Globalisation has facilitated the rapid, and devastating, worldwide spread of the new coronavirus within our “small world”. In times of increased global connectivity, and with widespread support for a multi-lateral approach to global issues, the Covid-19 pandemic has, however, fostered a resurgence of nationalism. Nation- states, even the members of regions where free movement of people and services are the norm, of which the European Union is a good example, have abruptly closed their borders to non-citizens. Individual countries have also responded to the global pandemic at different times, at different speeds and with different levels of enthusiasm, adopting widely divergent epidemic control strategies in the process.
There are many reasons for these varying national responses, apart from any local differences in the pattern and speed of transmission of the coronavirus. Social and cultural factors, economic constraints, urban overcrowding, differing political systems, and variable medical and other scientific advice appear to have influenced both the speed of response and the extent of the control measures adopted. The totalitarian regime in China, the source of the pandemic, was thus able to impose draconian control measures, such as mass quarantine, at an early stage, as a compliant public duly responded to the dictates of an authoritarian state. On the other hand, liberal democracies of the West have often preferred a less restrictive approach to begin with, relying on citizens taking personal responsibility for social distancing, thereby upholding civil liberties wherever possible. Sweden provides an extreme example of this liberal “light-touch” approach, adopted under expert guidance from the Swedish Health Agency, whereby schools, shops and restaurants have remained open at a time of widespread lockdowns, even in other Nordic countries.
Effective pandemic control involves limiting viral transmission . This requires action by both governments as well as by individual members of the general public. Governments can advise or actually enforce so-called “lockdown” measures, which include stay-at-home orders, social distancing in public areas, a ban on mass gatherings, the closure of schools, colleges and “non-essential” businesses and venues (shops, restaurants, cinemas, gyms, libraries, churches), internal travel bans, and the sealing of national borders. In some countries, the police and military have even been drafted in to enforce strict lockdown measures.
Changes in public behaviour are essential, requiring the voluntary and active cooperation of people. In poorer African and South Asian countries, social distancing may prove difficult to implement as desperate people are unable to comply with measures that only make them poorer and hungrier. Lockdown measures adopted in prosperous Western democracies may not be easily enforceable in countries where overcrowding is common and many struggle just to earn a meagre daily wage. The ambitious Indian lockdown of 1.3 billion people has unfortunately led to a mass movement of migrant labour, creating large numbers of stranded “refugees”, out-of-work and without ready access to food, water and healthcare.
Different levels of epidemic control may account for different health outcomes between countries. Some countries, such as South Korea, Taiwan, Singapore and Germany, are being held up as examples of good practice during the Covid-19 pandemic. In these countries, rates of infection, hospital admissions, and death rates have been significantly lower than in comparable countries, leading to such descriptors as the “German paradox”. Aggressive control measures adopted in these countries include widespread testing, even of people without any symptoms, the isolation of infected people (“cases”) and the tracing of contacts of these cases. Social media apps have been used to track the spread of virus. Successful initial control measures have meant that Singapore, South Korea and Taiwan did not need to enforce the major lockdown procedures necessary in other countries.
The success of any national response depends on a well-resourced healthcare system infrastructure. In both Germany and South Korea, public and private laboratories collaborated from the outset, allowing the “ramping up” of mass public testing. People were thus tested at walk-in and drive-through centres, as well as in airport arrival lounges. In addition to a large capacity to undertake tests for the coronavirus, Germany also benefited from the best per capita provision of intensive care beds in Europe.
Then there is the matter of political leadership. Those leaders who have seen coronavirus as yet another “flu” have frequently provided conflicting and mixed messages, even ones of near-total denial- Presidents Bolsonaro of Brazil and Lukashenko of Belarus, for example. Delayed and half-hearted attempts at disease control may indeed mean that “too little” is achieved, and far “too late”, with inevitably disastrous consequences. Thankfully, we still have leaders we can look up to in times of crisis. Among those able to take tough and timely decisions, communicated clearly and with empathy, an outstanding example is that of New Zealand Prime Minister Jacinda Ardern.
The last word has yet to be said, and there is still a long way to go. What seems clear, however, is that approaches to epidemic control must be tailored to local conditions, and that socio-economic factors will undoubtedly influence the timing and duration of any control measures that are adopted.
Ashis Banerjee