National responses to the COVID-19 pandemic

In response to the COVID-19 pandemic, national responses have been varied, and have included containment measures such as lockdowns, quarantines, and curfews. As of 29 November 2020, more than 62.5 million cases of COVID-19 have been reported in more than 191 countries and territories, resulting in more than 1.45 million deaths. More than 39.9 million people have recovered from the virus. The most affected countries in terms of confirmed cases are the United States, Brazil, India, Russia, South Africa, Peru, Mexico, Chile, the United Kingdom, and Iran. Lockdowns: The pandemic has caused worldwide curfews and similar restrictions (stay-at-home orders, shelter-in-place orders, shutdowns/lockdowns) established to prevent further spread of COVID-19. The pandemic has resulted in the largest amount of shutdowns/lockdowns worldwide at the same time in history. By 26 March, 1.7 billion people worldwide were under some form of lockdown, which increased to 3.9 billion people by the first week of April — more than half of the world's population. As of 12 April, nearly 300 million people, or about 90 per cent of the population, are under some form of lockdown in the United States, more than 50 million people are in lockdown in the Philippines, about 59 million people are in lockdown in South Africa, and 1.3 billion people are in lockdown in India. Africa- Ghana: The first two cases of the corona virus disease was confirmed on 12th March 2020, when two infected people came to Ghana; one from Norway and the other from Turkey. On 11 March, President Nana Akufo-Addo directed the Minister of Finance, Ken Ofori-Atta, to make the cedi equivalent of $US100 million available to enhance Ghana's coronavirus preparedness and response plan. The Ghana COVID-19 Private Sector Fund was also initiated to aid in the fight against the pandemic. Bans and Lock downs: On 15 March, at 10 pm, President Nana Akufo-Addo banned all public gatherings including conferences, workshops, funerals, festivals, political rallies, church activities and other related events to reduce the spread of COVID-19 at a press briefing on the state of COVID-19. Basic schools, senior high schools and universities, both public and private, have also been closed. Only BECE and WASSCE candidates were permitted to remain in school under social distancing protocols. The use of Veronica buckets have become very popular in Ghana following the outbreak of the novel coronavirus as citizens engage in frequent hand washing to stem its spread. On 30 March, the partial lock down of Accra and Kumasi took effect. In April 2020, At a press briefing, the Director General of the Ghana Health Service, announced the commencement of local production of nose masks as part of efforts to arrest the spread of the pandemic. According to the new Executive Instrument, E.I. 164, signed by the President on 15 June 2020, people who refuse to wear face masks in public could face jail terms of between 4–10 years or a fine of between GHS12,000 (approx US$2,065) and GHS60,000 (approx US$10,320) or both would be made. This came after the mandatory wearing of nose masks. Government responses: From April 3, over 464 markets were disenfected across the country. The second phase of nation wide fumigation begun in July. On 23 September, the MoE with GES collaborated with Zoomlion to disinfect SHS across Ghana to pave way for the reopening of schools. The Finance Minister claimed in his report that the Government spent about 54.3 million Ghana cedis to provide cooked and uncooked food to the vulnerable during the 3-week lockdown. He also claimed Government would provide free electricity and water for the rest of 2020. The Parliament of Ghana granted a tax waiver of GHS174 million cedis (equivalent to US$30 million) on income taxes of frontline workers. This spanned for three months from July to September 2020. On 15 October, the MoH received a Covid-19 AI software for detecting the virus on Chest X-rays. Government also relaunched the GH COVID-19 tracker app after it was launched on April 13. Various treatment centers were built across the country such as the Ghana Infectious Disease Centre, to help in the National COVID-19 Treatment. Ghana became the first country to use drone aircraft in the fight against the pandemic through the transport of Covid-19 test samples. Namibia: On 17 March President Hage Geingob declared a state of emergency as a legal basis to restrict fundamental rights. The prohibition of large gatherings was clarified to apply to 50 or more people. Measures such as the closure of all borders, suspension of gatherings were implemented. All public and private schools were also closed for a month. By 14 April, a National lockdown was enforced to all regions in the country. Access to information and surveillance: A COVID-19 communication hotline (0800100100) was established on 15 March 2020 which is run by the Ministry of Health and Social Services and the Centre for Disease Control of Namibia (CDC). The hotline serves to answer general enquiries of the public, assisting persons seeking guidance from the Ministry and reporting possible symptoms or cases of COVID-19. The Government also announced on 18 March that it will strengthen their communication to the public via various platforms, such as the COVID-19 communication centre operated by NBC, in an attempt to "mitigate and refute misinformation, fear and panic especially from social media". The centre was fully functional by middle April 2020. With the establishment of a multi-disciplinary Emergency Response team, the Ministry intensified their surveillance in monitoring the situation of COVID-19 in the country, especially at the borders of Namibia. The response team operates 24/7. Testing: Before the confirmation of COVID-19 in Namibia, tests could not be done locally. Test samples were instead sent to South Africa, which accounted for longer than usual waiting times. Namibian Institute of Pathology (NIP) started testing locally in Windhoek at the end of March 2020. In late April, private laboratory PathCare started testing samples. Namibia was hit by a lack of reagents at the end of April, which slowed down testing however, private testing at PathCare was expensive compared to the that of the state (NIP) which offers free COVID-19 tests. Economic stimulus package: An Emergency Income Grant was set up by government to distribute N$ 750 to every person whose income was affected by the pandemic or faced difficult conditions due to the lockdown. Over 800,000 people applied for this grant; 346,000 of them were paid by the end of April. South Africa: President Cyril Ramaphosa declared that South Africa would undergo a national lockdown, for a period of 21 days, from 26 March to 16 April 2020. This drastic measure was intended to help keep the viral infection rate as low as possible and save lives. On Thursday 9 April, President Ramaphosa announced an extension of two weeks to the lockdown, until the end of April. Exempt from the lockdown are people deemed necessary for the effective response to the pandemic such as health workers, pharmacy and laboratory personnel, emergency personnel, security services, supermarkets, transportation and logistical services, petrol stations, banks, essential financial as well as payment services and those working in industries that can affect the economy when shut down. This include mines and steel mills. Testing: The National Institute for Communicable Diseases (NICD) started testing people in South Africa for SARS-CoV-2 on 28 January 2020, and by 7 February had conducted 42 of such tests. State hospitals were offering free COVID-19 testing by mid-March. On 30 March 2020, the government announced its intentions of initiating an enhanced screening and testing programme. By the start of April, 67 mobile testing units had been established and 47000 people had been tested, some in drive-through facilities. Clinical trials, vaccines and treatment: On 17 March 2020, the South