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What can we learn from COVID-19 in Europe?

July 2020 YSM/GHR COVIDxBLM Review

In December 2019, no one could have foreseen the rapid political, social, and health changes the world would undergo as a response to COVID-19. Six months later, the virus has spread from Wuhan, China, to all corners of the globe. The rapid course of the spread forced country leaders to quickly enact policies that they believed could best control the situation. These high-pressure decisions may determine the fate of the community, both economically and socially. Apart from research and vaccine mobilization, many policymakers throughout the world enacted various non-pharmaceutical interventions (NPIs) to reduce the public transmission of the virus. These unprecedented interventions range from enforcing social distancing to closing non-essential businesses and schools.

Europe has recently seen a significant decrease in COVID-19 cases, and many countries have plans to reopen their borders to a select number of countries that contained the virus (Stewart 2020). Keeping an eye on case numbers, these countries are slowly returning to normal. Across the Atlantic in the U.S., on the other hand, cases have begun to increase (New York Times database). What did the U.S. do wrong? And what can we learn from Europe on how to effectively stop the spread of COVID-19?

Responses to COVID-19 across the United States varied from state to state. Some states imposed strict stay-at-home orders and closures for nonessential businesses, while other states remained mostly open, even as case numbers began to rise. Many argued that the economic consequences of implementing NPIs outweighed the benefits. However, the World Bank reports that early implementation results in improved economic and health outcomes as compared to delayed and reactionary policies (Demirguc-Kunt 2020) . This strongly endorsed preventive approach, which includes more proactive tracing, testing, and isolating of cases, was more commonly adopted in Europe than in the United States. A thorough analysis of public health interventions in Europe could help better inform policymakers of the practical strategies for overcoming a pandemic.

The Imperial College COVID-19 Response Team, assembled to advise COVID-19 policies in the United Kingdom, aimed to do just that. They created a microsimulation to model and predict the effects of various NPIs in the UK and the US. They concluded that only enacting one NPI is fairly ineffective. Rather, the combination of multiple NPIs substantially lowers infection rates (Ferguson 2020). Additionally, they distinguished between two types of policies: mitigation and suppression. Mitigation policies aim at mitigating the spread of the virus, whereas suppression policies seek to stop the spread completely. They found that even the best mitigation strategy resulted in “hundreds of thousands of deaths and health care systems being overwhelmed many times over” (Ferguson 2020). On the other hand, the best suppression policies, which included universal social distancing, home quarantining of potential carriers, and possible school and university closures, seemed to drastically reduce death numbers. The downside of these policies, however, is that they would have to be maintained until an effective vaccine is released to prevent another peak of cases (Ferguson 2020).

According to the model in which no NPIs are enacted, eighty-one percent of the population becomes infected, leading to at least 510,000 deaths in the U.K. and 2.2 million in the U.S. within a couple of months (Ferguson 2020). But, because of the NPIs implemented in Europe, researchers estimate more than three million lives were saved. The reproductive number, Rt, of the infection has also decreased. This value represents the average number of people to whom an infected individual spreads the virus. To efficiently suppress virus transmission, the Rt has to remain less than one. Data has shown that, since NPIs have been put in place, the Rt has been reduced by eighty-two percent in Europe, with a current and promising value of 0.66 (Flaxman 2020). These values help us understand the importance of NPI policy, even though we cannot physically see it. But there are limitations to modeling such a novel and variable situation.

Since many NPIs were implemented at once, it is almost possible to attribute changes to any one NPI. Furthermore, it is difficult to take into account the two-to-three week lag of hospital case results that emerge following a new NPI (Demirguc-Kunt 2020). There is also uncertainty in true case numbers, as many cases are asymptomatic and/or unconfirmed. Additionally, results can vary based on region and population, and community compliance is equally important as the NPIs themselves. As we learn more about COVID-19, the figures presented in this article may begin to shift and new conclusions may be drawn.

Beyond the scientific community, all eyes are on Europe, as many European countries are cautiously opening businesses and borders. Some of these countries have banned entry of travelers from specific high-risk countries, such as the US, while other countries require travelers to quarantine for two weeks immediately upon arrival. Some countries are even establishing travel bubbles, where a group of countries, usually neighboring, selectively open their borders to each other (McClanahan, 2020). According to Manuel Muñiz, the Secretary of State for Global Spain, the success of these so-called exit strategies are contingent on the countries’ ability to meet four criteria: “Track the virus’s spread; test anyone with symptoms; trace the contacts of those who test positive; and treat those who fall ill” (McClanahan, 2020). These rules establish clear guidelines for current and future policies, but just as we could not have predicted the global effects of a spreading virus in Wuhan back in December, we cannot truly predict what the next six months will look like. But with collaborative effort from all aspects of society, from governments, to the scientific community, to citizens, we can begin to combat the virus that has taken over the world.

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Economic Impact of Non-Pharmaceutical Interventions During the COVID-19 Pandemic.

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