66 Valuable lessons we can learn from our COVID-19 responses

Since March 2020, I have been intimately involved in the COVID-19 response. I have also read and researched many articles related to this pandemic.

For me, there are 66 lessons that we can learn through our response and living through a pandemic. Some of these lessons may overlap with each other.

These 66 lessons learned are categorised into five categories.

Category 1 – Identify the best strategy and implement it ruthlessly without wavering

There were two main strategies — suppression or elimination — that governments could have adopted in response to the pandemic in early 2020. 

New Zealand adopted the elimination strategy. It became the gold standard for quickly but ruthlessly implementing that strategy. The “go hard and go early” strategy proved to be more effective than most had anticipated. 

The country moved back to its lowest alert level on 8 June 2020. This was after only seven weeks of shutdown. Key to the management of this resurgence was the use of rapid genome sequencing and a new requirement for mask use when travelling on public transport.

In contrast to New Zealand, Iceland’s strategy involved no shutdown period, no official border closure to non-residents, and negligible use of managed quarantine facilities. Its aim instead was to mitigate infection so it did not overwhelm the health-care system. This kept the numbers as low as possible. The key strategy was to provide easy access to COVID-19 testing and mass screening, alongside quarantine and contact tracing.

No country has successfully eliminated COVID-19, though some like New Zealand have come close. But the economic and resulting health and social costs of adopting the elimination strategy could outweigh the benefits for most countries.

Many countries have instead adopted the suppression strategy with varying degree of success.

McKinsey listed three main paths for leaders to adopt:

• Near-zero virus — This path requires the opening of the economy while imposing virus-control measures that stop short of a lock-down. It has been effective in preventing the virus spread.
• Balancing act — This path involves a staged reopening of the economy. It is about controlling the virus spread within the capacity of the healthcare system.
• Transition act — This path involves switching from a balancing-act path to a near-zero-virus path by implementing elements of near-zero-virus packages as soon as they are ready.

Particular Asian countries like Hong Kong, South Korea and Taiwan have successfully adopted the near-zero virus pathway with low community transmission rates. These countries have also experienced much lower initial declines in their GDP — in the range of 1% to 2%, in contrast to the likely 8% to 13%.

Places that adopted the suppression strategy have unfortunately seen the emergence of second or third waves of the coronavirus. 

We have seen how different strategies to get COVID-19 under control have produced vastly different economic and social outcomes.

1. No one is immune to the coronavirus

The prolonged lockdown of economies and human isolation has led to an estimated loss of more than US$12 trillion in global GDP. Approximately one-third of the global population has experienced unemployment. More than 95% of countries are projected to have negative per capita income growth in 2020.

Many businesses were forced to close. This has led to a global ripple effect. Countries that allowed businesses to operate during their outbreaks are still experiencing economic downturns resulting from the global recession.

2. Act quickly — Time is of the essence

The coronavirus can spread fast.

If China implemented widespread testing, a cordon sanitaire around Hubei and other measures a week earlier, it would have reduced China’s caseload by 66%. Acting three weeks earlier would have cut cases by 95%.

Speed is the key to reducing future COVID-19 caseloads.

3. Stop reinventing the wheel

There were enough prior reviews and research of past pandemics like SARS that could enable a quick and decisive response. 

The basic principles for containing a disease, developed and refined with reference to hundreds of previous epidemics, have held true for COVID-19. These responses were well documented. They could be followed immediately without the need to wait-and-see.

4. Centralised decision-making; decentralise local action-taking

There are benefits of a highly centralised governance structure for key strategic decision making, especially during a crisis. It makes it easy for top-down decisions to be made quickly and consistently. 

But it could also make it harder to effectively monitor and enforce localised actions, as experienced in New Zealand. 

As the Fukushima nuclear disaster showed, depriving local authorities of their full autonomy and authority in a crisis can slow down responses precisely when speedy responses are most needed.

