[The Lancet] Are high-performing health systems resilient against the COVID-19 epidemic?

The Lancet, 6 Mar 2020

Helena Legido-Quigley, Nima Asgari, Yik Ying Teo, Gabriel M Leung, Hitoshi Oshitani, Keiji Fukuda, Alex R Cook, Li Yang Hsu, Kenji Shibuya, David Heymann

Highlights:

• As of March 5, 2020, there has been sustained local transmission of coronavirus disease 2019 (COVID-19) in Hong Kong, Singapore, and Japan. Containment strategies seem to have prevented smaller transmission chains from amplifying into widespread community transmission.
• First, after variable periods of adaptation, the three locations (HK, Singapore, Japan) took actions to manage the outbreak of a new pathogen. Surveillance systems were readjusted to identify potential cases while public health staff identified their contacts. 
• Different strategies were used to selectively control travellers entering these locations.
• Second, intra-governmental coordination was improved because health authorities drew on their experiences of severe acute respiratory syndrome during 2002–03 in Hong Kong and Singapore, H5N1 avian influenza in 1997 in Hong Kong, and the 2009 influenza H1N1 pandemic in all three locations.
• Third, all locations adapted financing measures so that all direct costs for treating patients are borne by the governments.
• Fourth, the three health systems developed plans to sustain routine health-care services, but the integration of services has been problematic
• Fifth, in all locations, critical care treatment and medicines have been available for patients with COVID-19, but adequate supplies of personal protective equipment in hospitals and face masks in the community are a key concern.
• Sixth, in all three locations training and adherence to infection prevention and control measures in hospitals have largely been appropriate, but Japan could face a shortage of infectious disease specialists.
• Seventh, management of information systems is comprehensive in all locations.
• Timely, accurate, and transparent risk communication is essential and challenging in emergencies because it determines whether the public will trust authorities more than rumours and misinformation.
• Finally, the political environment and differences in communities and their moods and values are important.

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