Medical experts from Iran, China, Spain, and Hong Kong count the failures and successes of countries and areas that have been battleing the Covid-19 for months.
MEXICO (Special report / El Universal) – With more than 1.2 million sick, over 60,000 dead, and rising, the coronavirus pandemic is advancing and staining territories. Ten countries account for 80% of the cases detected, and some nations have been dealing with Covid-19 for weeks and months. Four medical experts have analyzed the complicated situations in Iran, Spain, and China. The success in containing the autonomous region of Hong Kong, explains to EL UNIVERSAL what they did right and what they did wrong.
“Don’t let politics get involved in medical matters. That’s the message here. It happened in Iran, and it’s happening in the United States.” Summarizes Kamiar Alaei, an Iranian expert on health policy and co-chairman of the Institute for International Health and Education in Albany. “The Iranian government was in denial about the coronavirus for political reasons and acted late, which led to its spread throughout the country.”
In late 2019, Iran experienced a series of protests over a sharp rise in fuel prices, which coincided with the anniversary of the Revolution and the parliamentary elections in February 2020. In this context, Alaei assures that the people had lost confidence in the authorities.
“When the epidemic started, the government thought if they admitted that there was a coronavirus in Iran, people would have an excuse not to participate in the anniversary and the elections. They ignored the problem even though there were some cases in cities like Tehran, Qum, and others. Finally, on February 19, in the city of Qum, the first two deaths were reported, and with them the first mention of the coronavirus by Iran”.
According to the Johns Hopkins center, the first case of Covid-19 was reported in Iran on February 18, a day before the early two deaths. Now, according to the latest data, there are more than 55,000 infected and 3,400 deaths. It is the fifth country in the world with absolute numbers of deaths. For comparison, in Spain and Italy, the first deaths were reported more than 15 days after the authorities said the first cases.
“You never start with deaths, there are always cases before, and the question is whether they could have known that there were cases in the country. After the deaths, they began to discuss between the political and health authorities whether or not to quarantine the city of Qum. Still, then there was a long delay in taking action, and when they did take action, it was lukewarm,” explains Alaei.
“Millions of people traveled around the end of the year [the Persian calendar marks the spring equinox on March 20] from big cities to small towns, aggravating the problem.” he adds. Schools and colleges were closed on March 5, with 107 deaths accumulated.
Spain is one of the nations most affected by Covid-19. In total, it is the third, with more than 124,000 cases and 11,000 deaths. Although some days, the death toll has reached almost a thousand a day, after three weeks of a state of alarm and confinement, the growth curve is flattening out.
“We began with a containment strategy, identifying and diagnosing the cases and providing isolation measures to the suspects. Soon we had to move on to a mitigation strategy, basically trying to ensure that the intensity of transmission did not generate enough cases to overwhelm the health services.” Explains Ildefonso Hernández, professor of public health and former director-general of public health at the Ministry of Health and Social Policy (2008-2011), when the influenza (H1N1) pandemic struck.
“Given the lethality of the disease and its capacity to spread, the failure to adopt strict measures than those initially planned in each country could have led to the overflow of their health services.” He goes on to say, “Yes, better things could have been done in terms of preparedness and response.
Hernández reflects that, until we know what is going to happen with the pandemic, it is difficult to analyze what sequences of actions have been the right ones. “The countries that achieved excellent containment, limiting the cases to small groups of the population, will have to face at some point, the possibility of new cases appearing,” he concludes.
Lessons from the field
In China, the city of Wuhan and the province of Hubei were the origin of the pandemic. At Oxford University, a multidisciplinary team produced the paper “The Effect of Human Mobility and Control Measures” on the Covid-19 Epidemic in China. It was published on March 25 in the journal Science. One of its authors, Moritz Kraemer, explains: “in China, the outbreak appeared after there were probably thousands of introductions that triggered local transmission in other provinces”.
“In our study, we found that travel restrictions were implemented in China three weeks after the actual events. It was too late to contain the outbreak in Wuhan,” he asserts. “We now know that for the closures to be effective, they have to be done much sooner. Once there is local transmission at various points, the important thing is to keep physical and social distance, test, and track cases”.
In their study, they used cell phone geolocation data from Baidu Inc, China’s premier search engine, and combined it with databases from the Open Covid-19 Data Working Group. They found that local human-to-human transmission occurred well before the outbreaks and could only be mitigated by drastic control measures. Taking into account incubation periods of five to 14 days did not show results until after one week of implementation.
For Kraemer, most governments adopted a “wait and see” attitude, which can be fatal, as has been seen in the case of several states. As an example of good practice, only three nations stand out, Singapore, South Korea, and the former colony of the United Kingdom, now a Special Administrative Region of China: Hong Kong.
At the University of Hong Kong, Ben Cowling is head of the Department of Epidemiology. “Our first cases were detected because of visitors coming from China in the second half of January. We had a minimal amount of local transmission, with almost no evidence that was happening. On the same 25th of that month, with five sick people detected, schools were closed, and an almost total halt was declared. So far, the total number of deaths in Hong Kong is four.
In his view, Hong Kong succeeded in suppressing the spread for two reasons. “We identified almost all cases through testing. Even the mild ones, followed by isolation for the positives and quarantine of their close contacts, then we moderated the social distance, with people working from home, closing schools, improving hygiene, and making everyone wear mouth guards”.
As a recommendation to the Mexican authorities, he says that building field hospitals to treat cases would help keep those sick people away from regular hospitals. But now, as Hernández said, the return to normalcy in Hong Kong has led to an upsurge in cases. In mid-March, after almost two months of nearly total closure, the city returned to its daily life. Since then, the cases have multiplied, from 149 on March 15 to more than 800 at the beginning of April.
Several of the experts questioned compare this coronavirus to the Spanish flu pandemic of 1918 and ask to look in that historical mirror to see what impact this pandemic might finally have.
The Spanish flu pandemic caused 25 to 50 million deaths worldwide and lasted from January 1918 to December 1920, with three waves of contagion. By the time it ended, life expectancy in the United States had dropped by 12 years.
The Yucatan Times
With information from El Universal