5. There are always trade-offs in every decision

A seemingly unpopular or draconian strategy at first may be the best strategy to adopt.

There is a balance between the public health response to protect lives and the need to maintain economic and human activity to keep people employed. While we can be focused on saving lives, the economic and financial collapse are also catastrophic health risks to manage.

With these public health measures, it is no surprise that in April 2020, The International Monetary Fund projected the global growth in 2020 to fall to -3%. This makes the 2020 Great Lockdown the worst recession since the Great Depression. It is far worse than the 2009 Global Financial Crisis.

6. Make decisions based on the best available information

Use evidence-based strategies based on historical and best available data and information rather than acting on what is politically expedient. 

Although Iceland and New Zealand adopted different strategies, both countries demonstrated the importance of decisive, science-informed decision-making and clear communication involving regular public briefings by senior officials. As a consequence, there were high levels of public trust there were recorded in both Iceland and New Zealand although this has varied through the pandemic.

We also saw how a study helped change the course of the U.K. and the U.S. governments’ policy on COVID-19, possibly saving thousands of lives. It warned that an uncontrolled spread could cause as many as 510,000 deaths in Britain. Evidence-based information can trigger action-taking when done correctly.

7. Everyone has an opinion; celebrate diversity and inclusion

Everyone — experts in their fields, politicians, bureaucrats and the general public — will have their opinion on the best option to take. They will often disagree with themselves. 

The difference in options and perspectives can be valuable especially when we could easily miss something.

Celebrate diversity and inclusion. Have a strict process to manage these opinions, supplemented and supported by evidence-based information.

8. Be flexible and adaptable to change

Everyone, from governments and companies to individuals and communities, had to deal with the new reality of COVID-19. Many quickly adapted to this new reality.

When the outbreak changed rapidly on the ground, many people had to modify and constantly adapt their activities to their changing circumstances.

Testing strategies had to be flexible. They rapidly adapted their strategies to many changes depending on the local epidemiology, transmission, population dynamics and resources.

9. Always lookout for new strategies

People have been thinking creatively, exercising agility, and taking advantage of opportunities in a crisis. 

Many organisations have taken the opportunity to adopt new technologies and learn new skills. They are reflecting on their ability to adjust to new norms, to consider how to better meet customer needs, and even reevaluate how they do business. 

10. Strategy implementation is hard

The U.S. was ranked the “most prepared” in terms of its ability to respond to a pandemic in 2019, as shown below. 

But in 2020, we have seen the stark contrast between reality and perception. 

Between January 2020 and 25 September 2020, the U.S. has the highest number of COVID-related cases ( 6.8 million) and deaths (over 202,404). Its ongoing struggles with the coronavirus have caused tremendous human and economic pain. The pandemic has exposed deep political divisions and a disinformation ecosystem that muddies even the hardest facts.

11. Wait-and-see (or hope-and-pray) are not good strategies

When the coronavirus initially swept across the East — first in China, then Thailand, Japan, and South Korea — Western countries watched on cautiously from the other side of the globe. They initially adopted the wait-and-see strategy, hoping that they will not be impacted.

China, Taiwan and Singapore have all experienced SARS (Severe Acute Respiratory Syndrome) in 2003. South Korea learned hard lessons from the MERS (Middle East Respiratory Syndrome) outbreak in 2015. Experience counts.

Now, the U.S., Italy, Spain, France and the United Kingdom have all overtaken China with some of the highest numbers of reported cases and deaths around the world.

12. Culture can have a significant impact on your chosen strategy

Most people in Asia willingly submitted themselves to their authorities. Few complained. Traditions of Confucianism in countries like China, South Korea, and Singapore gave their paternalistic state a freer hand in exercising authority during a crisis like COVID-19.

Italy was the first country in the West to issue a nationwide lockdown order on 9 March 2020. Frustration grew as many people defied the order.

