As we mentioned in a previous blog post, the COVID-19 Pandemic of 2020 is a historic moment. It is a time where all countries around the globe are dealing with a similar challenge. The magnitude of the COVID-19 disease impact has varied a lot between countries: usually, those countries with an early and aggressive response have been more successful in limiting the spread of the disease and preventing deaths.  In this blog post, we will discuss the responses of some of the countries that have been most and least affected by COVID-19.
Least Affected Countries
China’s neighboring countries — Taiwan, Singapore, and South Korea — and along the island of New Zealand have had the best global responses to the coronavirus outbreak.
Taiwan, Singapore, and South Korea
Taiwan holds one of the lowest number of coronavirus casualties in the world. According to Hopkins’ COVID-19 Dashboard, as of August 20, Taiwan has had only 486 confirmed cases and 7 deaths! Their key to success was a combination of early action, coordinated government-wide response, clear communication with citizens, and community-oriented mentality.  Taiwan was one of the most prepared countries to deal with the coronavirus pandemic. They had learned the importance of a quick response and preparedness after being hit hard by SARS in 2003. After SARS, Taiwan created an entity in charge of coordinating the government response to health crises. The main role of this entity in the COVID-19 pandemics was keeping Taiwanese residents informed.
After China’s news on the novel coronavirus, Taiwan quickly started passenger screening on flights, and identification and isolation of travelers with symptoms. On January 21, Taiwan’s CDC reported the first confirmed case of coronavirus. This same day the government issued a level 3 alert to Wuhan. A few days later, all flights to and from China were cancelled and the government banned the export of face masks. In early February, a mask rationing system was instituted by the government, Taiwanese people needed to present their National Health Insurance card in order to get masks. This was only possible because Taiwan has a nationalized Health Insurance System.  Taiwan’s response and measures against the outbreak include: passenger screening on flights, identification and isolation of travelers with symptoms, thorough contact tracing and mobile Sim-tracking, widespread testing, travel restrictions, enforcement of social distancing measures, constant temperature checks and universal use of face masks. By mid July, most of Taiwan was mostly reopened and the only remaining signs of a COVID-19 pandemic were the frequent temperature checks and the widespread wearing of masks in public areas. [4, 5, 6] Taiwan was prepared to deal with a pandemic. They had a strong plan, which was thoroughly followed by the government and supported by their citizens.
Singapore, just like Taiwan, had a quick and aggressive response to the coronavirus outbreak. On January 23, the first confirmed case was reported, but it wasn’t until February and March when the disease started to spread among locals rather than travelers from China. Singapore had also dealt with SARS in 2003, and because of their experience, Singapore’s government built temporary bed spaces to house patients early in the COVID-19 pandemic. In addition, the Singapore government implemented widespread testing and utilized contact-tracing by scanning people’s IDs. As of August 20, there have been 56,031 confirmed cases and 27 deaths. [ 7, 2]
Similarly to other countries in the region, South Korea had an early and aggressive response to the coronavirus outbreak. On January 20, the first confirmed case was reported, and by mid February the number of confirmed cases started climbing. As these numbers started to increase, the government built screening clinics and, together with the private sector, began to develop and scale up production of COVID-19 tests. In addition to widespread testing, South Korea implemented thorough contact tracing, isolation of infected patients, social distancing, and real-time tracking of COVID-19 patients.  According to Hopkins’ COVID-19 Dashboard, as of August 20, South Korea, has reported 16,346 confirmed cases and 307 deaths. South Korea, just like Taiwan and Singapore, had also dealt with another outbreak before — the MERS epidemic in 2015. [ 2, 6, 8, 9]
New Zealand, without any previous experience dealing with respiratory outbreaks, has “crushed the curve” according to the WHO.  A few days after the coronavirus outbreak was declared an international public health emergency, New Zealand began implementing preventive measures like banning the entry of travelers coming from China. On February 28, New Zealand reported its first confirmed coronavirus case and the government began tightening restrictions gradually: shutting down its borders to travelers and non-essential businesses. By late March, Level 4 lockdown was declared, and New Zealanders had to stay at home. In addition to self-quarantine measures, the government implemented strong testing, thorough contact tracing, and clear and regular communication with its citizens via emergency text messages and Live Facebook videos. [2, 10] In addition, New Zealand’s government instituted financial policies to protect its economy and citizens — the prime minister promised no one would lose their residence, tax reforms were implemented to help small businesses, and New Zealand ministers took a 20 percent cut in their salary.  As of August 20, New Zealand has reported 1,304 confirmed cases and 22 deaths. [ 7]
Most Affected Countries
The epicenter of the coronavirus outbreak has been shifting constantly. From December 2019 to February 2020, the city of Wuhan was the epicenter of the outbreak in China. Then, in mid-march it shifted to Italy and Spain. Since April, the US has been the epicenter of the outbreak. Experts suspect it might soon shift to Latin America.
