How 5 of the worst-hit countries around the world are responding to coronavirus outbreak

China, South Korea, Italy, Iran and the US are some of the worst-hit countries by the coronavirus pandemic, and all have come up with their own unique responses.

(Representational Image) People wearing masks walk at Central district in Hong Kong, China | Paul Yeung | Bloomberg File photo

New Delhi: As the coronavirus pandemic worsens by the day, government responses around the globe have varied from complete lockdown and aggressive tests and isolation of suspected cases to even denial.

While the South Korean response has been termed as the prototype to follow, the Italian and Iranian governments have been criticised, and held responsible, for exacerbating the crises in their respective countries.

Meanwhile, China, which initially faced flak for its lack of transparency, has now emerged as the model for the most effective, if sometimes draconian, control on the pandemic. It has managed to bring down daily new cases from 2,500 in January to less than 24 now.

In view of this variance, ThePrint attempts to sketch out the five distinct models of government responses towards the coronavirus outbreak that now affects more than 100 countries.

China – Draconian, but unbelievably efficient

The source of the coronavirus pandemic, China faced a global backlash for its initial response, which was marked by “denial(s), coverups, and missteps”. But what the Chinese has government has been to accomplish ever since has garnered praise from both epidemic experts and the World Health Organization (WHO).

While the Chinese focus has been on the quarantine and lockdown of highly affected regions such as Wuhan, its efficacy is visible in the measures enforced within such regions. This includes highly aggressive test-and-isolation tactics, coupled with an active search for suspected cases.

In terms of testing, the Chinese authorities have set up “fever clinics” that are attached to hospitals but removed from their main compounds. These clinics have managed to carry out an extremely efficient testing regime, often at an industrial scale.

Once a suspected individual is brought in, the medical staff takes his/her temperature, ask questions for symptoms, and then do a quick test for White Blood Cell (WBC) count. This is followed by a flu test, which according to experts, is the only way to determine if the person has a flu or bacterial pneumonia.

If the tests still don’t yield a result, the person has to undergo a CAT scan, and is kept under quarantine until the results are out.

In addition to such a comprehensive testing infrastructure, China has turned massive gymnasiums into quarantine centres. As China has no concept of home quarantine, people who are infected or are suspected to be infected are kept here under observation. There are separate quarantine centres for men and women, and often parents are separated from their kids.

According to New York Times’ Donald G. McNeil, at the heart of the Chinese response was its estimate that 75 to 80 per cent infections were within family clusters. Thus, if infected people were removed from their families, they would manage to contain the epidemic. 

While some health experts have termed Chinese measures as draconian, others such as the WHO has termed them extremely “aggressive”.

South Korea – Trace, test and treat approach

South Korea, the second country to be hit massively by the coronavirus outbreak, has been lauded for its systematic and effective response.

The government’s “trace, test, and treat” approach has helped contain the spread of the infectious virus – and as a consequence the country features the lowest fatality rate at 0.7 per cent (compared to the global average of 3 per cent).

The South Korean health officials have carried out a comprehensive programme to track down individuals with coronavirus symptoms. This has been accompanied with a carefully thought-out communications strategy to inform residents about the possibility of being infected, which involves sending out “mobile phone alerts to citizens whenever a new case is reported in their districts”.

It is, however, the testing mechanism where the South Korean efficiency is at play. Nearly 20,000 people are tested in South Korea every day, in what is now being deemed as the “model to be followed” by other affected countries.

This has been achieved by setting up special testing centres such as drive-through clinics. Here, individuals with symptoms can stop by and get tested in their cars — in less than 5 minutes. The results are processed and sent back to people in less than 24 hours.

Such large-scale testing has been possible due to the large number of laboratories in the countries. Since the outbreak, 96 private and public labs have come up in South Korea, which are “working 24 hours a day to process the results”.

These tactics used for treatment have also emerged as a role model for other countries. “The initial reaction was to quarantine everyone infected with the virus in a hospital bed, but now the doctors have learned to treat those with mild symptoms in residential centres and leave the clinical beds for those needing critical care,” noted a report in the BBC.

To a large degree, South Korea has adopted the Chinese model, sans some of its draconian measures.

Italy – Lockdown sans treatment

Outside of China, Italy now features the highest number of coronavirus cases in the world. In a nutshell, the Italian response tried to mimic the Chinese lockdown of Wuhan, but has failed to adopt the measures Beijing implemented within the region. Now with an overburdened medical system, the country is struggling to treat all the infected people.

