Wśród licznych analiz dotyczących kryzysu zdrowotnego wywołanego pandemią COVID-19 autorzy poszukiwali takich, które pozwolą na ocenę rozwiązań instytucjonalnych. Postawili tezę, że istnienie dobrych instytucji (z odpowiednimi regulacjami, środkami i zapleczem eksperckim) stanowi niezbędny zasób umożliwiający szybkie, trafne i efektywne działania ochronne oraz lecznicze.

Autorzy zwrócili się do ekspertów z innych krajów, z którymi od wielu lat współpracują w dziedzinie zdrowia publicznego, aby tym razem, wykorzystując kompetencje w dziedzinie ochrony zdrowia, odpowiedzieli na pytania dotyczące zarządzania publicznego (governance) w pierwszym półroczu wybuchu pandemii (od stycznia do czerwca 2020), kiedy powszechnie zastosowano lockdown i stopniowo z niego wychodzono. Co szczególnie znaczące dla oceny zarządzania w sytuacji kryzysu zdrowotnego, zaproszeni do współpracy eksperci reprezentują kraje różnorodne pod względem: decentralizacji państwa, struktury społecznej, posiadanych zasobów, także organizacji ochrony zdrowia i tradycji politycznej w uzgadnianiu spraw spornych.

Raporty z Włoch, Holandii, Zjednoczonego Królestwa, Norwegii, Niemiec, Czech, Ukrainy oraz Kanady (w tym z prowincji Ontario) – załączone jako apendyks – uzupełniano bezpośrednimi konsultacjami. Analiza pozyskanych informacji oraz wymiana opinii stanowią przedmiot artykułu. W analizie porównawczej odwołujemy się także do polskich działań i rozwiązań. Polska perspektywa zarządzania publicznego jest wyrazem troski o zaniedbany obszar zdrowia publicznego. Artykuł wzbogacony jest refleksjami autorów oraz ogólnie sformułowanymi rekomendacjami.

Public governance of the health crisis in the first six months of the global COVID-19 pandemic. Comparative analysis based on the opinions of experts from selected countries

From among the numerous analyses of the health crisis caused by the COVID-19 pandemic, the authors looked for those that would enable assessment of institutional solutions. They put forward the thesis that good institutions (with appropriate regulations, means and expert support) constitute an essential resource enabling fast, accurate, and effective measures in terms of protection and therapy.

The authors turned to experts from other countries with whom they have been cooperating for many years in the field of public health and used their competences in the field to answer questions about public governance in the first six months of the pandemic outbreak (January to June 2020) when lockdowns were widely implemented and then gradually lifted. Particularly significant for the assessment of health crisis management, the experts chose countries that are diverse in terms of: state of decentralization, social structure, and resources available, as well as healthcare organization and political tradition in dispute resolution.

Reports from Italy, the Netherlands, United Kingdom, Norway, Germany, the Czech Republic, Ukraine, and Canada (with focus on Ontario) – attached as an appendix – were supplemented with direct consultations. The comparative analysis of the obtained information and the exchange of opinions are the subject of this article. In the comparative analysis, we also refer to Polish activities and solutions. The Polish perspective of public management signifies a concern for the neglected area of public health. This article is enriched with the authors’ reflections and generally formulated recommendations.

Since the beginning of the COVID-19 pandemic, Italy was one of the worst-affected European countries. The rapid surge of cases and the limited capacity of intensive care unit departments have posed a serious threat to the Italian national health system. In this paper we describe the first response and the main measures carried by Italian policy makers, as coordinated by a governmental committee of public health experts, which have succeeded in preventing the pandemic from turning into a disaster. Early closure of the school, quarantine measures and lockdown were put in place and the response of the population has been good overall.

Despite the Italian health care system of universal coverage is considered the second-best in the world, during phase 1, the Italian decentralisation and fragmentation of health services probably restricted timely interventions and effectiveness. In northern Italy, Lombardy, Emilia Romagna, Piedmont, and Veneto, which reported most of the Italian cases, carried out different strategies against COVID-19, with great differences in testing, quarantine, and public health procedures.

The improvement of the epidemiological situation has allowed an easing of the restrictive measures, with a progressive restarting of work activities. The government and technical-scientific bodies have prepared health strategies to support a possible second epidemic wave in the autumn.

The authorities’ first responses were the classification of COVID-19 as Group A-disease in the sense of the Law on Public Health, scaling up of regular crisis control structures, installation of an Outbreak Management Team OMT and a “National Operational Team-Corona”. COVID-surveillance is done by the RIVM (National Public Health Institute), and is based on data from Municipal Public Health Services (GGDs) supplemented with additional (inter)national sources. The OMT is the main advisory body regarding preventive measures and includes experts from relevant medical specialisms. Organisations of medical professionals gave separate advices. Sanctions to preventive measures can be fines and closure of accommodations. Initially, 80% of the population trusted the government’s messages and “intelligent lockdown” strategy. The Prime Minister’s addresses to the people were highly appreciated. However, at slow-down of the outbreak (May-June) society’s trust crumbled (“quarantine-fatigue”). The initial testing policy was very restricted and contrary to WHO’s adagium “Test, test, test!”. In June the Minister of Health announced that a capacity of 30.000 tests per day was achieved, to be scaled up to 70.000. The crises management’s primary concern was to increase the (ICU-)bed capacity and was achieved by transforming regular wards into COVID-care, setting-up external “Corona-wards” in hotels, and regional, interregional and crossborder spreading of COVID-patients. This focus on ICU-bed capacity was criticized, as half of the death cases and extreme equipment shortages occurred in other sectors (nursing homes, homecare, homes for the elderly, psychiatry, mental handicaps). Transformation of hospital wards also led to waiting lists for non-COVID care. End of June the government presented a step-by-step easing of the lockdown in which a fine-tuned epidemiological surveillance dashboard and the continuation of economical support for the economic sector are the backbones.