There was also early defiance of orders in Australia, with crowds of people gathering on Sydney’s Bondi Beach leading to its temporary closure.

13. Ruthless strategy execution is the key to long-term success

Wavering between strategies and adopting a seemingly “better” strategy mid-way can have detrimental effects. 

The U.S. is reaping the results of a halfway, half-hearted approach to COVID-19. As the coronavirus pandemic drags on, it remains an open debate whether the U.S. should aim for the elimination of COVID-19 and whether it’s even possible at this point. 

New Zealand and Iceland are two countries that demonstrated the need for ruthless execution of a chosen strategy.

14. Know your stakeholders’ appetite and tolerance for risk-taking

The world has two camps — the rule followers, those observant of social distancing and hopeful of quashing the pandemic; and the risk-takers, those who have been storming the nation’s beaches, bars, and burger joints despite the coronavirus and public health efforts to curtail its spread.

From the start of the pandemic in the U.S., there has been a gap between the goal of eliminating the coronavirus and what the government and many Americans are willing to do.

Knowing your stakeholders’ appetite and tolerance for risk-taking can go a long way to ensure that your chosen strategy can be effectively executed.

15. Over-action can have negative implications

A reporter has said that Australia had overreacted to the threat of the virus. He said while the coronavirus itself posed a moderate health risk to Australians, it was the country’s management of it which had damaged the country’s society and economy. 

“The more we know about this disease, how it behaves, how we can combat it, and the mistakes we’ve made, the more it’s clear we need to open up more, like Europe and North America, and learn to live with the disease,” he said.

16. Knowing your enemy is important

“So it is said that if you know your enemies and you know yourself you can win a hundred battles without a single loss.” The Art of War …Sun Tzu

COVID-19 is proving exceptionally difficult to stop. It’s difficult to
recognise, it’s difficult to distinguish between it and other
syndromes unless you have adequate and immediate testing.

We also know that testing everyone — including the asymptomatic — is of little use because those who are in the virus’s two-week incubation period could receive false negatives.

17. Always keep to the plan and cooperate with stakeholders

A set of international regulations came into force in 2007 after SARS. It laid the groundwork for sharing information, coordinating responses and pooling resources such as protective gear, medicine and tests. But when COVID-19 started to spread, these regulations were virtually ignored.

The world quickly threw out the global governance tools countries had so carefully negotiated. Coordinated shutdowns and reopenings would have slowed the spread of the virus and could have speed up the recovery.

18. We need unified responses rather than diverse disconnected strategies

The infectious coronavirus like COVI-19 ignores geopolitical boundaries. It attacks people regardless of nationality. This requires a unified global approach which transcends geopolitical boundaries. 

As countries consider lifting these measures, they must consult with one another and avoid making decisions in isolation.

Global solidarity, cooperation and coordination are required to win the war against COVID-19.

19. We must share information globally and transparently

Six weeks after announcing the appearance of a new, highly contagious and sometimes lethal virus, experts say China was still not sharing important data that could help contain the epidemic.

Unlike COVID-19’s lack of transparency, the SARS outbreak in 2003 did not go global.

For SARS, there was an unprecedented collaboration among scientists and laboratories around the world to work together to identify the causative agent, map its genome and develop reliable diagnostic tests. There were openness and willingness to share critical scientific information promptly. 

The virus responsible for SARS was identified and its genome mapped within weeks of the outbreak. Slower genetic sequencing technology would have made it much harder to identify and track the coronavirus. There needs to be greater and closer cooperation in the face of threats from new and emerging microbes and pandemics.

20. Adopt a whole-of-society approach

A whole-of-society approach engages individuals, families, religious institutions, civil society, the private sector, and media. All these stakeholders were needed to be on board for the chosen strategy to work. 

Active engagement of employers, universities and schools were crucial in promoting remote work, homeschooling and online education efforts. The Team Canada Effort was aimed at harnessing social and community support in managing the crisis.