African Health Products Regulatory Authority announced that it would expedite review of treatments, vaccines and clinical trials. A team from 8 universities and 14 hospitals led by Helen Rees and Jeremy Nel from the University of the Witwatersrand participated in the World Health Organization Solidarity Clinical Trials that investigated medications. A COVID-19 vaccine trial was launched in Gauteng province, towards the end of June 2020 in collaboration with the Jenner Institute, University of Oxford and AstraZeneca. A second vaccine trial was launched during mid August 2020 in collaboration with a US Maryland based biotechnology company, Novavax, with funding from the Bill & Melinda Gates Foundation. A third vaccine trial was launched in September 2020 by Johnson & Johnson/Janssen. Asia- China: The first person known to have fallen ill due to the new virus was in Wuhan on 1 December 2019. A public notice on the outbreak was released by Wuhan health authority on 31 December; the initial notice informed Wuhan residents that there was no clear evidence of human-to-human transmission of the virus, that the disease is preventable and controllable, and that people can wear masks when going out. WHO was informed of the outbreak on the same day. On 7 January 2020, the Chinese Communist Party Politburo Standing Committee discussed novel coronavirus prevention and control. The Wuhan government, which announced a number of new measures such as cancelling the Chinese New Year celebrations, in addition to measures such as checking the temperature of passengers at transport terminals first introduced on 14 January. A quarantine was announced on 23 January 2020 stopping travel in and out of Wuhan. A group tasked with the prevention and control of the COVID-19 pandemic was established on 26 January, led by Chinese Premier Li Keqiang. The leading group decided to extend the Spring Festival holiday to contain the outbreak. China Customs started requiring that all passengers entering and exiting China fill in an extra health declaration form from 26 January. The health declaration form was mentioned in China's Frontier Health and Quarantine Law, granting the customs rights to require it if needed. On 27 January, the General Office of the State Council of China, declared a nation-wide extension on the New Year holiday and the postponement of the coming spring semester. The office extended the previously scheduled public holiday from 30 January, to 2 February, while it said school openings for the spring semester would be announced in the future. Hong Kong's Chief Executive Carrie Lam declared an emergency at a press conference on 25 January, saying the government would close primary and secondary schools for two more weeks on top of the previously scheduled New Year holiday, pushing the date for school reopening to 17 February. Macau closed several museums and libraries, and prolonged the New Year holiday break to 11 February for higher education institutions and 10 February for others. On 1 February 2020, Xinhua News reported that China's Supreme People's Procuratorate (SPP) had "asked procuratorates nationwide to fully play their role to create a favourable judicial environment in the fight against the novel coronavirus pandemic." This included severe punishments for those found guilty of dereliction of duty and the withholding of information for officials. Tougher charges were proscribed for commercial criminal activities such as increasing prices, profiteering along with the "production and sale of fake and shoddy protective equipment and medicines." Prosecuting actions against patients who deliberately spread the infection or refuse examination or compulsory isolation along with threats of violence against medical personnel were also urged. The statement also included urging to prosecute those found fabricating and spreading coronavirus-related information and also stressed "harshly punishing the illegal hunting of wildlife under state protection, as well as improving inspection and quarantine measures for fresh food and meat products." Quarantine: On 23 January 2020, a quarantine on travel in and out of Wuhan was imposed in an effort to stop the spread of the virus out of Wuhan. Flights, trains, public buses, the metro system, and long-distance coaches were suspended indefinitely. Large-scale gatherings and group tours were also suspended. By 24 January 2020, a total of 15 cities in Hubei, including Wuhan, were placed under similar quarantine measures. Before the quarantine began, some in Wuhan questioned the reliability of the figures from the Chinese government as well as the government response, with some calling for quarantine, and a post also showed sick people and three dead bodies covered in white sheets on the floor of a hospital on 24 January, although many such posts in Weibo about the epidemic have since been deleted. Due to quarantine measures, Wuhan residents rushed to stockpile essential goods, food, and fuel; prices rose significantly. 5,000,000 people left Wuhan, with 9,000,000 left in the city. The city of Shantou in Guangdong declared a partial lockdown on 26 January, though this was reversed two hours later. Local authorities in Beijing and several other major cities, including Hangzhou, Guangzhou, Shanghai, and Shenzhen, announced on the same day that these cities will not impose a lockdown similar to those in Hubei province. By 6 February 2020, a total of four Zhejiang cities—Wenzhou, Hangzhou, Ningbo, and Taizhou—were under the "passport" system, allowing only one person per household to leave their home every two days. These restrictions apply to over 30 million people. Speciality hospitals: A speciality hospital named Huoshenshan Hospital has been constructed as a countermeasure against the outbreak and to better quarantine the patients. Wuhan City government had demanded that a state-owned enterprise construct such a hospital "at the fastest speed" comparable to that of the SARS outbreak in 2003. Upon opening, the speciality hospital had 1,000 beds and took up 30,000 square metres. The hospital is modelled after the Xiaotangshan Hospital, which was fabricated for the SARS outbreak of 2003, itself built in only seven days. On 24 January 2020, the authority announced that they would convert an empty building in Huangzhou District, Huanggang to a 1,000-bed hospital named Dabie Mountain Regional Medical Centre. Works began the next day by 500 personnel and the building began accepting patients on 28 January 2020 at 10:30 pm. In Wuhan, authorities seized dormitories, offices and hospitals to create more beds for patients. On 25 January authorities announced plans for Leishenshan Hospital, a second speciality hospital, with a capacity of 1,600 beds; operations are scheduled to start by 6 February. The hospital opened on 8 February. By 16 February 2020, 217 teams of a total of 25,633 medical workers from across China went to Wuhan and other cities in Hubei to help open up more facilities and treat patients. A total of 14 temporary hospitals were constructed in China in total, but all were reported to have closed after the crisis was determined be under control on 10 March 2020. Censorship and police responses: The early response by city authorities was criticised as prioritising a control of information that might be unfavorable for local officials over public safety, and China was also criticised for cover-ups and downplaying the initial discovery and severity of the outbreak. By the time China had informed the WHO of the new coronavirus on 31 December 2019, The New York Times reported that the government was still keeping "its own citizens in the dark". Observers have attributed this to the censorship institutional structure of the country's press and Internet, exacerbated by China's paramount leader Xi Jinping's crackdown on independent oversight such as journalism and social media that left senior officials with inaccurate information on the outbreak and "contributed to a prolonged period of inaction