The outbreak of the COVID-19 pandemic has resulted in various public health responses around the globe. Due to the devolved powers of the United Kingdom, the response has been centralized but simultaneously greatly differing across England, Wales, Scotland, and Northern Ireland. The following article examines the governmental responses to the outbreak, the public health measures taken, data collection and statistics, protective equipment and bed capacity, the society’s response, and lastly, the easing of the lockdown restrictions. In terms of the governmental response, the COVID-19 pandemic was initially met with less urgenon/populacy and social distancing, along with the development of herd immunity, were first mentioned. As the virus continued to spread, the government started imposing stricter measures and a lockdown was implemented. Tests were conducted using a five pillar typology. The collection of information, particularly on COVID-19 associated deaths, varied across the United Kingdom and among the governmental organizations due to differing definitions. In term of hospital bed availability, the rate of hospitalizations was the highest from late March to early April of 2020. Temporary hospitals were constructed, however, they mostly went unused. The United Kingdom society was generally compliant in adapting to the lockdown and trust in the government rose. Nonetheless, as the lockdown progressed, trust in the government began to fall. After several months, the rate of infection decreased and the lockdown in the United Kingdom was lifted in accordance with ‘Our plan to rebuild: The United Kingdom Government’s COVID-19 recovery strategy’. The slogan ‘Stay at Home. Protect the NHS. Save Lives’ was replaced with ‘Stay Alert. Control the Virus. Save Lives’.

Pandemics sudden influx claimed reaction from national authorities to protect their societies and ensure an operative functioning of the public health care. This article explains how the Norwegian government reacted in this unpredictable situation, which lockdown option was chosen and what economic consequences the applied measures might bring. How to weight public health against economic offers and future downturn? Trade-offs are compound and it is too early to conclude which country has made the best choice.

The Czech Republic initially managed the outbreak of the novel coronavirus remarkably, with relatively few cases and low death rate. Its public health response was characterized by swift implementation of public health measures driven by an implicit precautionary principle, but also chaotic communication of measures and a lack of transparency in justifying individual policies. June and July 2020 have seen a rise in COVID-19 cases linked to two regional clusters but later associated with community transmission, which exposed weaknesses in the country’s test-trace-isolate system.

In this article, the governmental response to the COVID-19 pandemic in Ukraine is described, starting from the first detected cases, up until the summer of 2020. Pandemic caught Ukraine’s health care system in the midst of a reform. At the time of COVID-19 outbreak, the first steps of primary health care reform were already being implemented while the reform at the secondary health care level were about to started. However, changes of the political environment (due to the elections 2019), two changes of the Minister of Health (since the beginning of the pandemic), the absence of the general plan of action followed by the inconsistent political decisions, and the uncertainty in financing mechanisms of the secondary health care facilities, made the COVID-19 pandemic challenging for Ukraine. The Ukrainian government had difficulties in devoting additional recourses to medical facilities to protect medical professionals and provide treatment for patients. Instead, as a main intervention to combat COVID-19, the government implemented lockdown from 12 of March to 12th of May that only postponed the raise of infections, preserved lives. While the pandemic still had a highly negative impact on the economy, initial analysis indicate that lockdown could be considered effective from the economics point of view.

In late January 2020, the first COVID-19 case was reported in Canada. By March 5, 2020, community spread of the virus was identified and by May 26, 2020, close to 86,000 patients had COVID-19 and 6,566 had died. As COVID-19 cases increased, provincial and territorial governments announced states of public health emergency between March 13 and 20, 2020. This paper examines Canada’s public health response to the COVID-19 pandemic during the first four months (January to May 2020) by overviewing the actions undertaken by the federal (national) and regional (provincial/territorial) governments. Canada’s jurisdictional public health structures, public health responses, technological and research endeavours, and public opinion on the pandemic measures are described. As the pandemic unravelled, the federal and provincial/territorial governments unrolled a series of stringent public health interventions and restrictions, including physical distancing and gathering size restrictions; closures of borders, schools, and non-essential businesses and services; cancellations of non-essential medical services; and limitations on visitors in hospital and long-term care facilities. In late May 2020, there was a gradual decrease in the daily numbers of new COVID-19 cases seen across most jurisdictions, which has led the provinces and territories to prepare phased re-opening. Overall, the COVID-19 pandemic in Canada and the substantial amount of formative health and policy-related data being created provide an insight on how to improve responses and better prepare for future health emergencies.

The first positive case of COVID-19 in Canada was reported on January 25, 2020, in the city of Toronto, Ontario. Over the following four months, the number of individuals diagnosed with COVID-19 in Ontario grew to 28,263 cases. A state of emergency was announced by the Premier of Ontario on March 17, 2020, and the provincial health care system prepared for a predicted surge of COVID-19 patients requiring hospitalization. The Chief Medical Officer of Health and the Minister of Health guided the changes in the system in response to the evolving needs and science related to COVID-19. The pandemic required a rapid, concerted, and coordinated effort from all sectors of the system to optimize and maximize the capacity of the health system. The response to the pandemic in Ontario was complex with some sectors experiencing multiple outbreaks of COVID-19 (i.e. long-term care homes and hospitals). Notably, numerous sectors shifted to virtual delivery of care. By the end of May 2020, it was announced that hospitals would gradually resume postponed or cancelled services. This paper explores the impact of the COVID-19 pandemic on multiple health system sectors (i.e., public health, primary care, long-term care, emergency medical services, and hospitals) in Ontario from January to May 2020. Given the scope of the sectors contributing to the health system in Ontario, this analysis of a regional response to COVID-19 provides insight on how to improve responses and better prepare for future health emergencies.