key: cord-1003896-5lrd70ir authors: Tabari, Parinaz; Amini, Mitra; Moghadami, Mohsen; Moosavi, Mahsa title: International Public Health Responses to COVID-19 Outbreak: A Rapid Review date: 2020-05-03 journal: Iran J Med Sci DOI: 10.30476/ijms.2020.85810.1537 sha: a794da97e3a64859ace19715c5e58af169a51e00 doc_id: 1003896 cord_uid: 5lrd70ir BACKGROUND: The outbreak of Coronavirus disease 2019 (COVID-19) has posed a significant threat to many countries. Since the disease does not currently have a particular treatment, there is a compelling need to find substitute means to dominate its expansion. In this rapid review, we aimed to determine some countries’ public responses to the COVID-19 epidemic. METHODS: In this study, academic databases, including MEDLINE, Scopus, and Embase, were investigated. The keywords applied in the search strategy besides the names of each country were: “Public Health,” “Public Response”, “Health Policy”, “COVID-19”, “Novel Coronavirus,” “2019-nCoV”, and “SARS-CoV-2”. The countries included China, Italy, Iran, Spain, South Korea, Germany, France, United States, Australia, Canada, Japan, and Singapore. RESULTS: The total number of retrieved articles in MEDLINE, Scopus, and Embase in April 2020 was 594, and after removing 259 duplicate articles, 335 papers were screened by the experts. After this investigation, 50 articles, in addition to 12 webpages, were extensively reviewed for the results section. Public health strategies and responses can be divided into four main areas, including monitoring, public education, crowd controlling, and care facilities. CONCLUSION: According to the results of the management decisions of some governments on quarantining, social isolation, screening methods, and flight suspensions due to the severity and anonymity of COVID-19, it is highly assured that these strategies would be the most successful approaches to confront the present pandemic. Governments should put in place timely and strict measures to halt the spread and diminish its unintended deadly consequences. • Emergency situations like outbreaks have caused various issues globally. • National and international responses to the outbreaks have had a critical role in reducing the infection rates and preventing the diseases from spreading. Social isolation and quarantining were beneficial in the previous epidemics. announced the COVID-19 outbreak as a Public Health Emergency of International Concern in which countries with vulnerable healthcare facilities may be at an excessive hazard. The disease transmission may be disrupted by early diagnosis, social isolation, instantaneous therapy, and other control measures. 1 This infection has imposed remarkable perils on the global health systems and economic sectors of countries. Since the disease does not currently have a particular treatment, there is a compelling need to find substitute means to dominate its expansion. 4 COVID-19 outbreak has led the public health officials of several countries to enact policies and manage the spread of the disease by employing different strategies, including encouraging people for self-isolating and quarantining. This rapid review aims to summarize these strategies and responses in some countries and, subsequently, discuss how these measures could help in curbing the virus transmission and comparing the effectiveness of their policies looking at the number of total cases in each of the mentioned countries. The extracted results may be helpful for both policymakers and researchers. In this rapid review, academic databases, including MEDLINE, Scopus, and Embase, were investigated. The keywords applied in the search strategy besides the names of each country were: "Public Health," "Public Response", "Health Policy", "COVID-19", "Novel Coronavirus," "2019-nCoV", and "SARS-CoV-2". The countries included China, Italy, Iran, Spain, South Korea, Germany, France, United States, Australia, Canada, Japan, and Singapore. In addition to this search, the official government websites of some countries, creditable news websites, and LitCovid literature hub 5 were also reviewed to acquire additional data about the recent national responses and control strategies. After removing duplicate articles, the abstracts of the remaining papers were screened by four experts, including an epidemiologist, a medical informatics expert, a statistician, and an infectious disease expert. Those relevant articles meeting the inclusion criteria were consequently selected to include in the study. The inclusion criteria were as follows: 1) Articles reported public health responses to COVID-19 outbreak or control measures when experiencing the virus outbreak, 2) Articles written in the English language, and 3) Articles published in 2020. The papers lacking these measures and out of scope ones were excluded from the study. The total number of retrieved articles in MEDLINE, Scopus, and Embase in April 2020 was 594, and after removing 259 duplicate articles, 335 papers were screened by the experts. After this investigation, 50 articles, in addition to 12 webpages, were extensively reviewed for the results section. In Table 1 , public health responses to the COVID-19 outbreak based on each country are categorized. There are various means by which preventing further transmission of the virus can be conducted, including investigating, categorizing, monitoring, and managing contacts by identifying the patients' travel routes. Many countries enacted policies on travel restrictions, such as flight suspensions [6] [7] [8] [9] [10] [11] [12] [13] [14] or close monitoring of the incoming travelers on their arrival at the international airports. 