How an outbreak became a pandemic: a chronological analysis of crucial junctures and international obligations in the early months of the COVID-19 pandemic.

Understanding the spread of SARS-CoV-2, how and when evidence emerged, and the timing of local, national, regional, and global responses is essential to establish how an outbreak became a pandemic and to prepare for future health threats. With that aim, the Independent Panel for Pandemic Preparedness and Response has developed a chronology of events, actions, and recommendations, from December, 2019, when the first cases of COVID-19 were identified in China, to the end of March, 2020, by which time the outbreak had spread extensively worldwide and had been characterised as a pandemic. Datapoints are based on two literature reviews, WHO documents and correspondence, submissions to the Panel, and an expert verification process. The retrospective analysis of the chronology shows a dedicated initial response by WHO and some national governments, but also aspects of the response that could have been quicker, including outbreak notifications under the International Health Regulations (IHR), presumption and confirmation of human-to-human transmission of SARS-CoV-2, declaration of a Public Health Emergency of International Concern, and, most importantly, the public health response of many national governments. The chronology also shows that some countries, largely those with previous experience with similar outbreaks, reacted quickly, even ahead of WHO alerts, and were more successful in initially containing the virus. Mapping actions against IHR obligations, the chronology shows where efficiency and accountability could be improved at local, national, and international levels to more quickly alert and contain health threats in the future. In particular, these improvements include necessary reforms to international law and governance for pandemic preparedness and response, including the IHR and a potential framework convention on pandemic preparedness and response.

Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries.

Health systems resilience is key to learning lessons from country responses to crises such as coronavirus disease 2019 (COVID-19). In this perspective, we review COVID-19 responses in 28 countries using a new health systems resilience framework. Through a combination of literature review, national government submissions and interviews with experts, we conducted a comparative analysis of national responses. We report on domains addressing governance and financing, health workforce, medical products and technologies, public health functions, health service delivery and community engagement to prevent and mitigate the spread of COVID-19. We then synthesize four salient elements that underlie highly effective national responses and offer recommendations toward strengthening health systems resilience globally.

Australia and the Rhythm of the Covid-19 Epidemic

Reeling from a devastating bushfire season, Australia was slow to respond to the Covid-19 threat, but when modelling in mid-March showed the same pattern of growth that had overwhelmed European health systems, a closely knit network of public health experts gained the ear of government and rapid national action was taken closing workplaces and imposing stay at home orders. With investments in localized testing, contact tracing and sequencing to track the genomic fingerprint of cases, by the end of April new cases had been brought to near zero. Australia's successful containment efforts have paralleled those of regional neighbours such as China, South Korea, Vietnam and Japan, in stark contrast to the uncontained spread in the United States, Australia's traditional ally. The Australian government has tried to navigate these geopolitical tensions by moderating the Trump administration's attempts to turn the pandemic into a political battlefield. Renewed outbreaks in Australia at the end of June suggest SARS-CoV-2 will not be totally eliminated in Australia, but continuing control efforts will bring it to 'virtual elimination'.

Modern Pandemics and Old Methods: What AIDS, SARS, Ebola and the Long History of Quarantine Tell Us about Covid-19

A generation ago, infectious diseases were seen as a medical backwater, with the eradication of smallpox and widespread vaccination against polio. However, the emergence of AIDS in the early 1980s, followed by SARS in 2003, pandemic influenza in 2009 and Ebola on an unprecedented scale in 2013-14 showed that infectious diseases of zoonotic origin could cause major new pandemics. Covid-19 has shown that very old public health techniques of quarantine and isolation are still needed to respond to new outbreaks. Public health always tries to get ahead of an emerging epidemic but rarely succeeds.