that allowed the virus to spread". A group of eight medical personnel, including Li Wenliang, an ophthalmologist from Wuhan Central Hospital who in late December posted warnings on a new coronavirus strain akin to SARS, were taken into custody by Wuhan police and threatened with prosecution for "spreading rumours" for likening it to SARS. Li Wenliang later died of the disease on 7 February, and was widely hailed as a whistleblower in China, but some of the trending hashtags on Weibo such as "Wuhan government owes Dr Li Wenliang an apology" and "We want freedom of speech" were blocked. His death widespread public anger in the aftermath, in what has been described as "one of the biggest outpourings of online criticism of the government in years," was not a topic that was permitted for coverage. On 20 January, Chinese Communist Party General Secretary Xi Jinping made his first public remark on the outbreak and spoke of "the need for the timely release of information". One day later, the CPC Central Political and Legal Affairs Commission, the most powerful political organ in China overseeing legal enforcement and the police, wrote "self-deception will only make the epidemic worse and turn a natural disaster that was controllable into a man-made disaster at great cost," and "only openness can minimise panic to the greatest extent." The commission then added, "anyone who deliberately delays and hides the reporting of cases out of self-interest will be nailed on a pillar of shame for eternity." Xi Jinping later also instructed authorities "to strengthen the guidance of public opinions", language which some viewed as a call for censorship after social media users became increasingly critical and angry at the government. On 30 January, China's Supreme Court, delivered a rare rebuke against the country's police forces, calling the "unreasonably harsh crackdown on online rumours" as undermining public trust. As part of the central government's "bifurcated approach to diffuse discontent", citizens were permitted to criticise local officials so long as they did not "question the basic legitimacy of the party". The Cyberspace Administration (CAC) declared its intent to foster a "good online atmosphere," with CAC notices sent to video platforms encouraging them to "not to push any negative story, and not to conduct non-official livestreaming on the virus." Censorship has been observed being applied on news articles and social media posts deemed to hold negative tones about COVID-19 and the governmental response, including posts mocking Xi Jinping for not visiting areas of the epidemic, an article that predicted negative effects of the epidemic on the economy, and calls to remove local government officials. While censorship had been briefly relaxed giving a "window of about two weeks in which Chinese journalists were able to publish hard-hitting stories exposing the mishandling of the novel coronavirus by officials", since then private news outlets were reportedly required to use "planned and controlled publicity" with the authorities' consent. Approval of Chinese responses: China's response to the virus, in comparison to the 2003 SARS outbreak, has been praised by some foreign leaders and analysts. UN Secretary General Antonio Guterres stated on February that it was clear "there is a massive effort that is made by China in order to contain the disease and avoid its propagation" and added the effort was "remarkable". U.S. President Trump thanked Chinese leader Xi Jinping "on behalf of the American People" on 24 January on Twitter, stating that "China has been working very hard to contain the Coronavirus. The United States greatly appreciates their efforts and transparency." Germany's health minister Jens Spahn, in an interview on Bloomberg TV, said with comparison to the Chinese response to SARS in 2003: "There's a big difference to SARS. We have a much more transparent China. The action of China is much more effective in the first days already." He also praised the international co-operation and communication in dealing with the virus. In a letter to Xi, Singaporean president Halimah Yacob applauded China's "swift, decisive and comprehensive measures" in safeguarding the health of the Chinese people, while prime minister Lee Hsien Loong remarked of "China's firm and decisive response" in communities affected by the virus. Similar sentiments were expressed by Russian president Vladimir Putin. At a Sunday mass at St. Peter's Square in Vatican City on 26 January, Pope Francis praised "the great commitment by the Chinese community that has already been put in place to combat the epidemic" and commenced a closing prayer for "the people who are sick because of the virus that has spread through China". Microsoft co-founder Bill Gates defended the nation's COVID-19 response amidst criticism from the Trump administration, saying "China did a lot of things right at the beginning" and that "they got to zero" with "an effective lockdown". Papers from academic journals and publishers such as Science Magazine, Nature, The Lancet, and Karger have regarded China's measures to contain the coronavirus in its own country to be effective. A study in March published in Science Magazine concluded that the Wuhan travel ban and national emergency response there may have prevented more than 700,000 COVID-19 cases outside the city. India: The Indian government airlifted 324 of its citizens from China on 31 January and 1 February via Air India special chartered flights. After Pakistan's refusal to evacuate its students from Wuhan, the Indian government offered to support them with evacuation along with citizens of other neighbouring countries. On 17 February, India announced a special C-17 Globemaster flight carrying medical supplies to support China in Wuhan and evacuating citizens of India and neighbouring countries. India eventually evacuated 647 people including citizens of Maldives and Bangladesh. On 15 March, after a video conference of SAARC leaders, PM Narendra Modi allocated ₹74 crore (US$10 million) of funds classified as COVID-19 Emergency Fund for the SAARC countries. As a precautionary measure, India closed all of its international land borders on 16 March. On 22 March, India locked down places where cases had been confirmed—82 districts in 22 states and Union Territories—until 31 March, although essential services and commodities were to continue. 80 cities including major cities such as Bengaluru, Chennai, Delhi, Mumbai, Kolkata, Nagpur, Varanasi and Raipur were also put under lockdown. On 24 March, the government announced a nationwide lockdown to be in effect for 21 days from 25 March until 14 April. This lockdown included Indian Railways, the biggest employer in India; it was the first shutdown of the trains in 167 years. Indonesia: Many Indonesians criticised the government for a slow response and downplaying the pandemic. WHO, Australian government, and United States embassy in Indonesia have expressed their doubts about the Indonesian government's response to the pandemic. The governor of West Sumatra province, Irwan Prayitno faced backlash for accepting 174 tourists from China to the province. 