13, [15] [16] [17] Some other countries have implemented social distancing and quarantine policies to fight this highly contagious disease [18] [19] [20] as well as encouraging the limitation of social contacts, postponing events, locking down schools, and isolating suspected cases. 14, 21 Technological approaches such as telemedicine for remote Containment strategies and core measures such as social distancing, case isolation, close contact tracking management, closing epidemic areas, and traffic controls were used to diminish movements and environmental actions were done to increase personal protection. Chen et al. 27 February 17, 2020 Wuhan -the outbreak's epicenter, was quarantined. Du et al. 28 May 2020 early release Online and offline wildlife sales and transportations (except fish and seafood) were prohibited in China due to Coronavirus outbreak. In case of any violation, lawbreakers were severely penalized. Loeb 29 February 8, 2020 1-By January 26, 2020, the first-level emergency response system for public health and safety had been triggered by 30 provinces in China. 2-China provided extra funds for public health, prevention, and management of the epidemics. 3-The Spring Festival holiday was extended, the spring term was deferred, mass meeting events were canceled, and transportation capacity regulations were enacted to diminish mass movement of people. 4-Residents of each community were isolated by civil society organizations. 5-Social isolation, home quarantine, and provision of personal safety devices such as facemasks were introduced to deter widespread transmission of the virus to the nation. 6-Providing simple and easy access to credible information and expert advice to help diminish speculations and misconceptions. It was brought to people by technological advancements. 7-The approaches to prevention and management have been modified throughout time to adapt to the challenging and modifiable circumstances. Initial measures in Wenzhou, China: 1. Assigning suspected and confirmed cases to pre-specific hospitals. 2. Investigation and tracking new arrivals from Wuhan through the utilization of a big-data network-They were subsequently convinced to go through a 14-day quarantine at their own houses. 3. Gathering and monitoring people who exposed to COVID-19 confirmed cases. Secondary measures in Wenzhou, China: 1. Traffic shut down of trains, buses, and planes. 2. All public gathering sites were closed, and community activities were canceled. 3. High-risk individuals were investigated and monitored promptly. 4. Seriously-ill patients were transferred to a specialized hospital for intensive care, and their close contacts were medically observed. Ruan et al. 33 April 3, 2020 Italy On February 21, the Italian government established an emergency task force of Lombardy and the policies of local health to respond to the virus outbreak. Grasselli et al. 34 March 13, 2020 1. National measures to restrict viral spread including the air travel ban from China, quarantining Italian passengers in China, and severe controls at international airports' arrival terminals were implemented 2. An algorithm for the recognition of the suspected cases was designed. Spina et al. 13 February 28, 2020 A surveillance system was launched at the beginning of the virus outbreak to gather information about the infected Italian people. Onder et al. 35 March 23, 2020 Social isolation became obligatory. Sani et al. 19 April 4, 2020 A response plan was recognized by a task force: 1. Setting up ICUs for COVID-19 confirmed cases. 2. Modeling suitable methods for detecting, isolating, and pre-triage of COVID-19 confirmed or suspected cases 3. ICU staff training in the field of personal protection and patient management. Carenzo et al. 36 April 4, 2020 Northern Italy entered an emergency shutdown on 8 March, and three days later, the government applied the quarantine to the entire country. Subsequently, it was announced that the lockdown would continue to at least April 3. Paterlini 37 April 2, 2020 National and regional governments established urgent control measures, including the development of quarantined areas that covered more than 50000 residents. Country Main control measures Reference Publication/cite date 1. Rapid institutional responses. 