After a few weeks of casual approach, the Italian government first initiated a lockdown in the Lombardy region of the north — the outbreak’s epicentre in Italy – and soon followed it up with a countrywide lockdown.

On Wednesday, the government decided to shut down all commercial activity in Italy, including bars, restaurants. Only food supply stores, chemists, and supermarkets remain open.

But according to public health experts, this was too little and too late. With around 1,000 new cases being reported every day, the number of coronavirus-affected patients continues to rapidly grow in Italy.

What really ails the country’s response is its limited medical infrastructure, especially an acute lack of capacity in terms of critical care. Some experts argue that the government has adopted such a harsh lockdown because it does not have the capacity to manage all the cases.

The shortage of beds and medical supplies is forcing doctors to make tough choices. Now, the government has drawn out guidelines that explicitly state which patients should be prioritised for treatment.

“Acute care units in Lombardy, the region with the most cases, are currently at capacity — and in some instances, doctors are forced to choose which patients to give priority to, following guidelines around life expectancy that are both brutal and inevitable in a state of emergency,” noted a report in the Atlantic. 

In another instance, Christian Salaroli, an anaesthesiologist from a hospital in Bergamo — the Italian city with the highest number of coronavirus patients — told an Italian daily, “The choice is made inside of an emergency room used for mass events, where only COVID-19 patients enter. If a person is between 80 and 95 and has severe respiratory failure, he probably won’t make it.”

Iran – ‘Denial and panic’

For weeks, Iran’s leadership remained in denial about the outbreak of coronavirus in their country, and even supplied masks to China if necessary. Now it has the third highest number of coronavirus cases across the globe and is the epicentre of the pandemic across West Asia.

“The authorities failed to take protective measures at this early stage. But the problem became impossible to ignore after nearly three dozen Iranian government officials and members of parliament were infected, and a senior adviser to the supreme leader died,” said a New York Times report.

Now, the government has enforced a partial lockdown, shutting down schools and colleges, and cancelling Friday prayers. But with over 10,000 cases, the country’s limited medical infrastructure is in no position to provide an effective response to the epidemic. Most prominently, the acute shortage of testing kits has left many untested and made it impossible for the government to truly asses the scale of coronavirus epidemic in Iran.

In the absence of a comprehensive testing and treatment response, the Iranian government has adopted some bizarre but iron-fist measures.

The foremost among these has been the government’s desire to control the spread of information. “The authorities seem as worried about controlling information as they are about controlling the virus,” noted the New York Times.

Some of the other measures include directing all the medical staff not to make any information public; threatening people found to be hoarding masks with death sentence; and a proposal to send 3 lakh Iranian militia to sanitise homes.

The key problem ailing Iran’s response has been the inability of Tehran to aid key regional governmental authorities in the fight against the pandemic.

“We were screaming at the health ministry that we have 594 corona patients but the ministry was telling us since you don’t have positive test results we won’t give you equipment you need,” Dr Abdulreza Fazel, an official from Iran’s Golestan province, told the New York Times. 

“They kept saying, ‘wait, wait, wait,’ and then suddenly they announce you are an epicentre,” added Fazel.

United States – A ‘testing’ debacle

In countries such as Germany, the response has been constrained by their federal structure and the mandated role of state governments in dealing with epidemics such as these. This problem, however, has been especially pronounced in the United States, leading to bureaucratic delays and a major testing debacle.

As several clusters in the US, like in Seattle and California, are already experiencing outbreaks, the state government has responded with lockdowns, and the federal government’s response has been largely absent.

The US government has made no provisions for isolating people, and hasn’t developed mechanisms to keep the suspected/infected away.

The real crisis in the US, however, seems to be a failure to test enough suspected people. With over 1,600 cases, until 12 March, only 5,000 tests had been carried out in the entire country. This is in stark contrast with South Korea.

This failure has been largely attributed to “lack of preparation and poor execution by the federal government”, and faulty tests developed by the country’s Centers for Disease Control and Prevention (CDC).

“After problems arose with the C.D.C.’s test, officials could have switched to using successful tests that other countries were already using. But the officials refused to do so, essentially because it would have required changing bureaucratic procedures,” noted an opinion in the New York Times.

This was further compounded by not easing regulations on US labs and hospitals, which were not allowed to carry out tests. In absence of large scale testing and isolation, the US federal government has enforced travel bans and lockdowns and increasingly it seems to be adopting the Italian model.