174 Chinese tourists from Kunming arrived at Minangkabau International Airport at Padang Pariaman Regency as Citilink adds Padang – Kunming route. Prayitno received further backlash after welcoming the group of tourists himself at the airport and giving them a "grand welcome" with a cultural parade. The move angered local residents who demanded the governor return the group to China. Health experts are concerned that the country is failing to identify the transmission of the virus. Marc Lipsitch, professor of epidemiology at the Harvard T. H. Chan School of Public Health, "analysed air traffic out of the Chinese city at the centre of the outbreak in China and suggested in a report ... that Indonesia might have missed cases" of coronavirus. Western diplomats as well as local and international news outlets postulated that the lack of cases within Indonesia result from inadequate testing and under reporting, as opposed to sheer luck and divine intervention. The government faced a backlash after instead pledging to set aside IDR 72 billion ($5m) to pay for social media influencers to attract tourists to Indonesia. Indonesian president Joko Widodo has been criticised by the Indonesian Chamber of Commerce and Industry, human rights groups, and by political parties including Golkar and Partai Keadilan Sejahtera for a lack of transparency regarding the information on COVID-19. Widodo has insisted not to share with the travel history details of patients tested positive with coronavirus in an attempt to reduce panic and uneasiness in the general public. Iran: Iran reported its first confirmed cases of SARS-CoV-2 infections on 19 February 2020 in Qom, where according to the Ministry of Health and Medical Education, both had died later that day. Early measures announced by the government included the cancellation of concerts and other cultural events, sporting events, and Friday prayers, closure of universities, higher education institutions and schools, and allocated 5 trillion rials to combat the virus. President Hassan Rouhani said on 26 February 2020 that there were no plans to quarantine areas affected by the outbreak, and only individuals would be quarantined. However, Shia shrines in Qom remained open to pilgrims. Iran became a center of the spread of the virus after China. Amidst claims of a cover-up of the extent of the outbreak in the country, over ten countries have traced their cases back to Iran, indicating that the extent of the outbreak may be more severe than that admitted by the Iranian government. The Iranian Parliament was shut down, with 23 of the 290 members of parliament reported to have had tested positive for the virus on 3 March. A number of senior government officials as well as two members of parliament have died from the disease. Criticism against Iranian government's responses: Iranians criticized government authorities for proceeding with elections while the disease was spreading and closing secular spaces while keeping shrines open, especially in the Shia holy city of Qom. Asif Shuja of the National University of Singapore's Middle East Institute suggested that "the fact that Iran reported deaths on the same day as its first infections right before its parliamentary elections 'can compel anyone' that there has been a cover-up". Scrutiny has also been targeted at the government's unwillingness to implement area-wide quarantine measures like those implemented by China and Italy, with Iranian officials calling quarantines "old-fashioned." There have been concerns that the Iranian government's official counts were an underestimate. The WHO's director-general, Tedros Adhanom Ghebreyesus, said that "the WHO has its "own mechanism" for checking facts and has not seen problems with Iran's reported figures". Japan: On 27 February 2020, Prime Minister Shinzo Abe requested that all Japanese elementary, junior high, and high schools close until early April to help contain the virus. The outbreak has been a concern for the 2020 Summer Olympics which is scheduled to take place in Tokyo starting at the end of July. The Japanese government has thus been taking extra precautions to help minimise the outbreak's impact. The Japanese government and the International Olympic Committee have negotiated postponement of Summer Olympics until 2021. Criticism against Japanese government's responses: Foreign Policy and the Guardian reported that the diplomatic relations between Japan and South Korea worsened, as South Korea criticized Japan's "ambiguous and passive quarantine efforts". On March 5, Japan announced that it would strengthen quarantine for new entrants from China and South Korea and add some areas of Iran to the target area. The Chinese authorities showed their understanding of the decision, but the Japanese media and South Korean government criticized it. The Japanese media said that the decision was too late because they were too careful with China, and the Korean government turned it into a political issue. Japan's Ministry of Health, Labor and Welfare has been criticized for a perceived delayed response. Critics have observed that while Japan announced the first case of infection on 28 January, it took until 17 February for the Health Ministry to inform the public on how to reach public screening centers and 25 February, for the government to issue a "basic policy" on outbreak response. The strict constraints on testing for the virus by Japanese health authorities have drawn accusations from critics such as Masahiro Kami, a hematologist and director of the Medical Governance Research Institute but not an infectious disease expert, towards Abe of wanting to "downplay the number of infections or patients because of the upcoming Olympics." But the fact-checking in some media later reported to proved that it was fake news that 'the number of infected people was being reduced for the Olympics by the government.' Reports that only a small select number of public health facilities were authorized to test for the virus, after which the results could only be processed by five government-approved companies, has created a bottleneck where clinics have been forced to turn away even patients who had high fevers. This has led some experts to question Japan's official case numbers, with Tobias Harris, of Teneo Intelligence in Washington, D.C. stating "You wonder, if they were testing nearly as much as South Korea is testing, what would the actual number be? How many cases are lurking and just aren't being caught?" As mentioned above, there were many articles criticizing the small number of PCR tests in Japan compared to South Korea, mainly in the Japanese and Korean media. However, the number of PCR tests in Japan at that time was actually not small at all. According to data released by the Ministry of Health, Labour and Welfare the Japanese authorities conducted PCR tests of 10,205 as of March 13 and 15,655 as of March 17, except for those returning from China by charter flight and passengers on the cruise ship. The number of tests in Japan appears to be small compared to 320,000 in China, 250,000 in South Korea, 86,000 in Italy, and 77,000 in Russia. However, only 30,000 in the UK, 16,000 in Taiwan, and the United States had a higher number of tests than Japan except for that four countries. In terms of population ratio, the ranking was lower, but the number of tests in Japan was still at the average level. The quarantine measures on the cruise ship Diamond Princess has also been criticised, even though there is no obligation under the international law to accept port calls for Japan and except for Japanese nationals on board, there is no obligation in Japan to treat all passengers, and the treatment is a good faith act, and the quarantine was the exercise of provisions in accordance with international and domestic laws. But Kentaro Iwata, an infectious disease professor at Kobe University Hospital, said that "the condition aboard was completely chaotic" and "violating all infection control principles". Dr. Yoshihiro Takayama, a member of the Ministry of Health, Labor and Welfare who helped Iwata board the ship, said that Iwata had fight with DMAT members about his separate action and was forced to disembark in two hours, so he just looked around the lounge. A preliminary report by Japan's National Institute of Infectious Diseases (NIID) estimated that most of the transmission on the ship had occurred before the quarantine, based on the first 184 cases. On 22 February, the Health Ministry admitted that 23 passengers were disembarked without being properly tested for the virus. On 23 February, a Japanese woman who tested negative before disembarking from the cruise ship later tested positive after returning to her home in Tochigi Prefecture. She was not among the 23 passengers. Many passengers who were negative in the PCR test were tested positive