COVID-19 curves: Compare Canada and other key nations
TORONTO -- Around the world, new COVID-19 infections and deaths continue to mount. From Canada to South Korea, every country has responded differently -- in some cases, quite significantly, resulting in vastly different outcomes.
Curious how different countries are faring? You can chart and compare the progression for jurisdictions that have reported more than 100 cases using our interactive graphs below.
An overview of the pandemic's progression -- from early containment measures to where things stand now -- are highlighted in a few, select examples below.
- For more in-depth maps, check out our Project Pandemic page, and for complete coverage, visit CTVNews.ca/coronavirus
Provinces, territories and global jurisdictions with fewer than 100 cases are not included.
WORLD HEALTH ORGANIZATION (TOP)
The COVID-19 pandemic is arguably the most catastrophic and devastating global event since the Second World War, impacting billions of people across at least 185 countries. More than 118 million people had been infected and more than 2.63 million had died one year after the World Health Organization began using the world “pandemic”.
The incredible speed with which vaccines have been developed and approved offers hope that perhaps an end to the pandemic is in sight, but the rise and spread of a number of variants in recent months combined with the extremely slow rollout of vaccines in many parts of the word appear to belie those hopes.
The WHO was informed of several unusual cases of pneumonia in Wuhan on Dec. 31, 2019 and began requesting information from China on the cases. The agency sent a tweet on Jan. 4 and issued a press release on Jan. 5, 2020 regarding 44 cases of pneumonia with an unknown cause in China.
By Jan. 30, the international health agency declared the outbreak a "public health event of international concern", amid 18 countries reporting a combined total of 83 cases, with seven involving no travel history to China and three countries reporting human-to-human transmission. According to a WHO spokeswoman, this declaration was meant to prevent a pandemic from happening. At this point, China had reported more than 7,700 confirmed cases, more than 12,000 suspected cases, and 170 people dead. The WHO advised all countries to prepare for containment, including early detection, isolation, contact tracing and to share their data with the WHO, but did not make recommendations on travel or trade restrictions at the time.
The novel coronavirus 2019-nCoV was officially named COVID-19 on Feb. 11 as the WHO warned against actions that promoted stigma or discrimination.
By Feb. 21, the health agency was warning the international community that the window to contain the COVID-19 outbreak was narrowing, but did not formally start calling it a global pandemic until March 11, 2020.
Six months after the declaration, data compiled by the AFP news agency found that roughly half of the world’s population -- some 3.9 billion -- had experienced some level of lockdown measure. At the official pandemic half-year point, there were nearly 30 million reported cases around the world, and more than 910,000 reported deaths.
Following a drop in cases in many parts of the world over the summer in 2020, many regions, including Europe, began experiencing a “second wave” dramatically worse than the first. The 2020 to 2021 winter was particularly devastating, with worldwide cases roughly tripling between the beginning of October 2020 and the beginning of February 2021 alone. Cases have continued to rise into the spring, driven primarily by the spread of variants of concern that appear significantly more transmissible, as well as pandemic fatigue.
Some countries, most notably the United States, experienced their third and worst wave over the winter, after seeing a second over the summer. Daily deaths through much of December 2020 into February 2021 regularly topped more than 3,000 in the U.S., a figure described by many news organizations as a “9/11 every day.” The aggressive deployment of vaccines in the U.S., however, has helped abate what was once the deadliest surge of COVID-19 in the world.
Despite the grim overall picture, some parts of the world have managed to contain the outbreak with extremely low to zero infection through aggressive and effective policies, allowing millions of people to lead normal or nearly normal lives with few restrictions.
COVID-19 has devastated Brazil, with the virus and P.1 variant tearing through the South American country. Its health-care system has reached a “breaking point,” with one medical expert describing it as a “biological Fukushima” to Reuters.
Brazil reported its first case on Feb. 25, 2020. Less than four months later, confirmed cases surpassed one million and nearly 49,000 people were dead. Half a year after the first reported case, infections had more than tripled to 3.67 million, while deaths reached nearly 116,600. Cases increased by a million during each subsequent month through the remainder of 2020. One year after the WHO began calling COVID-19a pandemic, Brazil reported nearly 273,000 lives lost and 11.28 million total cases, third only to the United States and India in total number of cases and second behind the U.S. in total number of deaths. It now stands second to the U.S. in total recorded infections.
