Speed, Scale, & Equity: The Global Response to COVID-19
The world as we know it will never be the same again. We’ve collectively witnessed a pivotal shift in our system and no one knows how this historic episode will unfold or when it will end.
The Coronavirus takes the crown for being the largest Black Swan event our generation has witnessed, shattering markets, disrupting people’s lives, and bringing light to our governments’ competence and response to the wide-scale pandemic. But crisis always presents an opportunity, and the COVID-19 virus is no different. Ladies and gentlemen, these are turbulent times, and the next 10 years are going to bring permanent shifts to our political, social, and economic powers.
Our lives have become threatened by this invisible danger lurking outside our doors- abstract, yet terrifyingly real. The absence of people, brutal restrictions, and adamant rules are exposing the evils of capitalism, bringing forth that, it was indeed interchangeable, and at the government’s disposal.
Data caps have been blown off by internet providers, “work from home” policies are being realized, and employment protection towards Canada’s workforce has been surprisingly feasible. $82 billion has been offered towards our aid to recover from this catastrophe.
The sudden disruption within our society proves we are in an inept and fragile system. It lacks versatility in dire events like this and substantiates that our greed, cruelty, and sadist approach towards the planet will eventually bring us our doom. Yet again, a vivid example of The Frankenstein Syndrome. What we do need now more than ever is a society built on resilience, solidarity, foresight, and plenty of compassion.
Urbanization: A Catalyst For Rapid Spread of Infectious Diseases
As we move into previously (ever decreasing) uninhabited areas, new contacts with the wild and our livestock have increased the risk of cross-species infection. We’ve created alarmingly fast developments in the technological sector, we’ve aggrandized land clearance and expansion and as a result, intensified climate change by twofold. Deforestation has inherently forced bats, rodents, and many other disease-ridden vectors to relocate closer to human habitation. Additionally, loss of biodiversity, urbanization, and high population density have created environments in which infections can thrive. Virulent strains of pathogens can evolve, antimicrobial resistance can occur, and the rapid spread of disease becomes viable.
Human society has experienced significant transitions that have affected the way we contract and transmit infectious diseases. Biologically weakened and vulnerable populations, especially if living in circumstances of deprivation and unhygienic conditions are highly susceptible to microbes. The changes in human social ecology in recent decades have largely altered the probabilities of infectious disease emergence and transmission. This includes increases in population size and density, urbanization, persistent poverty, the increase of political, economic, and environmental refugees, conflict, and warfare.
While many disease outbreaks have occurred in developing countries, our interconnectedness and increased human mobility have accelerated the speeds at which these microbes can travel. Although the global community has tried effortlessly to contain these diseases, it has witnessed the re-emergence of known and the emergence of new diseases. SARS being the most similar disease to COVID-19 was first identified in the Guandong province in China in November 2002. By May 2003, the disease had spread to 30 countries in 6 continents.
But Are Containment Policies Effective?
Unfortunately, the COVID-19 pandemic is forcing governments to make difficult decisions with limited information affecting social and economic costs. After the containment of the initial outbreak in Wuhan failed, attention drew to non-pharmaceutical interventions that could potentially slow the spread of the virus. These policies aim to decrease virus transmission by reducing human-to-human contacts, such as restricting travel, closing restaurants, and canceling large-scale events, causing the spread to be much more manageable. The actual effects of these policies, however, are unknown. The modern world has never experienced a pathogen like this before, spreading at an alarming rate, affecting the world’s population daily, nor has it deployed anti-contagion policies of such scale and scope.
In a study conducted in a journal published in Nature in June 2020, the effects of 1,700 local, regional and national policies were estimated on the growth rate of infections within China, South Korea, Italy, Iran, France, and the United States. Data was compiled based on daily infection rates and the timing of policy implementations including:
Travel restrictions
Social distancing, event cancellations, and educational, commercial, and religious activity suspensions
Quarantines, curfews, and lockdowns
Additional policies such as emergency declarations and expansions of paid sick leave
The timing of policy implementation is unrelated to infection growth rates. Policies tend to be deployed in response to:
the high total numbers of cases (France, for example),
in response to outbreaks in other regions (China, South Korea, and Iran),
after delays due to political constraints (the United States and Italy),
timings that coincided with arbitrary events such as weekends and holidays.
Information dissemination was also a major factor in changing public knowledge. If individuals altered their behavior in response to new information, it could change the growth rate of infections. If increasing availability of information reduces infection growth rates, it would cause this study to overestimate the effectiveness of anti contagion policies.
Most policy interventions were implemented in rapid succession in many countries, which makes it difficult to determine the individual effects of each intervention on its own. However, it has been determined that the effect of lockdown has had the most substantial effect (81% reduction in transmission rate) Given the observed infection fatality rations and the epidemiology of COVID-19, major non-pharmaceutical interventions were successful in reducing transmission.
