Singapore/Taiwan

The key to these countries’  success so far has been the decision to respond aggressively from the outset. For Singapore and Taiwan, the story could easily have been one of catastrophe. The novel coronavirus emerged just in time for Lunar New Year, when millions travel across the region in the world’s largest annual human migration. All three territories are closely interconnected with mainland China, with direct flights to Wuhan, China.

Yet by Feb. 1, all the three countries had proactively implemented travel restrictions on passengers coming from mainland China, contravening the World Health Organization’s [WHO] insistence that these bans were not necessary. The precautions came at a significant economic cost to this international hub, which all rely on mainland China as their biggest trading partner and source of tourists.

In 2003, Hong Kong had to deal with the SARS (severe acute respiratory syndrome) epidemic, which infected over 8,000 and killed 774, including 299 in Hong Kong. Following SARS in 2003, Taiwan established a central command center for epidemics. By Jan. 20, it was coordinating the government’s response to the coronavirus. It quickly compiled a list of 124 “action items,” including border controls, school and work policies, public communication plans and resource assessments of hospitals.

In Taiwan, an island of 23 million, arrivals from Wuhan were subject to health screenings before human-to-human transmission of the virus was confirmed on Jan. 20, 2020. Taiwan, just 81 miles from mainland China, was expected to have among the highest number of imported cases, he adds. But it has now tallied just 50 cases—fewer than Slovenia.

In order to uncover COVID-19 infections that may have otherwise evaded detection, Singapore’s health authorities decided early on to test all influenza-like and pneumonia cases. They have also spared no pains in hunting down every possible contact of those infected. The process, which operates 24/7, starts with patient interviews, and has also involved police, flight manifests and a locally developed a test for antibodies, which linger even after an infection clears. As of Mar. 13, the city-state had 178 cases and zero deaths.

European Case Studies

Germany (April 4, 2020)

As per the New York Times, Germany had more than 100,000 laboratory-confirmed infections as of  the morning of March 30, more than any other country except the United States, Italy and Spain. However, their total number of deaths was just 1,584 - just 1.6%, significantly less than other countries as the table to the right shows.

The reasons for this anomaly can be reduced to the 3Ts  - Testing, Tracking and Trust.

Testing: The first COVID-19 case was recorded by Germany in February, 2020. Soon after, laboratories across the country had built up stockpiles of test kits, doing up to 350,000 tests a week. This has allowed authorities to slow the spread of pandemic by isolating known cases while they are still infectious. It has also enabled lifesaving treatment to be administered in a more timely way. One key to ensuring broad-based testing is that patients pay nothing for it. This encourages people without health insurance to get tested even when their symptoms are mild.

Tracking: In most countries, testing is restricted to the sickest of patients. Not so in Germany where people a patient was associated with, who may not exhibit any symptoms are also tested. For example, a 22-year old man, exhibiting no symptoms - as asked by his employer, a school, to get tested since he had taken part in a carnival where someone else had tested positive. As soon as the test results were in, the school was shut and the students and staff were asked to stay home for two weeks. 

Trust (in Government): Many see Chancellor Angela Merkel’s leadership as a key reason for the low fatality rate. Ms. Merkel, a trained scientist, has communicated clearly, calmly and regularly throughout the crisis, as she imposed ever-stricter social distancing measures on the country. The restrictions, which have been crucial to slowing the spread of the pandemic, met with little political opposition and are broadly followed.

Italy (April 8, 2020)

Past: According to the Wall Street Journal, a series of early mistakes allowed the virus to spread. Northern Italy’s Lombardy region, the epicenter of Europe’s virus outbreak, adopted restrictions as early as Feb. 23, closing down cinemas, churches, schools, museums, stadiums and bars. It also imposed a quarantine on a cluster of virus-stricken small towns south of Milan. But many Italians, skeptical about the danger, scoffed at appeals for social distancing. Politicians encouraged citizens to visit bars and sports stadiums. Tens of thousands of Italians packed ski resorts. The central government in Rome pushed back against Lombardy’s pressure for more radical steps.

Present: The mood changed almost overnight as the body count mounted. On March 7, Nicola Zingaretti, head of the Democratic Party,  tested positive for the virus. The next morning, Prime Minister Giuseppe Conte’s government imposed a lockdown on Lombardy and nearby northern Italian provinces—the first democratic country to implement such restrictions on people’s movement in decades. This time, the measures were backed across the political spectrum. On March 10, Prime Minister Giuseppe Conte extended the lockdown to all of Italy and has since tightened the rules by closing down nearly all offices and factories in the country. 

Italians have been lining up diligently in front of supermarkets, bakeries and pharmacies, keeping a safe distance. Italian supermarkets have stayed well stocked, with nearly no sign of panic-buying—in contrast to the empty shelves in the U.K. and many American cities.

