Special issue : State and European Union health measures in the face of the first wave of COVID-19
Public health management of the COVID-19 epidemic at the national level: Shared formulae and national mindsets
Renaud GAY and Kevin GUILLAS-CAVAN
This article offers a cross-reading of this issue focusing on the public health measures taken by nine states and by the European Union in the face of the “first wave” of the COVID-19 epidemic. By looking at state interventions in access to health care, health services and the medical sector, it illustrates how most states tend to resort to similar formulae (lockdown, expanding hospital capacity, etc.) albeit within the framework of national mindsets shaped by the institutional and economic set-up of their healthcare systems.
Keywords: COVID-19, state, healthcare system, hospital, health inequalities, health professionals, shortages of medical equipment, access to health care, lockdown, health emergency.
The progression of excess deaths during the COVID-19 pandemic: Points of international comparison
Pierre CONCIALDI
This article looks at the progression of excess deaths, which is the most robust indicator—particularly for the purposes of international comparison—for tracking the worsening public health situation during the “first wave” of the COVID-19 pandemic in spring 2020. Excess death rates have increased more dramatically in the United States than in Europe, although circumstances vary considerably across European nations. The number of excess deaths in France over the first eight months of 2020 is estimated at less than 20,000.
Keywords: COVID-19, statistics, international comparison, excess mortality, excess deaths, pandemic.
China. Local government public health measures: The case of the city of Wuhan
Jingyue XING-BONGIOANNI, Jun CHU and Xuemin QI
In China, local authorities, in particular that of the city of Wuhan, the epicenter of the outbreak, have played a key role throughout the health crisis. For one thing, the important decisions have been made at this level; for another, most of the spending to fight COVID-19, including bonuses paid to the health professionals called into action, has been borne by local authorities. The role of central government, while hardly negligible, has consisted of coordinating the deployment of health professionals and supplies across regions, of rallying industry, and of financing a limited proportion of public spending. While this system of mobilizing resources has allowed efforts to be directed at the grassroots level, it raises questions of interregional equality and of the borrowing capacity of local authorities, particularly those in the poorest regions.
Keywords: China, COVID-19, state, local government, Wuhan, healthcare system, hospital, health inequalities, health professionals, shortages of medical equipment, access to health care, lockdown.
Argentina. The federal government’s measures: Strong, early … but insufficient
Virginia MELLADO and Arnaud TRENTA
After the country’s very first cases of COVID-19, the Argentinian federal government took strong measures to slow the spread of the new coronavirus and to boost the capacity of healthcare institutions. This preventative strategy succeeded, at first, in limiting the epidemic to the Buenos Aires metropolitan area and made it possible to focus testing on working-class neighborhoods. Later, the Argentine Republic’s federal constitution and its fragmented healthcare system limited the general cohesiveness of public policy and enabled the COVID-19 epidemic to accelerate in all of the country’s provinces.
Keywords: Argentina, COVID-19, state, healthcare system, hospital, health inequalities, health professionals, shortages of medical equipment, access to health care, lockdown, health emergency.
United States. Hospitals, health insurance, and the US federal system put to the test
Catherine SAUVIAT
It is in the United States that the COVID-19 epidemic has proved most deadly, even though its per capita health spending is the highest in the world. As such, the epidemic has brought into stark relief the chronic shortcomings of the country’s healthcare and health insurance systems (with their exorbitant costs, high inequality of access, underfunding of public health, and a hospital system governed by market logic). It has also revealed the drawbacks of the US federal system under the Trump administration, in particular its inability to manage a health crisis of such magnitude, most clearly exemplified in the incompetence of the president’s leadership.
Keywords: United States, COVID-19, state, healthcare system, hospital, health inequality, health professionals, shortages of medical equipment, access to health care, lockdown, health insurance, health emergency.
European Union. The Europe of Health through the lens of COVID-19: What progress has been made?
Gael CORON and Catherine SAUVIAT
The actions of the European Union in the face of the health crisis have been limited de jure by the treaties (lack of legal authority) and de facto by the extremely limited political and financial resources available to be devoted to European health policy. Secure supply lines of medical equipment at the European level could not be ensured, against a backdrop of diverging industrial trajectories of Member States, making it
difficult for a common industrial policy to emerge.
Keyword: European Union, COVID-19, health policy, industrial policy, medical equipment, public health, Directorate-General for Health and Food Safety.