The first confirmed cases of coronavirus in Italy were reported on January 31, a third case was reported a week later, and the first cluster of 16 confirmed cases were detected on February 21. After the first death, reported on February 22, small towns hit by the outbreak were placed under quarantine and public events were cancelled. Two weeks later, schools and universities closed down and the northern provinces were placed under lockdown. In early-mid march, the lockdown was extended nationwide; restaurants and bars were closed, and nonessential-factory production was stopped [ 7, 11, 12]. Italy was not well prepared for the rapid spread of coronavirus: tests were performed only on symptomatic patients and initially they were not performed on health care professionals. Additionally, there were not enough masks available for protection nor enough ventilators for patients who needed life support [ 12]. The peak of Italy’s curve was seen in late March to early April. Since then, the number of new cases and deaths have been decreasing. Italy’s lockdown restrictions started to ease in early May and a month later, Italy opened its borders to European tourists. As of August 19, 2020 there have been 254,636 confirmed cases and 35,405 deaths [ 7].
The United States was very slow to act. The first confirmed case was reported by the CDC on January 20 in Washington state, the same day as the first confirmed case reported in Taiwan and South Korea. The government response in these two countries was very different and it is clearly reflected in the spread of the virus and number of casualties. The US is currently considered the epicenter of the outbreak, whereas South Korea and Taiwan have reported very few confirmed cases and deaths.
A week after the first reported case, the US implemented screening in 20 airports. On February 29, Washington State was the first state to declare a state of emergency and to report the first death in the US. By March 1, about 60 cases had been confirmed countrywide, in the states of Washington, California, Illinois, Rhode Island, NY, Florida and Oregon . As the number of confirmed cases climbed, other states joined Washington in declaring a state of emergency, allowing state agencies to use all the necessary resources to respond to the outbreak. These resources include access to medical equipment and cleaning supplies, access to existing and new facilities to perform tests, and allow trained professionals, other than doctors and nurses, to conduct tests. 
Once health authorities expanded testing, the reported cases in the US surged. By mid-March, the US suspended entry to foreign nationals traveling from China, Iran, and European countries; state governors started to ban public events and gatherings, and implement lockdowns; schools were closed; President Trump declared a country-wide state of emergency on March 13. In late March, the social distancing guidelines were extended until April 30. However, due to the slow response of the government, the US had the highest number of confirmed coronavirus cases and coronavirus deaths in the world by mid-April.  Health professionals in the US suggested the state of emergency be extended. Regardless, with pressures to reopen to restimulate the economy and amidst an unprecedented millions who suddenly had to file for unemployment in April, the government decided to allow states to gradually reopen based on the severity in each state, “in a safe and smart way” as reported by The Whitehouse . Even though President Trump suspended immigration to the US through late June, the number of cases continued to increase. This is largely attributed to the eased lockdown restrictions. As cases rose, a mask order was issued: everyone that leaves home must wear a mask in public spaces. And that leads us to where we are now. As of August 19, the US has reported 5,393,138 confirmed cases and 169,508 deaths. 