after disembarking. Philippines: The first COVID-19 death outside China occurred in the Philippines on 1 February. On 9 March 2020, President Rodrigo Duterte suspended classes in all levels in Metro Manila from 10 to 15 March. The class suspension in Metro Manila was extended to 12 April, following the decision of concerned authorities to raise the COVID-19 alert level in the country to Code Red Sublevel 2. Work in the executive branch of the government was also suspended for the same period as part of the Stringent Social Distancing Measures in the National Capital Region (NCR), with the directive for the concerned government agencies to form skeletal forces to ensure the delivery of basic services. Congress and the Judiciary were encouraged to do the same. Agencies providing law enforcement services, health services, and emergency services were enjoined to continue to operate at full capacity. Other salient directives, contained in a resolution adopted by the Inter-Agency Task Force on Emerging Infectious Diseases (IATF-EID) and announced by the Philippine President on 12 March, at the Heroes Hall in Malacañang Palace, included, the prohibition of mass gatherings that could strain the resources of the host community, imposition of community quarantine over Metro Manila, and encouragement of flexible work arrangements for the private sector among others. A memorandum containing the guidelines for stringent social distancing measures and the management of COVID-19 in the National Capital Region was issued by Executive Secretary Salvador Medialdea by order of the president on 13 March. Among the directives embodied in the memorandum were suspension of classes and all school activities until 14 April, prohibition of mass gatherings, imposition of strict social distancing during essential meetings and religious activities, and provisions for alternative and/or flexible work arrangements. On 16 March, the president signed Proclamation No. 929 declaring a state of calamity throughout the country for a period of six months, bringing into effect the price control of basic needs and commodities, granting of interest-free loans, distribution of calamity funds and hazard allowance for public health workers and government personnel in the fields of science and technology. President Duterte also placed the island of Luzon (including its associated islands) under enhanced community quarantine on 16 March that further restricted the movement of people through the suspension of mass public transport and the closure of non-essential establishments. Business Process Outsourcing and export-oriented businesses were allowed to continue operation subject to certain conditions. Relevant government agencies were ordered to provide social amelioration measures. Following the sharp increase of confirmed cases, President Duterte called Congress to a special session to "authorize the President to exercise powers necessary to carry out urgent measures to meet the current national emergency related to the Coronavirus Disease (COVID-19)." South Korea: The first confirmed case of the coronavirus was identified with a 35-year-old Chinese woman on 20 January. The first South Korean national to be infected occurred three days later was a 55-year-old man who worked in Wuhan and returned for a checkup with flu symptoms. The two infection reports were publicly released on 24 January. The sixth patient was the first case in South Korea who had never visited Wuhan. The 56-year-old man caught the virus when visiting a restaurant with the third patient. A woman, who had returned from Thailand after a five-day vacation, was tested positive and confirmed as the sixteenth case on 4 February. Three more cases were confirmed on 5 February, bringing the total case count to 19. The seventeenth and nineteenth patients had attended a conference in Singapore and been in contact with an infected person there. The very same day the Centers for Disease Control and Prevention Korea (KCDC) announced that the second patient had been released from hospital after being tested negative in consecutive tests, becoming the country's first coronavirus patient to fully recover. On 19 February, the number of confirmed cases increased by 20. On 20 February 70 new cases were confirmed, giving a total of 104 confirmed cases, according to the KCDC. According to Reuters, KCDC attributed the sudden jump to 70 cases linked to "Patient No. 31", who had participated in a gathering in Daegu at the Shincheonji Church of Jesus the Temple of the Tabernacle of the Testimony. On 20 February, the streets of Daegu were empty in reaction to the Shincheonji outbreak. A resident described the reaction, stating "It's like someone dropped a bomb in the middle of the city. It looks like a zombie apocalypse." The first death was reported in a mental ward of Cheongdo Daenam Hospital in Cheongdo County. According to the mayor of Daegu, the number of suspected cases as of 21 February was 544 among 4,400 examined followers of the church. The hospital was suspected as the source of the present outbreak after it was visited by a woman who became the second fatal case of Korea on that day. The infection spread outside via a funeral ceremony attended by members of the church. All South Korean military bases were on lockdown after tests confirmed that three soldiers were indeed positive for the virus. Airlines cut connections and cultural schedules were being cancelled due to fears of further spread. United States Forces Korea raised the alert level from low to moderate and cut off non-essential travel to and from USFK Daegu. USFK Daegu's school facilities were closed and non-essential personnel were ordered to stay at home while any visitors going there were not allowed to enter. USFK announced that the widow of a retired soldier who was in Daegu was diagnosed to be positive for the virus on 24 February. Camp Humphreys enacted virus detection protocols, including temperature checks and raised the alert level to high. On 26 February, an American soldier based at Camp Carroll was diagnosed to be positive and was quarantined away from bases via off-base housing unit with contact tracing done that showed his movements to Camp Walker. As of 22 February, among 9,336 followers of the church, 1,261 reported symptoms. At the time, 169 confirmed cases involved the church and another 111 came from the Cheongdo Daenam Hospital. 23 February saw another 123 cases with 75 being from Shincheonji and 24 February saw 161 additional cases with 129 being from the religious group. Over 27,000 people have been tested for the virus with 19,127 negative results. On 24 February, 15 countries imposed travel restrictions to and from South Korea. It was also reported that a senior health official overseeing the COVID-19 efforts in Daegu tested positive and was also a member of Shincheonji. Within a few days, a petition to the nation's president urging for the disbandment of the church had over 750,000 signatures. Their headquarters in Gwacheon was raided by law enforcement; government officials said all 245,000 members of the religious group would be found and tested. On 28 February, over 2,000 confirmed cases were reported, rising to 3,150 on 29 February. On 8 March, KCDC in South Korea announced that 79.4% of confirmed COVID-19 cases were related to group infection. KCDC also announced that outbreak associated with Shincheonji Church totaled 4,482 infections, accounting for 62.8% of the total confirmed cases. 