Why Acting Fast Is the Key to Beating a Second Wave of Covid-19

By Chloe Whiteaker, Adrian Leung and Jeremy Scott Diamond

June 16, 2020, 12:00 PM EDT

Many nations are emerging from lockdowns even as experts are predicting a second wave of Covid-19 infections. Based on the first wave, they can avoid the worst if they move deftly.

Governments that hesitated to mount a broad containment response when the virus first emerged ended up with eight times as many deaths per 100,000 citizens, on average, compared to those that sprung into action soon after—or even before—confirming their first case. That’s according to a Bloomberg News analysis of the Stringency Index—which measures the strictness of “lockdown style” policies tracked by Oxford University’s Blavatnik School of Government—and data on Covid-19 infections compiled by Johns Hopkins University.

“If you’re slow, you have a much larger base number of infections and that’s much more difficult to control,” according to Mark Dybul, a professor of global health at Georgetown University Medical Center and former head of the Global Fund to Fight AIDS, Tuberculosis and Malaria. “Even when you put really severe restrictions in place, you’ve already got spread happening at a level that’s very difficult to contain.”

Note: Data as of June 14. Deaths are shown as a seven-day rolling average.

Sources: Johns Hopkins University Center for Systems Science and Engineering, Oxford COVID-19 Government Response Tracker, Blavatnik School of Government, analysis by Bloomberg

Fast responses were those where the full suite of containment measures went into effect within 35 days of reporting a first case—the average length of time for all countries analyzed. Slow responses entailed waiting to react—including the U.K.’s initial “herd immunity” strategy—or increasing restrictions gradually as infections rose.

Strong responses included a broad array of measures related to everything from the size of gatherings to domestic travel, and restrictions were often mandated for the entire country. Weak responses utilized fewer measures, with only regional mandates or mere recommendations. That includes Japan, where the federal government recommended staying inside, working from home and canceling events, but didn’t place limits on gatherings nor on its infamously crowded metro lines, and let prefectures determine school closures.

Almost all countries placed some limits on schools and international arrivals, but those with the strongest responses went far beyond that. Argentina earned the highest score on Oxford’s Stringency Index after bringing all semblance of normal daily life to a halt. Every school and non-essential business in the country was closed; all intercity buses, trains and domestic flights were suspended; international borders were sealed even for citizens; and checkpoints were set up on roads to catch those breaking quarantine—an offense punishable by up to two years in prison.

Neighboring Brazil took the opposite approach: a delayed response led by states and opposed by President Jair Bolsonaro, who encouraged people to get back to work. Brazil’s death toll is more than 11 times higher than Argentina’s, per 100,000 people, and is still rising rapidly.

Most countries started ramping up safety measures around the time the World Health Organization declared Covid-19 a pandemic in mid-March. By that time, dozens of countries had more than 100 cases.

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Fast & Strong
Fast & Weak
Slow & Strong
Slow & Weak

Note: Stringency scores are shown for the day a country first exceeded a benchmark number of cases. Response color categories are shown for maximum stringency scores.

Taiwanese government health officials were among the first to learn of a new SARS-like illness spreading through parts of China by spotting warnings from medical professionals posted on Chinese social media. The government acted quickly to block flights from the original epicenter of Wuhan, setting up temperature checks at airports and employing an impressive system for widespread testing, comprehensive contact tracing and enforced quarantines.

Taiwan began building an emergency-response network for containing infectious diseases after its experience with Severe Acute Respiratory Syndrome in 2003, when hundreds became ill and at least 73 died. Maintaining that system and remaining vigilant over the years allowed the government to effectively contain the virus from the outset, requiring few disruptions to daily life. Five months in, Taiwan has reported fewer than 500 cases and seven deaths. Its government is already preparing for the next pandemic.

“We treated the virus as a serious epidemic from day one,” Philip Lo, deputy director-general of Taiwan’s Centers for Disease Control, told Bloomberg News in an interview in April. “We didn’t wait till it broke out to take action.”

