What Policies Are Succeeding Against The Coronavirus?
The number of those infected with Covid-19 has exploded around the world in the last week. Global cases have doubled over the last seven days and daily case growth will top 100,000 by the time this article is published. Few countries have capably dealt with the outbreak and the ones which have are still at high risk of losing control of the virus. So it’s worth taking a look at three varied responses in order to evaluate what factors may determine success in combating the virus. For this, Taiwan—an early success story, Germany—which may be beating the curve, and the United States—whose worst is coming—should serve as good examples.
Taiwan has effectively halted the growth of Covid-19 within its borders after having prepared for an outbreak since the SARS virus 17 years ago. At the first sign of a potential outbreak in China, tight flight and quarantine regulations on travel from China, rationed face masks, and delayed school openings. Transparency and immediate communication with the populace has also been key, improving trust in the government and willingness to follow instructions. Taiwan has relied on controlling the flow of people into the country rather than comprehensive testing.
Taiwan’s Central Epidemic Command Center (CECC) recognizes the country isn’t out of the woods yet and has recommended suspending large gatherings. While Taiwan only has 306 confirmed cases and 5 deaths as of writing, new cases are still discovered each day and numbers could quickly climb if the country lets its guard down. Unfortunately, other governments would struggle to follow Taiwan’s example, as the country benefits both from its unique geography and historical preparedness.
Germany doesn’t share the same geographic advantages as Taiwan, and unrestricted EU movement creates challenges of its own. Many early cases in Germany were the result of Germans skiing in Italy and returning during Fasching, Germany’s country wide Carnivale. The federal government was slow to react, allowing states to craft their own strategies for weeks before implementing national guidelines and restrictions last week/earlier this week. Despite these challenges, Germany has remained an extreme outlier with a markedly lower morbidity rate (0.6%) than is seen elsewhere.
The low morbidity rate can be credited to a combination of luck and early, extensive testing. Germany’s cases are spread throughout the country so no single region’s hospitals are overloaded. Furthermore, the majority of Germany’s cases are distributed among across people aged 15-59, who have a high survival rate.
The country also put an early emphasis on testing heavily, utilizing contact tracing and isolation to protect the vulnerable and contain the virus. Recently, German Health Minister Jens Spahn said that the country had was carrying out 200,000 tests per week with capacity for 500,000, though precise data is not available. However, the effectiveness of this testing is borne out as the confirmed case rate has begun to slow despite increased testing.
While Germany’s morbidity rate is impressive, it is likely to climb in the coming days. If the case rate is just now beginning to slow, given that hospitalizations begin several days after infection and can last up to 18 days, we may need to wait 1-2 weeks before we see Germany’s morbidity rate start to shift downward. Hopefully this trend does reverse as currently the morbidity rate is rising at a rate similar to other EU nations when their deaths first began being reported.
In contrast, the number of confirmed cases in the United States has grown exponentially. Daily cases have doubled over the last five days and the United States is likely to see more than 20,000 new cases per day through the week.
Both Germany and the United States share similar federal structures where states are delegated significant authority. But where Germany eventually settled on a whole-of-government approach to containing the virus, the United States is still leaving testing and stay-at-home decisions up to the states. This, along with a massive early test kit failure and lack of central leadership, has produced the largest and fastest growing outbreak in the world.
Comparing the United States (330 mil) to a similar sized cohort of the EU (Italy, Spain, the UK, France, Germany; 320 mil) who share the largest and earliest outbreaks in Europe reveals how troubling the growing case rate in the United States is. According to the chart below, the US growth rate in confirmed cases is substantially faster than the EU+5’s. And while the United States has finally hit a testing rate comparable to South Korea and Germany, having tested only .15% of the population is still not enough. [By comparison, Germany has tested approximately .8%, South Korea 1%, and Italy .75% of their populations] The EU+5’s testing rate is more than double that of the United States providing a much clearer view of the spread of the disease and how it’s beginning to slow. It’s possible then to infer that since United States is lagging so severely, the real case rate could be much higher.
Fortunately, the United States has a lower morbidity rate (1.7%) than countries like Spain (5%), Italy (9%), and France (5%) even with its significantly higher and lagging case rate. The age of infected has been evenly distributed across all age groups over 20 years old and while there are worsening breakouts in its larger cities, the fact that breakouts are not yet concentrated gives healthcare systems more breathing room. However, the severe lack of testing could also be hiding a much higher morbidity rate as people dying across the United States from Covid-19 related symptoms haven’t been comprehensively tested post-mortem.
If there’s one lesson the United States should take from Germany and Taiwan, it is that a whole-government approach is necessary. The US’ current patchwork non-strategy of letting states formulate their own plans is only prolonging the impacts of Covid-19. Alternatively, Germany’s heavy testing despite a slow response appears likely to spare Germany from the healthcare disasters experienced in Spain and Italy. Taiwan has the most unique situation—previous epidemic experience and geographic isolation—but it still utilized a full government toolkit and continues to remain vigilant. There may be no single answer, but for governments two clear lessons emerge: act early, and act completely.