13 March was the first time since the outbreak on 20 January in which the number of recoveries, 177, was larger than the number of those who newly tested positive, 110. As infection rates have risen outside Korea leading to increases of sick arriving in the country (476 of 9,661 cases were imported as of 30 March), the KCDC implemented stronger infectious disease control measures for travelers coming from overseas as of 1 April. By 9 April 2020, South Korea had about 10,423 cases and 204 deaths, with over 494,711 people having been tested, a case fatality rate of 1.95%, which is lower than the WHO's global case fatality rate of 4.34%. Seeing the infodemic on COVID-19 information starting in China and spreading to Korea and the US, fake news researcher Cha Meeyoung of KAIST and the Institute for Basic Science, along with researchers from Ewha Womans University, started the multilingual Facts Before Rumors campaign to separate common claims seen online. By 17 April, the KCDC stated that it knew of 163 patients who were said to have recovered, but again tested positive. The exact cause was not known but they stated several possibilities. After several days with new infections numbering in the single digits (April 18, 20, 22), the government announced it was going to start lifting restrictions starting with stores, restaurants, gyms, cram schools, bars, and religious services; which is notable as most of the nation's infections came from places of worship. In coming weeks, arboretums, forests and national parks will begin to open with social distancing still in place until at least early May. After seeing Korea successfully lower cases of infection, President Moon Jae-in has engaged in "coronavirus diplomacy" with leaders of other nations, part of which involved exporting test kits to more than 20 countries. On April 26, confirmed patient number 31 in Daegu was discharged after 67 days. Criticism against South Korean government's responses: The Ministry of Health and Welfare has been criticized for unilaterally implementing telephone consultation and prescription without discussing with the Korea Medical Association, and for not restricting traffic from China despite several warnings from the association and a petition proposed by the society. On 22 February, the South Korean government apologized for calling the virus "Daegu Corona 19" in an official report. The term has been widespread on social media and raises concerns about discrimination. More than 1.5 million South Koreans have signed a petition to impeach President Moon Jae-in over what they claim is the government's mishandling of the outbreak. On 6 March, the South Korean government has only entry restricted to Japanese citizens out of 102 countries that blocked Korea. The action has been widespread on social media and raises concerns about anti-Japanese discrimination. Turkey: On 10 January 2020, the Ministry of Health set up the Coronavirus Scientific Advisory Board. It consists of 26 members specialized in fields such as chest diseases, infectious diseases and clinical microbiology. The number of board members later increased to 31 with the joining of experts and academics in virology, internal medicine and intensive care medicine. In the early hours of 11 March 2020 (UTC+03:00), the Minister of Health Fahrettin Koca announced that a Turkish man who had contracted the virus while travelling in Europe was the country's first confirmed coronavirus case. The patient had been placed in isolation at an undisclosed hospital, and family members of the patient were put under observation. On 12 March 2020, after a meeting between President Recep Tayyip Erdoğan and the rest of the Turkish government, Press Secretary İbrahim Kalın announced that primary schools, middle schools, and high schools in Turkey would be closed starting from 16 March 2020 for a week. Universities would also be closed for three weeks. Sports matches would be played behind closed doors in the stadiums until the end of April. The president also postponed all his overseas visits. At the press conference held on 25 March, the Minister of National Education Ziya Selçuk announced that remote teaching would continue until 30 April. On 26 March, President of the Council of Higher Education Yekta Saraç stated that there would be no in-person teaching at universities in the remainder of the spring semester, and that they would continue with remote education only. On 21 March, the Ministry of Transport and Infrastructure a total curfew for those who are over the age 65 or chronically ill. On 27 March, the Ministry of the Interior issued a new statement regarding gatherings during weekends, announcing that starting from 28 to 29 March, having picnics, fishing at the shores, doing physical exercise outside (including running and walking on the weekends in city and town centers) would be banned until the virus spread has been contained. It was also stated that, should they deem it necessary, local authorities may extend these new measures to weekdays. Also on 27 March, President Erdoğan announced that all overseas flights were terminated, adding that intercity travel was subject to permission by the state governors, and that places such as picnic areas, forests and historical sites would be closed on the weekend. On 3 April 2020, President Erdoğan announced a 15-day entry ban to 30 metropolitan municipalities as well as Zonguldak. Also, the curfew was extended to people younger than 20 years old. Using masks in public places became mandatory. Criticism against Turkish government's responses: The announced ₺100 billion economic measures package, set to be provided by the government, was criticized by institutions and individuals, including economists and politicians. The lack of a detailed action plan was the center of criticism. Additionally, at a time when people were encouraged to stay at home, the government was criticized for allowing airline passenger transport and tax reductions that support tourism. Critics asked for lowering the down payment of housing loans and emphasized on the need to provide employment support to different sectors. The donation campaign initiated by President Recep Tayyip Erdoğan was supported by representatives of the ruling party, members of the oppositions had a less favorable reaction to it. After the government's decision to take money from the income of several institutions in order to make donations to this campaign, the Confederation of Public Employees' Unions filed a criminal complaint as a result of the salary cuts of the staff of many institutions such as MEB, BOTAŞ, General Directorate of Forestry, Ministry of Justice, Constitutional Court and Social Service Provincial Directorates. Additionally, a similar donation campaign initiated by the metropolitan municipalities with CHP administration was terminated by the Ministry of the Interior and their bank accounts were blocked. Regarding this decision, the Ankara Bar Association issued a statement, saying: "Although the aforementioned circular and blocking process enforced by the Ministry of the Interior are clearly unlawful, the provision of social services belongs neither exclusively to the local governments nor to the central government." Europe: France: Although it was originally thought the pandemic reached France on 24 January 2020, when the first COVID-19 case in Europe was confirmed in Bordeaux, it was later discovered that a person near Paris had tested positive for the virus on 27 December 2019 after retesting old samples. A key event in the spread of the disease in the country was the annual assembly of the Christian Open Door Church between 17 and 24 February in Mulhouse, which was attended by about 2,500 people, at least half of whom are believed to have contracted the virus. On 13 March, Prime Minister Édouard Philippe ordered the closure of all non-essential public places, and on 16 March, French President Emmanuel Macron announced mandatory home confinement, a policy which was extended at least until 11 May. As of 14 September, France has reported more than 402,000 confirmed cases, 30,000 deaths, and 90,000 recoveries, ranking fourth in number of confirmed cases. In April, there were riots in some Paris suburbs. On 18 May, it was reported that schools in France had to close again after reopening, due to COVID-19 case flare-ups. On 12 November it was reported that France had become the worst hit country by the COVID-19 pandemic, in all of Europe, in the process surpassing Russia. The new total of confirmed cases