Greece is a European-Union country, of around 10 million people, located in the southeast part of Europe. The economy is recovering from a long period of deep recession, due to the economic crisis that started in 2008. The economic problems greatly influenced the structure and resources of the healthcare system of the country. In addition to the economic challenges, the country has been facing a refugee crisis, characterized by many overcrowded hotspots and tensions with neighboring Turkey. The COVID-19 outbreak arrived in Greece on 26 February 2020, at the time that Athens had declared a state of emergency at the Greek/Turkish border. From this point in time the government enforced a series of measurements, aiming to contain the epidemic and avoid the collapse of the healthcare system. The vast majority of the general population complied to the measures and consequently Greece’s death toll was low. The impacts of the outbreak are expected to be, as everywhere worldwide, multifaceted and to affect many parts of the economic, social and political life of the country.

The coronavirus disease 2019 (COVID-19) pandemic has affected millions of people worldwide. It brought about the implementation of various measures and restrictions at a global level. Iran has been one of the countries with the highest rates of COVID-19 cases. This study reviews the initial outbreak of COVID-19 in Iran and examines the mitigation strategies adopted by the country. Moreover, it reports the socioeconomic challenges faced by the authorities during the efforts to contain the virus. A transdisciplinary literature review was carried out and a political measures timeline was constructed. A broad overview of the initial phase of the COVID-19 outbreak in Iran is presented, starting from the first confirmed case on 19 February 2020 until April 2020. The results of this epidemiological and socioeconomic case review of Iran suggests that the political measures undertaken by the Republic of Iran contributed to the decrease of the prevalence of COVID-19. However, due to the existing financial bottleneck, Iran has faced limited health system resources. Therefore, the response was not sufficient to restrict the spread and the efficient handling of the virus in the long-term.

Objective: To quantify the initial spread of COVID-19 in the WHO African region, and to investigate the possible drivers responsible for variation in the epidemic among member states. Design: A cross-sectional study. Setting: COVID-19 daily case and death data from the initial case through 29 November 2020. Participants: 46 countries comprising the WHO African region. Main outcome measures: We used five pandemic response indicators for each country: speed at which the pandemic reached the country, speed at which the first 50 cases accumulated, maximum monthly attack rate, cumulative attack rate, and crude case fatality ratio (CFR). We studied the effect of 13 predictor variables on the country-level variation in them using a principal component analysis, followed by regression. Results: Countries with higher tourism activities, GDP per capita, and proportion of older people had higher monthly (p < 0.001) and cumulative attack rates (p < 0.001) and lower CFRs (p = 0.052). Countries having more stringent early COVID-19 response policies experienced greater delay in arrival of the first case (p < 0.001). The speed at which the first 50 cases occurred was slower in countries whose neighbors had higher cumulative attack rates (p = 0.06). Conclusions: While global connectivity and tourism could facilitate the spread of airborne infectious agents, the observed differences in attack rates between African countries might also be due to differences in testing capacities or age distribution. Wealthy countries managed to minimize adverse outcomes. Further, careful and early implementation of strict government policies, such as restricting tourism, could be pivotal to controlling the COVID-19 pandemic. Evidently, good quality data and sufficient testing capacities are essential to unravel the epidemiology of an outbreak. We thus urge decision-makers to reduce these barriers to ensure rapid responses to future threats to public health and economic stability.

During the first wave of the COVID-19 pandemic, sub-Saharan African countries experienced comparatively lower rates of SARS-CoV-2 infections and related deaths than in other parts of the world, the reasons for which remain unclear. Yet, there was also considerable variation between countries. Here, we explored potential drivers of this variation among 46 of the 47 WHO African region Member States in a cross-sectional study. We described five indicators of early COVID-19 spread and severity for each country as of 29 November 2020: delay in detection of the first case, length of the early epidemic growth period, cumulative and peak attack rates and crude case fatality ratio (CFR). We tested the influence of 13 pre-pandemic and pandemic response predictor variables on the country-level variation in the spread and severity indicators using multivariate statistics and regression analysis. We found that wealthier African countries, with larger tourism industries and older populations, had higher peak (p<0.001) and cumulative (p<0.001) attack rates, and lower CFRs (p=0.021). More urbanised countries also had higher attack rates (p<0.001 for both indicators). Countries applying more stringent early control policies experienced greater delay in detection of the first case (p<0.001), but the initial propagation of the virus was slower in relatively wealthy, touristic African countries (p=0.023). Careful and early implementation of strict government policies were likely pivotal to delaying the initial phase of the pandemic, but did not have much impact on other indicators of spread and severity. An over-reliance on disruptive containment measures in more resource-limited contexts is neither effective nor sustainable. We thus urge decision-makers to prioritise the reduction of resource-based health disparities, and surveillance and response capacities in particular, to ensure global resilience against future threats to public health and economic stability.