wide lockdown in most states was imposed only for March and April, increase in medical resource supply in badly-hit states was insufficient for the demand, and event suspension did not stop people from going onto the streets for protests against COVID measures or for racial justice purposes. One of the challenges for the United States is that the decentralized decision-making system resulted in many states undervaluing the risks for economic motives, hence made a minimal intervention to control the pandemic.
Brazil, where the first case of COVID-19 registered in Latin America, implemented the social distancing measure such as remote working for vulnerable civil servants and at-risk groups. That first patient, who had mild symptoms, was given standardized care recommended by the epidemiological surveillance authorities and told to self-isolate at home while contacts were investigated among family members. Another emerging developing country, India, confirmed its first case in the country on January 30 and similar like in Italy, the first coronavirus death was recorded much later, on March 12. With Italy as an alarming precedent reference, India was quick to close its international borders and enforce an immediate lockdown.
Reviewing the COVID transmission experiences and responses in these five countries, it’s fair to say that the COVID-19 pandemic has revealed many problems of public health governmence in these countries. In the early stage of the pandemic, the local government of Wuhan lacked the capacity and transparency in coping with the pandemic, which resulted in questions and doubts from the public. The lack of credible information prompted many citizens to panic and hoard daily goods. In addition, emergency medical supplies in all these countries were insufficient. The abrupt quarantine also particularly worsened the financial situations for large groups of low-income population, such as urban migrant workers, refugees in war-torn zones, and small medium-sized enterprises. Though the health system in Italy is highly regarded and has 3.2 hospital beds per 1000 people (as compared with 2.8 in the United States, see Table 1), it has been extremely challenging to take in all the critically ill patients simultaneously. In the most affected regions, the National Healthcare Service was close to collapsing. India was quick to act but without an adequate health system in place. Owing to the lack of accurate data collection and tracking as well as test equipment, India faced an even more complicated challenge of controlling the pandemic. What’s worse, in Brazil, false messages from political leaders and inadequate health system delayed in measures needed to contain the virus.
Table 1: COVID Country profile. Data source: European Centre for Disease Prevention and Control (ECDC), Oxford Martin School, and the Global Change Data Lab.
* Population density: Number of people divided by land area, measured in square kilometers, most recent year available from World Bank – World Development Indicators, sourced from Food and Agriculture Organization and World Bank estimates.
List of countermeasures
- Mandated city/region-wide quarantine/lock-down/curfew
- Case detection with immediate isolation
- Contact tracing
- Medical observation
- Increase in medical resource supply (equipments, temporary hospitals, professionals, etc)
- Centralized quarantine
- Travel restriction
- Event suspension
In a nutshell, all these five countries have been badly hit, also owing to high population mobility and economic volume. There are some common challenges faced by these five countries, including a shortage of medical supplies, difficulties in restricting travel. Contact tracing has been a common challenge too. In countries like India and Brazil, contact tracing has been a common challenge due to insufficient technological access, whilst in the United States and Italy, it has been due to the concern of privacy. Quarantine measures in these five countries were similar but differentiated regarding time and population coverage. Besides, there are also unique challenges faced by specific countries, for instance, for the United States and Italy, centralized quarantine is not only a concern of public expenditure but also is considered an infringement of certain civil rights. While it might be valid universally, but particularly for China, India, and Brazil, quarantine and suspension of activities have been economically devastating for the low-income population.
As a result, the outcome of COVID-19 control in these five countries was distinctive from one another. The pandemic has returned as a second wave as countries across the world reopened. The global urbanization trend is bringing people physically closer and more connected to each other than ever. The increasing urban density and speed of social and economic activities have exacerbated the spread of COVID-19 which is endangering particularly emerging, dense urban areas with less developed medical prevention and control mechanisms as well as with a large ageing population.
Besides, the industrilised economy driven urbanization has agravated global warming and consequencial impacts, even though is has increased many people income and life quality. The current consumption habbit of industrialized agricultural products as well wild animal consumption imply that we will continue to be exposed to viruses from nature in the foreseeable future. For now, the majority of the human population is still susceptible to COVID-19, which means authorities still need to be vigilant and take countermeasures to protect their citizens before an effective vaccine is developed. Thus, it is necessary to reflect on the current public health governance and propose new approaches to improve the current system.