New Zealand mounted one of the strictest lockdowns in the world over the span of 27 days—more than a week faster than countries took to impose more relaxed measures, on average. The government blocked travel from China before reporting a single infection and expanded to include Iran after confirming its first case was a person who recently returned from the country. By the time it found 28 infections, Prime Minister Jacinda Ardern sealed the border to anyone who wasn’t a citizen or permanent resident—including foreign students and temporary workers. Over the next week, she ordered the closure of all schools, non-essential workplaces and public transport; banned all gatherings and domestic travel; and ordered people to stay home.

Ardern ended the seven-week lockdown on May 14 and lifted all social distancing measures on June 8, after two weeks with no new cases. New Zealand’s borders remain closed to outsiders, but two citizens returning from the U.K. were confirmed to be infected on June 16.

Just as countries followed each other into lockdowns, now they’re filing out of them—whether or not they actually contained their outbreaks. The ones that succeeded in stifling infections will have to figure out how to protect themselves from the ones that didn’t.

“We are going to have quite a patchwork globally of countries doing different things,” said Stephen Morrison, Director of the Global Health Policy Center at the Center for Strategic and International Studies in Washington. “And the recovery process is going to be quite varied and a lot of countries will go through a roller coaster where infections will go up and down.”

Governments are starting to form agreements with each other to allow their citizens to travel back and forth, but the ones still reporting high numbers of infections are being left out. Norway has opened its borders to all its Nordic neighbors, except Sweden, where the government imposed some social distancing curbs but steered clear of a full lockdown. Hard-hit Italy opened its borders to all European Union members, but a handful of countries have yet to return the favor. And with the most infections and deaths in the world, the U.S. could face an uphill battle convincing other countries to let Americans visit.

“It’s possible that Europe will open up to everyone else, except the United States,” said Dybul.

The U.S. response to the virus was both slower and weaker than most other countries. With the exception of a ban on travelers arriving from China, and eventually Europe, containment was handled almost entirely by state and local governments that didn’t agree on how serious a threat the virus posed, or whether a lockdown was worth the economic hit. Despite confirming its first case in January, most states didn’t begin to cancel large gatherings or close schools until mid-March. Even then many people continued to travel across state lines.

“In a country that has the mobility of the United States, you just can’t leave it up to the states,” Dybul said. “So we are not going to be ready for a second wave unless there’s a federal response. And we can’t reopen safely, or well.”

Some countries, including Germany and South Korea, did manage to stem their outbreaks with a more localized approach, thanks to readily available testing and contact tracing. South Korea won global praise for being among the first countries to offer drive-through testing to entire communities. The U.S., on the other hand, has struggled to accurately gauge the scale of its infections. Testing rates have varied widely by state, and where drive-through testing exists, hospital workers have faced shortages of personal protective equipment, including surgical masks, gloves and gowns.

Countries that are reopening in spite of rising cases, including the U.S., are likely to face resurgences sooner than they otherwise would have, making it all the more urgent for them to prepare to act as soon as warning signs emerge. Unfortunately, that’s not always happening. New cases are ticking up in more than 20 states, according to a Johns Hopkins virus tracker measuring the three-day moving average in each state, though the trend is particularly pronounced in fewer than 10 states. In Turkey, President Recep Tayyip Erdogan scrapped a plan to reimpose a lockdown after cases jumped by 1,000 in a single day—instead urging people to be careful and maintain social distancing at all times.

“We’ll have more infections spreading throughout the next 3 or 4 months than we need to have,” said Dybul. “That doesn’t augur well for a large second wave. It means we’re not ready for one, and it means the second wave will be larger than it needs to be.”

Sources: Oxford COVID-19 Government Response Tracker, Blavatnik School of Government, Johns Hopkins University Center for Systems Science and Engineering, data compiled by Bloomberg

Note: Strong responses were those which had a maximum stringency score that was higher than or equal to the average of all countries’ maximum scores. Weak responses were any below that average. Fast responses were those in which the number of days that elapsed between reporting a first case and reaching maximum stringency was less than or equal to the average number of days for all countries. Slow responses were any with more days than that average. All data are as of June 14. Small-multiple country charts show cases as a seven-day rolling average.

With assistance from: K. Oanh Ha, Cindy Wang, Hayley Warren and Andre Tartar

Editor: Alex Tribou

Why Acting Fast Is the Key to Beating a Second Wave of Covid-19

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