What do international comparisons of Covid-19 responses tell us?

HIQA’s recent international review of different ‘lockdown’ strategies contains an important caveat at the end.
“Public health measures adopted by countries to limit the spread of Covid-19 are constantly changing,” according to the review on public health measures and strategies to limit the spread of Covid-19.

“As such, the review may have missed relevant information that was just (or about to be) published at the time of the review. To the best of our knowledge, the review is accurate as of 12 March 2021.”

The document, which was submitted to the national public health emergency team (NPHET), was published on 22 March. This issue of the Medical Independent is out on 8 April, which is almost a month since the review was completed. A month is a long time when it comes to Covid-19. HIQA also highlights the difficulty in comparing different countries with regard to the pandemic. The document notes that comparisons of the testing data, including test positivity, are not easy due to changes in testing criteria over time. There are also variations in the way countries define ‘tests performed’.

For example, the unit may refer to the number of tests performed or the number of people tested. Also, it states that variations in the epidemiological data, such as the 14-day notification of new cases, may be observed across different data sources due to differences in underlying population data. A cynic might say that such technicalities could be used by governments to excuse subpar responses to the pandemic.

These challenges in making comparisons do not prevent the Authority from drawing some broad conclusions.
The review focused on the national response to Covid-19 in 17 countries that were experiencing a resurgence in Covid-19 cases in October 2020 and which were identified by NPHET as being in a similar phase of pandemic response as Ireland.

HIQA says the measures that are being applied elsewhere are largely consistent. However, there are many differences in the detail between countries. The more prominent of these include how movement is restricted by numbers permitted at gatherings, events, religious services, and sporting activities; and the operating hours of businesses allowed to open within the hospitality sector.

HIQA found only five countries – Czech Republic, Ireland, Israel, Portugal, and the UK – had seen a reduction in 14-day case numbers per 100,000 population over the previous seven days to 14 March 2021, while all other countries included in the review had seen an increase. Comparing Ireland to other countries, hospitalisations per million population were lower only in Denmark and The Netherlands. Similarly, the numbers in ICU per million population were lower only in Denmark and the UK.

For the Irish Government, the review makes positive reading, as it continues to face questions about the current protracted lockdown and difficulties in the roll-out of the vaccination programme. But HIQA’s point about the limitations of the review is worth bearing in mind.

Also, what would a review look like which focused more on the Government’s calamitous lifting of restrictions before the Christmas period and the almost unbearable pressure it placed on our health service? For a global pandemic, international reviews are essential to ascertain best practice and hold individual governments to account. We should also be aware of any study limitations, question how comparisons were made, and ask how critical they are of official policy.