Countries with delayed COVID-19 introduction – characteristics, drivers, gaps, and opportunities

Abstract

Background Three months after the first reported cases, COVID-19 had spread to nearly 90% of World Health Organization (WHO) member states and only 24 countries had not reported cases as of 30 March 2020. This analysis aimed to 1) assess characteristics, capability to detect and monitor COVID-19, and disease control measures in these 24 countries, 2) understand potential factors for the reported delayed COVID-19 introduction, and 3) identify gaps and opportunities for outbreak preparedness, particularly in low and middle-income countries (LMICs). We collected and analyzed publicly available information on country characteristics, COVID-19 testing, influenza surveillance, border measures, and preparedness activities in these countries. We also assessed the association between the temporal spread of COVID-19 in all countries with reported cases with globalization indicator and geographic location. Results Temporal spreading of COVID-19 was strongly associated with countries’ globalization indicator and geographic location. Most of the 24 countries with delayed COVID-19 introduction were LMICs; 88% were small island or landlocked developing countries. As of 30 March 2020, only 38% of these countries reported in-country COVID-19 testing capability, and 71% reported conducting influenza surveillance during the past year. All had implemented two or more border measures, (e.g., travel restrictions and border closures) and multiple preparedness activities (e.g., national preparedness plans and school closing). Conclusions Limited testing capacity suggests that most of the 24 delayed countries may have lacked the capability to detect and identify cases early through sentinel and case-based surveillance. Low global connectedness, geographic isolation, and border measures were common among these countries and may have contributed to the delayed introduction of COVID-19 into these countries. This paper contributes to identifying opportunities for pandemic preparedness, such as increasing disease detection, surveillance, and international collaborations. As the global situation continues to evolve, it is essential for countries to improve and prioritize their capacities to rapidly prevent, detect, and respond, not only for COVID-19, but also for future outbreaks.

An in-depth statistical analysis of the COVID-19 pandemic’s initial spread in the WHO African region

“…This result could help the authorities to implement the necessary measures to more effectively control the upcoming surge of cases and protect public health. Previous research showed that a common characteristic among countries with delayed onset was the implementation of effective border measures and various preparedness activities at an early stage (Kousi et al, 2020;Li et al, 2021;Ayouni et al, 2021). Conversely, countries that had a higher value of preparedness index were among the first ones in which the outbreak initiated.…”

“…Perhaps, countries better prepared to control an epidemic had also enhanced testing capabilities, and as a result were able to detect and identify cases earlier. Indeed, a study focusing on the 24 SSA countries that were COVID-19 free as of March 30, 2020 documented that only 38% of them had COVID-19 testing capacities (Li et al, 2021). Although we found that stringent policies are helpful in controlling the pandemic, many of these measures were associated with other negative consequences (Katana et al, 2021;Bourgault et al, 2021).…”

COVID-19 data are messy: analytic methods for rigorous impact analyses with imperfect data

“…Other researchers look at growth rates of cases or estimates of R t , calculated in various ways. Some studies use the date of the first recorded case, or the 100th case, as the “beginning” of the pandemic in a country (or conversely, focus on countries not reporting a case by a certain date [ 15 ]). Others focus on hospitalized cases, or hospital capacity.…”

How have governments supported citizens stranded abroad due to COVID-19 travel restrictions? A comparative analysis of the financial and health support in eleven countries

“…Conversely, although no o cial temporary housing solution was available, the British government provided advice for citizens without accommodation and encouraged speaking to the local British consulate or high commission for further advice. 4. Support and information available for citizen/traveller registration Overall, 9/11 countries examined provided a form of registration focused on supporting citizens abroad, whether through information sharing, alerts, or the ability for local consulate support (see Table 2).…”

“…In response to the threats posed by the COVID-19 pandemic, countries around the world have imposed some level of international travel restriction for returning travellers (1)(2)(3). Border restriction (or closure) was one of the earlier and most common non-pharmaceutical interventions implemented, with countries -including Australia, Italy, the Paci c Island countries and territories, and the USA-imposing some form of travel restrictions as early as February 2020 (1,4). Restrictions included suspending (or limiting) the number of international ights, suspending visa free travel as well as the use of enhanced quarantine and screening measures, and the issuing of recommendations to avoid non-essential travel (1)(2)(3)5).…”