LTCcovid Country Profiles

Responses to 3.01. Brief summary of the overall pandemic response (not specific to Long-Term Care)

The LTCcovid International Living report is a “wiki-style” report addressing 68 questions on characteristics of Long-Term Care (LTC) systems, impacts of COVID-19 on LTC, measures adopted to mitigate these impacts and new reforms countries are adopting to address structural problems in LTC systems and to improved preparedness for future events. It is compiled and updated voluntarily by experts on LTC all over the world. Members of the Social Care COVID-19 Resilience and Recovery project are moderating the entries and editing as needed.

The report can be read by question/topic (below) or by country: COVID-19 and Long-Term Care country profiles.

To cite this report (please note the date in which it was consulted as the contents changes over time):

Comas-Herrera A, Marczak J, Byrd W, Lorenz-Dant K, Pharoah D (eds.) and LTCcovid contributors. LTCcovid International living report on COVID-19 and Long-Term Care. LTCcovid, Care Policy & Evaluation Centre, London School of Economics and Political Science. https://doi.org/10.21953/lse.mlre15e0u6s6

Copyright is with the LTCCovid and Care Policy and Evaluation Centre, LSE.

The first case of COVID-19 in Australia was identified on January 25, 2020, from a man who travelled from Wuhan to Melbourne. Prime Minister Scott Morrison announced the Australian Health Sector Emergency Response Plan for Novel Coronavirus on February 27 and the first economic stimulus package on March 12. By mid-March, most states and territories were in lockdown. Cases began falling across the country in April and on May 8, the government announced a three stage plan to ease lockdown restrictions. Victoria entered its second wave in late June and by October 26, it reported no new cases or deaths. COVID-19 cases have been stable nation-wide since October 2020 (sources: WHO; health.gov; Lupton, UNSW).

A report was published by the Parliament of Australia, which provides a chronological overview of the measures implemented across states and territory governments in response to the COVID-19 pandemic as well as when these measures were eased again (until June 2020). Measures included border restrictions, visiting restrictions at health sites, closure of non-essential businesses and activities, and remote learning for pupils.

A National Plan to transition Australia’s National COVID-19 response was agreed in August 2021, with transitions to less restrictive measures being triggered by the rates of vaccination, with a plan to move to a Phase C, with only very highly targeted lockdowns and re-opening of borders, once 80% of the population aged 16 and over are fully vaccinated (with two doses). It was expected that all jurisdictions in Australia would reach this threshold and enter phase C by the end of 2021.

Professor Deborah Lupton has characterised six phases in the management of COVID-19 risk in Australia:

  • – ‘A distant threat’ January 2020 to February 2020
  • – ‘The National Lockdown’ March 2020 to May 2020
  • – ‘COVID Zero’ June 2020 to January 2021
  • – ‘Vaccine Dilemmas’ February 2021 to May 2021
  • – ‘Delta Response’ June 2021 to September 2021
  • – ‘Living with COVID’ since October 2021

Since October 2021 the Government’s policy has been to ‘learn to live with COVID-19’, accepting higher case numbers, hospitalisations and deaths, particularly for people not yet fully vaccinated.

Last updated: January 9th, 2022


The first presumptive positive case of COVID-19 in British Columbia was found on January 28, 2020. The first case of community transmission was announced on March 5. On March 18, a provincial state of emergency was declared in British Columbia and by the end of March, all schools, personal service establishments, and dine-in restaurant services were closed. Health officials considered British Columbia to be successful in flattening the curve by late April and on June 24, the province entered phase 3 of its restart plan where most establishments were allowed to reopen and non-essential travel within the province resumed. A second wave of COVID-19 was declared in British Columbia on October 19 and in November, mandatory mask policies and new restrictions against social gatherings were introduced. In December, Pfizer and Moderna vaccines were approved for use in Canada. The first dose of COVID-19 vaccine in British Columbia was administered on December 15. As of January 29, 2021, 129,421 vaccine doses have been administered. Current restrictions on social gatherings, restaurant services, fitness centres, and travel have been extended indefinitely (Source: https://bc.ctvnews.ca/scroll-through-this-timeline-of-the-1st-year-of-covid-19-in-b-c-1.5284929).

