COVID-19: Too Little, Too Late? The Lancet Published: March 07,2020

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COVID-19: too little, too late?

The Lancet Published: March 07,2020: https://doi.org/10.1016/S0140-


6736(20)3052
Although WHO has yet to call the outbreak of SARS-CoV-2 infection a pandemic, it has confirmed that
the virus is likely to spread to most, if not all, countries. Regardless of terminology, this latest
coronavirus epidemic is now seeing larger increases in cases outside China. As of March 3, more than 90
000 confirmed cases of COVID-19 have been reported in 73 countries. The outbreak in northern Italy,
which has seen 11 towns officially locked down and residents threatened with imprisonment if they try
to leave, shocked European political leaders. Their shock turned to horror as they saw Italy become the
epicentre for further spread across the continent. As the window for global containment closes, health
ministers are scrambling to implement appropriate measures to delay spread of the virus. But their
actions have been slow and insufficient. There is now a real danger that countries have done too little,
too late to contain the epidemic.

By striking contrast, the WHO-China joint mission report calls China's vigorous public health measures
toward this new coronavirus probably the most “ambitious, agile and aggressive disease containment
effort in history”. China seems to have avoided a substantial number of cases and fatalities, although
there have been severe effects on the nation's economy. In its report on the joint mission, WHO
recommends that countries activate the highest level of national response management protocols to
ensure the all-of-government and all-of-society approaches needed to contain viral spread. China's
success rests largely with a strong administrative system that it can mobilise in times of threat,
combined with the ready agreement of the Chinese people to obey stringent public health procedures.
Although other nations lack China's command-and-control political economy, there are important
lessons that presidents and prime ministers can learn from China's experience. The signs are that those
lessons have not been learned.

SARS-CoV-2 presents different challenges to high-income and low-income or middle-income countries


(LMICs). A major fear over global spread is how weak health systems will cope. Some countries, such as
Nigeria, have so far successfully dealt with individual cases. But large outbreaks could easily overwhelm
LMIC health services. The difficult truth is that countries in most of sub-Saharan Africa, for example, are
not prepared for an epidemic of coronavirus. And nor are many nations across Latin America and the
Middle East. Public health measures, such as surveillance, exhaustive contact tracing, social distancing,
travel restrictions, educating the public on hand hygiene, ensuring flu vaccinations for the frail and
immunocompromised, and postponing non-essential operations and services will all play their part in
delaying the spread of infection and dispersing pressure on hospitals. Individual governments will need
to decide where they draw the line on implementing these measures. They will have to weigh the
ethical, social, and economic risks versus proven health benefits.

The evidence surely indicates that political leaders should be moving faster and more aggressively. As
Xiaobo Yang and colleagues have shown, the mortality of critically ill patients with SARS-CoV-2
pneumonia is substantial. As they wrote recently in The Lancet Respiratory Medicine, “The severity of
SARS-CoV-2 pneumonia poses great strain on critical care resources in hospitals, especially if they are
not adequately staffed or resourced.” This coronavirus is not benign. It kills. The political response to the
epidemic should therefore reflect the national security threat that SARS-CoV-2 represents.
National governments have all released guidance for health-care professionals, but published advice
alone is insufficient. Guidance on how to manage patients with COVID-19 must be delivered urgently to
health-care workers in the form of workshops, online teaching, smart phone engagement, and peer-to-
peer education. Equipment such as personal protective equipment, ventilators, oxygen, and testing kits
must be made available and supply chains strengthened. The European Centre for Disease Prevention
and Control recommends that hospitals set up a core team including hospital management, an infection
control team member, an infectious disease expert, and specialists representing the intensive care unit
and accident and emergency departments.

So far, evidence suggests that the colossal public health efforts of the Chinese Government have saved
thousands of lives. High-income countries, now facing their own outbreaks, must take reasoned risks
and act more decisively. They must abandon their fears of the negative short-term public and economic
consequences that may follow from restricting public freedoms as part of more assertive infection
control measures.