This special edition of International Health News Brief focuses on innovative approaches the countries that take part in the Commonwealth Fund’s annual international survey have taken in response to the COVID-19 pandemic, including those related to expanding health system capacity, including access to telehealth; addressing social determinants of health; supporting the development of vaccines and treatments; and collecting population data to inform exit strategies.
Countries Expand Health System Capacity and Share Resources — Within and Across Borders
Overloaded health systems across Europe are facing capacity shortages, including hospital beds. In London, a designated COVID-19 field hospital with 4,000 critical care beds was built in one of the city’s largest convention centers in just two weeks. England’s National Health Service also moved to purchase nearly all private hospital sector capacity, adding 8,000 beds, 1,200 ventilators, and 20,000 clinical staff. In Ireland, the government announced all private hospitals will be made public for the duration of the pandemic, ensuring all patients will “have equality of treatment” and “be treated for free, as part of a single, national hospital service,” according to Health Minister Simon Harris.
Across the channel, France has converted high-speed trains into designated COVID-19 facilities equipped with medical staff and ventilators to transport critically ill patients to hospitals throughout the country. German hospitals now submit data on ICU capacity and coronavirus patient load to a national website that helps steer patients from overburdened hospitals to ones with capacity. In the Netherlands, the National Corona Coordination Centre helps coordinate hospital capacity nationwide. And even in Sweden’s regionally governed health care system, coordination of ICU capacity and procurement of personal protective equipment (PPE) has been centralized at the national level.
German and Swiss hospitals, meanwhile, have taken in patients from neighboring countries overburdened with the virus, including France, Italy, and the Netherlands. The German military even converted aircraft into specialized “flying hospitals” to transport patients from Italy.
- By monitoring hospital patient load and being able to rapidly surge capacity, countries can share and activate resources where they are needed most.
- States in the U.S. could explore similar strategies to coordinate and share hospital capacity within, and across, state lines.
Telehealth Use Grows in Australia, France, the Netherlands, and Canada
Whether conducted by phone or video, telehealth visits enable health care providers to triage and monitor COVID-19 patients at home. They also help clinicians treat non-COVID-19 patients. In Australia, the federal government has come to an agreement with the Australian Medical Association to double the payment incentive for general practitioners to treat patients virtually. The Dutch Healthcare Authority loosened restrictions on digital consultations, even suspending the requirement that first visits must be conducted face-to-face. Similarly, French health authorities relaxed regulations around teleconsultations and agreed to fully cover the cost of virtual visits. Canada also moved to make telehealth platforms available to physicians and added virtual care billing codes.
Measures like these that facilitate telehealth access and reimbursement help ensure continuity of patient care while allowing people to remain at home — thereby protecting providers and patients as well as reducing use of personal protective equipment, or PPE.
- While telehealth plays a critical role in meeting primary health care needs under stay-at-home orders, it remains to be seen whether virtual care is regulated differently after the pandemic.
Netherlands, France, and U.K. Focus on Social Needs During COVID-19 Pandemic
Widespread job losses, food insecurity, and increased domestic violence are among the many social needs unleashed by the pandemic. Several countries are seeking to meet these needs in innovative ways.
The Dutch government, for example, has pledged EUR 4 million in emergency funding to the national food bank to help alleviate staff and food shortages. In addition to providing financial support to businesses and individuals, France has activated its ‘Civic Reserve’ of volunteers to help families shop for groceries, connect with socially isolated individuals, and provide child care to families headed by parents with essential jobs, such as health care workers. Through a web-based platform, people can request assistance or volunteer in their neighborhood. NHS England launched a similar initiative where volunteers can sign up through the Good Samaritan mobile application.
France has implemented several measures to protect women facing domestic violence during the lockdown, including a program initiated in Spain that enlists the help of local pharmacies. Women in danger can enter a pharmacy and use the codeword “mask 19” to alert staff to contact the authorities. Additional measures announced by the French Minister of Equality include paying for hotel stays for women who feel unsafe in their home, as well as pop-up counseling sites in supermarkets.
- Social distancing measures introduced to curb the spread of the virus have had disproportionate effects on vulnerable populations.
