This week, we’re taking a step back to look at elements of successful COVID-19 responses from countries around the world. As the U.S. begins to enter varying degrees of re-opening, this letter will highlight some positive reflections, and provide insight into our journey towards recovery and lessons for future public health crises.

Reaching Sufficient Ventilator and Hospital Capacity – United States

While the U.S. was slow to respond to initial signs of a growing global pandemic – similar to peer countries in Europe and North America – many elements of the response are laudable. Early on, ventilator availability was a major concern for healthcare systems, particularly in the New York City region, which became the epicenter of the pandemic in late March. However, through increased supply by way of contracts with Phlilips and GM worth over $1B, sharing of stockpiles across states, and lower-than-expected demand, no severe ventilator shortages were realized.

Similarly, New York City projections in March reported the need for 110,000 hospital beds. In response, the hospital ship U.S.N.S. Comfort was dispatched to the city, alongside the conversion of the Javitz Center into a 2,500 bed make-shift hospital. After a little over a month, the Navy’s hospital ship departed New York City and the Javitz Center field hospital shut down. While NYC and the country broadly continue to see a devastating amount of loss, numbers have been below worst-case projections.

Strong Public Health Infrastructure – Costa Rica

Costa Rica has received praise for its COVID-19 response efforts. To date, the country has seen just over 1000 cases with only 10 related deaths. Costa Rica’s preparedness can be attributed to several factors. First, the country has a national health care system covering 95% of the population with strong community care teams that support the primary health care infrastructure. This, combined with a swift response, preparedness plans developed after prior experiences with H1N1 and SARS, the mobilization of institutions for support, and a mutual trust between authorities and citizens, has resulted in a strong national response to COVID-19.

Protective Health Behaviors – Japan

Just a month ago, health experts in Japan were warning its citizens of an impending surge of COVID-19 cases, with projections reaching up to 400,000 deaths. Today, however, for a country with a population of 126 million, it has seen 16,800 COVID-19 cases and 886 deaths. Some experts have attributed Japan’s success to its national healthcare system, low obesity rates, and expertise in treating pneumonia. Others have pointed to Japanese cultural traits as protective against COVID-19 – namely, masks as a commonplace accessory during flu season, bowing instead of shaking hands, good personal hygiene, and a general culture of concern for others.

Compassionate and Evidence-Based Leadership – Germany

Germany, which has Europe’s largest economy, has been relatively successful in battling COVID-19. Chancellor Angela Merkel has deployed what The Atlantic calls “her characteristic rationality, coupled with an uncharacteristic sentimentality.” Germany’s strategy has primarily worked through strict social distancing protocols and shutdowns of public life, supported by a robust healthcare system. A scientist herself, Merkel’s efforts have been regarded as evidence-based by experts and journalists. Combined with atypical national addresses to connect and unify the German people, Germany achieved what Merkel called “interim success” and began lifting social and economic restrictions in mid-April.

Testing and Tracing – South Korea

South Korea and the United States both confirmed their first case of COVID-19 on the same day in January. Today, South Korea has seen less than 300 deaths due to COVID-19. In contrast to the “flattened curve” shape of plotted new daily cases in the U.S., South Korea’s cases appear to have fallen off of a cliff after March 1st. Like Costa Rica, South Korea’s COVID-19 policies were based on learnings from previous public health crises, particularly a MERS outbreak in 2015 that lacked government transparency and sufficient testing kits. In response, South Korea rewrote its Infectious Disease and Prevention Act, which now includes robust legislation that mandates information sharing between government, private telecommunications companies, medical institutions, pharmacies, corporations, organizations, and individuals, to track potentially infected individuals. The Act also includes a public “right to know,” which mandates that the ministry of health must promptly disclose the movement paths of infected individuals in epidemic situations.

Additionally, in response to early cases of COVID-19, South Korea began rapidly building up its testing capacity. In early February, the South Korean CDC approved several private companies’ diagnostic tests to begin production. By mid-March, South Korea had tested 290,000 individuals, approximately five times the testing rate in the U.S., adjusting for population. While the U.S. has since increased daily testing rates dramatically, the speed at which South Korea built its testing infrastructure provided a significant advantage in the country’s response.

Taken together, these case studies show vast room for improvement on the home front. While the U.S. has had its share of successes, there is much to be learned from public health responses around the world. As we move towards re-opening, and potentially a second wave, there are lessons leaders can learn from successful efforts abroad, and incorporate into preparation for future crises.