2. Announcing the condition of national emergency on 31 January 2020 3. Applying restrictions on public events and activities-which had an impact on colleges, conferences, and sports activities 4. Locking down of hospital wards, limiting the entrance to hospitals by visitors, establishing alternative triage areas, designating mobility and segregation locations for patients, and canceling several elective procedures to diminish the burden on critical care capacity. 5. Designating all Italian regions as "red zones" with imposing severe restrictions on any public event on 11 March 2020 6. Utilization of tele-counseling sessions 7. Home isolation of COVID-19 patients who were not terribly ill 8. Creation and broadcasting informative video clips. March 27, 2020 New restrictions were imposed on the intercity traffic. April 4, 2020 Spain 1. In January, a health screening protocol was implemented by the government. 2. Transparent information was ordered to be released. 3. The protection of highly exposed people to the disease was prioritized. 4. Support of health workers, families, and companies was planned. 5. The president demanded unity and social responsibility. France approved, reimbursed, and strongly encouraged the utilization of telemedicine (e.g., tele-expertise and remote-consultation). Ohannessian et al. 23 April 2, 2020 1. The president of France announced that the country would be considered as being in a condition of war on March 12. 2. Schools were locked down. 3. Self-quarantining, social distancing, and limiting social interactions were advised. 4. Several public areas were ordered to close. 5. Local municipal elections were postponed. 6. The National quarantining of the whole community was assumed to be the best strategy to curb the virus transmission. 7. The Schengen treaty zone was closed to non-EU citizens. Ghanchi 18 April 7, 2020 Germany March 5, 2020 Canada has positively been influenced by the experience of the SARS outbreak (e.g., in the field of virtual care and diminishing exposure hazards). Webster 56 March 21, 2020 As a part of the economic response plan in Canada, employers who were hugely affected by COVID-19 pandemic, have been financially supported. April 12, 2020 Singapore 20, [22] [23] [24] According to the published articles, public health strategies and responses are divided into four main areas: 1) Monitoring: In this respect, countries investigate the whole or parts of the community by either using tele-monitoring strategies or broad investigation in airports or borders of the region. Approaches, such as the utilization of Global Positioning System/credit card records or the development of websites for self-monitoring or psychological consultation services, were also employed in some countries, specifically in South Korea and Singapore. 2) Public education: To provide community education, many governments attempted to offer transparent information about the virus. Additionally, information on preventive measures or proper practices in the community were delivered to the people through diverse sorts of media or messaging services. 3) Crowd controlling: Governments employed some policies to diminish gatherings. These approaches included social distancing, quarantining, street traffic controlling, school and university closures, postponing events, and shutting down some businesses. 4) Care facilities preparation: Constructing or preparing suitable care settings, including major hospitals with the highest degree of facilities, were other responses in some countries. Hospitals or shelters for caring suspected or confirmed cases at both stages of therapy and recovery were built or allocated. These facilities might subsequently reduce the death rate in these countries. The mentioned control measures control measures in some countries could bring success strategies in coping with the current outbreak. However, other countries require to enact stricter laws or implement more practical policies. Based on the Worldometers website, 25 some countries could control the virus, and their total cases rate has remained steady after a specific date. Some other countries with a rising rate of total cases curbed their death rate, although their cases are still growing to a higher degree. The world has encountered three outbreaks since 2002 with the epidemic of SARS-CoV, followed by MERS-CoV in 2012, and COVID-19 in 2019, which spread swiftly to several countries and threatened public health. 70 The immediate spread and its high transmission rate between people have caused global distress. 71, 72 In South Korea, some methods for information collection were introduced for the screening and management of COVID-19 cases. By employing these techniques, precise information about the location and time of exposure and other details would be accessible to the general public. Since the release of a patient's contacts violates the patient's privacy, a protocol to protect this critical issue must be created. 