- Policymakers should work across sectors to protect households from the pandemic’s economic and social impact. Measures should target those most severely affected by lockdown measures.
International Collaborations to Support COVID-19 Treatments and Vaccine Development
Cross-national cooperation can expedite the identification of treatments for COVID-19 and a vaccine against SARS-CoV-2 by pooling resources such as data, funding, and expertise.
Examples include the Coalition for Epidemic Preparedness Innovations, an international collaborative headquartered in Norway, which has shifted from its founding focus responding to the Ebola crisis to developing a vaccine for SARS-CoV-2. The World Health Organization, meanwhile, announced the launch of the multinational SOLIDARITY trial to test four drug therapies across several countries. Another trial, Discovery, will test the same therapies in 3,200 patients in Europe.
Several research groups have also joined forces to distill emerging COVID-19 research from around the world into centralized databases. The University of Basel in Switzerland, in collaboration with Stanford University, launched an open-source comprehensive data set of treatment and vaccine trials. The Norwegian Institute of Public Health and McMaster University in Canada have created an interactive evidence map that summarizes publicly available research on COVID-19 diagnosis, disease progress, patient care strategies, interventions, and other topics. It contains a living library of peer-reviewed articles.
- Past international collaborations on infectious disease responses have been successful in producing vaccines for illnesses such as Ebola.
- With cross-national collaboratives offering the potential to combine resources and maximize the return on research efforts, policymakers and other funders have an opportunity to identify and support those with the highest impact.
European Exit Strategies Informed by Population Immunity Studies and Mobile Apps
As countries plan to reopen society and loosen social distancing restrictions, they will have to carefully weigh economic benefits against potential health consequences. Data on the share of the population that has developed immunity to the coronavirus (SARS-CoV-2) that causes COVID-19 can help inform these strategies. Experts estimate that between 50 percent and 75 percent of the population need to develop immunity in order to eradicate the epidemic.
Several regions in Germany, including Munich and Heinsberg, and the Netherlands are embarking on large-scale population studies to give a better understanding of asymptomatic infections and the development of herd immunity — resistance to infection that is spread when a sufficiently large share of the population has become immune. Thousands of randomly selected individuals will be tested for SARS-CoV-2 antibodies at regular intervals. The results will inform the loosening of lockdown and social distancing measures, such as stay-at-home orders and business and school closings, in real time. Germany also plans to launch a similar study with more than 100,000 people. The U.K. has expressed interest in potentially issuing “immunity passports” for those testing positive.
The accuracy of currently available antibody tests has not been established, however, although some organizations have started to evaluate them systematically. Experts have also highlighted ethical considerations to issuing “immunity certificates.” It is also unknown how long immunity lasts.
Mobile applications may provide additional data to inform exit strategies. Bluetooth-based contact tracing apps, already launched in Norway and planned for release in Germany and France, will inform of disease spread and exposure. One of these — the Pan European Privacy Protecting Proximity Tracing, or PEPP, technology — promises to protect users’ privacy by storing data in anonymized format, thereby addressing potential data privacy concerns. Germany has also launched an app that lets people provide data from their fitness tracking devices on pulse rates and sleep patterns to indicate fever and other potential COVID-19 symptoms. The Dutch Ministry of Health, Welfare and Sport organized a coronavirus “app hackathon” called #Appathon that saw members of the general public, scientists, lawyers, human rights specialists, and tech developers come together to discuss ethical, legal, and technical frameworks for potential apps.
- Until a vaccine against the SARS-CoV-2 virus or treatments for COVID-19 are made available, countries should seek ways to measure infection spread and herd immunity before loosening mitigation measures.
Authors: Roosa Tikkanen, Molly FitzGerald, Katharine Fields
Editor: Roosa Tikkanen
World news — Roosa Tikkanen
Australia — Sonĵ Hall
Canada — Mylaine Breton
France — Angèle Malâtre-Lansac, Ines Gravey, Véronique Raimond
Germany — Michael Laxy
Netherlands — Marit Tanke, Umar Ikram
Norway — Christer Mjåset
Sweden — Ulrika Winblad
Switzerland — Lars Hemkens
United Kingdom — Holly Krelle