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What Can the U.S. Learn from Innovative Strategies Used in Other Countries to Respond to COVID-19?

COVID-19 patient in France transported to Germany

Image caption: 68-year-old recovered corona patient Mohammed S. is transported into a helicopter by an employee of the DRF Luftrettung. Two healthy corona patients from France were flown back to Metz on April 17, 2020. (Photo: Marcel Kusch/picture alliance via Getty Images)

U.S. policymakers and health care leaders are looking for effective strategies to curtail the COVID-19 pandemic; they may well learn from innovative strategies used in other countries. Working this year in the United States as Commonwealth Fund Harkness Fellows, we have tracked the response efforts in our home countries of Canada, France, the Netherlands, Norway, and the United Kingdom while watching the pandemic unfold in the U.S. In this post, we share some of these strategies.

Stronger, Resilient Hospitals

Governments and the private sector have adopted different strategies to expand the supply of health care workers. We think the U.S. has ample opportunity here: It could tap into the enormous pool of foreign-trained and -certified physicians and nurses who live in the U.S. but are not eligible to practice because they lack board certification. By easing eligibility criteria, the U.S. could readily deploy highly skilled clinicians who are allowed to work almost anywhere in the world.

Our countries are also innovatively working to create additional hospital bed capacity. For example, to relieve overwhelmed hospitals, France is transferring COVID-19 patients via high-speed train to Germany. The U.S. is currently transferring health care workers across states. Somewhat similarly, hospitals in less overwhelmed states could relieve overwhelmed states by taking their patients, if travel time is not onerous.

To build up supply of ventilators and personal protective equipment (PPE), hospitals in European countries are partnering with local companies to develop innovative solutions. For example, Italian, French, and Dutch start-ups collaborated with a large sportswear retailer and hospitals to convert snorkel masks into ventilator masks. This innovation is currently being tested in ICUs in different countries. Bauer, a hockey mask company, has transformed its plant near Montreal to manufacture protective masks. Dutch hospitals are now using a smart patch with sensors to measure COVID-19 patients’ vital signs so nurses can enter their rooms less frequently and reduce their exposure and use of PPE.

Detecting the Virus in Wastewater

The Netherlands plans to start community testing by analyzing wastewater to identify RNA traces of the coronavirus in sewage systems. Not only does this approach allow for testing of many people simultaneously, it also may help detect an outbreak before symptomatic cases arise, as RNA traces can be detected within three days of infection. This approach could serve as an early-warning system. Although this approach does not provide a way to identify infected individuals, it does allow for regionalized social distancing measures or stay-at-home orders to contain local outbreaks. There is extensive experience with this approach for effectively detecting the virus that causes polio.

Digital Surveillance Technologies

Some countries have started using technology to track people’s movements and help promote social distancing. In the Netherlands, police use surveillance drones to identify group formation in public spaces. Now the government is also considering using aggregated, anonymized mobile phone data to augment that effort. Early data from China suggests these approaches might be effective. Currently, the police in the U.S. and in other countries use traditional surveillance techniques to enforce social distancing, but this is resource-intensive and less likely to be effective.

Other countries are considering a different technological approach: having people use tracking apps on mobile phones to monitor the virus spread. In Norway, an app developed by a public–private initiative will soon be available, as the country discusses easing restrictions. This voluntary app uses mobile phone data to track movements of those who tested positive and alerts people who might have been in touch with them so they can self-quarantine. Denmark, the Netherlands, and France might follow the Norwegian strategy soon. A Science report found a similar app in China was effective in containing the virus spread but suggested that 60 percent or more of the population is required to use it — and in addition, there must be proper testing capacity — for it to be effective.

In the U.S., Apple and Google recently published a white paper outlining plans to develop a similar tracking app. Although these tracking approaches raise some privacy concerns, growing pressure to open the U.S. economy while also protecting Americans could make them worth considering. It is unclear how to best maximize use — through incentives or a mandate, which could be difficult to enforce.

Vetting and Adopting International Strategies

Although strategies from other countries seem promising, it is important that we develop a better understanding of their effectiveness, scalability, and underlying drivers. Through continued international collaboration, we can share the lessons learned and promote adoption across countries.

Innovative Strategies for Improving COVID-19 Response in the United States

Objective Innovative strategy
Monitoring social distancing via digital technology
Improving testing
Creating resilient hospitals

Bolstering clinical personnel capacity

Expanding bed capacity

Increasing number of ventilators

Expanding the availability of personal protective equipment


Publication Details

Publication Date: April 30, 2020

Umar Ikram et al., "What Can the U.S. Learn from Innovative Strategies Used in Other Countries to Respond to COVID-19?" To the Point (blog), Commonwealth Fund, Apr. 30, 2020.


Umar Ikram
2019–20 Dutch Harkness Fellow in Health Care Policy and Practice
Management Consultant
PwC Strategy& Amsterdam
Christer Mjaset
2019–20 Harkness/Norwegian Institute of Public Health Fellow in Health Care Policy and Practice
Vice President
Norwegian Medical Association
Anne Marie Boxall
2019–20 Australian Harkness Fellow in Health Care Policy and Practice
Assistant Secretary, Australian Government Department of Health
Adjunct Associate Professor, Menzies Centre for Health Policy, University of Sydney, Australia
Mylaine Breton
2019–20 Canadian Harkness/CFHI Fellow in Health Care Policy and Practice
Canadian Research Chair in Clinical Governance on Primary Health Care
Associate Professor, Department of Social Science and Medicine, Université Sherbrooke
Ines Gravey
2019–20 French Harkness Fellow in Health Care Policy and Practice
Hospital Director
Paris University Hospitals
French Ministry of Health
Holly Krelle
2019–20 U.K. Harkness Fellow in Health Care Policy and Practice
Principal Analyst
Prime Minister’s Implementation Unit
Veronique Raimond
2019–20 French Harkness Fellow in Health Care Policy and Practice
Senior Project Manager
Department of Economic and Public Health Evaluation
Haute Autorité de Santé (HAS)
Reggie Williams
Vice President, International Health Policy and Practice Innovations , The Commonwealth Fund