
The effect on outcomes of country-specific strategies and primary health care strength in COVID-19 pandemic response: an international study

The effect on outcomes of country-specific strategies and primary health care strength in COVID-19 pandemic response: an international study
Study Overview
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
Distribution and relative number of responses by country.

Primary health care perceptions of COVID-19 responses on rate of death: an international study
Felicity Goodyear-Smith, Karen Kinder, Andrew Bazemore, Robert Phillips, Stefan Strydom, Cristina Mannie, under consideration for publication, 2020.