Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW, Sydney, 2109, Australia.
NHMRC Partnership Centre in Health System Sustainability, Australian Institute of Health Innovation, Level 6, 75 Talavera Road, NSW, Sydney, 2109, Australia.
Int J Qual Health Care. 2021 Feb 20;33(1). doi: 10.1093/intqhc/mzaa113.
The health, social and economic consequences of the severe acute respiratory syndrome coronavirus (SARS-CoV-2, henceforth COVID-19) pandemic have loomed large as every national government made decisions about how to respond. The 40 Health Systems, COVID-19 (40HS, C-19) study aimed to investigate relationships between governments' capacity to respond (CTR), their response stringency, scope of COVID-19 testing and COVID-19 outcomes.
Data over March and April 2020 were extracted for 40 national health systems on prepandemic government CTR (Global Competitiveness Index), stringency measures (Oxford COVID-19 Government Response Tracker Stringency Index), approach to COVID-19 testing and COVID-19 cases and deaths (Our-World-in-Data). Multidimensional scaling (MDS) and cluster analysis were applied to examine latent dimensions and visualize country similarities and dissimilarities. Outcomes were tested using multivariate and one-way analyses of variances and Kruskal-Wallis H tests.
The MDS model found three dimensions explaining 91% of the variance and cluster analysis identified five national groupings. There was no association between national governments' prepandemic CTR and the adoption of early stringent public health measures or approach to COVID-19 testing. Two national clusters applied early stringency measures and reported significantly lower cumulative deaths. The best performing national cluster (comprising Australia, South Korea, Iceland and Taiwan) adopted relatively early stringency measures but broader testing earlier than others, which was associated with a change in disease trajectory and the lowest COVID-19 death rates. Two clusters (one with high CTR and one low) both adopted late stringency measures and narrow testing and performed least well in COVID-19 outcomes.
Early stringency measures and intrinsic national capacities to deal with a pandemic are insufficient. Extended stringency measures, important in the short term, are not economically sustainable. Broad-based testing is key to managing COVID-19.
严重急性呼吸系统综合征冠状病毒（SARS-CoV-2，简称 COVID-19）大流行对各国政府造成了巨大的健康、社会和经济影响，各国政府都在权衡如何应对。40 个卫生系统、COVID-19（40HS、C-19）研究旨在调查各国政府应对能力（CTR）、抗疫措施严格程度、COVID-19 检测范围和 COVID-19 结果之间的关系。
2020 年 3 月至 4 月期间，对 40 个国家的卫生系统进行了研究，收集了各国政府在大流行前的应对能力（全球竞争力指数）、抗疫措施严格程度（牛津 COVID-19 政府反应追踪器严格程度指数）、COVID-19 检测方法和 COVID-19 病例和死亡人数（我们的世界数据）等方面的数据。采用多维标度（MDS）和聚类分析来检验潜在维度，并直观地展示各国之间的相似性和差异性。采用多元方差分析和单向方差分析以及 Kruskal-Wallis H 检验来检验结果。
MDS 模型发现了三个维度，解释了 91%的方差，聚类分析确定了五个国家群组。各国政府在大流行前的应对能力与早期采取严格的公共卫生措施或 COVID-19 检测方法之间没有关联。两个国家群组采取了早期严格措施，报告的累计死亡人数明显较低。表现最好的国家群组（包括澳大利亚、韩国、冰岛和中国台湾）采取了相对较早的严格措施，但更早地进行了广泛的检测，这与疾病轨迹的变化和最低的 COVID-19 死亡率有关。两个群组（一个应对能力高，一个应对能力低）都采取了后期严格措施和窄范围的检测，在 COVID-19 结果方面表现最差。
早期的严格措施和应对大流行的内在国家能力是不够的。短期内非常重要的扩展严格措施在经济上是不可持续的。广泛的检测是管理 COVID-19 的关键。
