New tool ranks COVID-19 responses of 19 hard-hit nations

The United States ranks ninth out of 19 based on a newly developed tool to evaluate public perception of different countries' responses to the COVID-19 pandemic, according to a study published today in PLOS One.

The 10-item COVID-SCORE tool, created and validated by the Barcelona Institute for Global Health, the City University of New York (CUNY), and other international organizations, was used in mid-June to survey the attitudes of 13,426 randomly selected participants in 19 countries heavily affected by the pandemic on key issues such as governmental messaging, access to health services, and social welfare.

Mean country score ranged from 35.76 out of 100 points for Ecuador to 80.48 for China. In general, Asian countries garnered better scores than Latin American and European nations.

Country scores were strongly tied to the level of people's public trust in their government, with higher scores reflecting higher levels of trust. Lower scores were associated with higher COVID-19 death rates or proportion of participants directly affected by the virus, in addition to low levels of trust.

Inter-, intra-country variation

The United States' composite score was 50.57, with 773 respondents. At 3.16 out of 5, the country's income, food, and shelter aid was the highest-rated facet of its pandemic response, while it was among the lowest in most countries. Notably, the poll was administered soon after US government stimulus checks were distributed in the spring.

However, at 3.03 of 5, the United States ranked 17th out of 19 on the topic of government cooperation with other nations and global agencies such as the World Health Organization, while this facet received the highest score across all countries (3.53). This finding is not surprising, given that the Trump administration has pulled its financial support of the organization.

In contrast, at 3.46 out of 5, Spain was rated highest on its international cooperation; its lowest score (2.09) was for access to free, reliable COVID-19 testing in people with symptoms. Across all countries, access to mental healthcare received the lowest average score: 2.79.

Responses ranged most widely in the United States, where similar proportions of participants rated the government pandemic response positively and negatively. US respondents earning more than the monthly median income tended to give the government higher scores than those earning less.

Other countries with broad ranges of responses were Brazil, Ecuador, Mexico, Poland, Sweden, and the United Kingdom. Responses were most homogeneous and strongly positive in China and South Korea.

A reflection of trust

While most countries have implemented disease mitigation measures such as business and school closures and movement restrictions, their approach and timing have varied widely. Public compliance with the measures, too, and thus pandemic mitigation, has differed and may reflect trust in government, public health officials, and science, as well as the clarity and consistency of public health messages, the researchers said.

They also remarked that trust is key to gaining public cooperation in fighting the coronavirus and that, conversely, lack of trust is associated with greater rates of mental illness and has been a barrier to seeking healthcare for minority populations.

"Effective control of COVID-19 requires governments and their constituencies to engage in mutually trusting relationships with a shared understanding of what is expected by both sets of actors," the authors wrote.

They added that the COVID-SCORE tool can help public health authorities and other decision makers identify and correct gaps in their country's coronavirus response and track trends in public perception over time.

"This tool is easy to implement and can guide researchers and authorities in designing measures to better control the pandemic," coauthor Ayman El-Mohandes, MD, MPH, MSc, MBBCh, dean of the CUNY Graduate School of Public Health and Health Policy, said in a CUNY news release.  

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