Despite the first reported case in February 2020, raw sewage samples from November and December 2019 tested positive for SARS-CoV-2, according to a study published in March 2021, indicating that the virus was likely circulating in the Americas nearly two months before the continents’ first reported cases.
Despite calling the public to follow health protocols at the very beginning, Brazilian president Jair Bolsonaro was pushing to reopen businesses by April 2020, clashing with his health minister over strategies on how to handle the pandemic and eventually firing him; his replacement resigned less than a month later forthe same reasons. Initial plans to take strong containment action in mid-March after the pandemic was declared were significantly scaled back within a day due to “intervention” from Bolsonaro’s chief of staff’s office which, according to a Reuters report, was seen as a turning point for Brazil.
Throughout the pandemic, Bolsonaro, who tested positive for COVID-19 in July 2020, has emphasized keeping the country’s economy running above all else, and opposed not only lockdown measures but also mask-wearing.
The P.1 variant, first discovered in early December in Manaus, Brazil, has dramatically exacerbated the fast-accumulating infections and deaths across the country, with the daily number of cases hitting 100,000 and fatalities surpassing 3,800 in late March 2021.
Scientists were alarmed by this variant early in part because it triggered an outbreak in Manaus even more deadly than the city’s first devastating outbreak a year earlier. The uncontrolled spring 2020 outbreak in the city of 2.2 million eventually infected some 76 per cent of the population, leading many experts to believe residents were close to or even above the threshold for herd immunity, according to an article in The Lancet. But a study in January 2021 found the P.1 variant was identified in 42 per cent of the samples sequenced from late December raising doubts about natural herd immunity and concerns over whether this variant could affect the ability for antibodies from either a previous infection or from vaccination to recognize the virus, according to the CDC.
Health-care experts have called the situation in Brazil a “catastrophe”, but Bolsonaro and his allies have described it as “quite comfortable” compared to other countries and said the situation “isn’t all that critical.”
Since the pandemic was first declared in March 2020, many parts of Canada have struggled to control the spread of SARS-CoV-2. Some jurisdictions, like Atlantic Canada and the territories, managed to stay relatively free of COVID-19 through strict regional public health and travel protocols. But as scattered outbreaks in Nunavut -- which had managed to evade infections for most of the year -- and Newfoundland and Labrador demonstrate, circumstances can change quickly from a single case.
Canada recorded its 10,000th infection within three weeks of WHO calling it a pandemic, and by mid-June 2020 had recorded 100,000 cases. More than 10,000 had died by Oct. 23, 2020. Half a million infections were documented by mid-December. Reaching another half a million took less time. The country hit the grim milestone of a million COVID-19 infections and 23,000 dead by the beginning of April 2021.
The country’s first wave was a disaster for vulnerable long-term care residents, with upwards of 80 percent of COVID-19 deaths arising out of the long-term care homes primarily in Quebec and Ontario. National daily new cases peaked around 2,000, while daily deaths peaked at 244 at the end of April 2020.
After managing to contain the number of daily new cases across Canada to the low hundreds throughout the summer, the second wave, which was dramatically worse than the first, began in the fall and did not peak until early January 2021 when daily new infections hit more than 9,200.
As the second wave ebbed, experts in Ontario, for example, were already warning by early February that the variants of concern sweeping through the U.K., many parts of Africa, and Brazil, would drive a third wave that could be worse than the first two, especially if public health restrictions eased.
In the beginning, a combination of lax border screening in the beginning, poor management at long-term care residences, and other missteps hampered containment efforts.
The Public Health Agency of Canada formally activated its Emergency Operation Centre on Jan. 15, 2020, but unlike other countries that initiated screening measures for air passengers coming in from China early on, Canada did not initiate extra precautions until Jan. 22, when it added warning signs at major Canadian airports to raise awareness of the new novel coronavirus. New health screening requirements were also implemented for all passengers coming from China to airports in Montreal, Toronto, and Vancouver. Three days later, on Jan. 25, the first case in Canada was confirmed in a patient returning from Wuhan, China.
The federal government announced it would be repatriating Canadians in China at the end of January, as Global Affairs Canada increased its risk level for China to “avoid non-essential travel”, amid frustration among expats that the government was failing to communicate and help its citizens abroad. Those returning from China would be quarantined for two weeks. Over the coming days, airport screening requirements would be expanded.
By Feb. 20, 2020 Canada confirmed its first case related to travel outside China. As the global situation appeared more dire, Canada’s minister of health recommended stockpiling food and medication “because things can change quickly.” By early March, B.C. confirmed the first case of community transmission in Canada, while Ontario reported its first evidence of it in mid-March.
