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Policy Disparities in Response to the First Wave of COVID-19 Between China and Germany Yuyao Zhang1, Leiyu Shi2, Haiqian Chen1, Xiaohan Wang1 and Gang Sun1,2*

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Policy Disparities in Response to the First Wave of COVID-19 Between China and Germany Yuyao Zhang1, Leiyu Shi2, Haiqian Chen1, Xiaohan Wang1 and Gang Sun1,2* Zhang et al. International Journal for Equity in Health (2021) 20:86 https://doi.org/10.1186/s12939-021-01424-3 RESEARCH Open Access Policy disparities in response to the first wave of COVID-19 between China and Germany Yuyao Zhang1, Leiyu Shi2, Haiqian Chen1, Xiaohan Wang1 and Gang Sun1,2* Abstract Objective: Our research summarized policy disparities in response to the first wave of COVID-19 between China and Germany. We look forward to providing policy experience for other countries still in severe epidemics. Methods: We analyzed data provided by National Health Commission of the People’s Republic of China and Johns Hopkins University Coronavirus Resource Center for the period 10 January 2020 to 25 May 252,020. We used generalized linear model to evaluate the associations between the main control policies and the number of confirmed cases and the policy disparities in response to the first wave of COVID-19 between China and Germany. Results: The generalized linear models show that the following factors influence the cumulative number of confirmed cases in China: the Joint Prevention and Control Mechanism; locking down the worst-hit areas; the highest level response to public health emergencies; the expansion of medical insurance coverage to suspected patients; makeshift hospitals; residential closed management; counterpart assistance. The following factors influence the cumulative number of confirmed cases in Germany: the Novel Coronavirus Crisis Command; large gathering cancelled; real-time COVID-19 risk assessment; the medical emergency plan; schools closure; restrictions on the import of overseas epidemics; the no-contact protocol. Conclusions: There are two differences between China and Germany in non-pharmaceutical interventions: China adopted the blocking strategy, and Germany adopted the first mitigation and then blocking strategy; China’s goal is to eliminate the virus, and Germany’s goal is to protect high-risk groups to reduce losses. At the same time, the policies implemented by the two countries have similarities: strict blockade is a key measure to control the source of infection, and improving medical response capabilities is an important way to reduce mortality. Keywords: Global health equity, COVID-19, China, Germany, Nonpharmaceutical intervention Introduction global recession since World War 2, with millions of Since December 2019, the new coronavirus (SARS-CoV-2) people falling into unemployment and poverty [1]. By has spread rapidly around the world, with fast spreading early November 2020, over 46 million confirmed cases of speed, wide range of infection, and difficult prevention and COVID-19 had been reported worldwide, with more than control, which has brought a huge impact to the whole 1 million deaths [2]. This death toll continues to rise rap- world. The World Bank’s projections point to the deepest idly each day. More than 450,000 new cases have been confirmed in a single day worldwide, and European coun- * Correspondence: [email protected]; [email protected] tries have also officially suffered the second wave of 1Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, Guangdong 510515, P. R. China COVID-19. The number of daily new cases in many 2Department of Health Policy and Management, Bloomberg School of Public European countries has exceeded 10,000. The World Health, Johns Hopkins University, Baltimore, MD 21205, USA © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Zhang et al. International Journal for Equity in Health (2021) 20:86 Page 2 of 7 Health Organization believes that the “epicenter” of the the period from the appearance of the first cases to the current global epidemic is Europe. Since there is no vac- gradual return to daily life in the two countries. cine or specific treatment for COVID-19, non- pharmacological interventions are particularly important. Results On December 31, 2019, Health Commission of Wuhan Major non-pharmacological interventions in China City reported that 27 cases of viral pneumonia had been As showed in Table 1,from 10 January to 25 May 2020, diagnosed. On January 9, 2020, the Chinese health ex- COVID-19 outbreak has led the Chinese government to pert team identified the virus as a new type of corona- enact the following policies aimed to control the spread virus, which has a very fast transmission speed. The of the disease: the Joint Prevention and Control Chinese government resolutely adopted a series of pre- Mechanism; locking down the worst-hit areas; the high- vention and control policies to contain the spread of est level response to public health emergencies; the COVID-19. On May 22, 2020, the number of new con- expansion of medical insurance coverage to suspected firmed cases in China was zero for the first time, and patients; makeshift hospitals; residential closed manage- since April 15, the number of new deaths has been zero ment; counterpart assistance. [3]. This has proved that China’s non-pharmaceutical in- terventions adopted in the first wave of COVID-19 are Major non-pharmacological interventions in Germany effective. In early March 2020, Europe became the epi- From 27 January to 25 May 2020, the surge in the center of the COVID-19 pandemic, with more cases and number of confirmed COVID-19 has prompted the deaths reported than in all other countries (excluding German government to develop the following non- China) combined [4]. In Germany, the first case was re- pharmacological policies (Table 2): the Novel Corona- corded on 27 January 2020 in Bavaria [5]. In early virus Crisis Command; large gathering cancelled or March, the cumulative number of confirmed cases in postponed; real-time COVID-19 risk assessment; the Germany passed 100. A week later, more than 1000 medical emergency plan; schools closure; restrictions on cases were confirmed, and by late March it had passed the import of overseas epidemics; the no-contact protocol. 10,000 [2]. COVID-19 has spread rapidly, and the pre- vention and control of SARS-CoV-2 officially kicked off Epidemiological timeline of the first COVID-19 wave in in Germany. In late April, with the joint efforts of the China and Germany German government and the public, the number of new Figure 1 shows the development trend of China’s cumu- confirmed cases fell to about 1000, and the number of lative confirmed cases, cumulative deaths, newly con- new deaths gradually dropped to double digits [2]. It can firmed cases, and new deaths from January 10 to May be seen that the non-pharmaceutical interventions im- 25, 2020. Since February 18, the cumulative confirmed plemented by the German government have also played case curve has gradually slowed down, and the cumula- an important role. tive death case curve has fluctuated slightly in February We have systematically summarized and quantitatively and March. The number of newly confirmed cases in- analyzed the prevention and control policies adopted by creased significantly from the end of January to the end China and Germany in the first wave of the global of February. At the beginning of March, the number of COVID-19 epidemic, and also compared the similarities newly diagnosed cases was less than 200, and the num- and differences of non-pharmaceutical interventions by ber of new deaths has dropped to zero since late April. the two governments. We hope to provide policy experi- Figure 2 shows the development trend of the cumula- ence for other countries and regions that are experien- tive confirmed cases, cumulative deaths, newly con- cing the second wave of COVID-19. firmed cases, and new deaths in Germany from January 27 to May 25, 2020. The cumulative curve of confirmed Methods cases fluctuates greatly, with a rapid increase since late The data are all from the epidemic information released March and a gentle trend at the end of April. The by the National Health Commission of the People’s cumulative death case curve has fluctuated to a cer- Republic of China [3] and Johns Hopkins University tainextentsincelateApril.Thenumberofnewly Coronavirus Resource Center [2]. Data indicators in- confirmed cases has increased rapidly since late clude cumulative confirmed cases, cumulative deaths, March, and has declined in late April. The number of daily new cases and daily deaths. new deaths was higher in April. As of May 1, 2020, all Chinese provinces have lifted the first-level public health emergency response (the Associations between non-pharmaceutical interventions highest level response) and gradually resume
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