Evaluating different national strategies to contain the COVID-19 pandemic before mass vaccination

Abstract

About a year ago, when the first wave of the pandemic in the Northern Hemisphere was ending, I proposed that the countries of the world would need to choose between four basic strategies in the further course of their respective responses:

1. “The complete suppression of the virus”, the implementation of which requires the practical “textbook” application of epidemiological measures: careful border control, two-week quarantine measures for all those who enter the country, a tremendously serious approach to all detected cases, the rapid detection and subsequent isolation of all of the contacts of an infected individual; and, if necessary, a temporary, short-term “lockdown” in limited areas with extensive testing accompanying it. These measures would include the cooperation and discipline of the population, as well as adherence to all of the anti-epidemic measures. With this approach, which isn't particularly financially expensive for most countries, it was possible to spend the vast majority of the time without the fear of the pandemic during 2020 and throughout the course of 2021 to date (this article is relevant to 20 April 2021). In the countries which chose this approach, life carried out more or less as it normally would, resembling the time before the pandemic struck. Examples of such countries are Vietnam, Taiwan, Laos, Thailand and Bhutan, which have recorded less than 1 death from COVID-19 per million inhabitants; followed by China, Cambodia, Singapore, and New Zealand, with less than 10 deaths per million; then, by Japan, Australia, Malaysia, South Korea and Myanmar, with less than 100 deaths per million inhabitants. To date (20 April 2021), these nations have performed the best in protecting their citizens from dying from a new infectious disease. Several of these nations have also shown that countries don't need to be particularly wealthy in order to successfully address this pandemic.
2. A “strong first line of defence”, in which a country chooses to introduce less stringent measures which allow for a certain level of coexistence with the virus, but which do not allow the virus to spiral out of control and begin spreading freely among the population. This strategy is based on scientific knowledge and technology, as well as on intensive testing and the isolation of the contacts of the infected. In addition, it also requires the cooperation and discipline of the population. Examples of this strategy are countries that had a very strong capacity to test-and-trace, and in addition, that deployed electronic applications for the tracking of contacts. Some countries from the first group can also be included here, because they also opted to use the methods of this second group, such as the likes of Singapore, South Korea and Taiwan. Along with them, other typical representatives are the United Arab Emirates (UAE), Qatar, Norway, Finland and Iceland, which to date have recorded 100-200 COVID-19 deaths per million inhabitants; followed by Denmark, Oman, Kuwait and Bahrain, with 200-400 deaths per million inhabitants.
3. “The relaxation and subsequent tightening of measures” was a strategy resorted to by many countries following the first wave of the pandemic. Unlike the first two strategies, which were proactive in their attempt to stay “ahead” of the virus and manage the crisis, this strategy left countries in a passive position towards the virus all too often. Owing to that, the spread of the virus conditioned the stringency of the measures and the way of life of the entire population. This strategy has since proved to be risky. Many nations simply failed to introduce their measures at the time in which they were able to act in a preventative manner, thus warding off the spread of the wave and averting a large number of deaths. Instead, the measures were introduced too late, when the virus would already be spreading freely among the population and the first line of defence would have been breached. Examples of these countries are Canada and Israel with 500-700 COVID-19 deaths per million inhabitants, followed by Greece, Germany, Ireland and the Netherlands which had 800-1000 deaths per million inhabitants. This is also how Austria, Switzerland, Argentina and Chile reacted, which today (20 April 2021) have 1000-1500 deaths per million inhabitants, followed by France, Spain, Italy, Croatia, the United Kingdom, Mexico and Peru, with 1500-2000 deaths per million inhabitants. Finally, several of the hardest-hit countries to date - Belgium, the Czech Republic, Slovakia, Hungary, Bulgaria, Bosnia and Herzegovina, North Macedonia, Montenegro and Slovenia - have recorded more than 2000 deaths per million inhabitants.
4. “The liberalisation of personal risk management”, which arose as a possible option only when sufficient evidence emerged from seroprevalence studies, ie, the presence of antibodies in a person's blood. These studies confirmed that the death rate among all those who had become infected should not exceed 0.5-1% in the majority of countries. Countries that employed this strategy decided not to pay excessive attention to the pandemic and to preserve their economic activities to the greatest extent possible. Elements of this approach could be found in Sweden (1359 deaths per million inhabitants), the United States (1749 deaths per million) and Brazil (1755 deaths per million), as well as some countries in Africa and the Middle East where the data on deaths from COVID-19 isn't reliable enough.

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© 2021 by the Journal of Global Health. All rights reserved. This work is licensed under a Creative Commons Attribution 4.0 International License.

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DOI

https://doi.org/10.7189/jogh.11.01004

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https://www.research.ed.ac.uk/en/publications/ecb4a0cb-d3c3-4984-996d-c8ca95191c4b