Germany. A coordinated response by the healthcare system, powered by the federal government
Marcus KAHMANN
Germany has stood up relatively well to the ravages of the pandemic. The health crisis has presented an opportunity to showcase the considerable “proactive” means of the healthcare system, but it has also highlighted the difficulties of making them function well. While those difficulties have not given rise to further damage to public health, this is also because the federal system was able to demonstrate a capacity for coordination. Fearing that the system might not withstand a second wave, the federal government has injected considerable funding in order to overcome industrial and social weaknesses.
Keywords: Germany, COVID-19, state, healthcare system, hospital, health inequalities, health professionals, shortages of medical equipment, access to health care, lockdown.
France. A centralized, disorganized management by the state
Renaud GAY and Monika STEFFEN
This article analyzes the French state authorities’ management of the COVID-19 epidemic between February and August 2020. It highlights the centralized and relatively disorganized nature of state interventions, which can be explained by longer-term institutional, political, and economic rationales. The blanket lockdown of the population, the central role given to hospitals, and their supply problems are also in large part down to the peculiarities of a national healthcare system that, despite recent organizational improvements, remains characterized by a biomedical and curative approach to health care in which industrial and technological independence are lacking.
Keywords: France, COVID-19, state, healthcare system, hospital, health inequalities, health professionals, shortages of medical equipment, access to health care, lockdown, health emergency.
Ireland. Fragilities in the healthcare system exacerbated by the health crisis
Noélie DELAHAIE
The arrival of the COVID-19 pandemic has put to the test a public health system that was already in a critical state: hospital beds in short supply, no universal health coverage for primary care, and extensive entanglement of the public and private sectors, resulting in waiting times among the longest in Europe and inequality of access to health care. In an effort to hold back the “first wave” of the epidemic, the authorities put their faith in social and economic restrictions, the extension of universal access to primary care, and the drafting of private hospitals.
Keywords: Ireland, COVID-19, State, healthcare system, hospital, health inequalities, health professionals, shortages of medical equipment, access to health care, lockdown.
Italy. After the initial shock, renewed resources for the healthcare system, pending more ambitious reform?
Mara TOGNETTI-BORDOGNA, Battista Roberto POLILLO and Jean-Olivier MALLET
As the first European country hit by the COVID-19 pandemic, Italy had to face the crisis while relying on a healthcare system weakened by budget cuts following the Great Recession of 2008–2009, with varying levels of funding between Regions. Tensions between central government, responsible for dealing with health emergencies, and the Regions, which are in charge of organizing care, hampered responses to the pandemic. The rapid adoption of exceptional measures (the Cura Italia and Rilancio bills) nevertheless provided a temporary boost to the financial and human resources of the national healthcare system in anticipation of a second wave, while the traumatic shock of the epidemic served to revive interest in ambitious healthcare reform.
Keywords: Italy, COVID-19, state, healthcare system, hospital, health inequalities, health professionals, shortages of medical equipment, access to health care, lockdown, health emergency.
United Kingdom. Initial underestimation of the risk followed by chaotic management
Jacques FREYSSINET
The initial underestimation of the risk posed by the pandemic gave way to chaotic management of the various stages of lockdown and, later, of the first lifting of restrictions. The savage spread of the virus highlighted the failings of a healthcare system subjected to privatization policies since the 1980s and weakened by austerity from 2010 onward. Faced with the influx of patients, public hospitals were crippled by massive understaffing and suffered shortages of essential equipment, which lasted for many weeks. Emergency measures admittedly allowed those challenges to be addressed, but on terms that revealed the scale of inequalities in the face of a pandemic.
Keywords: United Kingdom, COVID-19, state, healthcare system, hospital, health inequalities, health professionals, shortages of medical equipment, access to health care, lockdown, health emergency.
Sweden. A unique response to the health crisis and a decentralised healthcare system under pressure
Annie JOLIVET
Sweden implemented a combination of limited prohibitions and recommendations. A willingness to plan ahead and to manage the COVID-19 crisis over the long term has been underpinned by a clear and transparent division of responsibilities between government agencies, government, and local actors. With capacity adapted to minimal levels, hospitals were forced to reorganize, to increase working hours, and to call on extra staffing. Centralized coordination proved necessary for the supply of protective and care equipment and for the management of intensive care spaces.
Keywords: Sweden, COVID-19, state, healthcare system, hospital, health inequalities, health professionals, shortages of medical equipment, access to health care, lockdown.