LOCAL CHAPTER LEGAL WRITINGS
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COVID-19: What Countries Can Learn From One Another by Muhammad Labib Wajdi
In late January, Italy discovered its patient zero of COVID-19. A Chinese couple on vacation in Rome tested positive for the virus. At the time nobody knew how many people were infected by said couple. Four weeks later the number of cases sprung up, with 1,128 cases and 29 deaths. Roughly two months after the couple had arrived, the number of cases is estimated at about 105,792 with 12,428 deaths. For a number of months, Italy has been in the media spotlight as the epicenter of an ongoing pandemic. Even with a healthcare system regarded by the World Health Organization as the 2nd best in the world1 and developed country amenities, how come it had arguably the worst outcome out of all EU countries? What does this mean for countries with inferior healthcare systems? And how should other countries respond to this pandemic?
1
"The World Health Organization's ranking of the world's health systems". Photius.com.
The key to ending the pandemic is rather simple, physical distancing. It is by far the simplest way to ensure that the virus doesn’t spread to the point where it’s uncontrollable. It is also arguably the least affecting method of safeguarding the country’s economy.
FLATTENING THE CURVE
To understand the importance of physical distancing, we should understand how the virus spreads. The main way the virus spreads is through droplets. When an infected person coughs, sneezes, or exhales, viruses encased in droplets spread into the area in front of the person. The droplets can then be inhaled by anyone 6 feet nearby or land on surrounding surfaces. If somebody were to touch the contaminated surface and proceed to touch their face, it’s a sure-fire way for the person to get infected. Maintaining a distance of at least 1 meter from other people is crucial in slowing down COVID-19 spread.2 It will still likely spread but what physical distancing does is giving the healthcare system room to breathe. Having fewer people go out and gather in groups means fewer people get infected which in turn makes fewer people go to hospitals. By having fewer people in the hospital means the healthcare system isn’t overburdened and can tend to those in need which results in fewer deaths. This process is called “flattening the curve”.
2
“Coronavirus disease (COVID-19) advice for the public”. WHO.int.
This process not only halts the spread but also buys time for vaccine-manufacturers to produce a vaccine for the ongoing pandemic. Given the current vaccine technology, a pandemic vaccine might not be available for up to 6 months. 3 It is unlikely that the world economy can survive a 6 months-long period of lockdown and not suffer from any downturn. In the meantime, countries should take additional safety measures to reduce casualties. The problem is, it’s hard to establish measures as countries have to take the economic impact, foreign affairs, and other factors into consideration before making any decision regarding the subject. That is where international law comes into play. INTERNATIONAL HEALTH REGULATIONS Safety measures oftentimes lie in grey areas. To define them, there are boundaries established by international law that helps determine whether a safety measure is legal or worth doing. In terms of international health issues, a commonly used, legally binding document is the International Health Regulations (IHR) by the WHO, a set of rules agreed upon by WHO’s 193 member states to handle outbreaks.4
RISK ASSESSMENT If any of the member states happen to stumble upon an event related to public health,
Annex 2 of the IHR provides a guide for members on how to assess it to dictate whether or not it is of international concern. It provides four main criteria to determine the severity of the situation and how to respond to the situation. These criteria are: 1. Is the public health impact of the event serious? 2. Is the event unusual or unexpected? 3. Is there a significant risk of international spread? 4. Is there a significant risk of international travel or trade restrictions? If the answer is “yes” to any two of the four criteria, the member should notify WHO under Article 6 of the IHR.5
3
N Qualls, Community Mitigation Guidelines to Prevent Pandemic Influenza, (CDC, United States: 2017) International Health Regulations (2005), (WHO, 2007) 5 WHO guidance for the use of Annex 2 of the International Health Regulations (2005), (WHO, Geneva: 2008) 4
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NON-COMPLIANCE
A question frequently asked about the IHR is, what happens to a member state if one fails to comply with the regulations? Will the state be adversely affected by non-compliance? Is there any form of enforcement for the IHR? This is where the regulations may fall short of doing its job as it has no form of enforcement. In a Q&A by Dr. Guénaël Rodier, appointed director of the IHR Coordination, when asked about the impact a country could get for not complying with the IHR, he simply stated that the price of non-compliance is a “damaged image” and potential economic losses. 6 “A country that knows something and does not report it may make a short-term economic gain, but will incur long-term losses when it gains a reputation as being unreliable as a country and as a business partner” he added.
