Ten countries currently facing serious increases in COVID-19 infections are among those nations with less stringent approaches to managing their outbreaks.
An analysis of caseloads in 45 countries by British newspaper The Guardian in cooperation with the University of Oxford’s COVID-19 Government Response Tracker has identified that 10 of the most badly-affected countries are also among those rated as having a “relaxed response” to the pandemic, underlining the mitigating impact of effective government public health policies.
The countries include the US — which is experiencing its largest increase in COVID-19 cases since April; Iran, Germany and Switzerland — two European countries where the R rate, which measures the reproduction number of a contagious disease, has risen above one this week, meaning that each infected person in average passes on the virus to more than one other person.
Each of these countries faces the prospect of a second wave, with lower stringency in their pandemic response allowing week-on-week cases to creep up.
Of the worst-hit countries still imposing stringent lockdowns, nine are reporting rising numbers of cases while three are reporting that the curve is flattening.
Experts warn of the risk of a second wave of COVID-19, with the WHO on Sunday last week reporting a record increase in global cases.
As countries face the harsh economic realities of lockdowns, many are choosing to reopen their economies.
According to the University of Oxford tracker, a country is categorized as “relaxed” if its stringency score is under 70 out of 100. The tracker assesses countries’ public information campaigns, containment measures and closures.
Germany’s COVID-19 R rate jumped to almost three earlier this week, after an outbreak at an abattoir forced two German states back into lockdown. This was after the county lowered its response to the pandemic, with its stringency score falling from 73 early last month to 50.
WORLDWIDE FLARE-UPS
While Germany’s rise in cases is still small at this point, Saudi Arabia and Iran are experiencing pronounced second waves after relaxing lockdown measures.
Iran began to see a second peak of infections as it lessened its lockdown last month. While officials suggested the surge could be due to more testing, the proportion of tests returning positive increased at the same time, indicating that the virus had once again spread among the population.
Meanwhile, the stringency score in the US dropped this month after several state governors relaxed their lockdowns. This has led to local flare-ups, with a 25 percent increase in new cases in the last seven days compared with the seven-day period before.
Thomas Hale, University of Oxford associate professor and research lead for the government response tracker, said: “Countries that were hit earlier in Asia and Europe and which managed to contain cases, have moved out of lockdown more quickly. We’ve also seen countries moving quickly out of lockdown when the economic costs become too great — for example, India. As our lockdown rollback checklist shows, many countries are now moving out of lockdown before meeting the WHO’s recommended conditions.”
However, there are positive signs that the number of cases in other countries with less stringent policies is still falling. In total, 11 of the 45 worst-hit countries have a stringency score below 70 while seeing cases fall.
This includes countries that imposed strong lockdowns after suffering from early first waves, such as Italy and Spain, as well as others that did not lock down as hard, such as Belarus.
Italy and Spain, which combined have recorded almost half a million COVID-19 cases and 62,000 deaths, have both recorded the weekly number of new cases dropping by more than 25 percent despite lockdown measures being relaxed significantly.
Despite the falling number of cases in these countries, experts warn that countries had to remain cautious.
Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine, said: “We have seen some surges in US States such as Arizona that had stabilized rates and even achieved small declines from the peak. Iran is also experiencing what appears to be a second peak, although there is continued debate about the role of increased testing. Easing of restrictions can be safe providing the incidence of infection has been brought down to very low levels, well below what we have in the UK now, and there is a robust find, test, trace, isolate and support system in place.”
In total, seven of the 45 countries to record over 25,000 COVID-19 cases are still locked down — with a stringency score of between 70 and 80 — while cases continue to rise.
This group includes Brazil, which has recorded the second highest number of cases worldwide. While Brazilian President Jair Bolsonaro’s rhetoric is far from cautious, the country’s stringency score is still relatively high as state governors retained some lockdown policies.
The number of infections in Brazil is continuing to rise — by 17.5 percent week-on-week — and the country’s stringency score has fallen slightly in the last month, after state governors have cautiously relaxed local lockdowns in order to prioritize the country’s fragile economy.
Five other countries still have a similar level of stringency, but are seeing the policy paying off with new cases falling week-on-week: Afghanistan, Ireland, the UK, Russia and Mexico.
The UK’s stringency score after the last update is 73, having stood at 76 early last month, with measures such as the quarantine for international arrivals balancing out social distancing relaxations early this month. Last week’s new cases were 11.4 percent lower than new cases the week before, showing that this relaxation has not yet caused any signs of a second wave.
Several countries in the Middle East and in Latin America still have tough lockdowns in place, with stringency scores of over 80. Three of these — Ecuador, Qatar and Peru — are having some success, with a marked flattening of their epidemiological curves.
New weekly cases in Peru and Qatar have dropped by over a quarter week-on-week. Both countries have struggled with major outbreaks of the disease, but if the positive trend continues, they might soon start to lessen the stringency of their response to the pandemic.
INEPT LOCKDOWNS
More worryingly, there are still nine badly hit countries with tough lockdowns in place that are reporting rising numbers of cases.
Three of these are in South America — Bolivia, Argentina and Colombia — which was designated the center of the pandemic by the WHO late last month.
All three of these countries are in the grip of their first wave of infections. Argentina locked down early in the pandemic and was hailed as a South American success story as cases remain flat through March and April. However, after opening up slightly in late April and early last month, COVID-19 cases have more than quadrupled.
European Centre for Disease Prevention and Control director Andrea Ammon last month warned that COVID-19’s characteristics, low levels of population immunity and high levels of virus circulation, mean that countries had to be “realistic” and that “it’s not the time now to completely relax.”
The tracker data paints a similar picture.
“Closure and containment policies have proven essential to break the chain of infection and slow the spread of the disease. These costly measures buy governments time to put in place the test and trace policies, increased healthcare capacity and other policies we need to manage the disease long-term. The key question is: How have governments used the time they have bought at great expense? If governments roll back measures too quickly, without having put protective policies in place, then they are likely to risk a second wave of cases,” Hale said.
Every country with over 25,000 recorded COVID-19 cases as of Tuesday has been included in this analysis, and countries have been divided into six categories.
This categorization is based on two factors: the percentage change in the number of new cases week-on-week; and the latest two-week average of a country’s stringency index score. This data is based on the most recent day with complete data.
The six groups are “relaxed and rising” — with a stringency score under 70 and an increase in weekly cases, “relaxed and recovering” — with a stringency score under 70 and a decrease in weekly cases, “cautious as cases rise” — with a stringency score between 70 and 80 and an increase in weekly cases, “cautious as cases fall” — with a stringency score between 70 and 80 and a decrease in weekly cases, “lockdown flattening curve” — with a stringency score above 80 and a decrease in weekly cases, and “rising despite lockdown” — with a stringency score above 80 and an increase in weekly cases.
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