Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Harry Radzyner Law School, Reichman University, Herzliya, Israel.
Isr J Health Policy Res. 2023 Jan 30;12(1):5. doi: 10.1186/s13584-022-00549-2.
Early in the coronavirus disease 2019 (COVID-19) pandemic, governments implemented exceptional public health measures (PHMs) in the face of uncertainty. This study aimed to compare mitigation policies implemented by Israel and their timing in the first wave of the pandemic to those of other countries, and to assess whether country characteristics such as democracy, trust, education, economic strength and healthcare reserve were associated with decision-making.
PHMs and pre-pandemic characteristics, using internationally accepted indices, of 50 countries were collected from 1/1/2020-30/06/2020; and associations between them were assessed. Time to implementation of these measures was compared among the Organisation for Economic Co-operation (OECD) nations. Log-rank test was used for univariate analysis. Cox regression was performed to assess the independent contribution of pre-pandemic characteristics to time-to-implementation of measures. Correlations between timing of specific measures and COVID-19 mortality at 60 days were assessed.
Israel ranked in the upper third of the OECD in swiftness to implementation of eight of the ten measures compared. In univariate survival analysis, countries with an education level below the OECD median were more likely to implement a lockdown (p-value = 0.043) and to close restaurants and entertainment venues (p-value = 0.007) when compared to countries above the OECD median. In Cox regression models, controlling for geographic location, democracy level above the OECD median was associated with a longer time-to-implementation of a lockdown (HR=0.35, 95% CI=0.14-0.88, p-value=0.025). Similarly, a high level of GDP per capita was inversely associated with closing schools; and a high level of education inversely associated with closure of restaurants and entertainment venues. Earlier initiation of all PHMs was associated with lower mortality at 60 days, controlling for geographic location.
Israel's initial response to the pandemic was relatively quick, and may have been facilitated by its geographic isolation. Countries with lower pre-pandemic socio-economic indices were quicker to initiate forced social distancing. Early initiation of PHMs was associated with reduced mortality in the short run. Timing of initiation of measures relative to the country-specific spread of disease is a significant factor contributing to short-term early local pandemic control, perhaps more than the exact measures implemented. It is important to note that this study is limited to the initial pandemic response. Furthermore, it does not take into account the broader long-term effects of certain PHMs, which should be a focus of further research.
在 2019 年冠状病毒病（COVID-19）大流行早期，各国政府在面对不确定性的情况下实施了特殊的公共卫生措施（PHM）。本研究旨在比较以色列在大流行第一波期间实施的缓解政策及其时间安排，并评估国家特征（如民主、信任、教育、经济实力和医疗保健储备）是否与决策相关。
从 2020 年 1 月 1 日至 2020 年 6 月 30 日收集了 50 个国家的 PHM 和大流行前特征，使用国际公认的指数；评估了它们之间的关联。比较了经济合作与发展组织（OECD）国家实施这些措施的时间。单变量分析采用对数秩检验。进行 Cox 回归分析，以评估大流行前特征对措施实施时间的独立贡献。评估了特定措施的时间与 60 天 COVID-19 死亡率之间的相关性。
在比较的十项措施中，以色列在实施其中八项措施的速度方面位列 OECD 的上三分之一。在单变量生存分析中，教育水平低于 OECD 中位数的国家更有可能实施封锁（p 值=0.043），并且更有可能关闭餐馆和娱乐场所（p 值=0.007），而不是教育水平高于 OECD 中位数的国家。在 Cox 回归模型中，控制地理位置后，民主水平高于 OECD 中位数与实施封锁的时间延长有关（HR=0.35，95%CI=0.14-0.88，p 值=0.025）。同样，人均国内生产总值较高与关闭学校呈负相关；而教育水平较高与关闭餐馆和娱乐场所呈负相关。在控制地理位置的情况下，所有 PHM 的早期启动均与 60 天死亡率降低相关。
以色列对大流行的初始反应相对较快，这可能得益于其地理位置的孤立。大流行前社会经济指标较低的国家更快地开始强制社会隔离。PHM 的早期启动与短期死亡率降低相关。与疾病在特定国家的传播相关的措施启动时间是短期早期本地大流行控制的重要因素，可能比实施的确切措施更为重要。需要注意的是，本研究仅限于大流行的初始反应。此外，它没有考虑到某些 PHM 的更广泛的长期影响，这应该是进一步研究的重点。
