Now a global pandemic, COVID-19, has revealed just how vulnerable some countries are to unanticipated public health emergencies. COVID-19 has spread to over 100 countries, infecting over 150,000 people and with over 5000 confirmed deaths. As the rate of new cases in China continues to fall, proximity to the Middle Kingdom is becoming increasingly irrelevant to the contagion. In addition to China, there are now three primary transmission regions for the spread of COVID-19: South Korea, Iran and Italy.
Given such broad geographical coverage, it’s highly likely that community transmission—the classification for infection cases that can’t be traced back to an original disease carrier—of COVID-19 is already taking place across sizeable tracts of Southeast and East Asia, the Middle East, and Europe. Despite this disquieting prognosis, robust and proactive public health responses are expected to remain the most effective method for both treating COVID-19 and containing the disease’s spread, irrespective of whether secondary outbreaks are unavoidable or not.
How Have Public Health Authorities Responded So Far?
So far, the authorities that have seen the most success in controlling the spread of COVID-19—Singapore, Hong Kong, Israel, and the United Arab Emirates (UAE)—all share the same thing: a strong, government-funded healthcare system and early, aggressive action. Well-funded public healthcare programs not only provide unwell citizens with admission to advanced medical centers and low-cost medicine, they also offer the government a direct mechanism to strongly encourage, or even mandate in the case of high-risk travelers, possible virus carriers to take a COVID-19 test. This take-charge approach to COVID-19 transmission identification gives public health authorities a significantly more informed idea of case origin, leading to more precisely targeted travel restrictions and more effective quarantine procedures.
It also allows governments to take early policy action, putting in place social distancing measures before outbreaks grow out of control. Proactive closures, like those seen in Israel and the UAE, can happen thanks to extensive testing and virus tracing.
Broadly speaking, government-funded healthcare services tend to be more optimized for inter-government and private sector cooperation. In the UAE, for example, this administrative efficiency allowed the expedited rollout of some key COVID-19 prevention measures such as the installation of wall-mounted hand sanitizers in all hotels, and early implementation for distance education in government schools. Indeed, the UAE implemented distance programs weeks ago, long before the rest of the world began the shift to online meetups. The Emirates’ proactive public health responses are likely part of the reason why the country has experienced so few COVID-19 cases, an especially impressive feat considering the high volume of international travelers moving through the regional transit hub every day.
However, what makes the UAE, and other countries with comprehensive universal healthcare systems, so effective is their testing, hospitalization and treatment programs. Authorities are able to test large swathes of their population for the virus and guarantee treatment for those infected without charge. These sorts of programs are crucial to identifying the communities affected by the virus and quickly preventing its spread. In the case of the UAE specifically, it has frequently acted on behalf of other governments to evacuate, treat and then repatriate foreigners from break-out zones in China, making it an important ally for those nations who cannot afford such initiatives. On the contrary, countries without adequately functioning healthcare programs like Iran, have seen explosions of infection rates as health authorities lack the preparedness and resources to identify and treat new cases.
The Real Cost of Ineffective Public Healthcare Programs
It is no secret that a poorly equipped healthcare system compromises both domestic and international public health outcomes. That said, a higher level of economic development offers no guarantee of above-average healthcare results either. Nowhere is this dichotomy more apparent than in the United States. In 2018, the bloated U.S. healthcare sector soaked up more than $3.6 trillion in spending. Now, given the exorbitant cost of basic public health services, the average American is understandably hesitant to visit a doctor to request a test for COVID-19. The ubiquity of this phenomenon has prompted a host of healthcare experts, including Gavin Yamey, Professor of Global Health and Public Policy at Duke University, to speculate that the real rate of COVID-19 cases in the U.S. is significantly more than what has been so far been reported.
“One of the disadvantages the US has in trying to tackle COVID-19 is that many people avoid going to see a health care provider because they are worried about the cost,” said Professor Yamey. “You absolutely want people in this situation to be going to see a health provider.”
Professor Yamey’s thesis is particularly compelling when considering the ease and effectiveness of visiting a doctor as part of a free public healthcare program in the UAE, Israel or Northern Europe. Without free or heavily subsidized access to treatment and testing, the U.S. healthcare sector is essentially disincentivizing people to report COVID-19 symptoms. In addition to undermining quarantine procedures, this system of deterrence may also be facilitating the silent spread of COVID-19 across domestic and international borders to otherwise unaffected regions.
If symptom under-reporting in the U.S. is as endemic as Yamey fears, it’s highly likely that similar trends are playing out in other countries with inadequate government-sponsored health care programs. At this point in time, public health experts are especially concerned by the alarmingly low number of cases that have been reported in Indonesia and India, two countries that only recently suspended travel with mainland China. With a combined population of over 1.5 billion people, it seems impossible that India and Indonesia only have 32 cases of COVID-19 between them.
The unfortunate reality is that a lack of low-cost healthcare offerings and an inadequate number of testing facilitates are almost certainly responsible for the deceptively low number of confirmed COVID-19 cases in Southeast and South Asia. Without affordable and easily accessible hospital admission and treatment, governments across these regions are unable to use the two most effective mechanisms for controlling the spread of COVID-19: risk-based testing and strict social distancing policies.
Now, as the international community scrambles to contain the pandemic, the COVID-19 outbreak is set to teach world leaders an important lesson: comprehensive and functional public healthcare, such as that seen in Northern Europe, Israel and the United Arab Emirates, is vital to curb outbreaks and maintain public health.