The Large Scale Impact of COVID-19 Crisis: How Nations Responded and What We Have Learned

In March 2020, Coronavirus disease 2019 (COVID-19) was officially declared a pandemic by World Health Organization (WHO) [1]. From there, the entire world went under a massive transformation in virtually every aspect of life. This article will discuss the major challenges posed by COVID-19 particularly in the healthcare sector, followed by the responses of leading nations during the early phases of the pandemic.

COVID-19 IMPACT ON HEALTHCARE

The increasing number of new hospitalized cases and deaths in the initial surge of COVID-19 placed significant demands on the healthcare systems, especially in low-income and middle-income countries. Hospitals faced a shortage of doctors, nurses, pharmacists, and other medical staff, forcing many to work longer hours to provide medical care for the growing number of patients. Heavy workload, stress, and high-risk exposure to the virus led to burnout, resignations, and absences, leaving a greater gap in the already overburdened healthcare systems [2]. Moreover, many hospitals faced shortages of essential supplies or medical equipment to accommodate the increasing number of hospitalizations. The lack of ventilators, symptomatic drugs for SARS-CoV-2 (midazolam, fentanyl, albuterol), surgical gowns and masks, and other personal protective equipment, put both patients and healthcare staffs in an extremely vulnerable state [2-3].

Figure 1. Visualization of number of new hospitalized cases from the World Health Organization COVID-19 surveillance database [4]

HOW NATIONS RESPONDED

In response to the initial outbreaks of the pandemic, many countries adopted various prevention and control measures while waiting for the vaccination to be developed. Differences in healthcare systems and political systems in nations are the primary reasons that led to different approaches to combat COVID-19. These approaches could be divided into two types: containment strategy and mitigation strategy. The main target of a containment strategy is disease spreading prevention by breaking at least one of the components in the chain of infection: infectious sources, transmission routes, and susceptible populations [5]. The containment strategy also focuses on screening cases, isolating and treating mild cases, and managing close contacts of these cases [5]. Some of the countries using these strategies were China, Hong Kong, Japan, South Korea, Singapore and Vietnam. Meanwhile, a mitigation strategy aims to slow the spread of the virus and reduce the burden on health systems, by prioritizing hospitalizations of severe cases or vulnerable patients with underlying conditions, and mild cases are often not detected early nor provided with medical care [6]. Some of the countries leaning towards these strategies were United States, United Kingdom, and France. Whichever strategy - containment or mitigation - is implemented, an effective pandemic response typically relies on four key pillars: containment and surveillance, clinical services, border control, and community and societal measures, all of which complement and support one another [7].

A study was conducted in 2021 to assess the effectiveness of the measures adopted by six leading countries (China, Singapore, South Korea, United States, United Kingdom and France) using data of the total of new daily cases and confirmed cases, total deaths and daily new deaths to generate mortality rate (per 100,000 population) [8]. China, Singapore and South Korea, the countries that were affected by the MERS (Middle East respiratory syndrome) and the SARS (severe acute respiratory syndrome) outbreaks, have learnt their lessons and responded to the situation in a timely manner [9,10]. A proactive approach was taken by these countries to respond to the COVID-19 outbreak by early detection, early reporting, early isolation of all suspected cases, and early treatment of confirmed cases, supported with medical personnel and makeshift hospitals in the outbreak regions. Measures such as social distancing, lockdowns, and public place closures were implemented (e.g. Zero-COVID policy in China [11]). Results showed that countries adhering to containment strategies had mortality rates per 100,000 population lower than 2.0, and the total of new daily cases in these countries declined steadily throughout the year 2020 [8]. Meanwhile, countries that adopted mitigation strategies initially witnessed positive effects, but relaxed restrictions after the first wave led to a surge in new cases during the second wave. Containment strategies were less productive in certain nations due to political structures and liberal democratic values, which led to public resistance against mandates such as mask-wearing and lockdowns. In these regions, governments focused on mitigation strategies by focusing on COVID-19 testing development programs, improving specialized treatment for severe cases, establishing temporary hospitals, and expanding healthcare capacity. However, at the time when the launch of COVID-19 vaccine had yet to be launched, the effectiveness of these efforts proved to be limited compared to containment strategies, as reflected in rising new daily cases and mortality rates [8].

Figure 2. Epidemic curves and population mortality rates of two demonstrating countries, United States and China, in 2020 [8]

In conclusion, the COVID-19 crisis has served as a critical reference point and reshaped the way societies think about and prepare for future pandemics. Learning from the past and improving response strategies by enhancing preparedness, coordination, and resilience could make the world become better equipped to face similar crises in the future.

References

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2. Wu, H., Soe, M. M., Konnor, R., Dantes, R., Haass, K., Dudeck, M. A., Gross, C., Leaptrot, D., Sapiano, M. R. P., Allen-Bridson, K., Wattenmaker, L., Peterson, K., Lemoine, K., Chernetsky Tejedor, S., Edwards, J. R., Pollock, D., Benin, A. L., & National Healthcare Safety Network (2022). Hospital capacities and shortages of healthcare resources among US hospitals during the coronavirus disease 2019 (COVID-19) pandemic, National Healthcare Safety Network (NHSN), March 27-July 14, 2020. Infection control and hospital epidemiology, 43(10), 1473–1476. https://doi.org/10.1017/ice.2021.280

3. Ranney, M. L., Griffeth, V., & Jha, A. K. (2020). Critical Supply Shortages - The Need for Ventilators and Personal Protective Equipment during the Covid-19 Pandemic. The New England journal of medicine, 382(18), e41. https://doi.org/10.1056/NEJMp2006141

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7. OECD (2020), “Flattening the COVID-19 peak: Containment and mitigation policies”, OECD Policy Responses to Coronavirus (COVID-19), OECD Publishing, Paris, https://doi.org/10.1787/e96a4226-en.

8. Chen, H., Shi, L., Zhang, Y., Wang, X., Jiao, J., Yang, M., & Sun, G. (2021). Response to the COVID-19 Pandemic: Comparison of Strategies in Six Countries. Frontiers in public health, 9, 708496. https://doi.org/10.3389/fpubh.2021.708496

9. Hui, D. S., Perlman, S., & Zumla, A. (2015). Spread of MERS to South Korea and China. The Lancet. Respiratory medicine, 3(7), 509–510. https://doi.org/10.1016/S2213-2600(15)00238-6

10. Lam, W. K., Zhong, N. S., & Tan, W. C. (2003). Overview on SARS in Asia and the world. Respirology (Carlton, Vic.), 8 Suppl(Suppl 1), S2–S5. https://doi.org/10.1046/j.1440-1843.2003.00516.x

11. Ba, Z., Li, Y., Ma, J., Qin, Y., Tian, J., Meng, Y., Yi, J., Zhang, Y., & Chen, F. (2023). Reflections on the dynamic zero-COVID policy in China. Preventive Medicine Reports, 36, 102466. https://doi.org/10.1016/j.pmedr.2023.102466

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