For a long time, however, the messaging from Canadian health officials was that the novel coronavirus outbreak risk for Canadians was low and that efforts would be concentrated on containing the spread. Government officials were also guided by advice from the World Health Organization, which had initially discouraged travel restrictions, border closures and the wearing of masks, positions that were later criticized and reversed as the spread became increasingly dire in many countries.
Provinces and territories went into high alert in mid-March, as the WHO formally declared a global pandemic, with states of emergencies declared across Canada and different regions implementing various levels of restrictions on social gathering sizes. Schools closed across the country, along with daycares, and non-essential businesses. Events and activities involving large groups of people were cancelled as the public was advised to practice physical distancing.
At the same time, Canadians were advised to avoid all non-essential travel outside the country indefinitely, with Canadians returning from abroad asked to self-isolate for 14 days. Anecdotally, some returning passengers noted that “screening” measures at airports still appeared minimal given the circumstances, with federal officials saying there was no need for additional measures like recording temperatures of travellers.
As the tally of cases grew in Canada, it became increasingly clear that many of the cases were linked to the United States. The level of movement between the two countries made containment impossible without drastic measures. By midnight on March 18, Canadian borders were closed to all but Canadians, their families, residents, and Americans, with international flights redirected to airports in Vancouver, Calgary, Toronto and Montreal. On March 20, the 8,891-kilometre-long U.S.-Canada border also closed to non-essential travel and remains closed.
The Quarantine Act was invoked on March 25 and all in-bound travellers were required to self-isolate for two weeks.
As infections rose in Canada, long-term care homes, especially in Ontario and Quebec, suffered a disproportionately devastating impact, with more than 80 per cent of the total deaths in Canada attributable to outbreaks at hundreds of these facilities.
The territories and East Coast provinces have remained mostly unscathed throughout the pandemic so far, with very few cases and deaths -- if any -- reported in these jurisdictions compared to the rest of the country. Atlantic provinces also formed their own travel “bubble” and tightened provincial borders with measures that limited travellers into the region.
The rest of the country began turning a corner in early May, some three-and-a-half months after its first case was identified. The number of new infections fell and the daily death toll dropped as low as the single digits from a peak of 177, prompting provinces to slowly reopen again.
By mid-July, however, Western Canadian provinces were seeing the number of new cases rise again. Regions like Ontario and Quebec began seeing the curve bend upwards by mid-August. As tens of thousands of children returned to in-class schooling, the daily number of new cases relentlessly climbed into the new year.
The arrival of variants of concern raised considerable alarm among medical experts. By early April 2021, ICU admissions for COVID-19 in the province surpassed 500, a record, with doctors noticing that patients were getting younger and sicker faster. In B.C., an outbreak involving the P.1 variant reportedly made the province the largest hotspot for that mutation outside Brazil.
The incredible speed with which vaccines were developed marks a turning point for the pandemic. To ensure Canadians had ready access to promising vaccine candidates, Canada invested over $1 billion, securing contracts that could deliver more than 400 million doses, or enough to vaccinate the entire population several times over.
Expectations were high for the vaccine campaign, which kicked-off earlier than planned. But a lack of domestic manufacturing capacity combined with delivery delays and a vaccination schedule some criticized as not aggressive enough meant less than 4 percent of the population had been inoculated by the beginning of March, two months into the rollout. More than 15 percent of the U.S., 30 percent of the U.K. and 50 percent of Israel had received at least one dose by then, drawing further attention to the importance of being able to manufacture the vaccines domestically.
Following some adjustments including delaying the second shot and the arrival of new vaccine shipments, the campaign picked up significant speed in March. Now Ottawa hopes all eligible Canadians will have their first shot before Canada Day. But how the battle between the vaccines and the variants will play out remains to be seen.
For more background on Canada’s handling of COVID-19, read our report detailing the evolution of Canada’s plans to fight the virus, the response by each province, and track every case.
- Documents reveal glimpse into Canada’s early COVID-19 plans
- This is how each province is handling the pandemic
- Tracking every case of COVID-19 in Canada
The country has been hit hard by COVID-19, but received attention early in the pandemic due to its low mortality rate compared to other European countries at the time. New infections also rose slower in Germany compared to its European counterparts for much of the year. All that changed during the second wave that hit European countries in the fall and stretched through the winter, leaving many asking what happened to the once-role model?
