Summary of Recommendations

The analysis of effective practices of these top 20 countries includes examination of the impact of interventions in the areas of testing, contact tracing, movement restriction and public engagement. The aim is to identify common successful practices. Countries that have excelled in COVID-19 health recovery have been able to deploy all five health-recovery related interventions systematically and rapidly, independent of their socio-economic status and health security capabilities.

Figure 1: COVID-19 health recovery interventions

The five interventions are presented in no particular order and have equal importance in the fight against the COVID-19 pandemic.

Effective leadership and public compliance, however, serve as cross-cutting enablers to ensure successful implementation of the five key interventions. A pathway to recovery can be achieved through strategic and coordinated delivery of these interventions. Yet, how the government and public work together will be different in each country, contributing to a growing body of knowledge of effective practices, of which this publication is a start.

Intervention CategoryRecommendations
Testing Approach
Recommendation 1: Implement large-scale testing as soon as possible with priority target groups identified and isolation/quarantine protocols established and enforced.

Recommendation 2: Encourage community participation in mass testing.

Recommendation 3: Capitalise on public-private partnerships to optimise testing capacity and capability.
     
Contact Tracing
Recommendation 1: Deploy digital contact tracing apps alongside clear and implementable data privacy laws to encourage high user adoption.

Recommendation 2: Combine manual and digital contact tracing to address the gaps and limitations in the two approaches.

Recommendation 3: Ensure adequate access to testing facilities and clear advice on self-isolation at the time of the launch of a digital contact tracing app.
     
Restricted Movement Practice
Recommendation 1: Close international borders to prevent the import of foreign cases and buy time for adoption of preventive and protective measures.

Recommendation 2: Implement and enforce lockdowns; adjust stringency based on capacity to test and isolate.

Recommendation 3:  Relax lockdowns gradually as the data show that the spread of the disease is being contained.
   
Easing of Restrictions
Recommendation 1: Use data to guide decisions on when to open the different sectors of the economy and, ultimately, the economy as a whole.

Recommendation 2: Reopen targeted parts of the education sector with adequate support and guidelines in place to facilitate safety.
Risk Communication and Community Engagement
Recommendation 1: Run clear and simple campaigns with high communication frequency.

Recommendation 2: Engage local communities in the communication process.

Recommendation 3: Understand the channels through which the public gets their information.

Recommendation 4: Address rumours and misinformation swiftly.

Table 1: Summary of recommendations

These interventions are strongest when they are combined. Their strategic sequencing matters as well. For example, digital contract tracing and testing interventions worked well where they were implemented concurrently and without compromise. Without access to testing facilities and medical support, potential carriers identified via contact tracing cannot be diagnosed accurately and rapidly. Given extensive and real-time availability of digital contact tracing, any individual identified as a potential carrier or contact needs prompt and easy access to immediate medical attention and treatment, regardless of their physical location. Hence, it is crucial that governments have adequate testing facilities, equipment, and standard operating procedures (SOPs) prior to deploying a digital contact tracing application (app). Lack of capacity to meet a surge in testing demand will cause panic and commotion – potentially exacerbating the spread of the virus.

Similarly, restricted movement practices and the easing of restrictions work hand in hand, with outcomes of the former dictating the terms and implementation approach of the latter. Some countries, such as Sweden and South Korea, have not imposed nationwide lockdowns. In these cases, the easing of restrictions will be less complicated. For countries that have imposed strict lockdowns and restricted movement orders, the easing of restrictions needs to be planned strategically and meticulously, to ensure the public trusts the health and safety guidelines and acts accordingly. The World Health Organisation (WHO) has established six conditions for countries to fulfil prior to lifting restrictions, including systems established for transmission control, detection, track and trace, outbreak minimisation, workplace preventive measures, export/import case risk management, and public awareness. Non-compliance with these conditions can result in dire consequences, such as a proliferation of cases leading to a second wave and a second lockdown phase.

Public engagement and communication throughout a pandemic are fundamental. The most effective governments have overseen these efforts through a central coordinating body. As governments take countries through the different phases of interventions and strategies, clear, concise and consistent communication can enable the public to understand both the rationale behind decisions and what they need to do. The more people choose to comply with advice or instructions, the less compulsion and enforcement are required. Citizens of different social and economic backgrounds need to adhere to the same intervention approaches. It is important that the communication strategy is integrated with the overall strategy to help citizens understand the bigger picture of why a decision was made and how it will contribute to the welfare and healthcare of the public.

Our research has found that people and their governments are, for the first time, equal players at the frontline. Unless responsible leadership is met with public responsibility, the success of any combination of interventions, in any selection of countries, would be unable to withstand the pandemic. This publication focuses on countries where strong leadership is met with a responsive public.

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