63 Early and rapid responses to the outbreak as well as implementing preventive strategies, have helped South Korea to preclude community infection and limit it to some specified medical centers. By utilizing appropriate approaches, entrance of COVID-19 patients, and simultaneously, the dissemination of the virus across the country have been deterred. 67 Although South Korea was once one of the most infected countries outside China, the outbreak has reached a period of stability after stringent monitoring approaches and mass quarantine. 17 Based on the "Worldometers" statistics, the total cases in South Korea had been rising sharply until early March 2020, while since then, the rate has been experiencing a gradual increase. 25 Singapore has used a robust surveillance program to identify many cases and restrain them at a personal level. By early identification of cases by monitoring and intensive contact tracking among confirmed cases along with implementing border control policies, Singapore has managed to prevent the virus from spreading without substantial disturbances to daily routine life. 17 Additionally, Singapore had the experience of the 2003 SARS outbreak and performed well due to its readiness. Intensive Care Units (ICUs) of the country were fully prepared and responded swiftly to the virus outbreak. 17, 58, 59 Although in Australia, the number of confirmed cases is rising, the death rate in this country has remained relatively low. This might be the consequence of the country rapid response to the emerged crisis through control measures such as social distancing, public education, and the use of technological advancements. 20 Similar to Australia, Singapore has experienced a very low death rate, thanks to its early responses and control policies. 25 Iran is among countries that have launched a psychological assistance system for residents as well as establishing a self-monitoring website for suspected cases of COVID-19. 42 This country has made several attempts to combat the epidemic, but now it seems that it takes more cohesive, prompt, and effective interventions to halt the spread of this virus, specifically among the most susceptible population. 73 Additionally, adequate and stable economic resources and the effective utilization of them are required. 74 Social distancing and travel restrictions were among the key methods used by Japan government to confront the recent crisis. 12, 49 This country has successfully controlled the virus outbreak with a comparatively low casualty rate. 25 According to the epidemic control experts of Canada, the experiences with the SARS outbreak could positively affect Canada's response to the epidemic of COVID-19, specifically in the field of facility preparation. However, the increased burden in hospitals and care settings due to the growing number of new cases might remain a key challenge. 56 Given the accelerated proliferation of the disease and the need to offer urgent care treatment to an increasing number of patients, the current COVID-19 outbreak in Italy has imposed a tremendous pressure on the healthcare system. 38 Although the Italian health system was highly equipped, and the government responded rapidly to the outbreak, this country was not prepared enough to deal with the COVID-19 epidemic, and the number of cases is still rising. This situation has led to several challenges for the healthcare system all over this country. It seems that more appropriate measures of team working, proactive planning, and training can provide a better support in coping with this epidemic. 24 In Italy, data on the prevalence of the disease in asymptomatic individuals were deficient. Therefore, the actual prevalence and precise mortality rate were unclear. In this case, more apparent and comprehensive data are also required to help decision-making and increase consciousness among the public. 75 Although some countries such as Spain and France have implemented of suitable control strategies including massive lockdown to combat the epidemic, 18, 46 more real-time screening of the transmission and mortality are required to be prioritized in these countries. 76 In Spain, the government's late response to the outbreak was the leading cause of its failure in controlling the disease. In addition, due to the financial crisis in this country, the hospitals have been experiencing an austere decade. 77 In France, the underlying reasons might be different; the French citizens tended to follow the national lockdown policies less firmly than other nations. 78 At the beginning of the epidemic, China led the virus transmission rate with the fastest pace of the spread, while in the next few weeks, other countries took over China. 79 As mentioned above, Italy and Spain confronted a remarkable increase in the number of confirmed cases and deaths. As on March 19, 2020, it was reported that Italy overtook China with more than 3400 deaths from the virus 80 and at the time of writing, United States has the highest total cases compared to other countries. 