International Lessons Learned From Coronavirus Reopenings
This column was published in Center for American Progress,
Getty/AFP/Jonathan Nackstrand
A medical staffer at Sophiahemmet hospital in Stockholm talks on a cell phone
while exiting a tent for testing and receiving potential COVID-19 patients, April
How the US Response Compares to Those of Other

by Kelly Magsamen, Maura Calsyn, Michael Fuchs, Thomas Waldrop,
and Haneul Lee

Like the United States, many countries around the world are trying to
figure out, in real time, how to respond to the novel coronavirus.
Different countries have experienced and responded to the pandemic
in different ways, and some have been more successful than others
in managing the impacts due to a variety of factors—from testing
rates to the extent to which positive cases were isolated. Now, after
weeks, if not months, of lockdowns, some countries are beginning to
slowly reopen their economies, while others continue to struggle
with the spread of COVID-19. As the United States considers how to
safely reopen its economy, it should look to these international
experiences and develop policy responses to ensure a sustained U.
S. public health and economic recovery.

It is important to understand how and why, for instance, South Korea,
New Zealand, and Taiwan have been so successful, while Italy and
Spain have struggled; and in the case of Singapore, it looked
successful at first but is now experiencing a resurgence in cases.
But there are some general lessons that the United States can learn
from others in terms of how to begin reopening the economy safely. Above all else, it must act quickly to mitigate the virus’s spread; reopen businesses
in measured, careful steps, only after there has been significant progress in slowing the spread of the virus; and have in place adequate testing and
contact tracing, which will allow for
evidence-based decision-making.

Key preliminary findings
So far, most countries have had to cope with the effects of the COVID-19 pandemic. And while it is still early in the world’s response to the virus, it is
already clear that some countries have been able to manage the impacts of the virus more successfully than others. Every country is different, but to
determine what lessons can be learned across a variety of different cases, this analysis studies the actions that nine countries in particular—Denmark,
Germany, Italy, New Zealand, Singapore, South Korea, Spain, Sweden, and Taiwan—have taken to deal with COVID-19. It also examines the steps that
these countries have taken to reopen society in the wake of the initial wave of the disease. Based on this analysis, the United States can learn the
following lessons.

Early action is essential: Across the world, almost every country that has been successful in tackling the pandemic acted early. South Korea and
Germany began testing their populations very early in the crisis, and by April, Germany was testing 350,000 people a week. New Zealand imposed a
national lockdown before anyone had died. And Taiwan had enacted travel restrictions, begun isolating presumed positives, and banned the export of
personal protective equipment (PPE) in January. In contrast, even after locking down certain towns in early February, Italy waited more than two
weeks before ordering a national lockdown, by which point the disease had spread widely. It is clear that the countries with the most success took
early and aggressive steps on lockdowns, testing, and contact tracing while isolating those who tested positive or were at high risk of having the

The public health response cannot be considered separate from the economic recovery: Countries only considered partially reopening their economies
once they had flattened the curve. After five weeks of a national lockdown, New Zealand considered its response to be a success and began the
process of slowly easing its lockdown. Germany made the decision to begin opening parts of the country only after it had flattened the curve, lowered
its transmission rate to a manageable level, and had unused hospital capacity. Denmark was able to flatten its curve and maintain extra hospital and
health care capacity, which allowed it to make the decision to start to reopen.

Safely reopening requires testing and contact tracing: The availability of reliable and expansive testing and contact tracing is key to reopening. South
Korea has consistently been one of the top countries in terms of per-capita testing, and it has also developed a tracking system that includes
notifications sent to phones when they have been near someone with COVID-19. Taiwan quickly created a similar system for tracing individuals based
on risk factors for COVID-19, alerting officials of those at risk and even locating people with respiratory problems who had tested negative for the flu in
order to test them for COVID-19. New Zealand’s prime minister has claimed one of the highest test rates in the world and says that the country has the
capability to test 8,000 people a day in a country of only 5 million. Such widespread testing and surveillance capability will be necessary to monitor any
resurgence of the disease but will need to be balanced with privacy concerns; approaches taken in some countries may not be politically or legally
possible in the United States.

Even after reopening, continued social distancing is necessary: Those countries that are beginning to reopen their economies are doing so with ongoing
social distancing requirements and only allowing select businesses to resume operations. While New Zealand is opening many businesses, factories,
and schools, it is keeping public gathering places such as museums, libraries, and gyms closed. Moreover, it has asked people who can to continue
working from home and has imposed limits on the kinds of gatherings that are permitted; events such as weddings and funerals, for example, have
limits of 10 people. Denmark and Germany, meanwhile, are easing restrictions by allowing parts of schools to reopen, along with businesses that follow
certain precautionary measures. And Taiwan—which, due to its prompt response to the outbreak, did not have to impose strict lockdown measures in
the first place—maintains widespread temperature checks, and many of its businesses have asked customers to keep 1 1/2 meters apart and wear
face masks.