was more than 1.8 million and counting; additionally it was indicated by the French government that the current national lockdown would remain in place. Germany: At the end of January 2020, the first cases occurred in Bavaria in direct connection with the outbreak in Wuhan, China. After initial stagnation, several other cases were reported in different locations. During carnival in February, Heinsberg in Northrhine Westfalia was most affected, and case numbers steadily increased. By the second week of March, all federal states were affected and the first fatality was reported. As of 28 March 2020 the incidence was highest in the city state of Hamburg, followed by Baden-Württemberg and Bavaria. The Robert Koch Institute recommended an initial strategy of containment, until more cases would occur than could be traced back to an known case. The next phase of the epidemic, namely community transmission, was assumed to have begun first in Heinsberg, where a strategy of protection of vulnerable groups was adopted. Greece: On 26 February, the first case in Greece was confirmed, a 38-year-old woman from Thessaloniki who had recently visited Northern Italy. Within the next days, health and state authorities issued precautionary guidelines and recommendations, while measures up to that point were taken locally and included the closure of schools and the suspension of cultural events in the affected areas (particularly Ilia, Achaea and Zakynthos). Various municipalities around the country began disinfecting schools. The Greek National Public Health Organization (NPHO), in collaboration with local authorities and doctors, is tracking and testing everyone who came in close contact with the confirmed carriers. By 10 March, with 89 confirmed cases and no deaths in the country, the government decided to suspend the operation of all schools, universities, daycare centers and all other educational establishments nationwide and then, on 13 March, to close down all cafes, bars, museums, shopping centres, sports facilities and restaurants in the country. On 16 March, all retail shops were also closed and all services in all areas of religious worship of any religion or dogma were suspended. Supermarkets, pharmacies, food outlets that offer take-away and delivery only, as well as some other businesses, remained open. On 18 and 19 March, the government announced a series of economic measures of more than 10 billion euros to support the economy, businesses and employees. On 22 March, the Greek authorities announced significant restrictions on all nonessential transport and movement across the country, starting from 6 a.m. on 23 March. Movement outside the house is permitted only for specific reasons that include moving to or from the workplace, shopping for food or medicine, going to the bank, visiting a doctor or assisting a person in need of help and walking a pet or exercising outside individually or in pairs. Citizens leaving their home are required to carry their police ID or passport, as well as some type of attestation depending on the purpose of travel. All passenger flights to and from Italy, Spain, Albania, North Macedonia, Turkey, the United Kingdom, the Netherlands and Germany are suspended until 15 May, and land borders with Albania, North Macedonia and Turkey are closed, with exemptions for cargo and sanitary transports, among others. The measures put in place in Greece are some of the most proactive and strict in Europe and have been hailed internationally for slowing the spread of the disease and keeping the number of deaths among the lowest in Europe. Italy: The outbreak was confirmed to have spread to Italy on 31 January 2020, when two Chinese tourists tested positive for SARS-CoV-2 in Rome. In response, the Italian government suspended all flights to and from China and declared a state of emergency, with Prime Minister Giuseppe Conte stating that Italy is the first EU country to take this precautionary measure. On 31 January, the Italian Council of Ministers appointed Angelo Borrelli, head of the Civil Protection, as Special Commissioner for the COVID-19 Emergency. A unassociated cluster of COVID-19 cases was later further detected starting with 16 confirmed cases in Lombardy on 21 February, an additional 60 cases on 22 February, and Italy's first deaths reported on the same day. The Ministry of Health announced new guidelines for reporting cases on 27 February in response to the previous blanket testing that caused case numbers to surge and inflamed public panic. It would no longer report asymptomatic cases (swabs taken from patients which tested positive but were not showing symptoms) which counted as 40 to 50% of all reported cases at the time. These people would undergo isolation at home and would be followed up with new tests until they were negative. On 22 February, the Italian Council of Ministers announced a new decree law to contain the outbreak, including quarantining more than 50,000 people from 11 different municipalities in northern Italy. Prime Minister Giuseppe Conte said "In the outbreak areas, entry and exit will not be provided. Suspension of work activities and sport events has already been ordered in those areas." Punishments for violating of the lockdown range from a fine of 206 euros to 3 months imprisonment. Italian military and law enforcement agencies were instructed to secure and implement the lockdown. On 3 March, Chinese authorities reported that on March first and second, eight virus victims who had returned to the county of Qingtian, in East China's Zhejiang province, were suffering from the virus. All eight appear to have acquired COVID-19 in the northern town of Bergamo, a virus-ravaged municipality, where they had worked at a restaurant, Qingtian officials said. Chinese authorities called these "backflow cases" — virus carriers who contract the disease outside China, then bring it back to their homeland. On 4 March, the Italian government ordered the full closure of all schools and universities nationwide as Italy reached 100 deaths. Additionally, all major sporting events, including Serie A football matches, would be held behind closed doors until April. On 9 March, all sport was suspended completely for at least one month. On 21 February, at least ten towns in the Lombardy and Veneto regions of Italy, with a total population of 50,000, were locked down in quarantine procedure following an outbreak in Codogno in Lombardy. Police mandated a curfew closing all public buildings and controlling access through police checkpoints to the so-called 'red zone' which is enforced by penalties for violations ranging from a €206 fine to three months of imprisonment against trespassers who are not health or supply workers. The government of Giuseppe Conte said that sending in the armed forces to enforce the lockdown was a possibility. The governor of Basilicata, Vito Bardi, instituted a mandatory 14-day quarantine for people arriving from areas in northern Italy affected by the outbreak on 24 February. On the same day, 500 extra police officers were assigned to patrol the quarantined areas in Lodi and Veneto. On the morning of 8 March 2020, Conte said that much of Italy's northern territories, including Milan and Venice, would be quarantined within their region. Conte said the country was locking down all of the populous Lombardy region, with movement restrictions applying to about 16 million people. This will be the most aggressive response taken in any region beyond China, and will paralyse the wealthiest parts of the country as Italy attempts to constrain the rapid spread of the disease. On 8 March 2020, there have been 7,375 confirmed cases, and 366 deaths in Italy. On the evening of 9 March 2020, the quarantine was expanded to all of Italy. Criticism against Italian government's responses: Italy's government has drawn criticism from scientists and WHO, for its decision to suspend direct flights to mainland China that while sounding "tough" on paper, was ineffective as "people can still