Though “staying home” may be the obvious choice in reducing transmission, the problem does not lie within our duty as citizens to do our due diligence. The problem inherently lies within our systemic choices as a whole. We chose to respond too late.
Thinking Beyond Containment: What Could We Have Done Better?
Despite efforts at a global, regional, national, and community level, the world is just as at risk as it was 20 years ago to viruses. Infectious diseases remain a perpetual challenge with their unpredictability and global effect.
In December 2019, a virus-infected three patients who developed a severe cause of acute respiratory illness. After genetic analyses were made, it was discovered that the new coronavirus was closely related to two bat-derived SARS-like strains. After further analysis, the virus was then speculated to have a membrane that not only acts as a receptor to the SARS-like virus but also enables it to enter human cells.
The pandemic was first detected in Wuhan, China, and immediately spread to more than 143 countries. Hotspots emerged in Europe, specifically in Italy & Spain, affecting nearly 21,157 patients, with 170 deaths daily. The first death outside of China was reported in the Philippines on 2 February 2020.
The virus slowly spread across Europe, Asia, Africa, the Americas, and so forth, leading to the first deadly pandemic in 100 years. Countries came together to fight the pandemic and implemented similar measures and restrictions to control the spread of the virus. But one of the bigger questions lies within our systemic approach. Why was the handling of COVID-19 successful in some countries more than others? The goal to “flatten the curve” offers a different insight on how the spread was controlled and how many countries successfully maintained a low level of cases within the healthcare system.
Taiwan
June 2020: 443 cases. 7 deaths.
February 2021: 940 cases. 9 deaths.
Population: 23.7 million
With a population of 23.7 million, Taiwan’s aggressive, early approach proved an admirable response to the global pandemic. Instead of closing businesses and announcing a “stay home” order, the government quickly closed its borders. The government was quick to adapt to the situation at hand and immediately used contact tracing and sim tracking software on mobile devices to ensure those who were in quarantine were following the rules.
Businesses were kept open and abided by stringent rules set forth by the government, ordering them to take precautionary measures such as taking temperatures and providing sanitizer before people entered the establishment.
Australia
June 2020: 7,276 cases. 102 deaths
February 2021: 28,912 cases. 902 deaths.
Population: 25.36 million
Australia was largely similar to Taiwan in responding quickly. The government had limited travel from both outside and within the country and ensured that when new cases did arrive, things were shut down immediately.
The response from Australian government officials was largely admired as their economic stimulus (10% of their GDP) went to wage subsidies, doubling unemployment benefits, and provided free childcare for all, helping those in need.
Today, 93% of Australians say the government “handled COVID-19 very or fairly well.”
Canada
June 2020: 98,645 cases; 8,035 deaths.
February 2021: 839,455 cases. 21,455 deaths.
Population: 37.59 million
Canada’s numbers proved it was the best at handling COVID-19 from the G-7 though not as successful as Taiwan at keeping its numbers low. Canada’s free healthcare proved it was competent in responding to a global pandemic. Part of Canada’s success relies largely on the idea around public messaging and communication of the virus amongst health agencies rather than depending on partisan politics, letting science guide the healthcare response instead.
By the end of March, all provinces were ordered to close schools, universities, public playgrounds, and nonessential businesses. Federal and provincial governments encouraged everyone to stay home except for essential workers. Social interactions were discouraged within different households, with fines issued by police for non-adherence. Gatherings were limited to 5-10 people outside and were required to physical distancing (varied from province to province) as well as severity on travel restrictions, with Canadian officials urging Canadians to avoid non-essential travel.
“New Year, New Me”
Strangely enough, we aren’t the only ones indulging in retrospection and readapting to life for the new year. While it is known and expected that viruses constantly change through mutation leading to new variants of the virus, previous analysis in the UK suggests that this variant is significantly more transmissible than previously circulating variants, with estimated increased transmissibility of up to 70%.
The high number of spike protein mutations, other genomic properties of the variant, and the COVID 19 coverage in the UK suggest that the variant has not emerged through the slow accumulation of mutations in the UK. It is also unlikely that the variant rose through the ongoing vaccination programs as the increase does not match the timing of the vaccinations.
One possible hypothesis for the emergence of the variant is the prolonged COVID-19 infection in a single patient that may have had reduced immunocompetence. Another could be the adaptation processes in a virus that occur in animal hosts and then transmitted back to humans, however, it is unclear how accurate this epidemiological link is. Lastly, it may be the circulation of the virus within countries with no or very low COVID 19 detection.
Since viruses constantly change through mutation, the emergence of a new variant is expected. Diversification of the COVID 19 virus is due to the evolution and adaptation processes that have been observed globally and are expected to occur with ongoing transmission.