Last updated: November 6th, 2021


Denmark was one of the first countries to introduce a lock-down. This started on March 13, 2020. All persons working in non-essential functions in the public sector were ordered to stay at home for two weeks. Private employers were encouraged to ensure that their employees could work from home. All public institutions, including secondary education, universities, libraries, and museums closed down. Exams were cancelled (Source: https://ltccovid.org/2020/05/28/new-country-report-the-covid-19-long-term-care-situation-in-denmark/).

Last updated: September 7th, 2021


The first wave was relatively mild. However, the second wave experienced mostly during December 2020 and January 2021, was a lot more severe (Source: https://www.zdf.de/nachrichten/heute/coronavirus-ausbreitung-infografiken-102.html). Since March 2021, a third wave is developing with currently high incidence rates and mounting pressure on the health system and critical care resources (Source: https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Situationsberichte/Apr_2021/2021-04-09-de.pdf?__blob=publicationFile), caused by a more infectious variant of SARS-CoV-2 (VOC B.1.1.7) becoming the dominant strain (Source: https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/DESH/Bericht_VOC_2021-03-31.pdf?__blob=publicationFile) and relaxation of measures to curb transmission at the beginning of March 2021 (Source: https://www.bundesregierung.de/breg-de/themen/coronavirus/fuenf-oeffnungsschritte-1872120).

General measures agreed between the Federal and the Länder governments include the closure of restaurants, bars, and non-essential retail outlets as well as cultural venues such as cinemas, theatres, and clubs. Wearing of masks in public (shops, transportation, workplace) is mandatory and employers and employees are urged to work from home whenever possible. An evening curfew 8pm – 5am had been in place for a while in some regions and there are restrictions in the number of people that are allowed to gather privately. The measures are being regularly revisited in meetings between the chancellor and the 16 Minister presidents. The Minister presidents have decision making power to alter some of the rules, which is why slight differences in measures can be observed across Germany. The rules also differ depending on the COVID-19 incidence (there are changes in rules even at the local level) (Sources: https://ltccovid.org/wp-content/uploads/2020/05/Germany_LTC_COVID-19-26-May-2020.pdf; https://www.bundesregierung.de/breg-de/themen/coronavirus/corona-diese-regeln-und-einschraenkung-gelten-1734724).

On April 23, 2021, a new infection prevention bill was enacted. The aim of the bill is to unify COVID-19 related measures across the country depending on local incidence levels (Source: https://www.bundesgesundheitsministerium.de/service/gesetze-und-verordnungen/guv-19-lp/4-bevschg-faq.html).

Last updated: September 8th, 2021


Following the experience with the SARS epidemic (2003), the government quickly imposed strict policies and guidelines in community and long-term care facilities. Already in late January 2020, the Social Welfare Department provided the first COVID-19 guideline ‘for special arrangements for publicly funded welfare services’. In addition to daily updates regarding its public services arrangements, the government also offers ‘helplines for daily necessities and/or food’ for people confined at home (Source: https://ltccovid.org/wp-content/uploads/2020/07/Hong-Kong-COVID-19-Long-term-Care-situation_updates-on-8-July-1.pdf).

In July 2020, with the development of a third wave, containment measures across society were escalated. This included screening and quarantine for foreign domestic workers entering Hong Kong, orderly return of travellers from higher-risk countries, mandatory COVID-19 testing and medical surveillance for crew members of aircrafts and vessels, tightening of social distancing measures, limiting of the number of people in restaurants and entertainment venues, and suspension of visits to LTC facilities, rehabilitation centres, and non-acute hospitals (Source: https://ltccovid.org/wp-content/uploads/2020/07/Hong-Kong-COVID-19-Long-term-Care-situation_updates-on-8-July-1.pdf).

Last updated: September 8th, 2021


Iceland began lifting its COVID-19 restrictions in June 2021. Even before that, from May 2021, the country’s international borders were open to travellers from selected regions meeting negative tests and (from 1 July) vaccination requirements. For travellers with close relatives in Iceland, a negative test is required within two days of entering the country.