Both the public and private sector have been working hard to combat the pandemic.

• For two weeks, some 400 people toiled around the clock building a new 205-bed ICU facility at Milan’s trade-fair center.

• Car maker Fiat Chrysler is manufacturing components for ventilators, and Ferrari is mobilizing its supply chain to assist.

• Giorgio Armani converted all its Italian factories to production of single-use gowns for doctors and nurses. Other fashion companies are making face masks.

New infections are declining, the number of people needing intensive therapy and other hospital care is stabilizing, and even the daily death toll is finally trending down. Economic hardship is growing among poorer families without savings. But there has been little social disorder so far. Italy is enforcing its lockdown by handing out fines, but without imprisoning people or welding shut the doors of apartment blocks

Future: Italy is set to continue its national lockdown until Easter, and to unwind it only slowly from mid-April onward. The government is subsidizing employers’ payrolls while their workforce is idle, and sending checks to the self-employed. That isn’t enough for many households, particularly in the poorer parts of southern Italy, where many people work off the books in the informal economy and don’t qualify for the government subsidies.

The question is how long this can last. While some Italian manufacturing plants may be reopened in mid-April, there is little likelihood that the country’s vital tourism industry will rebound in time for summer. The same goes for fashion, retail and restaurants.

When before the first reported cases of the disease, Iceland prepared cross functional teams - consisting of medical professionals and law-enforcement officials - to perform contact tracing. So when the first cases hit the country, it was better prepared. The team was also very thorough. For example, to find people who had been exposed, team members scanned airplane manifests and security-camera footage. They tried to pinpoint who was sitting next to whom on buses and in lecture halls. Other proactive measures include buying  more protective gear for its health-care workers. They also had a backup medical team consisting of retired doctors and nurses, many of whom were used to counsel patients over the phone. They also had strict quarantining laws early on and their testing rates were one of the highest in the world on a per-capita basis. Iceland’s testing capacity was helped by the presence of Reykjavik-based bio-pharmaceutical company deCODE Genetics, which early in the outbreak teamed up with health authorities to ramp up public testing.

Iceland never imposed a lockdown and its citizens hardly wear masks. At the height of the outbreak, Iceland’s government imposed a ban on gatherings of more than twenty people. It also closed high schools and universities.The restrictions started to ease up in early May. On May 12th, the country’s Prime Minister, Katrín Jakobsdóttir, announced a plan to let visitors into the country by mid-June. Under the plan, foreigners arriving at Keflavík would be presented with three options. They could show a certificate confirming a recent negative COVID-19 test, be screened for the virus, or go into quarantine. Who would perform the screening, and how this would all work, was left unspecified. As of early June, it was announced that travelers arriving at the island’s international airport will soon be able to avoid a mandatory two-week quarantine by opting to pay 15,000 kronur ($115) for an on-the-spot test as the nation seeks to salvage a tourism industry crippled by the COVID-19 pandemic. Tourism accounts for almost half of Iceland’s export revenue after the industry replaced banking as the key source of foreign exchange in the wake of the global financial crisis.

Oceania Case Studies

As of June 5, 2020, New Zealand is on the verge of eradicating the virus from its shores after it notched a 13th straight day with no reported new infections. Only a single person in the nation of 5 million people is known to still have the virus, and that person is not hospitalized. However, it remains likely that the country will import new cases once it reopens its borders, and officials say their aim remains to stamp out new infections as they arise.

Geography played a big role in controlling the virus spread in New Zealand. Because New Zealand is a geographically isolated and sparsely populated island country, infectious diseases that plague other parts of the world are often delayed in breaching its borders and spreading widely once they do. The country identified its first case in late February, more than a month after the U.S., South Korea, and Italy identified theirs. That delay bought New Zealand time to learn from what was happening elsewhere and to integrate other countries’ successes and challenges into its own plan. So in late March, when the country shut down nonessential businesses, banned most domestic travel, and closed its borders, its tactics received broad public support from a public that had seen other countries suffer from different strategies. By the middle of May, there were hardly any new cases. The Prime Minister of New Zealand, Jacinda Ardern, started off with a 4 week confinement, which was then extended by another 3.

The country has already lifted many of its virus restrictions and could remove most of those that remain, including limiting crowd sizes, next week. Just over 1,500 people have contracted the virus during the outbreak, including 22 who died.

Although New Zealanders might soon be able to see movies in a theater, its borders will remain closed to non-nationals for the foreseeable future. That’s a big problem in a country where tourism is a critical part of the economy.

Updated Aug 17, 2020

Around June 2020, New Zealand had virtually eliminated the pandemic. However, recently there was a spike in the number of cases, which has led to the quarantining of dozens of people in Auckland. Officials still do not know how the virus was reintroduced into the country. As a result, the general elections in that country will be postponed by a month to October 2020. Learn more about this development HERE.