25 In the United States, the comparison between New York and California would be an excellent illustration of a rapid response. California, unlike New York, has successfully managed to curb the virus from spreading. Disease prevention experts believe that the most significant distinction between these two regions is not a matter of population or location, but the time people began staying at home, and distinctions in their social distancing approach. In general, New York has experienced nine times more number of cases, seven times higher number of hospitalized patients, and fourteen times more fatalities than California. 81 Although China was the first infected country with once the highest rate of confirmed cases and mortality, looking at its present statistics, it can currently be categorized as a successful country in controlling the disease with strengthened strategies and public health response. 25 The community was also well-informed on COVID-19's significance to conform with the national approaches of mask-wearing, hand-washing, social distancing, and temperature screening. Additionally, by retaining a firm containment policy, China is seeking to restore usual social and economic activities. 30 However, in the early days of the epidemic, there were some failures and negligence, the government avoided identifying the epidemic and undermined its seriousness in the initial days. 82 Regarding management and investigative strategies, there has still been a remarkable unfamiliarity in many countries. In this case, international cooperation would be beneficial in controlling the pandemic, 83 and by screening the situation deeply, further knowledge about the new virus would be gained, and nations can respond better. 84 The most known measures to control and prevent the disease include finding suspected cases and their contacts, blocking the transmission of the virus by isolation and personal protection as well as managing the infection sources. 85 There are also some prediction models in which experts forecasted the positive impact of these plans on controlling COVID-19 infectious transmission. 86 More efficient clinical management of the infected patients in addition to public health preparedness 1 and a prompt and accurate screening of the epidemic are needed in all countries in order to succeed in managing the spread of the infection. 87 According to the results from the management decisions of some governments on quarantining, social isolation, and flight suspensions, it is highly assured that these strategies would be the successful techniques to confront the present pandemic due to the severity and anonymity of COVID-19. In addition to those strategies, some countries have focused more on the utilization of robust case detection and screening approaches. All in all, governments should enact serviceable laws and put in place timely and strict measures to halt the disease spread and diminish its unintended deadly consequences. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19) 2019-novel Coronavirus (2019-nCoV): estimating the case fatality rate -a word of caution Passengers' destinations from China: low risk of Novel Coronavirus (2019-nCoV) transmission into Africa and South America Potential interventions for novel coronavirus in China: A systematic review Initial Public Health Response and Interim Clinical Guidance for the 2019 Novel Coronavirus Outbreak -United States The Rate of Underascertainment of Novel Coronavirus (2019-nCoV) Infection: Estimation Using Japanese Passengers Data on Evacuation Flights The response of Milan's Emergency Medical System to the COVID-19 outbreak in Italy PubMed Central COVID-19 control in China during mass population movements at New Year Update: Public Health Response to the Coronavirus Disease 2019 Outbreak -United States COVID-19): Outbreak update Interrupting transmission of COVID-19: lessons from containment efforts in Singapore Adaptation of the National Plan for the Prevention and Fight Against Pandemic Influenza to the 2020 COVID-19 epidemic in France Mental health during and after the COVID-19 emergency in Italy Australia's primary care COVID-19 response School Opening Delay Effect on Transmission Dynamics of Coronavirus Disease 2019 in Korea: Based on Mathematical Modeling and Simulation Study Novel Screening and Triage Strategy in Iran During Deadly Coronavirus Disease 2019 (COVID-19) Epidemic: Value of Humanitarian Teleconsultation Service Global Telemedicine Implementation and Integration Within Health Systems to Fight the COVID-19 Pandemic: A Call to Action The Italian coronavirus disease 2019 outbreak: recommendations from clinical practice COVID-19 Coronavirus pandemic Assessing the Impact of Reduced Travel on Exportation Dynamics of Novel Coronavirus Infection (COVID-19) Early containment strategies and core measures for prevention and control of novel coronavirus