That the World Health Organisation hasn’t exactly shone in the coronavirus crisis is now well-documented. It should remind us of the dangers of following one centrally-guided approach to tackling the disease. Thankfully, given how even experts have been unsure about how to respond to this enormous challenge, there was no unified EU response to Covid-19. Instead, European countries have been dealing with the virus using trial and error.
As a result, looking at the responses of European and Asian countries, we can now distinguish five important things that seem to have worked to prevent the need for a strict, economically devastating lockdown.
1. Testing people with mild symptoms
Even though Germany’s first locally transmitted Covid-19 case was before Italy’s, Germany has had almost six times fewer deaths – with a 30 per cent larger population. There are caveats: Germany is lucky that the average age of its Covid patients has been only 49, compared to 62.5 in France and 62 in Italy. And it should also be noted that counting the number of deaths from Covid-19 is anything but straightforward.
But Germany’s testing practices have been singled out by the UK government’s chief medical officer, Chris Whitty, as key and in the last two weeks, Germany’s curve of infection growth has been flattening.
From the moment it became clear that a Chinese woman – dubbed ‘Case #0’, had visited Bavaria at the end of January, a medical manhunt was launched to trace, test and isolate those she had infected, giving Germany crucial time to prepare. The workplaces of those infected were shut down and all those who tested positive were sent to hospital.
Crucially, testing does not just seem to be about quantity. Last week Italy had conducted 807,000 tests since 21 February, which isn’t that much below Germany’s 1.3 million tests, when compared per capita. But Italy mostly tested people with severe symptoms that were in hospital. Germany also tested those with less severe symptoms and was therefore able to detect clusters of infection much earlier.
It’s important to note as well that German testing wasn’t the result of a conscious government decision but thanks to its many private laboratories. Christian Drosten, Director of the Institute of Virology at Berlin’s Charité Hospital explains that ‘Germany does not have a public health laboratory that would restrict other labs from doing the tests. So we had an open market from the beginning.’ In other words, the private sector elements of Germany’s health care system have played a very important part in its success.
German healthcare policy expert Frederik Roeder, who directs the Consumer Choice Center, highlights how in contrast to the UK, which has a centralised testing system with no room for mistakes, ‘a decentralised and independent system… allows for some parts in the chain to fail and the others still to perform, and crucially allows room for innovation.’ Worryingly, EU regulation will centralisethis process from 2022 onwards.
Early, widespread testing was also performed in South Korea, but it was the result of conscious government action. The country has the world’s most expansive and well-organised testing programme, including drive-thru testing stations.
A comparison between more than forty European and Asian countries has found a statistical correlation between having a high positive test rate – meaning mainly testing those with severe symptoms – and a high number of deaths per capita. This correlation is especially strong for Spain and France.
2. Sufficient intensive care capacity – enabled by the private sector
The whole point of imposing economically devastating lockdowns was to avoid overburdening the health care system, so people that could otherwise be saved would not have to die. South Korea did not impose lockdowns, while Germany imposed what could be called ‘lockdown light’. It did not order people to stay at home, apart from in Bavaria and Saarland. There was only a recommendation to respect strict social distancing measures, issued on March 22, more than a week later than other European countries like France or Belgium. Public gatherings of more than two people were banned, while restaurants and non-essential shops were shut. But all in all, the restrictions were modest, given that German manufacturers are still running at up to 80 per cent capacity.
The reason that those two countries, which also were successful in curbing the pandemic, were able to avoid the enormously expensive measures imposed elsewhere is that they believed their healthcare systems would be able to cope.
Before the Covid crisis, Germany already had the highest number of intensive care beds per capita in Europe. It then used the time it gained from ‘testing and tracing’ to increase the number of its ICU beds from an estimated 28,000 to more than 40,000. This also enabled German hospitals to take patients from other European countries. Before the crisis Germany had more than four times the intensive care capacity of the NHS.
In Germany and South Korea, the private sector plays an important role in healthcare. In Germany, only 28 per cent of hospitals are government owned. German healthcare economist Frederik Roeder notes that private hospitals in Germany ‘receive the same amount of reimbursement per case as the public ones’ but also have higher investment, which leads to ‘more state-of-the-art treatment and newer medical equipment.’
In South Korea, 80 per cent of people have private health insurance, at an average cost of about $120 per month. Hospitals are able to charge patients more than what the government will refund.
3. Masks or scarves in crowded places
The WHO initially recommended that only medical workers and ill people should wear masks, before making a U-turn. Now, as a spokesman recently stated, the organisation believes ‘we can certainly see circumstances on which the use of masks, both home-made and cloth masks, at the community level may help with an overall comprehensive response to this disease.’
There now seems to be a consensus that disposable masks will not prevent you from catching coronavirus, but – given that surgeons wear them when treating patients – they will help prevent you from infecting others. Logically, if everyone wears them, at least in crowded places, everyone will be better protected than otherwise.
4. Imposing border checks in time
Just as supporters of economic globalisation and relaxed migration restrictions should oppose uncontrolled migration and its chaotic side-effects, it should be clear that during a pandemic, other rules apply. It makes no sense whatsoever to ‘test and trace’ while increasing hospital capacity, when people are allowed to cross borders unchecked.
This harsh reality is what ultimately led countries to shut their borders, after some hesitation. Where firm restrictions were instated early on, for example in Taiwan, the results in fighting Covid were positive. Here, South Korea acted more slowly, and did not restrict travel from China as firmly as Taiwan, which banned nearly all visitors from mainland China and ended up with less than 400 Covid cases, despite its proximity to China. Taiwan did not see the surge in cases South Korea witnessed before it controlled the virus – although one third of South Korea’s cases did originate from a secretive cult.
5. Transparent communication about social distancing
Social distancing is hard to police. Some countries, like Spain, have gone as far as preventing citizens going out for a walk or exercising outside, and have shut down ‘non-essential’ industry. In most European countries with a lockdown, such extreme measures were not necessary, as the public generally respected their recommendations. It’s clear, however, that trust in government can be bolstered by transparent communication. Belgium’s lockdown followed a U-turn by authorities, who had first claimed that Covid-19 was similar to a ‘mild flu’. Distrustful citizens ended up organising ‘lockdown parties’ before the start of the restrictions. When people feel something is being hidden from them, they will not cooperate with future measures.
Treating the public as adults and communicating in a transparent manner is absolutely key. A comparison between South Korea and China or European countries with tough lockdowns illustrates this.
South Korea’s handling of the outbreak was all about transparency, while relying heavily on public cooperation, to ask for social distancing. The South Korean authorities have reserved extreme confinement to those infected and those they were in close contact with, while recommending everyone else to stay indoors, avoid crowded places, wear masks and practise good hygiene. A similar lockdown-free approach has worked in Hong Kong, Singapore and Taiwan, as well as Germany. For an example of the way public trust was diminished by the authorities, we need only look at the mismanagement of the Chinese government.
Avoiding draconian lockdowns was perhaps not possible for many countries with insufficient testing or intensive care capacity during this crisis. Precisely because of this, countries wanting to avoid lockdowns in future need to improve these measures, while introducing early border restrictions, recommending masks and making sure government strategies are transparent, next time a crisis like this occurs.
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