How countries around the world have tried to contain the coronavirus

How many cases a country has confirmed reflects, in part, how many people it has tested. South Korea and Italy have conducted widespread testing; the United States and Japan have not. Certain factors may also make some societies more vulnerable than others. The virus has proved deadliest for older people, and Japan, Italy and Germany have the oldest populations in the world. Some researchers have further theorized that weather could have something to do with the spread, just as seasonal flu has a winter peak in the Northern Hemisphere. Others have suggested that population density and the degree of physical contact societies are accustomed to could affect transmission. All of that remains highly uncertain.

But epidemiologists say how and when governments impose containment and mitigation measures can make a difference. China, after initially denying any problem and moving to silence whistleblowers, has gone after the virus aggressively with a mandatory quarantine in Hubei province. Italy has now extended its lockdown to the entire country, restricting freedom of movement on a scale unprecedented in a democracy - but it is still playing catch-up, trying to control a virus that spread in the country for weeks before anyone noticed. Other nations are beginning to promote social distancing, while assessing how much economic fallout, curtailment of civil liberties and disruption of routine their populations will tolerate.

 

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Measures taken by countries experiencing outbreaks

 

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114.84 cases per 100,000 people in Hubei province; 5.81 cases per 100,000 people in all of China

The first inkling of serious trouble came on Jan. 8, when Chinese authorities and the World Health Organization revealed that scientists in China had discovered a new strain of coronavirus responsible for a mysterious surge of pneumonia cases. The timing could not have been worse, coming just as millions of Chinese citizens were preparing to travel for the Lunar New Year holiday.

Authorities soon began taking temperature checks at airports and tracing contacts between infected individuals and others in the community. It was already too late. Wuhan, an industrial city where an exotic animal market is believed to have been the source of the virus, became the epicenter of the outbreak and soon found its nearly 12 million residents under a mandatory quarantine. On Jan. 23, that lockdown was extended throughout Hubei province, home to Wuhan, trapping roughly 50 million people in their homes. The lockdown continues today.

Most means of transportation, including bus and train travel, have also been shut down in Hubei province; international travel to and from China largely remains off limits. President Xi Jinping has been criticized for refusing to give international medical experts access to its findings and processes.

His government has also been pilloried for relying on draconian measures, including silencing and punishing a young doctor and whistleblower who alerted a small group of friends and family about the coronavirus's existence. That doctor, Li Wenliang, died in early February after contracting the virus. He was 34.

Although China continues to lead the world in the number of confirmed cases (about 81,000) and deaths (nearly 3,100), it has recently begun to slow the rate of infections.

 

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Japan

0.50 cases per 100,000 people

Most of Japan's initial cases had a directly traceable link back to China. The first documented case was that of a Chinese man in his 30s, living outside Tokyo, who had just returned from visiting Wuhan. He was hospitalized with a fever on Jan. 3, but discharged after five days, only to test positive for coronavirus on Jan. 15. Japan imposed its first travel restrictions 2½ weeks later, on Feb. 1, with a ban on travelers from Hubei province in China. Restrictions were gradually expanded to cover visitors from parts of South Korea, Iran and Italy. Nevertheless, clusters of infections began to emerge around the country.

On Feb. 3, the Diamond Princess cruise ship docked in the port of Yokohama. With a former passenger having contracted the virus, the boat was soon placed under quarantine. For the next two weeks, the fate of its 3,711 passengers and crew transfixed the world. In the end, about 700 people contracted the virus and seven died.

Onshore, a key moment came in mid-February, when several infections in the eastern prefecture of Wakayama could not be traced back to China. Experts said they believed an invisible chain of transmission had begun.

Japan has continued to focus on identifying clusters and tracing contacts, rather than widespread testing. Prime Minister Shinzo Abe recommended on Feb. 26 that organizers should cancel, scale back or postpone large events, and on Feb. 27, he recommended that schools across the country close until the end of spring break, in early April. Although some companies are allowing employees to work from home, commuter trains are still fairly crowded. So far, Japan has conducted more than 22,000 tests, with 725 positive cases and 21 deaths as of March 14, not including the people who contracted the virus on the Diamond Princess.