In November 2021 the restrictions in place were:

  • The maximum number of people allowed in the same location is 50 (with certain restrictions) – in public and private locations, both indoors and outdoors. Restrictions on numbers and social distancing rules do not apply to children born in or after 2016.
  • Up to 500 people may attend an organised event if additional conditions are met – namely:
    • negative rapid antigen tests for all, taken less than 48 hours ago;
    • one-metre distancing rule except when seated;
    • all guests registered; and
    • face masks obligatory.

Sources:

Directorate of Health. (October 2021). COVID-19 instructions for outdoor and indoor areas. Retrieved from https://www.landlaeknir.is/um-embaettid/greinar/grein/item43697/COVID-19-Instructions-for-outdoor-and-indoor-areas

Low LF, Feil C, Iciaszczyk N, Sinha S, Verbeek H, Backhaus R, Fadnes Jacobsen F, Hulda Tómasdóttir Þ, Ayalon L, Dixon J and Comas-Herrera. (2021) Care home visitor policies: a rapid global scan of current strategies in countries with high vaccination rates. International Public Policy Observatory and LTCcovid.org.

Last updated: November 29th, 2021


A National Action Plan in response to COVID-19 was issued in March 2020. One of the aims is to ‘maintain […] critical and ongoing services for essential patient care’. This also captures long-term care services for different groups of people with needs for care and support. There is also a specific point on ‘Caring for our people who are ‘At Risk’ or vulnerable’.

By March 2020, additional public health restrictions emphasising the importance of people staying at home were published.

Last updated: September 7th, 2021


The pandemic was maintained at reasonably low levels of infection in Israel between February 21 (first case detected) and September 2020, with an effective first lockdown easing by May. In September, the first major wave coinciding with the Jewish High Holidays resulted in a second lockdown. This wave peaked at 6,276 cases on September 27. In tandem with a record-breaking vaccination campaign rollout, a second wave began in mid-December. The daily number of cases peaked at 8,624 on January 17, 2021, with the majority of cases due to a new, more virulent strain (Source: CGD)

As of November 24th 2021, a total of 8,178 people died due to COVID-19. However, due to massive vaccination, there are currently (November 2021) only 6,505 individuals defined as active COVID-19 patients, and 124 defined as severely ill. As of November 23rd 2021, only 603 new cases were identified.

The Israeli Ministry of Health was charged with leading the Government’s pandemic response, with publishing both weekly and daily press releases starting January 24, 2020. Lockdown measures were implemented the second week of March, which proved effective in terms of minimizing the rate of infection. According to the Government Stringency Index produced by the Oxford COVID-19 Government Response Tracker, the Israeli Government’s policies (e.g., stay at home orders, business closures) were most stringent in April at a score of 95 (when rates were low). In the first and second wave, the index measures were at 85 (with a significant drop to a score of 40 and a reopening of society in November 2020) (Source: Our World in Data).

 

Last updated: December 5th, 2021   Contributors: Shoshana Lauter  |  LIAT AYALON  |  


After the first two Covid-related cases in Italy were registered and confirmed in Rome on the 21st of January 2020, the Italian government suspended flights to China and declared a six-months state of emergency throughout the national territory with immediate effect on 31st of January 2020. At the same time, the Italian Council of Ministers appointed the head of the Civil Protection as Special Commissioner for the Covid-19 emergency. In the following days and weeks, additional regulations opened the possibility for the central government as well as other administrative levels (regions, cities etc.), in case of absolute need and urgency, to adopt stricter containment measures in order to manage the epidemiological emergency. At the end of February the first cases and deceased were registered in small towns in Northern Italy (Codogno, Vo’) that were placed under stricter quarantine(schools closed, public events cancelled, commercial activities closed etc.); on February 22rd carnival celebrations and some soccer matches were cancelled. On 1st of March, a Ministerial Decree established that the Italian national territory was divided in three areas: (i) Red zones (composed of Northern Italy municipalities that registered a certain level of COVID-19 cases where the population was in lockdown); (ii) Yellow zones (composed of regions of Lombardy, Veneto and Emilia-Romagna where certain activities were closed – schools, theatres – but people still had the liberty of limited movements); (iii) the rest of the nation where both safety and prevention measures were advertised but no further limitations were put in practice. On March 8th the government approved a decree to lockdown the entire region of Lombardy (and 14 other neighbouring provinces) establishing “the impossibility to move into and out of these areas” – with only few exceptions. Just a day later, on the evening of 9th of March, the government extended the Lombardy quarantine measures to the entire country. This national lockdown was expended several times until the 3rd May (Galeazzi et al., 2020).

