PHM-Exch> Article by Wim de Ceukelaire and Chiara Bodini

[Richa Chintan]

*We need strong public health care to contain the global corona pandemic*



*By Wim De Ceukelaire and Chiara Bodini[1] <#_ftn1>*



The corona virus (COVID-19) outbreak has spread from China to over a
hundred countries in less than two months. As of March 10th, confirmed
cases were above 100.000 and deaths over 4.000. Now is the time to take
stock and to assess the responses of different countries to the outbreak so
far.



The report of the WHO-China joint mission on COVID-19 (
https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf
) offers essential insights in containment strategies, explains why health
systems in many parts of the world are much less capable of implementing
them and shows the way towards more resilient health systems.



The report concludes that China has rolled out perhaps the most ambitious,
agile and aggressive disease containment effort in history. And it did this
with success. Cases have decreased considerably and daily life is slowly
resuming in areas that have been under huge stress in the past few weeks.



As there is no vaccine nor specific treatment, the containment of the
outbreak is based on a number of measures including identifying people who
are sick, bringing them to care, following up on contacts, preparing
hospitals and clinics to manage a surge in patients, and training health
workers (
https://www.who.int/news-room/detail/07-03-2020-who-statement-on-cases-of-covid-19-surpassing-100-000
). The WHO-China joint mission report’s conclusion is remarkable as it says
that this has only been possible “due to the deep commitment of the Chinese
people to collective action in the face of this common threat.”



Similar conclusions can be drawn from experiences in other Asian
territories. In an article on the website of The Lancet (
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30551-1/fulltext
), experts assess resilience of health systems in Hong Kong, Singapore, and
Japan according to their ability to apply adequate containment strategies
with regard to the current COVID-19 crisis. Health systems in these
locations have generally been able to adapt.



The three locations introduced appropriate containment measures and
governance structures; took steps to support health-care delivery and
financing; and developed and implemented plans and management structures.
Integration of services in the health system and across other sectors has
amplified the ability to absorb and adapt to shock. Besides, this
experience has demonstrated that the trust of patients, health-care
professionals, and society as a whole in government is of paramount
importance for meeting health crises. Interestingly, also Singapore, Japan
and Hong Kong rely on strong public health systems that enjoy wide support
and that are able to reach and mobilize the population beyond health
workers.



In many countries across the globe, public state-funded and government-run
health systems have been gradually dismantled. Privatization has affected
their ability to coordinate large-scale preventive campaigns, limited their
capacity to expand curative services in crisis situations while eroding the
broad public’s confidence in the health system as a whole.



For example, in order to apply effective contact tracing, a fine-grained
health system with an expanded first line is imperative. China has been
able to mobilize thousands of health workers in the efforts to track down
the contacts of infected individuals. In the US, where primary health care
is almost non-existent and the health system is highly dependent on
secondary and tertiary care, large-scale contact tracing is almost
impossible.



Now that COVID-19 is rapidly spreading to Europe and the US, we might
witness the vulnerability of more privatized health systems. In Italy, the
European country worst hit by the epidemic, the regionalization of
healthcare – very much part of a broader design to progressively dismantle
and privatize the national healthcare service (NHS) – has significantly
delayed the adoption of coherent measures to contain the disease and
strengthen the health system.



As their health systems are unable to coordinate adequate collective
responses, it is not surprising that the measures taken by European
governments are calling on people’s individual responsibilities. Social
distancing has become the cornerstone of their COVID-19 mitigation plans.



Of course it is correct to call on people’s individual responsibility and
it’s true that social distancing has also played a role in China’s
containment of the virus outbreak but it’s also important to acknowledge
that these measures are inadequate to handle large-scale health threats.
What we can learn from the global Corona pandemic is that strong public
health systems have the resilience to address massive health threats with
the collective responses they require. Privatization of health services and
individualization of risks might further undermine our ability to address
this and future global pandemics.



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[1] <#_ftnref1> Wim De Ceukelaire and Chiara Bodini. Both are health
professionals working with the Belgian NGO Viva Salud and health activists
with the global People’s Health Movement. Chiara is currently under
quarantine in Bologna.
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