Primary care perspectives on pandemic politics

Figures & data

Figure 1. Confirmed COVID-19 deaths per 1,000,000 population. Mortality data downloaded from Johns Hopkins University repository12 on 11 September 2020 12:34 UTC.

Figure 2. Relationship between pandemic plan execution and COVID-19 death rates.

Table 1. Illustrative quotes from countries with and without executed plan with high and low death-rates.

High mortality, no pandemic plan executed	High mortality, pandemic plan executed
Belgium (855.68/million): ‘In the first phase, all attention was focused on providing sufficient ICU-bed capacity in hospitals  …  . Primary care reacted quickly, but with insufficient protection and testing capacity.’ Spain (635.21/million): ‘We have been late, we dońt have proper protection and we dońt have enough test.’ ‘We have a strong primary care with high accessibility to the entire population.’ ‘Unfortunately, PHC has not been used properly in Spain to prevent COVID. All information in the media, and the majority of resources were focused on hospital.’ UK (62.61/million): ‘Initial models the UK government used were different to those in other countries. They also discussed behavioural science as a reason for not locking down too soon.’ ‘UK government took far too long to implement social distancing policies’ ‘The public health response was sluggish’ Kazakhstan (8.69/million): ‘Primary care facilities were ignored first 2 weeks of quarantine, had to provide usual care, visit patients at home, and were not provided by PPE’	Brazil (59.91/million): ‘Very different throughout the country  …  In the place I live  …  measures were taken earlier than the federal government, and more strict, test are available and also correct PPE, which I know is not the case in the north; Brazil is a continental and very unequal country’ ‘Part of the population (30%) with a private plan and the rest totally dependent on the governments response to the pandemic.’ ‘Brazil has a large number of people that uses private health sector, although we do have a universal health system  …  . there was poor coordination between public and private health sectors.’
Low mortality, no pandemic plan executed	Low mortality, pandemic plan executed
Fiji (2.23/million): ‘In February we stopped all visitors from coming to our island. We developed highly restrictive protocols for our captain and crew on our once per week boat between our supply-island and our island. The crew now remains on the boat when docked at the supply-island.’ [outer island respondent] ‘The mobile screening teams are using military officers  …  to go house to house and take temperature of people with the help of nurses and health inspectors. This teams are also checking  …  on self-quarantine.’ Trinidad & Tobago (2.23/million): ‘Our Chief Medical Officer from the Ministry of Health gave great advice from early in the outbreak and his advice was followed by the government and aided in flattening the curve in my country’ Australia (2.99/million): ‘Early on there was some tension between the political thinking and the medical thinking federally  …  the states responded more aggressively than the federal government.’	Korea (6.83/million): ‘I think the government takes the correct stance on this issue from the early stage’ ‘I think the strategy and measures against the COVID-19 epidemic in Korea were appropriate. Active early testing for COVID to suspected patients, tracking to find out contacted persons, proper quarantine, and treatment with cooperation between public and private care sectors were well performed.’ New Zealand (4.98/million): ‘Learning from the rest of the world NZ government (thankfully) put us into lockdown early.’

Table 2. Priority and level of authority guiding COVID decision-making.

Key No plan, high mortality Plan, high mortality No plan, low mortality Plan, low mortality.

Table 3. Leadership and communication associated with COVID-19-related mortality.

Poor leadership, high mortality	Poor communication, high mortality
Italy (death-rate 588.59/million): ‘A huge leadership lack disaster, crossing all sectors’ Israel (124.43/million): ‘In our leaders, we had a problem with leading by example – where they afforded themselves exceptions that were punishable to the general public. It does not build trust – quite the opposite.’ United States (582.05/million): ‘Totally irresponsible, incompetent, destructive, dangerous response by the leadership of the US’	Israel (124.2/million): ‘Doesn’t seem to be logic which was communicated effectively  …  to the professional or non-professional public’ United States (582.05/million): ‘Initial statements of denial re the pandemic were motivated to preserve political appearance and avoid economic disruption.’ UK (614.22/million): ‘Communication overload and constant changing of advice is confusing.’
Effective leadership, low mortality	Good communication, low mortality
Australia (31.22/million): ‘Political leaders cooperating across state and federal government and opposing parties’ Ghana (9.11/million): ‘After initial uncertainties the President has exhibited strong and exemplary leadership’ Thailand (0.83/million): ‘Prime Minister and team gave priority to control the outbreak by using strong disease control policy’ Malaysia (3.95/million): ‘Our DG has taken the leading role to head the pandemic response management of the country’ New Zealand (4.98/million): ‘Strong leadership jointly by the Prime Minister and by the Director-General of Health (PH physician) on medical & public health matters’	New Zealand (4.98/million): ‘Fantastic government leadership and open communication. Public support high for strategies put in place’ Iceland (29.3/million): ‘There was very good cooperation with the chief epidemiologist and the director of health and it probably helped to have a single payer system/national health system that could easily talk and coordinate actions and make quick decisions when needed. The homogenity of the nation and the common trust people have in the authorities, the police and the health system also helped and the nation usually followed well all recommendations about social isolation’ Australia (31.3/million): ‘I have been so impressed by my nation’s coordinated cross-sector unified approach to this problem, the positive messaging, and the community responsiveness imply a trust in the medical and political decision-makers’ Finland (60.82/million): ‘Ministers hold press conferences regularly, answering questions with detail and share openly the models they are using to estimate progress on epidemic’

Table 4. Geopolitical characteristics of the 37 study countries.

Key No plan, high mortality Plan, high mortality No plan, low mortality Plan, low mortality.

^a John Hopkins University of Medicine. COVID-19 Data Repository by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University Baltimore, US2020 [Available from: https://github.com/CSSEGISandData/COVID-19 accessed 29 May 2020.

^b See https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups

^c Full democracy 8.01-10; Flawed democracy 7.01-8; Hybrid regime 5.01-7; Authoritarian 1-5. 4 https://en.wikipedia.org/wiki/Democracy_Index

^d See https://en.wikipedia.org/wiki/List_of_countries_and_territories_by_land_borders

^e Countries were ranked according to the proportion of respondents that agreed that their county had a pandemic strategy in place and that it was executed. The ranking was then shifted (by subtracting a constant) such that countries that scored below the 50th percentile had a negative rank and countries that scored above the 50th percentile had a positive rank.

All accessed on 11 September 2020 12:34 UTC.