Between early October 2020 and early April 2021, cases in Germany soared to 2.94 million from around 300,000. Deaths soared to about 77,000 from 9,500 over the same six-month period.
Early during the outbreak, the government considered the new disease a "very low threat" and far less dangerous than SARS, making travel warnings unnecessary. But less than a week later, on Jan. 27, health officials confirmed the country's first case of the novel coronavirus. Two days after, Lufthansa, Germany’s flagship airline, suspended all flights to China.
According to media reports, face masks were quickly sold out, and measures to screen travellers from high-risk regions of China were placed at Frankfurt Airport, which has no direct flights to and from Wuhan. In mid-February, the German health minister rejected temperature screenings for inbound travellers and believed travel restrictions between China should be a decision made across Europe, rather than done unilaterally by individual countries. Towards the end of the month, however, travellers arriving from China, South Korea, Japan, Iran, and Italy were required to provide more information for contact tracing purposes, as were rail passengers, amid stricter land border patrols.
Some regions of Germany began closing schools and other public places by late February, while some sporting events were suspended or cancelled altogether. Organizers of the world’s largest travel trade fair cancelled the event a week before launch. By early March, the government officially recommended that German states ban events involving more than 1,000 people. Berlin closed its theatres, concert halls and opera houses just before the WHO formally declared a pandemic.
Just two days before the pandemic declaration, two seniors became the first COVID-19 deaths in Germany. Infections were doubling at this point.
In the days that followed the pandemic declaration, parts of Germany launched drive-through COVID-19 testing, land borders surrounding the country were fully closed, while 14 out of 16 German states closed its schools and kindergartens. The government recommended against all non-essential domestic and foreign travel; flights from Iran and China were also suspended.
The European Union also agreed on an immediate travel ban into Europe for all non-EU citizens, while Germany expanded its list to include citizens from Italy, Spain, and other EU countries. Many of these changes were a reversal of the German health minister’s position in early March discouraging border closures.
A national curfew was enacted on March 22, which allowed people to leave their home only to work, buy groceries, etc. Gatherings were limited to no more than two people from different households, while physical distancing was required. Restaurants and other services closed on April 2.
By early April, Germany’s mortality rate stood at less than 1.5 per cent while Italy’s stood at around 12 per cent. Spain, France and Britain were roughly 9 to 10 per cent. Earlier during the pandemic, the testing rate for the latter three countries was also a fraction of Germany's, with some media reports indicating that Germany was able to ramp up extensive testing more quickly and earlier.
Germany also has more than double the number of hospital beds in Italy and Spain, according to OECD data, and a number of media reports cited Germany's "expensive and extensive" public health care system as a key reason for the lower mortality rate. Like many other countries, however, there was ongoing concern over a shortage of masks and other protective equipment during the height of the country’s outbreak.
Germany's outbreak also began mostly among young and healthy skiers who caught the virus at European ski resorts and the overall average age of infected patients early in the pandemic was more than a decade younger than its neighbouring countries. At first, the government appeared reluctant to impose physical distancing measures, travel restrictions, school and border closures, even as it advised against unnecessary travel and asked recent travellers from high-risk destinations to stay home.
The country began easing restrictions in May, with an “emergency brake” set-up for restrictions to be reinstituted locally if infections climbed above a threshold of 50 per 100,000 residents.
The outbreak in the first wave peaked in early April 2020, when it was reporting more than 6,000 new cases a day.
Despite its early successes, the number of infections more than tripled to over one million between late-September and late-November. Cases reached 2 million by mid-January 2021. Daily infections topped more than 49,000 at one point, while the number of deaths, which had remained relatively flat throughout the summer and early fall, hit a high of 1,734 one day near mid-January. The government imposed a hard lockdown in mid-December that was extended several times.
As the B.1.1.7 variant first discovered in the UK spread rapidly, German Chancellor Angela Merkel warned that the country was “in a new pandemic”. But hampering the country’s battle has been its slow vaccine rollout -- Germany sits outside the top 50 in the percentage of residents who have received the first dose. Meanwhile, the country’s overall number of infections and cumulative deaths have now reached the top 10 globally.
India has reported one of the highest number of total cases in the world. There was significant worry that COVID-19 could be devastating for the world’s second most populous country. Despite the high risk of spread due to its dense population, testing was extremely limited in the beginning and remains on the lower end compared with other many countries on a per capita basis.
