Aim:

This multinational survey aimed to understand characteristics and strategies employed by different countries to deal with COVID-19 from a PHC perspective to determine:

• Factors most associated with national mortality rates during the pandemic period to date
• Lessons to better address both current and future pandemics

Preliminary Results (1035 responses, 111 nations):

What factors correlated most with lower death rates?

• Testing: Lower death rates were observed in countries where participants indicated that the following testing practices were employed:
  • Having readily available testing at the time of first COVID death
  • Testing all incoming travelers
  • Testing symptomatic persons
  • Testing those exposed to COVID positive individuals
• Movement Restrictions: Lower death rates were observed where participants indicated that the following movement restrictions were employed:
  • Physical distancing
  • Event closures, and border closures at time of first death
  • Closure of all but essential services
  • Isolation based on contact tracing
  • Self-Isolation in households
  • Quarantine for suspected cases

Strong PHC System and Death Rates:

Existing strong PHC systems were not correlated with death rates. This may be attributed to:

• Uncoordinated responses between public health and PC personnel
• Lack of PPE and testing for community-based workers
• Reduced reliance on PHC if potential carriers were stopped at the border (most relevant to small island nations)
• PC not being engaged

Methods:

1035 surveys were collected from PHC clinicians (73.0%), researchers (16.9%), and policymakers (10.0%) across the world. The survey was distributed in both English and Spanish via PHC networks and snowballing. Participants were asked a series of questions that addressed the nature of their PHC system, how it responded to the pandemic, the use of health information technology in their country, if their country had a pandemic plan, and various strategies utilized to respond to the virus. Countries that had 10 or more surveys are referred to as the “top 21 countries

Data for Each Country:

For each country, the maximum death rate on a 7-day moving average served as the response variable in the survey.

Analyses:

Univariate and bivariate analyses were employed to arrive at the preliminary results.

Current Public Health and Primary Care Responses:

• Implementing hygiene measures: hand washing and wearing PPE
• Limiting person-to-person contact: physical distancing, banning mass gatherings, providing primary care remotely, self-isolating, and shutting down
• Identifying Cases: testing, contact tracing, counsel & care for high risk groups, and surveillance

Current Approaches to Address the Pandemic:

Most countries utilized a combination of the following strategies:

• Blocking entry to country: border control, testing and or quarantining new arrivals
• Reducing the spread within the country: employing a variety of public health and primary care measures
• Managing severe cases to reduce deaths: hospitalization, oxygenation, ventilation, and intensive care