Fortunately, data has indicated that the antibodies from the vaccine will neutralize the UK variant. The new virus variant displays several mutations in the spike protein, including the receptor binding site. Most of the vaccines (Pfizer- BioNtech and Moderna) are based upon the spike protein sequence. It is essential to monitor the effectiveness of the COVID-19 vaccine using a variant-virus-specific estimate. Constant surveillance of these vaccine outcomes may help in understanding if there is an impact on vaccine effectiveness.
Winning the War Against the Virus
Increased globalization has made the world significantly more vulnerable to infectious disease outbreaks, however, methods of distributing global aid are constantly changing. To achieve better health for the community, countries should move to encourage partnerships and cross-sector coordination focused on achieving the shared goal of security from disease threats.
In 2005, the International Health Regulation (IHR) increased its attention to the need to shift from halting diseases at national borders to finding and halting them at their source. The H1N1 flu, however, revealed that there are continued vulnerabilities in public health capacities, limitations in scientific knowledge, complexities in international cooperation, and challenges in communication amongst experts and with the public. Unfortunately, only 33% of the 196 WHO countries complied with the IHR capacities.
As COVID-19 increased globally, many countries have shifted their focus to the quick identification, testing, and treatment of patients with the highest risk of COVID-19. Multi-level government entities have worked together to put in place the capacities for testing, diagnosis, isolation, contact tracing and quarantine, and as a result, must engage everyone in one or more of these processes.
National Action Plans have taken the forefront in governmental policies to slow down transmission and lower mortality rates. The World Health Organization states that every national strategy must implement the following:
Coordination and Planning of COVID-19 Response Strategies: Every country must implement and a strong national and subnational preparedness and response plan including multidisciplinary national coordination, a national public health emergency management mechanism, an incident management system, and the engagement of relevant ministries including health, foreign affairs, finance, education, transport, travel, etc.
Engaging and Mobilizing Communities to Limit Exposure: This outlines that every individual is responsible for controlling the virus’s transmission rate to avoid infection of at-risk and affected communities. This includes taking adaptive measures such as washing hands more frequently, avoiding touching their face, practicing respiratory etiquette, and cooperating with physical distancing measures.
Finding, Testing, and Controlling COVID-19 Contacts to Control Transmission: Finding and testing all suspected cases of COVID-19 is the first step to controlling the onset of transmission. Confirmed cases of the virus must be isolated and must receive appropriate care, as well as quarantined within the 14 day incubation period of the virus. Self-surveillance and active case finding have also been outlined as a fundamental role in tracing COVID-19 cases through online applications or mobile tracing applications.
Providing Clinical Capacities to Lessen Mortality Rates: With the different ranges in the severity of COVID-19, it is heavily important for healthcare systems to be able to provide for patients who require medical equipment to sustain their lives. Many patients require assistance breathing, placing burdens on many hospitals if there is low availability in equipment and supplies such as personal protective equipment (PPE).
Transitioning to a Contingency Plan of a Steady to Low-Level Rate of Transmission: For countries to return to a state of normalcy, six of these key criteria must be met:
COVID-19 transmission must be controlled
Health system and public health capacities are in place
Outbreak risks in high vulnerability settings are minimized
Workplace preventative measures are established
The risk of imported cases are managed
Communities are fully engaged
Covid-19 continues to threaten human life, threatens livelihoods, and threatens the way of life of every individual in our society, however, the world is at a pivotal moment in which collaborative research and knowledge sharing has helped answer important questions about the pandemic.
Speed, scale, and equity have become the guiding principles set forth by the World Health Organization to fight the COVID-19 pandemic. Speed, to ensure the urgency of implementing the correct response in order to avoid risking lives. Scale, to involve everyone in our society’s capacity to work together to control the spread of the virus; and Equity, to underline the notion that everyone is at risk of the virus and that it must be controlled by our own individual actions.
Sources:
National Academies of Sciences,, et al. “Infectious Diseases, Pandemic Influenza, and Antimicrobial Resistance: Global Health Security Is National Security.” Global Health and the Future Role of the United States., U.S. National Library of Medicine, 15 May 2017, www.ncbi.nlm.nih.gov/books/NBK458470/.
Hsiang, S., Allen, D., Annan-Phan, S., Bell, K., Bolliger, I., Chong, T., Druckenmiller, H., Huang, L. Y., Hultgren, A., Krasovich, E., Lau, P., Lee, J., Rolf, E., Tseng, J., & Wu, T. (2020, June 8). The effect of large-scale anti-contagion policies on the COVID-19 pandemic. Nature. https://www.nature.com/articles/s41586-020-2404-8?error=cookies_not_supported&code=b4cfa335-ff55-410d-9b94-6b32ed4caed8
Bremmer, I. (2021, February 24). The Best Global Responses to the COVID-19 Pandemic, 1 Year Later. Time. https://time.com/5851633/best-global-responses-covid-19/
COVID-19 Strategy update. (2020). World Health Organization. https://www.who.int/publications/m/item/covid-19-strategy-update