If containment measures and lockdown were enforced by the central government, the same cannot be said for provisions detailing how the health sector and the LTC should respond to the COVID-19 crisis. In Italy, in fact, the health sector management and legislation fall within the competence of the Regional level; hence, especially during March and April all Italian Regions have adopted, at different times, plans, norms and decrees for managing the crisis.

Sources:

Galeazzi, A., Cinelli, M., Bonaccorsi, G., Pierri, F., Schmidt, A. L., Scala, A., … & Quattrociocchi, W. (2021). Human mobility in response to COVID-19 in France, Italy and UK. Scientific Reports11(1), 1-10

Last updated: November 23rd, 2021   Contributors: Elisabetta Notarnicola  |  Eleonora Perobelli  |  


Most of the early attention on Japan was focused on the Diamond Princess cruise ship: people on board started a 2 week quarantine on February 5, 2020 (Source: https://pubmed.ncbi.nlm.nih.gov/32183930/).

A published article gives an account of the different measures implemented in Japan during the COVID-19 pandemic.

Last updated: September 8th, 2021


During the first wave of the pandemic, southern regions of the Netherlands were hardest hit, with Carnival celebrations being one of the main accelerators. The second wave started in September 2020 and by November was most pronounced in the west, including in the large urban centres Rotterdam, the Hague, and Amsterdam. The Dutch government introduced an “intelligent lockdown” during the first wave. A regional approach was attempted at the beginning of the second wave, but was abandoned by mid-October 2020, when the government introduced a second lockdown, with similar rules like the first (Source: https://ltccovid.org/wp-content/uploads/2020/11/COVID-19-Long-Term-Care-situation-in-the-Netherlands-_-the-second-wave-25-November-2020-2.pdf). A published paper describes the economic and public health interventions during the first wave. An overview of measures to reduce community transmission, such as an overnight curfew, have been published online.

Last updated: September 8th, 2021


Since 25 September 2021, there have been no national COVID-19 restrictions in Norway. Since 6 October, all national borders were open, with no particular COVID controls in place. However, from 26 November, some entry restrictions have been reintroduced – namely, the duty of all travellers entering the country to:

  • register their entry at the border;
  • produce evidence of a negative Coronavirus test if they have no valid COVID-19 certificate; and
  • subject themselves to testing if they are neither fully vaccinated nor have had a COVID-19 infection during the previous six months.

Other possible national restrictions are being debated, but have not been announced as of 24 November.

Source:

Low LF, Feil C, Iciaszczyk N, Sinha S, Verbeek H, Backhaus R, Fadnes Jacobsen F, Hulda Tómasdóttir Þ, Ayalon L, Dixon J and Comas-Herrera. (2021) Care home visitor policies: a rapid global scan of current strategies in countries with high vaccination rates. International Public Policy Observatory and LTCcovid.org.

 

Last updated: November 29th, 2021


General measures introduced to manage the pandemic include early adoption of extensive testing and contact tracing, low cost tests and treatments covered by the health system, social distancing, and immigration control (Source: https://ltccovid.org/wp-content/uploads/2020/05/The-Long-Term-Care-COVID19-situation-in-South-Korea-7-May-2020.pdf).

The government plan to implement mass vaccination of key groups starting February 2021 (Source: https://www.reuters.com/article/us-health-coronavirus-southkorea-novavax/south-korea-in-talks-to-secure-40-million-doses-of-novavaxs-covid-19-vaccine-idUSKBN29P0BB). Laws introduced after earlier public health shocks (Sars in 2003 and Mers in 2015) allow the Korea Disease Control & Prevention Agency to access phone data, credit card records, and CCTV footage to trace people’s movements.

Last updated: September 7th, 2021


Singapore has put in place a multi-pronged strategy with an emphasis on epidemiological surveillance, case finding, testing, mandatory reporting, contact tracing and containment.

