case_images: PMC9472296_01
case_images: Timeline for public health policy response over cases and number of cases per country (Switzerland, Spain, Iran and Pakistan, January-July 2020). (A) The duration of the measures, organized by the six building blocks of health systems (Switzerland, Spain, Iran and Pakistan, January-July 2020). The first gray dashed lines represent the day that the World Health Organization declared the pathogen a subject of international concern and the second line represents the first day of a COVID-19 case was detected in each country: 23 February in Switzerland, 31 January in Spain, 18 February in Iran, and 24 February in Pakistan. In Spain, the day that the WHO declared the pathogen of international concern was 1 day before the first case was found in Spain, and therefore the difference between the first two lines is indistinguishable in the graph. The third gray line shows the day when the WHO declared the pandemic: 11 March 2020. (B) The duration of preventive policies (Switzerland, Spain, Iran and Pakistan, January-July 2020). (C) The number of cases and effective reproductive number (Switzerland, Spain, Iran and Pakistan, January-July 2020). The number of cases (in gray bars) and the estimated effective reproductive number (R, in green) with 95% confidence intervals as estimated by, and assuming a serial interval of 7 days. The dashed horizontal line in black shows Re = 1, the threshold above which the pandemic is growing.
case_images: ijph-67-1604969-g001.jpg
case_images: PMC9472296_01_ijph-67-1604969-g001.jpg
case_images: F1
case_images: February 2020. Following an increase in cases in July 2020 (Figure 1), the first national mask mandate in public transport was issued. Despite the growing number of cases in February 2020, authorities hesitated to impose more restrictive measures such as national lockdown, which did not come into effect until early March 2020 (Figure 1). On 19 May 2020 and right before the religious festival of Eid which ends the month of Ramadan (23-24 May 2020), the Supreme Court decided to ease the measures and opened shopping centers and public transport, resulting in a sharp increase in cases in the following 2 weeks (Figure 1).
case_images: Testing statistics per country (Switzerland, Spain, Iran and Pakistan, January-July 2020). (A) Tests per million population. The first gray dashed lines represent the day that the World Health Organization declared the pathogen a subject of international concern and the second line represents the first day of a COVID-19 case was detected in each country: February 23 in Switzerland, January 31 in Spain, February 18 in Iran, and February 24 in Pakistan. In Spain, the day that the WHO declared the pathogen of international concern was 1 day before the first case was found in Spain, and therefore the difference between the first two lines is indistinguishable in the graph. The third gray line shows the day when the WHO declared the pandemic: 11 March 2020. (B) Positivity rate, measured as the fraction of all tests that are positive each week. (C) The relationship between test intensity (measured as tests per million population) and the positivity rate each week. In Switzerland, the COVID-19 Datahub did not have testing numbers before epidemiological week 22, but the Swiss government provides those estimates for download, so we have combined both datasets. In Iran, the COVID-19 Datahub did not have testing numbers before epidemiological week 15, but we knew that there would be 78,434 tests administered on week 16, and we found a publication that stated that there were about 600 tests per day done at the end of the first week after the first case, and 6000 tests performed by the end of the first month. We therefore took a linear interpolant to calculate the number of tests that were done in those first 8 weeks.
case_images: ijph-67-1604969-g002.jpg
case_images: PMC9472296_01_ijph-67-1604969-g002.jpg
case_images: F2
case_images: However, only symptomatic individuals were allowed to be tested free of charge and upon a physician's request, perhaps explaining the relationship low testing intensity in the country (Figure 2). Health (NIH). However, within the 4-country case study presented here, Pakistan observed a relatively low testing intensity (Figure 2), probably representative of the testing capacity of poorer countries around the world. The accuracy of the observed incidence might not be comparable as different countries had different testing and diagnostic policies (Figure 2).