What some Western countries could learn about fighting pandemics in the community

Countries that successfully kept COVID-19 infections and deaths down not only acted early but in a more community-centred way, says a public-health physician who aims to improve preparedness for the next wave and beyond.

Dr. Saverio Stranges chairs the department of epidemiology and biostatistics at Western University's medical school in London, Ont. In a recent commentaryin the International Journal of Health Policy and Management, he examined some of the reasons why places like South Korea, Vietnam, Hong Kong and Germany curbed community transmission of the novel coronavirus early on compared with Italy, France, Spain, the United Kingdom and the U.S.

Based on epidemiological indicators such as the number of new cases and mortality rates, Stranges, colleague Mostafa Shokoohi and co-author Mehdi Osooli of Lund University in Sweden said that what counts is a strong community health response.

"From our Western arrogance, sometimes we believe that our systems are the bestand there is nothing to be learned from other countries, especially, if you like, from the Asian continent," said Stranges, who has worked in Europe, Canada and the U.S. "Butin these systems, I think there is a lot that can be learned in terms of emergency preparedness for either a second wave or even for the next pandemic."

What works? A community-centred approach means testing people outside of hospitals quickly to find cases, tracingtheir contacts and containing infections in a timely and efficient fashion.

The paper's authors gave successful examples, such as:

• South Korea's rapid expansion of diagnostic capacity and innovative drive-through and walk-in screening.
• Quarantine of suspected cases and mass masking in Vietnam.
• Taiwan'sefforts to address stigma associated with people who test positive.
• Germany's extensive testing policy to identify milder cases, including in younger people.

Stranges initially focused on his birth country, Italy, and why the northern Lombardy region was so hard hit that deaths spiked when hospitals and intensive care units were overwhelmed. Hospitals also transferred patients to other regions, spreading the virus.

The early timing of the pandemic in Italy, which has the world's second-largest share of people aged 60 and older after Japan, and a health-care system overly focused on chronic diseases and hospitalcare are some potential contributing factors, he said.

"Our [Western] health-care systems are not necessarily designed to tackle pandemics in the community in the first place."

Stranges said compared with most other Western countries, he thinks Canada benefited from preserving public-health infrastructure after the SARS virus killed 44 people in this country in 2003. But Canada's response to COVID-19 hasn't been ideal, he said.

More than 8,000 people in Canada have died of COVID-19, with outbreaks among vulnerable long-term care residents, prisoners, food-processing plant workers, people in shelters and migrant workers living in cramped quarters.

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As the economy gradually reopens, people need to continue to stay home when sick, practise physical distancing of two metres or more, keep up impeccable hand hygiene and wear face coverings measures that when combined reduce transmission, Stranges said.

'Reopening does not equate with safe'

Dr. Samantha Hill, president of the Ontario Medical Association, said reopening society needs to happen in a balanced, slow fashion that lets the evidence on measures like infection rates catch up before governments proceed to the next phase.

"My personal perspective on [face coverings] has always been that I don't know when someone else is going to be in my six-foot bubble. So any time I walk out of the office or out of the house, I'm wearing a mask, as are my children," Hill said.

"We all have a responsibility to each other to remember that reopening does not equate with safe, and that we have to do the necessary things to protect the most vulnerable."

During the pandemic, Canada hasn't focused on community health care, such as family medicine or diagnostic imaging like X-ray clinics outside of hospitals.

Not overwhelming the health system remains a goal of gradually reopening. But securing reliable supplies of personal protective equipment to care for the backlog of patients needs to happen first, Hillsaid.