HOW THIS CORRELATES WITH CURRENT SITUATION As seen above, one of the main criteria for determining a public health situation is if
there’s a significant risk of international travel or trade restrictions, meaning that WHO puts great value in deciding travel restrictions. The reason being, travel restrictions are not usually effective in preventing the importation of cases but may result in significant economic and social impact.7 That sentiment is reflected in Article 43 of the IHR, which also encourages members to report to WHO the justification if they were to implement a travel restriction. This report must be done within 48 hours from when the implementation takes effect. According to a WHO report back in February, during the early days of the outbreak as much as 72 countries had implemented a travel restriction. 8 Of these 72 countries, only 23 (32%) had given an official report to the WHO. As we’ve established earlier, the remaining countries that haven’t reported in 48h will not receive any form of punishment as the IHR’s only compliance tool is peer pressure and potential economic losses. With this information, we can understand why different countries chose different routes to protect themselves from the pandemic, as each world leader has a different take on the IHR and WHO as a whole. Some kept their countries open, as per WHO’s advice. Some went against WHO’s advice and closed their country. Some even declared the pandemic as public health emergency before WHO did. All with differing results which will be discussed later on.
6
“New rules on international public health security”. WHO.int. “Updated WHO recommendations for international traffic in relation to COVID-19 outbreak”. WHO.int. 8 “Novel Coronavirus (2019-nCoV) Situation Report – 18”. WHO.int. 7
ITALY’S FAULTS As we’ve established earlier, Italy discovered its first patients back in late January as a Chinese couple on vacation in Rome. The two were quickly quarantined and every flight from China from then on was suspended. This is not enough however, remembering that COVID19 is highly contagious. Just mere days later two small clusters formed in Lombardy and Veneto. During the early days of the outbreak, Italian Prime Minister Giuseppe Conte and other top officials tried to downplay the threat and instead blamed the small clusters on excessive testing on the northern region, saying that “exaggerated” swab tests “would end up dramatizing the emergency”. 9 In Milan, the capital of Lombardy, mayor Beppe Sala held a campaign titled “Milan Non Si Ferma” or “Milan Does Not Stop”, assuring people that all would be well and life would continue normally despite the COVID-19 outbreak. This slogan is short lived as nine days later the death toll had rose to 233 and confirmed cases 5,883, which forced the whole region of Lombardy to shut down.
SUCCESSFUL ATTEMPTS
9
“Italy, Mired in Politics Over Virus, Asks How Much Testing Is Too Much”. Nytimes.com.
VIETNAM
Compared to Italy, Vietnam doesn’t strike as having a good healthcare system. That’s because, in reality, this developing country’s healthcare system was only ranked at 160th according to the aforementioned WHO list which placed Italy in the 2nd place. 10 Coupled with being close to China, the ground zero for COVID-19 outbreak, in theory, this outbreak would spell doom for Vietnam. Oddly enough, however, it is one of the first countries in the world to have flattened the curve. This is mainly because the Vietnam government acted fast and deemed COVID-19 as a public health emergency (24/01) before WHO did (30/01).11 12
10
"The World Health Organization's ranking of the world's health systems". Photius.com.. “Deputy Prime Minister Vu Duc Dam: Immediately implement the medical declaration at all border gates”. Hanoimoi.com.vn. 12 “Rolling updates on coronavirus disease (COVID-19)”. Who.int. 11
Another major factor at play also includes the large number of tests done by Vietnam compared to other countries.
The tests proved beneficial to the country. Remember Vietnam’s daily confirmed cases chart we showed you earlier? This is the same chart compared with Italy’s.
With only a measly total of 334 cases at the time of writing, Vietnam proved that simple measures like testing and physical distancing when done right can make a huge dent in slowing down COVID-19.