There were reports of outbreaks in slums, where families live in extreme poverty and crowded conditions. A sudden lockdown imposed across the country in March sparked a mass exodus of migrant labourers back to their home villages, spurring worries of possible outbreaks in regions poorly equipped to handle a health-care crisis. According to the OECD, India has just 0.5 hospital beds for every 1,000 people, for example -- China, by comparison, has 4.3 beds.
Despite these and other concerns, the number of reported deaths per capita and case fatality rate for India sits far below many other countries -- though the data has been called “sparse, and sporadic”. By mid-April, masks were mandatory across India. The country was reopening by early June amid concerns over the massive economic costs of staying closed, and despite worries that the move was too risky and too soon.
Italy suspended its air connections from Wuhan on Jan. 23, and all flights to and from China a week later, on Jan. 31. They were the third country after the Czech Republic and Greece to no longer receive and process visa applications in China. In addition, the country declared a state of emergency.
Despite some of these early measures, leaders, including the president, downplayed the outbreak in the early days, resulting in initial complacency. A few short weeks later, on Feb. 22, 11 municipalities in Northern Italy were placed under quarantine, locking down more than 50,000 people, with penalties including fines and prison for violation. Schools and universities closed within the affected areas, while public events, religious services, train service to affected areas, sporting events, carnivals– including the Carnival of Venice–were all cancelled or suspended. Two days later, 500 police officers were added to patrol the regions under quarantine. Key buildings, such as the Palazzo Madama, implemented thermal scanners for everyone entering the premises.
Despite these measures, by March, Italy became the centre of the worst outbreak outside of China at the time, with deaths at one point doubling every few days. Within two short weeks, daily cases spiked to a high of more than 6,500 and daily death tolls hit as high as 971. The country instituted an unprecedented lockdown, considered by many to be the most drastic response outside China at the time.
Schools and universities were shut down nation-wide on March 4, and quarantine measures were expanded to all of Lombardy and more than a dozen other northern provinces by March 8, putting 16 million people under lockdown. In addition, Prime Minister Giuseppe Conte announced the closure of all commercial businesses, museums, entertainment venues, etc. across Italy. The next day, the entire country of 60 million people was put under quarantine, and all sporting events within the country were cancelled. All non-essential commercial activities were prohibited, on March 11, including bars and restaurants.
With the number of daily new cases and deaths soaring, the Italian government enlisted military help to enforce lockdown on March 19. Parks and playgrounds closed the next day, along with other additional restrictions meant to limit movement throughout the country. All non-essential businesses and factories closed on March 21.
In March, Italy became the centre of the worst outbreak outside of China at the time, with deaths at one point doubling every few days. Within two short weeks, daily cases spiked to a high of more than 6,500 and daily death tolls hit as high as 971. The country instituted an unprecedented lockdown, considered by many to be the most drastic response outside China at the time.
The elderly were hit especially hard, a pattern that would be repeated later in places like Canada. The percentage of Italy’s population over 65 is the second highest in the world, second only to Japan, according to the world bank. “Dozens” were dying in nursing homes in the worst-affected areas, but were untested due to strict testing rules, according to media reports.
Testing ramped up slowly early in the pandemic, with the eligibility criteria varying between jurisdictions. In the small town of Vo, mass testing was said to help quickly contain the spread. Leaders, including the president, downplayed the outbreak in the early days, resulting in initial complacency.
While the country’s first case was identified in mid-February, a national waste water study in June found the virus was detected in samples collected in December, indicating that when doctors first reported cases in China, the virus was already present in Italy too.
Italy’s mortality in March was 41,329, roughly double that of the previous five years, according to a report published in July. This included 5,000 deaths not included in the toll attributed to COVID-19, suggesting how undercounted initial numbers likely were.
Italy turned a corner in April and by June, was steadily reporting roughly 200 to 300 new cases a day, with deaths generally falling to under 20 a day. The country began significantly easing restrictions in mid-May and by late July, also reopened its borders to tourists from more than two dozen countries.
Since restrictions eased over the summer, Italy began experiencing an uptick in new cases toward the end of August, but with a seven-day average of less than three daily new cases per 100,000 throughout September, the country is fairing significantly better than its European counterparts including Spain, which peaked at more than 24 cases per 100,000 over a seven-day average, and France at more than 18 cases per 100,000.
NEW ZEALAND (TOP)
New Zealand launched a national coordination centre on Jan. 28 to respond to the outbreak, a month before reporting its first case. Any traveller who left from China or transited through the country was barred from entering New Zealand as of Feb. 3, with only citizens and permanent residents allowed; a travel advisory for all of mainland China was raised to "do not travel". Days later, returning travellers coming from or transiting through China were advised to also self-isolate for 14 days.
