Table 6 Examples of public health functions

From: Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries

Subdomain Snapshot of health systems resilience measures in reviewed countries
Countries with the least deaths per 100,0000, with a population of over 20 million Countries with the most deaths per 100,0000, with a population of over 20 million Countries in the middle category in terms of deaths per 100,000 population
Diagnostic testing strategies China: in Wuhan, two rounds of community-based mass screening were carried out with tests administered free of charge, resulting in 4.21 million households receiving the test to rule out potential sources of infection. Vietnam: the country had performed targeted testing. Initially, those with a travel history, who were close contacts of confirmed cases and those who showed symptoms were tested. This was later expanded to mass testing in entire hot spots or high-risk areas. Spain: to mitigate spread in the long-term care sector, the Interterritorial Council expanded the frequency and coverage of PCR testing in long-term care facilities. Peru: used mass antigen rapid testing to find COVID-19 cases among the national police force, urban transport and food market workers. New Zealand: testing was performed for all symptomatic individuals or people who were identified as being in close contact with a positive case. Border testing was also mandatory. The government ensured access to testing was effective and equitable for all groups, in particular Māori and Pacific islanders. Uruguay: tests were randomly conducted on construction workers covering the entire country to identify any potential clusters during reopening measures; active case finding was also conducted in senior’s homes across the country. Additionally, Uruguay had also implemented an open testing policy at its borders regardless of symptoms.
Increasing laboratory capacity Vietnam: increased the number of testing laboratories nationwide from 3 in January 2020 to 112 by April 2020. Mozambique: national testing capacity from public laboratories increased from around 60 tests per day in April 2020 to 3,186 tests per day across the country in November 2020. Expanded laboratory capacity to seven of eleven provinces either through open PCR platforms or through existing platforms in clinical laboratories. Peru: decentralized test processing throughout the national territory by equipping and training staff of Regional Reference laboratories. Argentina: in March, the Ministry of Health started the delivery of 35,000 reagents to expand testing to 21 laboratories for diagnosis in all 24 jurisdictions in an effort to decentralize test processing. Pakistan: the National Disaster Management Authority worked with the National Institute of Health to increase the number of laboratories from 15 to 144 as of November 2020, thus increasing the number of tests conducted per day. Uruguay: rapidly developed a network of 24 laboratories known as the ‘COVID-19 diagnostic lab network,’ which increased diagnostic capacity from 200 tests per day in March to nearly 1,000 per day by the end of May.
Contact tracing policies China: all cases undergo contact tracing; county/district level CDC staff should complete contact tracing within 24 h after receiving the reports of suspected or confirmed cases. Vietnam: ‘Four Tier’ contact tracing process based on the degree of contact from the infected individual (F0), to the person who had close contact (F1), to the person who had close contact with F1 (F2+), all the way to F5. United Kingdom: implemented NHS Test and Trace to ensure that people who develop COVID-19 symptoms can quickly be tested, which includes asymptomatic testing of NHS, social care staff and nursing home residents. If positive, the NHS will ask for details of close contacts to be shared via a secured website or through a call with contact tracers. Argentina: the Detectar program, launched in May 2020, is a unified national protocol for proactive case detection and contact tracing in communities, with an emphasis on vulnerable communities. Japan: conducted retrospective contact tracing (14 d before symptom onset) to identify the source of the infection and break up clusters. Sweden: infected individuals are themselves responsible for contacting people who they may have infected.
Contact tracing teams Mozambique: contact tracing is carried out by staff at the National Institute of Health with assistance from medical residents, and students from the master program on Field Epidemiology and Laboratory Training, supported by the Centre for Disease Control. Sri Lanka: contact tracing is carried out by community physicians, regional epidemiologists and nearly 900 medical officers of health from 357 Ministry of Health areas in late January 2020. United States: some states have increased their number of employees and volunteers to meet the demand for contact tracing staff, while others have reassigned state and county staff to contract tracing responsibilities. Argentina: contact tracing is conducted by teams of volunteers, or reassigned personnel, as well as by primary-care teams, or through specific field operations. Germany: public employees from other areas of the bureaucracy were transferred to help identify and control COVID-19 outbreaks. In areas that have been particularly affected, soldiers and officials of the armed forces were called to support contact tracing efforts. Liberia: contact tracers were recruited from communities and trained on their roles and responsibilities.
