David Pratt: The different approaches to tackling coronavirus

In all this is a chaotic time with only one thing certain, coronavirus is here with a vengeance and people are dying. That much none of us could have failed to notice.

Besides the growing sense of being spooked by unfolding events, it also feels right now like we are drowning in information, some accurate and some far from reliable.

It was at last month’s Munich Security Conference that World Health Organisation (WHO) Director-General Tedros Adhanom Ghebreyesus declared: “We’re not just fighting an epidemic; we’re fighting an infodemic.”

By the WHO’s own definition an infodemic is “an over-abundance of information,” the veracity of which is sometimes questionable – making it hard for people to find trustworthy sources and reliable guidance when they need it.

Given this deluge of data it’s sometimes all too easy at such times to lose track of the big picture, or keep in mind the key questions that the pandemic has presented us with.

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Questions like why do we find ourselves where we are now, and why wasn’t the kind of global plan ready that one might expect in response to such a virus?

And what too of those countries hardest hit, how are they faring and what lessons might we learn from them in drawing up our own response measures?

Let’s take this question of a global response plan first and whether such a thing even exists. The short answer is yes it does, though many could be forgiven for thinking otherwise given the disparate and contrasting strategies adopted around the world towards the pandemic.

As the world’s leading public health agency, it was 15 years ago that the WHO revised the International Health Regulations, which acts as the blueprint for responding to epidemics and pandemics. That came in the wake of the Sars outbreak that severely tested even the most developed healthcare systems.

The aim of the overhaul was simple enough, making the WHO the key coordinating body through which countries across the world would liaise in helping experts head off any global epidemic.

So far, so good, and on the face of it given the revised blueprint had been signed by 196 countries, it appeared to be a fairly solid bulwark against the challenge posed by any worldwide outbreak.

But as an investigation by The New York Times recently revealed in an incisive article entitled Countries Are Ignoring WHO’s Pandemic Plan, there has been little in the way of global solidarity when it comes to fighting an outbreak that has already killed thousands, infected many more and spread to more than 110 countries.

At the heart of this failure lies the fact that many countries remain wary of handing over control to the international agency which in itself is also dependent on its global donors, some of whom are major powers like China or the United States.

At precisely the moment when there should be a concerted collective effort, individual nations often insist in adopting their own strategies.

International travel bans are a point in case, sometimes introduced without WHO consultation and largely implemented as a domestic political placebo, they can even at times be counterproductive in the battle against the virus.

Speaking at the WHO mission briefing on the coronavirus last month, the health agency’s director-general expressed his frustration with this lack of collaboration.

“One of the biggest challenges we face is that too many affected countries are still not sharing data with WHO,” warned Dr Tedros.

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To support countries affected, WHO has already published operational planning guidelines to support country preparedness and response. These focus on what it calls a step-by-step guide, with concrete actions according to eight areas or “pillars”.

AMONG these are: country-level coordination; planning and monitoring; risk communication and community engagement; surveillance, rapid response teams and case investigation; points of entry; national laboratories; infection prevention and control; case management; and operational support and logistics.

But as Dr Tedros also explained at the mission briefing last month, WHO is hamstrung in its ability to disseminate country-specific public health guidance if those same countries are reluctant or hesitant to come forward with what he described as “disaggregated data and detailed line lists”.

“We’re communicating with ministers directly, there is some improvement, and we urge all countries to share this data with WHO immediately,” Dr Tedros emphasised, evidently frustrated by the lack of dialogue with some political leaders.

A few days ago, in another speech to diplomats in Geneva, the WHO chief also said the time had come to “double down” in the fight against the pandemic while giving some insight into the difficulties that involved.

Maintaining a containment strategy was vital said Dr Tedros, but all countries must “strike a fine balance between protecting health, preventing economic and social disruption, and respecting human rights”.

Which brings us to the question of just how individual countries, especially those hardest hit, are going about the immense challenges facing them and are there any early lessons to be learned for the UK’s own response?

The first thing to remember here is that this is a race against time and despite the WHO’s overarching guidelines there is no one-size-fits-all solution.

Those tasked with monitoring the pandemic say the approaches adopted by individual countries differ markedly. While some have imposed what has been described as heavy-handed restrictions, others, critics say, are falling short.

Inevitably these different approaches have led to questions about which strategy has been most successful. What is not in question now though is that how governments respond to this virus matters.

Take for example Hong Kong and Singapore that were hit early with the coronavirus. Each now has fewer than 200 cases, while France, Germany and Spain, which were hit late, all have more than 10 times that number. Barely three weeks ago too, Italy had only three cases. Now it has more than 10,000.

Mike Ryan, head of emergencies at the WHO and a veteran health worker of numerous global crises, including Sars, bird flu and Ebola, stresses that, “hope is not a strategy”.