The first case for New Zealand was detected on Feb. 28, in a citizen who had just returned from Iran. That same day, additional travel restrictions were implemented and included inbound travellers from Iran. By the end of February, Hong Kong, Iran, Italy, Japan, South Korea, Singapore and Thailand were all added to the list of countries and regions of concern.
On March 14, after the WHO declared COVID-19 a pandemic, New Zealand required that all travellers returning were required to self-isolate for 14 days, including citizens. Non-citizens who did not comply with the self-isolation rules were required to leave the country after the quarantine period was over. New Zealanders were urged to return home.
Indoor events with more than 100 people were prohibited (excluding work, schools, public transit) starting March 19 and borders closed to all but citizens and residents. A day later, public facilities such as libraries, community centres, museums also shuttered in major cities. Schools across the country closed on March 23 as the number of cases in the country jumped from 66 to 102. The national alert level was also raised to 4, triggering a highly restrictive, four-week nationwide lockdown. Bars, restaurants and other non-essential services were ordered to close within two days.
New Zealand, which reported its first case roughly a month after Europe and North America, may have benefited from seeing how its counterparts in Europe and North America fared and not being a landlocked country. It is notable how quickly the country moved to mitigate the spread by closing its borders even when only a handful of cases were reported. At its peak, New Zealand reported just 95 new cases.
By mid-May, all lockdown measures had been lifted except size limits on social gatherings and physical distancing. Following the recovery of its final active case of COVID-19 at the time, all restrictions except for border closures were lifted by June 9. After more than three weeks without a new case, however, two travellers who had arrived from Britain tested positive in mid-June, prompting Prime Minister Jacinda Ardern to put the military in charge of its border quarantine operations.
For 102 days, there was no community spread reported in the country, maintaining between zero to less than five new cases a day. The number of cases ticked higher mid-August, though still remained under 20 new cases per day. Overall, the country has only suffered a handful of deaths.
Following the mid-August uptick, a lockdown in Aucklandwas extended for another two-weeks and lifted by the end of the month, though gathering limits remain in place. New Zealand borders also remain closed, with the country mainly under physical distancing rules.
UNITED STATES (TOP)
The first known case of COVID-19 was diagnosed on Jan. 21 in Washington State. Toward the end of the month, a White House Coronavirus Task Force was established to “monitor, prevent, contain, and mitigate” the pandemic’s spread. Two days later, on Jan. 31, the government declared a public health emergency and restrictions were placed on travellers arriving from China. A “do not travel” advisory was issued for China on Feb. 2.
On Feb. 26, the CDC warned Americans to prepare for an outbreak as the first evidence of community spread in the U.S. appeared involving a case in California with an unknown origin. By the end of the month, Washington state declared a state of emergency. Over the course of the next week or so, Florida, New York and other states declared a public health emergency as well.
Testing in the United States was severely hampered in the first several weeks according to medical journal articles and numerous media reports. Screening was “rationed” because only CDC – not public health or hospital labs – could run the tests initially, with a strict criteria for testing only those with known exposure. State labs also ran into verification problems with the CDC test kits, with results coming back “inconclusive or invalid due to failure of the negative control”. Under pressure by state labs to expand testing capacity, tests developed by hospitals and other labs were finally permitted by the FDA at the end of February. On March 3, testing restrictions were also officially lifted, allowing medical professionals the discretion to determine whether a patient needed to be tested.
But even when the testing criteria was loosened and testing capacity ramped up, the demand far exceeded availability. Two-and-a-half weeks after a pandemic was declared, the U.S. was still only conducting 2,250 tests per million, two-thirds of what South Korea was able to accomplish three weeks earlier, and despite regulations around testing that were loosened four weeks earlier, according to the Washington Post.
Compounding the regulatory and technical problems with testing was the varying political response from all levels of government, with cities and states and the White House reacting with skepticism to urgency to conflict over the situation, despite warnings. Even prior to the outbreak in China, government reports and pandemic prep exercises as late as last year were not taken seriously. The world’s richest country “squandered” an entire month, a New York Times investigation said.
The NBA became the first major sports league to suspend games as WHO formally declared a pandemic on March 11, marking a major shift in tone and the sense of urgency around the pandemic. The following day, the CDC recommended against non-essential travel to a number of countries and regions including China, most of Europe, and Iran. Two days later, the U.S. declared a national emergency, while travel restrictions were also imposed for incoming visitors from Europe and elsewhere.
