Sheila Riazi
A research team led by Dr. Sheila Riazi, an anesthesiologist at Toronto Western Hospital, found that when it came to the number of deaths from COVID-19, a country’s social and economic policies were as important, if not more so, than the public health measures taken to mitigate the virus. The study is published in The Lancet’s EClinicalMedicine today. (File Photo: Courtesy Dr. Sheila Riazi)

How do we prepare for the second wave?

It's a question heard often now that a majority of the world has navigated through its first wave of SARS-CoV-2, the virus that causes COVID-19.

After several months of deploying a variety of public health measures – from full lockdown to aggressive testing and contact tracing – to slow the transmission of the disease, the daily number of reported COVID-related cases and deaths are continuously declining in a number of countries, including Canada.

And though these victories are to be celebrated, the current slowdown in COVID's urgency has experts asking: "What worked?" "What didn't?" and "What do we need for next time?"

At UHN, researchers are finding the public health measures that were put in place in a country may matter less than the over-arching infrastructure to support them.

In a study published July 21 in The Lancet's journal EClinicalMedicine, Dr. Sheila Riazi and her team found that a country's Global Health Security Index (GHS) – which includes government actions, the country's preparedness and socioeconomic factors – is a significant indicator for the number of deaths a country experienced from COVID-19.

"What's unique about our research is that we used a country-level model incorporating data from 50 different countries to compare country-specific socioeconomic factors and healthcare capabilities on COVID-19-related outcomes," says Dr. Riazi, an anesthesiologist at UHN's Toronto Western Hospital and the principle investigator of the study. "What we found is that a country's social and economic policies were as important, if not more so, than the public health measures taken to mitigate COVID-19.

"National preparedness, as measured by GHS, tells us how prepared a nation is to face a pandemic prior to it coming while public health policies are formed to face the biological threat once it arrives, such as social distancing, universal masks, mandated vaccinations," she explains.

Tale of two countries – Canada and the United States

"Of course travel restrictions and containment measures such as testing and physical distancing all play significant roles in reducing the number of affected individuals, but they aren't very effective in reducing the critical cases or mortality of the disease.

"Instead, low levels of national preparedness in early detection and reporting, limited healthcare capacity, and population characteristics such as advanced age, obesity and higher unemployment rates were key factors associated with increased viral spread and overall mortality."

The GHS index is made up of six categories, all of which had crucial roles in supporting measures against COVID-19:

  • Prevention
  • Detection and reporting
  • Rapid response
  • Health system
  • Compliance with international norms
  • Risk environment

Dr. Riazi cites the tale of two countries – Canada and the United States, often regarded as relatively similar – to show the role of infrastructure in practice.

"In Canada, there was early support for testing, ensuring manageable capacity in our healthcare system as well as implementing financial policies to support people so they would stay at home," she explains. "Of course, the pandemic played out differently in long-term care which needs to be addressed but, otherwise, we did really well."

"In the U.S., initial focus was on travel restrictions for visitors which may have helped with cases in the short term. While the U.S. ranked as the country with highest GHS score, during the pandemic the categories that make up the GHS index were not implemented as planned.

"Testing was slow to ramp up and the economic policies weren't enough to encourage people to stay home," Dr. Riazi continues. "So here you have two countries with advanced health systems, but when it came to COVID-19, it was crucial to have the right health structures in place – the agencies to support the public health measures.

"Our research has shown that, globally, these areas of support matter," she concludes. "While we consider what is needed to face a second or third wave or even a new pandemic, these are the things focus on."

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