 

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South Korea

15.23 cases per 100,000 people

South Korea began conducting one-on-one temperature checks on visitors from Wuhan, China, as early as Jan. 8, and it identified its first coronavirus case on Jan. 20, in a woman who had flown from Wuhan and was isolated upon entry after displaying a fever. For a time, the temperature checks appeared to help prevent a wider outbreak, with only 30 new cases of the virus reported in the weeks after that first confirmed infection. President Moon Jae-in said on Feb. 13 that the virus would "disappear before long" and urged citizens to resume regular economic activities.

However, after a 61-year-old woman was diagnosed with the virus on Feb. 18 in Daegu, the southern city saw an exponential growth in infections. Most were traced to a local branch of Shincheonji church she attended, and health authorities ordered coronavirus tests on more than 200,000 members of the church nationwide.

South Korea has done the biggest number of covid-19 tests per capita, with more than 10,000 people tested daily over the past few weeks. People can even submit test samples at drive-through centers. Health authorities conduct robust contact tracing on all confirmed patients, then test identified contacts. Most controversially, the South Korean government is publishing the movements of people before they were diagnosed with the virus - retracing their steps using tools such as GPS phone tracking.

The government has dismissed the idea of lockdowns. People can still travel in and out of Daegu. Local governments across the country promote social distancing, but there is no ban on mass gatherings, only recommendations. In late February, the Seoul mayor banned mass demonstrations typically held in the city center on weekends, but many protesters crowded Seoul's main square the following weekend anyway. The Education Ministry has postponed the start of the new school year by three weeks to March 23.

On March 13, South Korea reported more recoveries than new cases for the first time, though an emerging outbreak in Seoul threatens to undermine progress. In total, the country has confirmed more than 8,000 cases and reported 72 deaths.

 

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France

3.40 cases per 100,000 people

France announced Europe's first known coronavirus cases on Jan. 24, one in Bordeaux and two in Paris, all affecting people who had recently been in China. By Feb. 8, a small cluster of cases was identified among British nationals who stayed at a ski chalet in the French Alps. Almost all of the 12 people diagnosed in late January and early February recovered; an 80-year-old tourist from China's Hubei province, died at a Paris hospital on Feb. 14, becoming Europe's first coronavirus death.

The French government has lagged behind others on the continent with its interventions. While the streets of Rome emptied, life in Paris remained largely unchanged. On Feb. 29, after an emergency Cabinet meeting at a point when the country had 100 cases and two deaths, the French government announced a ban on gatherings of more than 5,000 people, leading to the cancellation of the Paris Book Fair. On March 3, Education Minister Jean-Michel Blanquer announced the closure of 120 schools, mostly in Brittany and the Oise region north of Paris, where clusters of community transmission were detected. "We will not paralyze the economic and social life of the country," Health Minister Olivier Veran said in an interview published March 5.

The tone in France has shifted abruptly. On March 6, President Emmanuel Macron urged French citizens to "avoid visiting our elders as much as possible," to protect that vulnerable population. On March 8, with nearly 1,230 confirmed cases and 19 deaths, the government revised its restrictions on public gatherings, banning events larger than 1,000 people. On March 12, Macron announced that schools and universities would close nationally starting Monday. And on March 14, with more than 3,600 cases and 79 deaths, the government moved to close all nonessential businesses, including cafes and restaurants.

 

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Germany

2.50 cases per 100,000 people

Germany's initial outbreak is thought to have begun with a Chinese woman who traveled to the Bavarian town of Stockdorf for a workshop at a car parts factory on Jan. 21. On Jan. 27, a German man who participated in the workshop became the country's first confirmed case. The factory closed for two weeks and asked all employees and their family members - some of whom were diagnosed in subsequent days - to stay home.

Airline employees were asked to look out for sick passengers arriving from China as early as Jan. 24, but they did not administer temperature checks. Health Minister Jens Spahn said on Feb. 12 that checking temperatures "makes no sense," because so many people with the virus are asymptomatic. He said flight passengers may be questioned about recent contacts.

While Germany's first cluster could be controlled through contact tracing and isolation, by Feb. 26, the country was starting to see cases that were harder to track; Spahn created a crisis management committee and told German states to activate their pandemic plans. On March 9, with more than 1,150 cases in Germany, Spahn said events with more than 1,000 people should be canceled. But this is only a recommendation; it's up to each German state to decide what to do. The German government has issued travel warnings but no restrictions. Some state governments have closed schools, and Berlin is reducing public transport and shuttering all bars starting Tuesday.

