Coronavirus in the United States: What We Could Learn from Other Countries
Many countries have controlled Covid-19 better than the United States. What lessons could they teach us?
The United States continues to struggle in its effort to contain the novel coronavirus, far surpassing many other nations in the number of Covid-19 infections (approaching six million) and deaths (about 180,000) while stumbling in its reopening efforts. Other countries, such as New Zealand, Vietnam, and Germany have fared much better in controlling the coronavirus known as SARS-CoV-2.
These nations are smaller than the United States, have different governmental structures, and some have other natural advantages (New Zealand and Australia, for instance, being self-contained islands). They also acted very early in the pandemic, but there are still lessons to be learned from countries that tackled the coronavirus more successfully.
Widespread testing for Covid-19 has been a cornerstone of the successful responses to Covid-19. “The countries that were successful did testing and contact tracing very, very promptly and comprehensively,” says H. Dirk Sostman, MD, president of the Houston Methodist Academic Institute. That meant testing not just people with symptoms and their contacts but asymptomatic people as well, as Germany did. South Korea was quickly able to test 15,000 to 20,000 people a day, while Vietnam had rapid tests (results in as little as 70 minutes) by early February.
By contrast in the United States, in late August the Centers for Disease Control and Prevention (CDC), dropped the recommendation that exposed people without symptoms should be tested. Although testing requires infrastructure and personnel, it’s never too late. “We still have to control the pandemic as best we can,” says Dr. Sostman.
Controlling a virus means not just testing but also tracing any and all who have been in contact with a positive case. This requires a huge amount of manpower, which is why Germany trained “containment scouts” to help its effort. Vietnam was a star in its effort, tracing contacts of contacts of contacts and more. Positive folks were isolated or quarantined. Successful countries also relied on smartphone apps and GPS data to track contacts.
The United States has stumbled in its contact tracing, hampered partly by limited resources, says Dr. Sostman. And, let’s face it, certain strategies (like tracking people with technology) aren’t going to be popular or even possible in a country that safeguards privacy. The Association of State and Territorial Health Officials, though, has outlined a plan for how it could be accomplished. It includes using three tiers of contact tracers: lay community workers, professional “disease investigator specialists,” and health care providers or other medical professionals.
“Generally speaking, Europe and a lot of the Asian countries that have gotten good control of their pandemics implemented around the same time similar lockdown containment approaches,” says Brandon Guthrie, PhD, assistant professor of global health and epidemiology at the University of Washington School of Public Health in Seattle. And they did it “with higher intensity and a higher sort of uniform adherence,” he adds.
This isn’t easy to do in the United States, with its jumble of states, counties, jurisdictions, laws, and cultures—but it’s not impossible. “It’s obvious with the initial lockdowns that the appropriateness of a given response for dense urban centers and for dispersed rural areas are very different,” says Dr. Guthrie. “For a long-term plan, strategies do have to be tailored to different settings for it to be something it can be adhered to, to be effective.”
Many parts of the world ran into trouble when they reopened too fast and too soon, something the World Health Organization (WHO) warned about in March. Many parts of the United States—among them Arizona, Florida, Georgia, and Texas—have already learned this painful lesson. New Zealand waited five weeks before trying to reopen, and Germany only relaxed measures when transmission rates were down.
In the United States, says Dr. Guthrie, “there was a degree of overconfidence.” A phased strategy probably is better, he says. “There needs to be a thoughtful approach on which of the activities are going to give you the most bang for your buck in terms of preventing transmission,” he adds. In other words, opening bars, restaurants, and gyms without good mitigation strategies is likely to result in more cases.
Successful reopening also means expecting and being ready for more waves. “Even if you’ve got it under great control, you have to be constantly vigilant,” says Dr. Sostman. “It is out there waiting for you to make one big mistake.”
The key to successfully controlling SARS-CoV-2, the virus that causes Covid-19, is participation. “What we need for our country more than anything is participation from everybody,” says Peter Kuhn, PhD, Dean’s professor of biological sciences and professor of medicine at the University of Southern California. That means the willingness to socially distance and wear masks, among other things. “The problem is not insurmountable,” he says.
More than 100 countries have nationwide mask mandates, including Spain and France, according to the Council on Foreign Relations. This isn’t likely to work in the United States, but there are other ways to get people involved. The government of Vietnam “repurposed” a well-known pop song with new lyrics to emphasize handwashing. The song, “Ghen Co Vy,” which means “Jealous Coronavirus,” led to a Tik Tok dance challenge.
Mustering up enthusiasm depended in large part on clear communication, says Krutika Kuppalli, MD, an infectious diseases physician and vice-chair of the Global Health Committee at the Infectious Diseases Society of America (IDSA). “There was consistent messaging and engagement with the public in the countries that have done well,” she adds. This hasn’t happened in the United States, although there were a few bright spots: When neighboring states collaborated in their efforts to curb Covid-19, they had greater success.
- Johns Hopkins University: "Coronavirus COVID-19 Global Cases"
- H. Dirk Sostman, MD, president, Houston Methodist Academic Institute
- Our World in Data: "Emerging COVID-19 success story: Germany's strong enabling environment"
- Our World in Data: "Emerging COVID-19 success story: South Korea learned the lessons of MERS"
- Our World in Data: "Emerging COVID-19 success story: Vietnam's commitment to containment"
- The New York Times: "Top U.S. Officials Told C.D.C. to Soften Coronavirus Testing Guidelines"
- Association of State and Territorial Health Officials: "A Coordinated, National Approach to Scaling Public Health Capacity for Contact Tracing and Disease Investigation"
- Brandon Guthrie, PhD, assistant professor of global health and epidemiology at the University of Washington School of Public Health in Seattle
- Kaiser Health News: "Record Number Of Coronavirus Cases Is A Result Of States Reopening Too Soon, Health Experts Say"
- New England Journal of Medicine: "Successful Elimination of Covid-19 Transmission in New Zealand"
- Peter Kuhn, PhD, Dean's professor of biological sciences and professor of medicine, University of Southern California
- Council on Foreign Relations: "Which Countries Are Requiring Face Masks?"
- Krutika Kuppalli, MD, infectious diseases physician and vice-chair, Global Health Committee, Infectious Diseases Society of America
- Council of Northeastern Governors: "Governors Take Swift and Decisive Actions Responding to Spread of Coronavirus"