Quarantine strategies Thailand: close contacts or those suspected to be infected are mandated to be quarantined either at home or in a state facility, under the close supervision of health workers. They are tested twice—on 7th day and 14th day. Uganda: implemented auto-monitoring of case contacts for 14 d. The person under auto-monitoring measures his or her temperature twice a day and makes sure there are no breathing problems or coughing. During auto-monitoring, normal activities can be continued. Spain: contacts are not actively followed up or tested, but they are instructed to quarantine at home for 10 d. The health authorities may assess individual situations that require other types of recommendations if needed. United States: policies to provide facilities for close contacts have focused on workers who are expected to be in close proximity to infected individuals such as first responders and health workers, not family or other contacts exposed to people with COVID-19. New Zealand: people who have been in close contact with a person who has confirmed or probable COVID-19 need to self-isolate for 14 d from the last date of contact with the infected individual while they were considered infectious; in some cases, they may be able to quarantine in a facility (for example, if a dependent has confirmed COVID-19). Nigeria: the International Organization for Migration will construct, manage and maintain self-quarantine shelters to quarantine internally displaced persons and host community members with travel and contact history, as well as new arrivals from other towns.
Self-isolation strategies (home-based) Mozambique: institutional isolation in a health establishment if therapeutic criteria are met. If the symptoms are mild, they will be isolated at home for recovery. Uganda: auto-isolation applies to people who have symptoms of COVID-19 but whose infection is not confirmed. They are required to stay home for 7 d from the onset of symptoms and avoid contact with other people if possible. Once the symptoms have resolved, they must stay at home for another 24 h. Brazil: symptomatic individuals are asked to stay home for 14 d and to be hospitalized if condition worsens. Spain: phone hotlines are offered for nonhospitalized patients with COVID-19 who are required to self-isolate at home. Nigeria: offers home care management for patients with mild to moderate cases of COVID-19. Egypt: once diagnosed, those with mild symptoms go home, while those with medium to serious symptoms remain in the hospital.
Self-isolation strategies (designated facilities) China: all confirmed cases will be isolated and treated at COVID-19 designated hospitals and treatment facilities. Thailand: government-subsidized hotels, public or private dorms were modified to isolate asymptomatic cases. United States: isolation strategies vary by state. In New York, officials collaborated with hotels to provide shelter for people not ill enough to be admitted at the hospital and for patients who had been discharged but not quite recovered. Peru: persons considered to have suspected, probable or confirmed COVID-19 who do not require hospitalization but do not have domestic conditions that guarantee isolation in a room with adequate ventilation and hygienic services will be offered housing in a temporary isolation center for follow-up. Fiji: community isolation centers are used to isolate people with mild symptoms and who were determined as low risk for developing severe COVID-19. Japan: asymptomatic cases and patients with mild symptoms who do not require hospitalization can recuperate at designated lodging facilities.
Social and economic support for the general public to aid adherence to public health interventions Sri Lanka: the Presidential Task Force collaborated with cooperative societies and supermarket chains to offer home delivery of food to prevent uncontrolled gathering of people at marketplaces. Niger: implemented price controls for essential goods for food distributions and 2 months of free utilities to vulnerable households. The Council of Ministers declared the implementation of state support for electricity and water bills for the months of April and May 2020. Argentina: the government prohibited basic public service companies, such as those providing electrical energy, water, gas, mobile telephones, internet and TV cable, from suspending their services due to lack of payment by certain people, for up to three periods of payment. United Kingdom: over 1 million food boxes have now been delivered to those most at risk from coronavirus through the shielding program. Uruguay: subsidy of up to 50% of rent for individuals enrolled in the unemployment insurance. Flexible agreements on mortgage payments either with a discount or with deferral of installments, with further deferrals for pensioners or retirees. Russia: citizens with a mortgage or consumer loan could take advantage of debt standstill for the period of up to 6 months in the event of a decrease in income by 30% or more; citizens of the Russian Federation who lost their jobs due to the COVID-19 pandemic had the maximum unemployment benefit, regardless of the length of service and level of earnings.