Additional measures were implemented over the coming days: flights from restricted countries were required to land at designated airports with enhanced screening; the White House advised against gatherings of more than 10 people; a global “do not travel” advisory was issued for Americans; further travel restrictions were imposed on foreign nationals who had visited Europe within the previous two weeks; and further quarantine and monitoring measures are added to earlier travel restrictions.
On March 20, U.S. and Canada closed its international borders -- the longest in the world -- to all non-essential travel between the two countries, a restriction that still remains in effect.
The next day, governors in NY, California, and other large states ordered most businesses to close and for people to stay indoors, with varying exceptions. Within days, more than a dozen other states impose lockdown orders.
New York became the centre of the U.S. outbreak by late March, with more confirmed cases than any other country outside the U.S., according to one media report. Hospitals, health care workers, and the 911 emergency response system were all reportedly overwhelmed, with one doctor describing the situation at his hospital as “apocalyptic”.
By mid-April, all 50 U.S. states and Washington, D.C. were under a disaster declaration as the number of COVID-related deaths in the U.S. crossed the 20,000 mark and surpassed Italy, becoming the highest in the world. Many parts of the country issued stay-at-home orders, cancelled mass-gatherings like sporting and music events, and closed schools.
While the total number of cases still surged from about half a million to two million over the following two months and deaths soared past 100,000, the restrictions helped cap the rise in daily new infections and deaths during that period, with the curve marginally sloping downward.
But as states began reopening, that modest dip in new infections made a dramatic upward reversal that eclipsed what unfolded between March and April. The explosion of cases nearly doubled in just over a month, hitting Arizona, Florida and Texas the hardest. Meanwhile, leadership at all levels of government continued to be unco-ordinated, with mayors clashing with state governors over measures including wearing face masks, and reopenings of businesses and schools. Some Americans protested the restrictions amid a rampant problem of false information spreading around the pandemic. Testing remained contentious. As other countries gird for the possibility of a “second wave,” experts including Dr. Anthony Fauci, said the U.S. never emerged from the first.
The second surge peaked in late July as cases hit more than 4 million; since mid September, the curve has resumed an upward trajectory again. On Sept. 22, more than 200,000 COVID-19-related deaths were officially recorded and by Sept. 26, more than 7 million Americans had contracted the virus.
SOUTH KOREA (TOP)
South Korea initiated containment measures almost immediately after China reported the unknown pneumonia cases to the World Health Organization - days before the global health agency issued a press release on Jan. 5. Quarantine and screening measures were put in place for all travellers coming from Wuhan, China as health authorities beefed up national surveillance of pneumonia cases in hospitals.
The first case was identified just weeks later, on Jan. 20, caught during heightened airport checks through thermal screening during entry at Incheon International Airport. That same day, the country’s infectious disease alert was raised to yellow (level 2) from blue. The public was advised to continue hand washing, practice proper cough etiquette, and mask-wearing if they had respiratory symptoms. A national hotline was launched to allow the public to report symptoms within 14 days of travel. The following day, the government issued travel recommendations and advisories for travellers to China. Inbound travellers who visited Wuhan within 14 days were asked to submit a health questionnaire and to report to health officials if a fever or respiratory symptoms developed.
Health officials quickly and aggressively ramped up their testing capacity, contact tracing, tracking, and quarantine measures in a national, co-ordinated, and detailed fashion, allowing for early mass testing, long before a pandemic was declared.
A high-level of transparency -- at times seen as controversial and intrusive -- allowed for real-time anonymous information to be shared with the public and used for tracking by early March. Officials were able to trace the movements of an infected patient and alert those who were in contact or nearby by taking information from GPS trackers in mobile phones, credit cards, and CCTV cameras. Infected individuals venturing outside their quarantine zone would also get a warning through a phone app.
Concerned that the novel coronavirus could become a pandemic, health officials and more than 20 medical companies met on Jan. 27 to discuss the urgency of developing an effective test quickly, promising “swift regulatory approval,” according to a Reuters investigation. The first diagnostic test from a company was approved within a week, on Feb. 4, and a second company was ready by Feb. 12.
The day after the meeting, the government also issued a requirement that all inbound travellers (Korean and foreign) coming from anywhere in China undergo tougher screening and quarantine measures, including a health questionnaire at the point of entry; giving false information was subject to a fine of up to US$10,000. Meanwhile, the country’s infectious disease alert was raised to a level three “orange”.