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“There’s clearly an indication that a systematic government-led approach using all tactics and all elements available seems to be able to turn this disease around,” Ryan told Washington-based National Public Radio (NPR) in a recent interview.

At one point last month Hong Kong had 12,000 people in quarantine and while the territory and Singapore continue to find a few new cases each week, they’ve avoided the explosive outbreaks that have occurred elsewhere because of their strategy, say experts like Ryan.

In both places they rapidly deployed systems to try to identify and treat every case in their territory. In Hong Kong’s case they developed diagnostic tests and rapidly deployed them to labs at every major hospital in the city.

In Singapore, meanwhile, the prime minister Lee Hsien Loong called for calm and assured residents that all healthcare related to the disease would be free. This kind of clear thinking and its presentation to an often-confused populace has proved invaluable.

In other Asian countries hardest hit like South Korea, mass public testing programmes have also been rolled out. Officials there have sought to test anyone who might have been exposed to the virus, including many asymptomatic patients as well as those with symptoms. More than 210,000 tests have been conducted with as many as 10,000-new tests conducted each day. As a result the mortality rate has remained below 1%.

Hong Ki-ho, a doctor at Seoul Medical Centre, believed the accuracy of the country’s coronavirus tests was “99% – the highest in the world”.

He pointed to the rapid commercial development and deployment of new test kits enabled by a fast-tracked regulatory process.

“We have allowed test kits based on WHO protocols and never followed China’s test methods,” Dr Hong said, speaking to the Financial Times.

Though concerns remain over China’s handling of the virus, official data there too now suggests the outbreak has slowed. Much was initially made of China’s failure to stem the outbreak at the beginning and the communist regime’s draconian approach, but little has been said of what worked.

As the Beijing-based writer Ian Johnson noted: “There’s nothing authoritarian about checking temperatures at airports, enforcing social distancing or offering free medical care to anyone with Covid-19.”

More than 80,000 people have been infected and 3,000 have died in mainland China from coronavirus, but the number of new infections reported each day appears to be declining in the country where the outbreak originated.

Beijing says the latest figures point to the fact that its tight lockdown worked, but some epidemiologists warn that a lack of testing capacity may have led to a vast undercounting of the number of coronavirus cases in China.

For the moment though the news seems positive in stark contrast to other hardest hit countries like Iran and Italy.

IN both these countries even as people began to succumb to the disease little testing was done. Both were also slow to stop mass gatherings leading eventually to them being overwhelmed with cases. Now they have had no choice but to become more aggressive in their strategies.

In Iran about 300,000 medical teams, joined by the elite Revolutionary Guards, have started checking on every household across the country. In Italy the most drastic steps of all were taken with the entire country under restrictions. The measures, while necessary, are expected to deepen the economic pain for the Eurozone’s third largest economy.

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Given all this and the varying strategies deployed, what then might the UK learn in its own response as the virus takes grip here? Certainly if global experience to date is anything to go by in places like Hong Kong and Singapore the UK would do well to become far more aggressive in its approach.

There remains the feeling that the UK Government like its counterpart in the US is still playing catch-up, though the US has now declared a national emergency and travel ban.

A ban on mass gatherings and the rolling out of much wider testing must surely be deployed based on the evidence elsewhere in the world. The UK Government – albeit belatedly – now seems to be moving in that direction. There’s no doubt though that overall despite the best efforts of the WHO, the lack of common standards on testing, cancellation of public gatherings and on quarantines, have deepened the anxiety of people and eroded confidence in leaders not just in the UK but in other countries.

The simple inescapable fact is that many world leaders – with some notable exceptions – have been desperately found wanting during this crisis and failed to raise their voice in the right way at the right time.

As Mark Landler in The New York Times wryly observed, those voices “remains less a choir than a cacophony – a dissonant babble of politicians all struggling, in their own way, to cope with the manifold challenges posed by the virus, from its crushing burden on hospitals and health care workers to its economic devastation and rising death toll”.

There are other wider global lessons to be learned from this pandemic too, like being wary in future of those same politicians who denigrate science and the experts who really know what they are talking about. It’s also worth noting that some world leaders have also cynically used the upheaval caused by the virus to cover moves in consolidating their own power.

All this when the main objective and strategy should have been and remains defeating a virulent and complex contagion. Some might argue that now is not the time to over dwell on what could have been done better, but these issues must be addressed once the current threat from coronavirus has been neutered.

For the moment urgently making the most from positive lessons learned globally in the fight against the virus is what matters most.

“The decisions we all make, as governments, businesses, communities, families and individuals, can influence the trajectory of this epidemic,” says WHO chief Dr Tedros. He’s right we all have our part to play.