SLOVENIA
Bordering Italy in the eastern region is Slovenia, a country with less than 1,500 total confirmed cases of COVID-19. Unlike it’s neighbor, Slovenia fared quite well in terms of handling the coronavirus pandemic. This is done by having a stringent rule of physical distancing and quarantines set up early during the outbreak. The country discovered it’s first case on March 4, it took the government less than two weeks to impose a nationwide lockdown. 13 Slovenia also gave off 6% of it’s GDP (3 billion euros) to struggling citizens and businesses during the lockdown period. Not only that, anyone entering the country (including cargo passing through) must go through a mandatory 14-day quarantine within their homes or a hotel suited for quarantine, with a penalty of 400 euros for anyone violating said rule. These efforts resulted in the first European country to declare an end to the coronavirus outbreak.14 Most businesses have reopened again during early May and school follows on May
13 14
“Slovenia Declares Victory Over Coronavirus Pandemic”. Balkaninsight.com. “Slovenia Is The First European Country To Declare An End To Coronavirus”. Forbes.com.
18. Though huge public gatherings such as concerts and soccer games will still be postponed until a vaccine for COVID-19 is found.
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NEW ZEALAND
Another successful country implementing the physical distancing and lockdown method is New Zealand. It has imposed a nationwide lockdown since March 26 and at the time of writing, only has 1,154 total cases. A government program funding worth of USD 12 million for small businesses and workers hit by the pandemic had also taken place. Being far away from the rest of the world has its perks during a worldwide pandemic. Geography-wise, New Zealand is located far away from the epicenter of the outbreak such as Italy and China. Whilst that might sound like good news, it might not be economic-wise. With a tourism and travel-based economy, closing off the country means cutting off the main source of income. This is reflected by a forecast of a 13% drop in New Zealand’s GDP in the coming months due to nationwide lockdown. This however does not take away from the governmental prowess of New Zealand’s Prime Minister, Jacinda Ardern. Her way of handling the pandemic has been met with great praise, with an approval rating of a whopping 84%.15
CONCLUSION
By analyzing the case at hand, we can deduct answers to the questions in the beginning. 1. How did Italy become an epicenter despite having world-renowned healthcare?
15
https://static.colmarbrunton.co.nz/wp-content/uploads/2019/05/CB-COVID-Times_8-April-2020.pdf
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What does this pandemic mean for countries with inferior healthcare systems?
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How should countries respond to this pandemic? To answer the first question, if we were to compare Italy’s response to any nation
mentioned beforehand, we can see that the Italian government is hell-bent on saving Italy’s face instead of Italy itself. By refusing to do mass testing in fear of accidentally painting Italy in a bad light, Conte has denied Italy a chance to get out of the outbreak early. The same could be said to Milan’s Mayor Beppe Sala, who insisted on the city staying open during the pandemic as to not perturb the city’s economy. Had he taken preventative measures and careful procedures by shutting down businesses and schools, Milan could’ve recovered from coronavirus and reopened earlier. Ironically, Vietnam implemented mass testing and shutdowns across the country and got out relatively scot-free compared to Italy. What does this pandemic mean for countries with inferior healthcare systems? In hindsight, having an inferior healthcare system may mean that the country will face a more difficult period than those with better healthcare. However, that is not always the case, as proven by Vietnam. Vietnam didn’t use ground-breaking technology or brand-new methods of eliminating the virus, it just stuck to the tried and true method of regular testing and physical distancing. How should countries respond to this pandemic? Lessons can be learned by seeing how different countries deal with pandemic using different strategies that end up with different outcomes. We can learn from Italy that down-playing an outbreak to save face and the economy is not ideal in lowering the ever-increasing case numbers and could backfire in the long run. We can learn from Vietnam that tests are paramount in ensuring safety and keep track of the virus. We can learn from Slovenia that closing business and schools early on will do much in keeping the majority of the population uninfected, putting off some of the GDP to help businesses survive is also a good idea to make sure that once the ban is lifted, businesses need not struggle as much, thus the economy could recover faster. We can learn from New Zealand that orders to limit people's movement need to be put in place early, with absolute clarity, then strictly enforced. In conclusion, most countries have a good chance of surviving COVID-19, even those with inferior healthcare. By taking into account how other countries handle the pandemic and learning from their successes and failures, together they can collectively figure out the best way to handle the ongoing pandemic. A formula that for now consists of physical distancing, regular testing, and temporary shutdowns if need be.