Citations and Links
 Max Roser, Hannah Ritchie, Esteban Ortiz-Ospina and Joe Hasell (2020) — “Coronavirus Pandemic (COVID-19)”. Published online at OurWorldInData.org. Retrieved from: ‘https://ourworldindata.org/coronavirus' [Online Resource]
 Ian Bremmer. “The Best Global Responses to COVID-19 Pandemic”. Times. June 12, 2020.
Retrieved from https://time.com/5851633/best-global-responses-covid-19/
 WIKIPEDIA. “COVID-19 pandemic in Taiwan”. Retrieved from
 Lanhee Chen. “The US has a lot to learn from Taiwan’s Covid fight”. CNN. July 10, 2020. Retrieved from https://www.cnn.com/2020/07/10/opinions/taiwan-covid-19-lesson-united-states-chen/index.html
 Christina Farr & Michelle Gao. “How Taiwan beat Coronavirus”.CNBC. July 15, 2020. Retrieved from https://www.cnbc.com/2020/07/15/how-taiwan-beat-the-coronavirus.html
 Johns Hopkins. “COVID-19 Dashboard”. Retrieved from https://coronavirus.jhu.edu/map.html
 World Health Organization (WHO). WHO Coronavirus Disease (COVID-19) Dashboard. Retrieved from https://covid19.who.int/
 Keren Landman. “What We Can Learn From South Korea’s Coronavirus Response”. Medium. June 1 2020 .https://elemental.medium.com/what-we-can-learn-from-south-koreas-coronavirus-response-97a4db5c9fef
Exemplars in Global Health. “Emerging COVID-19 success story: South Korea learned the lessons of MERS”. Our World In Data. June 30, 2020. Retrieved from https://ourworldindata.org/covid-exemplar-south-korea
 World Health Organization (WHO). “New Zealand takes early and hard action to tackle COVID-19”. July 15, 2020. Retrieved from https://www.who.int/westernpacific/news/feature-stories/detail/new-zealand-takes-early-and-hard-action-to-tackle-covid-19
 Lawler, Dave. “Timeline: How Italy’s coronavirus crisis became the world’s deadliest”. March 24, 2020 Retrieved from https://www.axios.com/italy-coronavirus-timeline-lockdown-deaths-cases-2adb0fc7-6ab5-4b7c-9a55-bc6897494dc6.html
 Ciro Indolfi, Carmen Spaccarotella. “The Outbreak of COVID-19 in Italy”.J Am Coll Cardiol Case Rep. 2020 Jul, 2 (9) 1414–1418. Retrieved from https://casereports.onlinejacc.org/content/2/9/1414
 Andrew Selsky. “Wash. state sees 1st virus death in US, declares emergency”. AP NEWS. February 29, 2020. Retrieved from https://apnews.com/f175d89567a26d59cab27725c9e8a0d7
 Matthew Impely. “What U.S. States Have Declared a State of Emergency Amid Coronavirus Outbreak“. March 9, 2020. Retrieved from https://www.newsweek.com/what-us-states-have-declared-state-emergency-amid-coronavirus-outbreak-1491299
 Derek Hawkins et al. “Confirmed U.S. covid-19 death toll reaches 20,000, highest in the world”. WashingtonPost. April 11, 2020. Retrieved from https://www.washingtonpost.com/world/2020/04/11/coronavirus-latest-news/
 The Whitehouse. “President Donald J. Trump Is Beginning the Next Phase In Our Fight Against Coronavirus: Guidelines for Opening Up America Again”. Whitehouse. April 16, 2020. Retrieved from https://www.whitehouse.gov/briefings-statements/president-donald-j-trump-beginning-next-phase-fight-coronavirus-guidelines-opening-america/