Additional waves of the virus should be expected: The United States should be prepared for additional waves of COVID-19 outbreaks and develop
threshold criteria for putting restrictions back in place. After initial success in coping with the virus early on in the pandemic, Singapore has
experienced a second wave of infections, likely due to a failure to enforce precautionary measures in populations of migrant workers. Singapore has
now, for the first time, imposed a national lockdown.

Every country is different: South Korea and Taiwan acted very early by adopting measures such as testing, contact tracing, and isolation; they did not
even need to impose national lockdowns. New Zealand, on the other hand, imposed a national lockdown before a single person had died. It might seem
obvious, but it is important to note that every country is different: Demographics are different, health care infrastructure and workforces are different,
and the way in which the virus spreads through countries can also be different. This is why it is vital that every country tailor its response to its own
unique situation. Especially in larger systems—including federal systems such as the United States and Germany—strategies need to be determined not
only at the national level but also at subnational levels.

The unique case of Sweden
Sweden’s experience with the COVID-19 pandemic to date does not seem to fit as neatly into the lessons learned from other countries. It has seen
a higher fatality rate than have other European countries that imposed lockdowns—for example, Denmark—but far lower cases and fatality rates than
countries such as Italy and Spain. In addition, Sweden has maintained a relatively low level of transmission despite not taking aggressive steps to
impose a national lockdown. Some have attributed this to its strong health care system and high levels of public trust, which have presumably led
people to be cautious and pursue social distancing without mandates from the government. Even still, the brunt of the impact seems to have been
borne by Sweden’s elderly community and nursing homes, which may have suffered because of the lack of early measures. There are also some
who claim that Sweden is attempting to gain herd immunity, though the government denies it.

How the United States compares
As of the beginning of May, the United States has more total confirmed cases and deaths from COVID-19 than any other country. After examining how
other countries have managed this crisis, it is clear that the disastrous impact of the virus in the United States is a direct result of the federal
government’s slow and uncoordinated response.

The United States did not act early. While countries such as South Korea and Taiwan moved so swiftly that they have not even had to impose national
lockdowns, the United States waited months before marshaling a federal response to the pandemic—a deadly delay that caused the nation to
experience devastation amid a lockdown similar to those imposed in other hard-hit countries such as Italy and Spain. Likewise, certain U.S.
localities that took decisive action early in the crisis have fared much better than those that were slow to take action.

The United States still has not put in place the components of a national strategy to safely reopen its economy. It neither has the wide-scale testing and
contact tracing of South Korea nor the high levels of testing in place in Germany and New Zealand. Until the United States has adequate operations in
place for testing and tracing, reopening the economy would be dangerous—and likely lead to a second wave of infections.

The road ahead
While recognizing its own unique needs and situation, the United States should learn the lessons of countries that have already been successful in
flattening the curve and are starting to reopen segments of their economies. The essential elements of the policies implemented by those countries are
reflected in the Center for American Progress’ plan to end the coronavirus crisis. They include:
National stay-at-home policy: A 45- to 60-day national stay-at-home policy is an essential first step for containing the spread of COVID-19.
Increase in testing and production of PPE: Testing must be expanded to include all individuals with a fever as well as those who have come in
contact with a confirmed COVID-19 case.
Rapid contact tracing and isolation policies: Mobile phone data should be used to anonymously track contacts and alert individuals exposed to the
virus. These data must be administered by a public health nonprofit and protected from use by third-party entities.
Travel restrictions and protections: Nonessential travel should remain minimized. Congress must pass additional infrastructure funds and operational
subsidies to ensure that transit authorities can continue operating and can make necessary changes to reduce the risk of transmission, such as by
installing protective barriers for bus drivers and more frequently sanitizing buses, trains, and paratransit vans.
Guidelines on face mask usage: The Centers for Disease Control and Prevention should issue guidelines on the use of face masks until herd immunity
is reached.
Gradual lifting of restrictions: Even once reopening has begun, gatherings of 50 or more people should remain prohibited, remote work should be
continued where possible, and public transit restrictions should remain in place to reduce risk for individuals most reliant on it.

While it is too early to make any firm conclusions for the United States based on international case studies, it is clear that there are key emerging factors
separating success from outright failure. The United States has a lot to learn from the world, including from some of its closest democratic allies. In the
weeks and months ahead, a more coordinated international response will be necessary to beat this pandemic. The United States must pursue greater
dialogue and cooperation on everything from reopening experiences to vaccine research and development. Only then will it be able to respond
effectively to COVID-19, as well as the next pandemic.

Kelly Magsamen is the vice president for National Security and International Policy at the Center for American Progress. Maura Calsyn is the managing
director of Health Policy at the Center. Michael Fuchs is a senior fellow at the Center. Thomas Waldrop is a policy analyst for Health Policy at the Center.
Haneul Lee is a research assistant for Asia Policy with the National Security and International Policy team at the Center