Did We Respond Quickly Enough? How Policy‐Implementation Speed in Response to COVID‐19 Affects the Number of Fatal Cases in Europe

• Published date: 01 December 2020
• Author: Reinhold Stockenhuber
• Date: 01 December 2020
• DOI: http://doi.org/10.1002/wmh3.374

413

doi: 10.1002/wmh3.374

© 2020 Policy Studies Organization

Did We Respond Quickly Enough? How

Policy‐Implementation Speed in Response to COVID‐19

Affects the Number of Fatal Cases in Europe

Reinhold Stockenhuber

The health crisis caused by COVID‐19 reached Europe by February 2020, with remarkable differences

in its potency by nation (ECDC, 2020). This effectively caused variation in mitigation efforts in

European countries, in opposition to the World Health Organization's recommendations to a common

response. Highly contrasting policies were implemented by neighboring countries, from “stay‐at‐

home”requirements to very light restrictions. Furthermore, the application time of these measures

was extremely variable across Europe. This study investigated whether the stringency of containment

policies and the implementation speed of 24 European countries may have affected the number of

COVID‐19‐associated casualties. The overall stringency (i.e., the containment measures in place)

fluctuated over time and by country, which prohibited a clear association with the mortality rate.

Importantly, the implementation speed of these containment measures in response to the coronavirus

had a strong effect on the successful mitigation of fatalities. The results also suggest that early

adopters of strategies are likely to return to normal life more rapidly. Based on these data, the

implementation of containment measures at the very early stages of a future health crisis is highly

recommended to reduce the negative impact on society and improve the speed of recovery.

KEY WORDS: COVID‐19, policy implementation, Europe, risk communication

Introduction

A novel coronavirus was detected in December 2019 in Wuhan, a metropolis in

the Chinese province Hubei (Zhu, Wei, & Niu, 2020). Owing to high reproduction

rates (Liu, Albert, Wilder‐Smith, & Rocklöv, 2020), it dispersed rapidly, and by

April 15, 2020, over two million people were infected worldwide (Dong, Du, &

Gardner, 2020). Global spread and potential hazards were recognized by the

World Health Organization (WHO)on January 30, 2020 (World Health Organ-

ization, 2020b). From this date, the novel coronavirus, then called 2019‐nCoV, today

known as COVID‐19, was declared as “Public Health Emergency of International

Concern”(World Health Organization, 2020b). By March 12, 2020, the WHO ac-

knowledged a pandemic spread of COVID‐19 (World Health Organization, 2020c).

Policymaking in the course of a pandemic generally focuses on (i)containment

or if failing to do so, (ii)mitigation of potentially catastrophic events toward short

occurrences with as low as possible impact on society. A strategic paper on social

distancing policies, urging governments to act swiftly and in unison, was for-

mulated by the WHO on February 3, 2020 (World Health Organization, 2020a).

These recommendations were partly in effect in countries that reported COVID‐19

outbreaks ahead of the WHO recommendations, such as in Taiwan, China, and

South Korea and helped to alleviate the spread of the virus.

In Europe, policies to mitigate the spread of the novel coronavirus were for-

mulated gradually and country‐by‐countryratherthaninajointactionplan.Hence,a

wide variety of social distancing measures were put in place: from “stay‐at‐home”to a

“none‐at‐all”(herd immunity)approach. The implementation of these measures also

varied over time, and often multiple containment policies were applied in blocks, thus

obstructing the disentanglement of single measures (ECDC, 2020).

A recently introduced framework using a stringency score for all containment

measures in place over time (Hale, Petherick, Phillips, & Webster, 2020)may allow

comparing countries' efforts to overcome the effects of COVID‐19. The main mo-

tivation of this study was to identify whether an overall stringency level of social

distancing measures in place and the time to the implementation of the strictest

policies would be associated with the number of fatalities linked to COVID‐19. This

may give important information for policymakers in response to future health

crises. Data from 24 European countries were compared with determine if and how

social distancing measures and the national response speed to COVID‐19 correlate

with the number of fatalities.

The results suggest that the swiftness of reaching a national policy rather than the

rigidity of the containment measures mitigated the number of fatalities in that country.

Material and Methods

Data for the number of COVID‐19 infections and deaths and policy information for

24 countries (Appendix Table 1)were acquired from the Oxford COVID‐19 Govern-

ment Response Tracker (OxCGRT)version 6.0 (Hale et al., 2020). Multiple social dis-

tancing measures were often introduced at one point in time or in very short time

intervals (ECDC, 2020). Therefore, rather than testing the effects of single measures

implemented, this study incorporated the OxCGRT stringency index that covers eight

social distancing measures and one prevention measure (Hale et al., 2020).

Data related to health statistics were collected from the European Health for All

family of databases (HFA‐DB, WHO), information on urbanization was collected from

the World Bank and population counts from Eurostat, respectively (Tables 1 and 2).All

following steps were performed using R version 3.5.1 (R Core Team, 2018).Figures

were created with R packages factoextra (Kassambara & Mundt, 2020), ggplot2

(Wickham, 2016), ggpubr (Kassambara, 2020), and ggrepel (Slowikowski et al., 2020).

Principal Component Analysis (PCA)

PCA was performed with the “prcomp”function in the R‐core package stats for

selected seven different variables to count data to detect major partitioning effects

of the 24 countries of interest (Table 1).

414 World Medical & Health Policy, 12:4