pneumo Risk for Transportation of 2019 Novel Coronavirus Disease from Wuhan to Other Cities in China China bans sale of wildlife following coronavirus COVID-19 containment: China provides important lessons for global response What China's coronavirus response can teach the rest of the world Fangcang shelter hospitals: a novel concept for responding to public health emergencies New measures for COVID-19 response: a lesson from the Wenzhou experience Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy: Early Experience and Forecast During an Emergency Response Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy Hospital surge capacity in a tertiary emergency referral centre during the COVID-19 outbreak in Italy Lockdown in Italy: personal stories of doing science during the COVID-19 quarantine Potential short-term outcome of an uncontrolled COVID-19 epidemic in New traffic restrictions Coronavirus disease 2019 (COVID-19) outbreak in Iran: Actions and problems Trust in humanitarian aid from the earthquake 2017 to COVID-19 in Iran: A policy analysis IR of Iran National Mobilization against COVID-19 The challenges and considerations of community-based preparedness at the onset of COVID-19 outbreak in Social distancing policies in Iran President of the Government calls for political and public unity to overcome coronavirus emergency The Guardian Spain orders nonessential workers stay home for two weeks Development of Genetic Diagnostic Methods for Novel Coronavirus 2019 (nCoV-2019) in Japan Limiting spread of COVID-19 from cruise ships -lessons to be learnt from Japan Japan declares state of emergency over coronavirus First cases of coronavirus disease 2019 (COVID-19) in France: surveillance, investigations and control measures Rapid establishment of laboratory diagnostics for the novel coronavirus SARS-CoV-2 in Bavaria Merkel announces strict measures, tells Germans to stay home in virus fight Germany expands border controls for EU travelers, minister says The Politico Germany's Merkel bans meetings of more than 2 people to slow coronavirus The Guardian Germany's devolved logic is helping it win the coronavirus race Canada and COVID-19: learning from SARS Canada's COVID-19 Economic Response Plan Preparing for a COVID-19 pandemic: a review of operating room outbreak response measures in a large tertiary hospital in Singapore Preparing for COVID-19: early experience from an intensive care unit in Singapore COVID-19 in Singapore-Current Experience: Critical Global Issues That Require Attention and Action Everything you need to know about Quarantine Orders Singapore Government Agency Website COVID-19 Resources Case Management Team KCfDC, Prevention. Contact Transmission of COVID-19 in South Korea: Novel Investigation Techniques for Tracing Contacts Epidemiologic characteristics of early cases with 2019 novel coronavirus (2019-nCoV) disease in Korea How to train the health personnel for protecting themselves from novel coronavirus (COVID-19) infection during their patient or suspected case care How is COVID-19 affecting South Korea? What is our current strategy? Disaster Med Public Health Prep Lessons Learned From Korea: Covid-19 Pandemic Senior Medical Students in the COVID-19 Response: An Opportunity to Be Proactive Coronavirus 2019-nCoV: A brief perspective from the front line The 2019-nCoV epidemic control strategies and future challenges of building healthy smart cities. Indoor and Built Environment Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany COVID-19 Pandemic and Comparative Health Policy Learning in Iran Fighting COVID-19 in Iran; Economic Challenges Ahead COVID-19 in Italy: momentous decisions and many uncertainties. Lancet Glob Health Monitoring Transmissibility and Mortality of COVID-19 in How did Spain get its coronavirus response so wrong? France's coronavirus death rate accelerates, cases near 100,000 11 charts that explain the coronavirus pandemic Italy death toll overtakes China with 3,405 deaths from virus NBC bay area Difference Between COVID-19 Cases in CA vs. NY Is Likely Sheer Luck: Experts Strengthening China's Public Health Response System: From SARS to COVID-19 The 2019 Novel Coronavirus Outbreak -A Global Threat Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges Risk Assessment of Novel Coronavirus COVID-19 Outbreaks Outside China Why outbreaks like coronavirus spread exponentially, and how to "flatten the curve First two months of the 2019 Coronavirus Disease (COVID-19) epidemic in China: real-time surveillance and evaluation with a second derivative model This article is the result of a research project that was approved and financially supported by Vice-Chancellor for Research at Shiraz University of Medical Sciences (Ethics code: IR.SUMS. REC.1399.105).We would also like to express our very great appreciation to Dr. Manica Negahdaripour in providing valuable comments and recommendations that significantly improved the manuscript.Conflict of Interest: None declared.