There is a strict isolation policy for people who test positive. If they are clinically unwell  according to a set clinical protocol, they are hospitalised. If they are clinically well are housed and cared for in designated community isolation facilities. These community facilities include hotels, army barracks, stadiums, and exhibition halls which have been repurposed. Clinically well individuals are closely monitored by designated healthcare professionals at these facilities.

Extensive contact tracings done for all positive cases, in April 2020 there were more than 1,300 Singapore Armed Forces personnel and civilians deployed to contact tracing. This is complemented with the use of technology.

The country has a Disease Outbreak Response System Condition (DORSCON) framework. The severity of an outbreak and associated actions are highlighted through a colour-coded system

Source:

Last updated: November 2nd, 2021


The overall Public Health response to COVID-19 in Sweden included staying at home if presenting with symptoms, good hygiene, physical distancing, and avoiding unnecessary travel. The strategy aimed to protect people older than 70 years and avoid overwhelming the health system (Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7455549/).

Last updated: November 30th, 2021


Thailand experienced the first wave of COVID-19 during March and April 2020, prompting the government to declare a nationwide emergency curfew on the 25th March 2020. Even if the government relaxed the measures after the first COVID-19 outbreak was declared to be under control in May 2020, most Thai people have continued to practice social distancing (Srifuengfung et al., 2021).

References:

Srifuengfung, M., Thana-Udom, K., Ratta-Apha, W., Chulakadabba, S., Sanguanpanich, N., & Viravan, N. (2021). Impact of the COVID-19 pandemic on older adults living in long-term care centers in Thailand, and risk factors for post-traumatic stress, depression, and anxiety. Journal of Affective Disorders, 295, 353–365. https://dx.doi.org/10.1016/j.jad.2021.08.044

Last updated: January 14th, 2022


The government imposted a curfew on people aged 65 and older, as of 22nd March 2020. This became became a partial curfew on the 1st of June 2020, when infection rates had started to decrease. The hours that people were authorised to go out varied according by region and changed according to infection rates. As of 22nd November 2020, individuals aged 65?years and over have been allowed to go out between 10:00–13:00?hours (Arpacioglu et al., 2021).

References:

Arpacioglu S, Yalçin M, Türkmenoglu F, Ünübol B, Çelebi Çakiroglu O. Mental health and factors related to life satisfaction in nursing home and community-dwelling older adults during COVID-19 pandemic in Turkey. Psychogeriatrics. 2021 Nov;21(6):881-891. doi: 10.1111/psyg.12762.

Last updated: January 12th, 2022


On the 1st March 2020, the first positive case of COVID-19 was confirmed in Scotland. Two days later, the UK Government announced its Coronavirus Action Plan; a four staged collective approach for the UK to contain and respond to the spread of the virus. The main advice given to the public at this stage was to wash their hands regularly with soap and water, for at least 20 seconds.

In the following months, a series of recommendations and guidance on isolating, social distancing and event closures were followed by the formal placement of the NHS on an emergency footing and eventually orders were enacted to ask all Scots to stay at home, as the UK entered lockdown on the 24th March 2020. School closures followed. Towards the end of May, the Scottish Government published its Routemap through the pandemic, outlining a five-phased approach to varying

Between May and July Scotland moved through Phases 1 to 3 of the Routemap. The test and protect scheme was rolled out from 28th May and the new contact tracing app was developed. By August, COVID-19 cases were increasing in certain parts of Scotland and localised restrictions were brought into place. On the 20th August 2020, the Scottish Government announced that Scotland would remain in Phase 3 and they set out updated dates for further changes.

Throughout September more localised restrictions were implemented as cases continued to spread and by November 2nd the new five-level strategic framework indicating varying levels of restrictions that would be required depending on the level of transmission of the virus came into effect.

The roll-out of the vaccination programme was announced in December with care home residents, their carers and frontline health care workers being vaccinated first. The over 80s would follow, along with other groups identified as being at risk of serious harm and death from the virus.

Further restrictions were introduced over the festive period and on 5th January mainland Scotland entered its second lockdown. All travel corridors were suspended from 18th January. At this point, the roll out of the vaccination programme was well under way and by 17th March, 44% of the adult population had received their first dose of the vaccine.