Germany reported its first two deaths related to the virus on March 9. Two days later, Chancellor Angela Merkel warned that coronavirus could spread to two-thirds of the country's population before the end of the outbreak, but she did not announce new control measures. As of March 14, Germany had nearly 4,000 confirmed cases and eight deaths.

 

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Italy

20.62 cases per 100,000 people

Italy's first detected cases of coronavirus involved two Chinese tourists visiting Rome. The couple tested positive on Jan. 31; Italy immediately declared a six-month state of emergency and suspended flights from China. "The system of prevention put in place by Italy is the most rigorous in Europe," Prime Minister Giuseppe Conte said.

Infectious disease specialists now believe the virus may already have begun spreading in communities in northern Italy by that point. The first identified case resulting from apparent community transmission was that of a 38-year-old man in the town of Codogno, outside Milan. He sought medical attention multiple times, starting on Feb. 14, but he wasn't diagnosed until Feb. 21 (after he infected his wife, hospital staff, several patients and others). The next day, Feb. 22, Conte announced a lockdown affecting 50,000 people, who are prohibited from leaving hotspot towns in the Lombardy and Veneto regions without specific permission.

Italy expanded its restrictions in phases. On March 4, with more than 2,500 cases confirmed, it announced the closure of schools and universities nationally. On March 8, with nearly 5,900 cases confirmed, the government ordered a lockdown for 16 million people in the north, while also closing museums and theaters across the country. On March 9, with nearly 7,400 total cases, the lockdown was extended to the rest of the country, limiting travel abroad and across regions. On March 11, with nearly 12,500 cases, the government ramped up the lockdown even further, halting nearly all commercial activity aside from supermarkets and pharmacies.

Italy has been testing fairly widely, performing more than 50,000 swabs. That partially explains why it has identified so many cases. The country, with the world's second-highest proportion of seniors, is also particularly vulnerable. As of March 13, Italy had recorded more than 17,600 total cases and 1,266 deaths.

 

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United States

0.50 cases per 100,000 people

The United States identified its first coronavirus case on Jan. 21, the day after a 35-year-old man who recently returned from Wuhan, China, showed up coughing at a clinic in Washington state. A few major airports had already begun screening passengers arriving from Wuhan. Health officials began tracing his contacts right away, locating 60 people, who all tested negative, and on Jan. 31, they established mandatory quarantines for certain passengers traveling from China.

That wasn't enough. Washington state has emerged as the pandemic's largest foothold in the United States, with new cases confirmed every day across the country. On Feb. 6, the Centers for Disease Control and Prevention began sending out test kits, which turn out to be flawed, and weeks passed before new kits could be delivered. In that time, the virus continued to spread, and health officials were left blind. By the end of February, new cases had arrived from Italy and South Korea. "CDC and my Administration are doing a GREAT job of handling Coronavirus, including the very early closing of our borders to certain areas of the world," President Donald Trump said on Feb. 25.

The country marked its first case of apparent community transmission in California on Feb. 28. Until late February, testing criteria remained narrow. A 56-year-old woman in Chevy Chase, Maryland, who returned in February from northern Italy and who had suffered from a cough and flu-like symptoms for 10 days, told The Washington Post that she could not get a coronavirus test at a hospital because she was not hospitalized or severely ill. The CDC approved widespread testing on March 3, but complaints about the availability of testing continued to mount.

In the first two weeks of the month, a new normal rapidly emerged, with school and universities closures, workplaces going remote, state and local governments banning large gatherings, and sports leagues suspending their seasons. By mid-March, the virus had spread to at least 11 nursing homes in the Seattle area, and facilities around the country were on lockdown. On March 10, New York Gov. Andew Cuomo declared a one-mile containment zone in the town of New Rochelle, the center of a growing outbreak in Westchester County. The National Guard was deployed to deliver food. On March 11, Trump placed travel bans on most of Europe, to the surprise of many officials there, adding to restrictions already in place on travel from China and Iran.

On March 13 - with more than 2,100 cases confirmed in nearly every state, and after the worst day for U.S. stocks since 1987 - Trump declared a national emergency and pledged to increase testing. The House passed a relief bill on March 14, dedicating tens of billions of dollars for paid sick leave, unemployment insurance, free testing and other measures. The Senate is expected to pass the legislation this coming week.