Surveillance strategies Sri Lanka: the Ministry of Health requests mandatory case reporting by all healthcare institutions. Active surveillance in communities is conducted through contact tracing. Mozambique: multiple surveillance strategies, involving sentinel surveillance, serological surveillance, active surveillance at entry points and through contact tracing. United States: the CDC deploys multiple surveillance systems, including case reporting, syndromic surveillance and surveillance systems for influenza and respiratory diseases. Mexico: case reporting by 475 Viral Respiratory Disease Monitoring Units and medical units, which reported cases to a centralized system called the Epidemiological Surveillance System for Viral Respiratory Diseases of the Mexican Ministry of Health. New Zealand: multisource surveillance systems, involving mandatory case reporting, sentinel surveillance, syndromic surveillance, serological surveillance and scenario modeling. Japan: multiple surveillance strategies, including case reporting by healthcare providers, active surveillance of suspected cases, and monitoring the use of medical consultation hotlines among the public. Additionally, LINE Corporation also implemented its own COVID-19 syndromic surveillance system that collects demographic information and reported symptoms.
Contact tracing technologies Vietnam: NCOVI mobile app creates a ‘neighborhood watch system’ for citizens. It includes a map of positive cases and clusters, enables users to declare their health status and report suspected cases. Thailand: Thai Chana online platform launched to facilitate monitoring of customers at shops; those who come in close contact with infected people are notified and called for testing. Spain: Radar COVID app is based on the DP-3T protocol and uses the Apple/Google API for contact tracing. United Kingdom: NHS COVID-19 contact tracing app allows users to scan official NHS QR code posters at businesses, venues and transport hubs for contact tracing purposes. Russia: ‘Stopcoronavirus. My Contacts,’ scans the user’s surroundings in a 10-m radius and measures how close and for how long they interact with other users. Users who become infected will voluntarily notify the app, which then sends alerts to all others who were in close proximity to them. Singapore: TraceTogether, a mobile app or token-based proximity tracing tool (non-location based) using Bluetooth technology to identify contacts of people with confirmed COVID-19.
Online or phone-based case management tools for the public Niger: the Urgent Medical Aid Services have set up a green line. All callers with symptoms of COVID-19 will be redirected to the center, examined and tested. Mozambique: online risk assessment for exposure and risk factors, with toll-free hotlines to direct people who are eligible for testing at National Health Institute public laboratories or private laboratories in the different provinces. Spain: mobile app for citizens to self-assess their health status, provide recommendations and direct to onwards care. Mexico: coronavirus information hotline, mobile app and text services are made available for questions and self-assessment of COVID-19. Pakistan: Ministry of Health launched the Corona Helpline on WhatsApp which provides up-to-date information about COVID-19 using an automated ‘chatbot’ service to obtain information 24 h a day. Russia: implemented a hotline for COVID-19-related information and also a source of triaging potential cases. At the request of the Rospotrebnadzor, all regions have established their own hotline.
Surveillance databases Vietnam: an online COVID-19 reporting system was developed, which allows the Ministry of Health to access and analyze epidemiological developments across the country in real time. China: the China CDC launched a web-based surveillance system that allows real-time reporting of COVID-19 cases by healthcare providers. United States: data on COVID-19 cases is sent to the National Notifiable Disease Surveillance System managed by the CDC. Brazil: a new surveillance tool for COVID-19 case reporting was developed based on the existing surveillance system for flu-like symptoms. Japan: the Ministry of Health, Labour and Welfare launched the COVID-19 Surveillance and Management System (HER-SYS), which is an online reporting system. Fiji: The SORMAS (Surveillance, Outbreak Response Management and Analysis System) is deployed for real-time digital surveillance and early detection of outbreaks.
  1. Countries were selected according to the recorded number of deaths attributed to COVID-19 per 100,000 inhabitants on 6 November 2020. API, application programming interface.