The second national lockdown would remain until restrictions began to be eased from 2nd April. From the 26th April, free lateral flow test kits were to be made available to anyone in Scotland without symptoms and Scots were encouraged to test themselves twice weekly. By the 15th May, 66.6% of eligible Scots had received their first dose of the COVID-19 vaccination.

Due to the success of the vaccination roll out, on the 19th July 2021, the whole of Scotland entered level 0. Up until November 2021, the focus of the Scottish Government has been continuing to administer vaccines, including the roll out of booster vaccinations.

Source:

https://spice-spotlight.scot/2021/11/26/timeline-of-coronavirus-covid-19-in-scotland/

Last updated: December 5th, 2021   Contributors: Jenni Burton  |  David Henderson  |  David Bell  |  Elizabeth Lemmon  |  


The United States has been the country hit hardest by the pandemic per capita. Public health responses have primarily been delineated by state and local government, but general stay-at-home and mask-wearing orders have been in place across the country since March 2020 (Source: https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm).

Last updated: September 8th, 2021


By the end of 2020, Vietnam had emerged as one of the few countries to effectively contain COVID-19, having gained epidemic response experience as one of the first countries in the world to successfully eliminate SARS in 2003. Vietnam had therefore made invaluable investments into its public health infrastructure prior to the current pandemic, including a national public surveillance system, a national public emergency operations centre (PHEOC), and four regional operations centres. These were all used to successfully manage the spread of COVID-19 immediately after the first outbreak (Thi Mai Oanh et al., 2021).

This experience also meant that the government was able to make quick decisions in response to the outbreak in the first wave. This included an immediate nationwide lockdown, limiting international flights, and shutting its borders. The aggressive contact tracing, testing, and quarantining of anyone who had been within three degrees of separation of any positive case, as outlined in section 2.01, also ensured that no potential cases could go undetected. Communications with the public were consistent and went out through a vast array of sources throughout the pandemic, with timely updates on the details of new cases and details of the actions being taken. A hard stance was also taken against fake news and the spreading of disinformation on social media (Thi Mai Oanh et al., 2021).

References:

Thi Mai Oanh, T., Khanh Phuong, N., & Anh Tuan, K. (2021). Sustainability and Resilience in the Vietnamese Health System Sustainability and Resilience in the Vietnamese Health System Sustainability and Resilience in the Vietnamese Health System. https://weforum.org/phssr

Last updated: December 30th, 2021   Contributors: Daisy Pharoah  |  


Contributors to the LTCcovid Living International Report, so far:

this list is regularly updated to reflect contributions to the report, if you’d like to contribute please email a.comas@lse.ac.uk

Elisa Aguzzoli, Liat Ayalon, David Bell, Shuli Brammli-Greenberg, Jorge Browne Salas, Jenni Burton, William Byrd, Sara CharlesworthAdelina Comas-Herrera, Natasha Curry, Gemma Drou, Stefanie Ettelt, Maria-Aurora Fenech, Thomas Fischer, Nerina Girasol, Chris Hatton, Kerstin HämelNina Hemmings, David Henderson, Stefania Ilinca, Margrieta Langins, Shoshana Lauter, Kai Leichsenring, Elizabeth Lemmon, Klara Lorenz-Dant, Lee-Fay Low, Joanna Marczak, Elisabetta Notarnicola, Cian O’DonovanCamille Oung, Disha Patel, Eleonora Perobelli, Daisy Pharoah, Stacey Rand, Tine Rostgaard, Olafur H. Samuelsson, Maximilien Salcher-Konrad, Benjamin Schlaepfer, Cheng Shi, Cassandra Simmons, Andrea E. SchmidtAgnieszka Sowa-Kofta, Wendy Taylor, Thordis Hulda Tomasdottir, Sharona Tsadok-Rosenbluth, Sara Ulla Diez, Lisa van Tol, Patrick Alexander Wachholz, Jessica J. Yu

This report has built on previous LTCcovid country reports and is supported by the Social Care COVID-19 Resilience and Recovery project, which is funded by the National Institute for Health Research (NIHR) Policy Research Programme (NIHR202333) and by the International Long-Term Care Policy Network and the Care Policy and Evaluation Centre at the London School of Economics and Political Science. The views expressed in this publication are those of the author(s) and not necessarily those of the funders.