Additional staff was also added to the KCDC’s national call centre on Jan. 29 to deal with the influx of calls for consultation. Additional law enforcement and health staff were also added to airport quarantine checkpoints.
At the beginning of February, the country’s occupational safety and health agency announced it would provide 720,000 masks to industries and workplaces considered more vulnerable to infectious diseases due to the large number of foreign employees or visitors. These include the construction, manufacturing and service industries.
Over the next few days in early February, new measures were initiated: A 14-day self-isolation requirement for anyone who came in contact with a patient who tested positive, foreigners arriving from Hubei province were barred from entering the country and a separate airport arrival hall was created for travellers coming in from China. Visitors also had to provide verified domestic contact information prior to entry for contact tracing purposes. Meanwhile, daycare centres, nursing and long-term care facilities were asked to temporarily close if anyone, including visitors, tested positive or was a contact of a positive case.
Strict quarantine measures for arrivals expanded Feb. 12 to include Hong Kong and Macao.
By mid-February, the number of diagnostic test kits available, which had increased dramatically from 200 to 3,000 per day, continued to ramp up towards a capacity goal of 10,000 a day -- a figure they eventually exceeded.
The number of confirmed cases jumped by Feb. 20, attributed to “Patient 31” identified two days earlier. “Patient 31” had participated in a large church gathering in Daegu and was the source of a major outbreak. All citizens in the city of Daegu were asked to self-isolate for two weeks and those with symptoms had to get tested. Tens of thousands of members of the Sincheonji Church of Jesus, a main cluster and exposure point by “Patient 31”, were tested.
Drive-through testing sites were established quickly, offering citizens an efficient way of getting tested while minimizing exposure to others, with results sent via text within three days.
Around this time, the government also announced plans to designate certain hospitals as national infectious disease hospitals with orders to transfer all existing patients to other health-care facilities by Feb 28. South Korea’s infectious disease alert was raised to "red" or level 4, the highest threat level.
While businesses were allowed to stay open, many places, including offices and hotels as well, checked temperatures at the door or installed thermal cameras to screen for fevers. By the end of the month, public libraries, museums, churches, and daycares in Daegu closed.
The number of daily new infections peaked by the end of February before dropping sharply.
By mid-March, inbound travellers (both citizens and foreigners) from Japan, Italy, Iran, and within days – the rest of Europe - had to undergo special immigration screening, including installing a self-diagnosis mobile app. Travellers were advised to minimize their movement and required to submit a daily self-check for 14 days. Authorities followed-up in person if anyone failed to comply.
Government declared several cities including Daegu "special disaster zones" and mass testing of everyone at high-risk facilities in Daegu was conducted. Days later, the government advised South Koreans to cancel all non-urgent international travel, and like many other countries, all travellers entering Korea, regardless of citizenship, must fill a health questionnaire, provide verifiable contact information, and install the self-diagnosis mobile app. Travellers arriving from Europe were automatically tested. By March 25, all travellers arriving from the U.S. were also tested at the airport.
Between April 3 and July 25, South Korea, with a population of roughly 52 million, reported less than 100 new cases daily. Since the first case was identified, daily deaths have yet to exceed the single digits.
Nightlife establishments in Seoul closed in May after a number of cases were linked to an infected individual who visited nearly half a dozen nightclubs in one evening.
South Korea experienced another spike in August, with the number of new cases peaking at 441 in one day after the Sarang Jeil Church became the focus of another mass outbreak amid accusations the pastor flouted quarantine rules and was obstructing contact tracing efforts. An anti-government protest attended by thousands of people including the pastor also raised concerns of further spread. But the seven-day average number of new cases fell below 100 by late September after the public was urged to limit their movements amid the rising numbers.
South Korea never enacted strict nationwide lockdown measures like many other countries and its economy never really shut down, though gathering restrictions were placed for high-risk locations like churches, entertainment and sports facilities, and schools remained closed for much longer. Infected people are isolated and those who come in contact with them are put into quarantine. The public was also encouraged to practise physical distancing and stay home as much as possible, aside from work and buying essentials, in the early days of the pandemic and during case spikes like the one in August. But with case numbers relatively low, daily life has been more normal than many other parts of the world. Much of the country otherwise operated and continues to operate under relatively minimal restrictions, though mask-wearing is extremely common everywhere.