arrive from risk areas via indirect routes." Walter Ricciardi, professor of Hygiene and Public Health at the Università Cattolica del Sacro Cuore in Rome and a member of the European Advisory Committee on Health Research has said "Italy was wrong, closing flights from China is of no use when there are indirect ones." Italy's government has also been criticised for not testing or enforcing lockdowns sufficiently in some regions, sending mixed messages, and downplaying the severity of the situation. Criticism followed disclosures by Italian Prime Minister Giuseppe Conte that protocols had not been followed at the hospital in Codogno, Lombardy that treated "patient 1" which "certainly contributed to the spread" of the virus in Italy, with Conte responding to inquiries by journalists on what protocol was broken with "This is not the time for controversy." In response to a statement by Conte that the central government may need to "revoke regional health policy powers," President of Lombardy Attilio Fontana called Conte's statement "fascist" and "talking nonsense." On 8 March, plans by the government to quarantine 16 million people in Northern Italy were leaked early by a national newspaper, causing thousands of people to flee the region before it took place. Conte condemned the leak, calling it "unacceptable". Spain: On 31 January 2020, the first case was confirmed when a tourist tested positive for SARS-CoV-2 in La Gomera, Spain. On 14 March, due to the increased number of cases, Spanish Prime Minister Pedro Sánchez declared a state of alarm, placing all citizens in quarantine except for those working in healthcare or other vital activities, closing all non-critical businesses, and only allowing citizens to go outside for activities such as grocery shopping or walking a pet. Criticism against Spanish government's responses: Spanish government has received criticism for its perceived slow response to the pandemic, as it did not prevent any concentrations until 11 March when there already were 1,646 infected. The large march in Madrid for International Women's Day (8 March), which was attended by around 120,000 people received special criticism, as this event was promoted and attended by members of the government such as Irene Montero who was later confirmed to be infected. United Kingdom: The nature of devolution in the United Kingdom meant that each of the four countries of the UK had its own response to COVID-19 with different rules and restrictions at different times and many of the UK government actions only applying to England. On 24 March 2020, the United Kingdom brought in "some of the most far-reaching curbs on personal freedom ever introduced" in peacetime, including a three-week lockdown of the country. This included a ban on public gatherings of more than two people (excluding those one lives with) and the closing down of all non-essential businesses. Scotland: The first case of COVID-19 in Scotland was confirmed on March 1st with the first death of someone with COVID-19 occurring 12 days later. The following week, on March 20th, the Scottish government instructed a number of businesses to close, including pubs, cafes, cinemas and bingo halls. On 21 May, First Minister Nicola Sturgeon outlined a four-phase "route map" for easing lockdown restrictions in Scotland to take effect from 28 May subject to the number of new cases of COVID-19 continuing to fall. Criticism against British government's responses: The UK government received intense pressure for its lax measures taken against the virus in comparison to other European countries. The World Health Organization questioned the UK government's response to COVID-19 with spokeswoman Dr. Margaret Harris stating in an interview on Today that not enough is known about the science of COVID-19 to justify the UK's approach to developing "herd immunity" against the virus, saying that while "theories" can be talked about, the current situation requires "action". The UK's controversial plan to tackle COVID-19 has been developed by Sir Patrick Vallance and Prof. Chris Whitty. Government Minister Helen Whately responded by saying that the Government is "following the evidence". North America- Costa Rica: Since the start of the pandemic, the Ministry of Health, together with the Government, were in charge of informing the general population through a daily press conference. By 6 March, the first confirmed case of COVID-19 is registered after several results obtained by INCIENSA (Costa Rican Institute of Research and Teaching in Nutrition and Health). The 49-year-old American woman was isolated, along with her husband in a San José lodging. There were 2 previous suspected cases under investigation. The positive patient arrived with her husband on Sunday, 1 March without symptoms, at the Juan Santamaría airport, they visited Alajuela and Puntarenas, so investigations were carried out from these areas to follow up on contacts, as well as 152 people traveling on the flight that brought them to the country. On 9 March, due to the nine confirmed cases of COVID-19, the Ministry of Health in coordination with the National Emergency Commission (CNE) reported that from 10 March, events and concentration activities are canceled massive, both free and paid, while teleworking for public institutions is instructed through the Presidential Directive. The President Carlos Alvarado and the Minister of Health, Daniel Salas announced, on 12 March, preventive closings to educational centers at risk, the reduction in 50% of the approved capacity of public meeting spaces and suspension of trips abroad for public employees. A telephone line is created for inquiries about COVID-19. On 15 March, the Ministry of Health made the decision to instruct a total lockdown placing all citizens in quarantine except for those working in healthcare and delivery restaurant and food services. The closure of bars, clubs and casinos and the amusement park was informed. By this date 35 confirmed cases of COVID-19 are registered in the nation. On 16 March, The Government declares a state of National Emergency, prevents the arrival of foreigners and lessons are suspended in all schools. Costa Ricans and residents who entered the country will have to carry out mandatory preventive isolation for 14 days. 41 cases are confirmed. The first death of a patient confirmed by COVID-19 is recorded by 18 March. This is an 87-year-old man who was hospitalized in intensive care at the Alajuela Hospital. By 31 March, were registered 8 in intensive care and 347 people were infected. 4 people recovered. United States: On 28 January 2020, the federal government publicly released its approach to COVID-19 testing. Despite this, the U.S. testing effort was slow, obscuring the extent of the outbreak. Many of the 160,000 test kits produced in February were found to be defective and were not used. Academic laboratories, hospitals and private companies were not allowed to use their own tests until 29 February, when the FDA started issuing approvals for them. Initially, there were eligibility restrictions for receiving a COVID-19 test (based on recent international travel, hospitalization for respiratory illness, or contact with another person already diagnosed with COVID-19). By 27 February, fewer than 4,000 tests had been conducted in the United States. On March 5, the CDC relaxed its restrictions, allowing doctors to decide whom to test; a week later, nearly 14,000 tests had been performed. Federal funding was used to run 41 "community-based testing sites" (CBTS), but the federal government said it would stop this funding on 10 April; as a result of that decision, some of these testing sites were expected to close, shifting demand to hospitals. Those that remain open will likely be funded by states. On 31 January 2020, President Donald Trump issued a proclamation limiting entry into the United States, as immigrants or nonimmigrants, of all aliens who were physically present within the People's Republic of China, excluding the Special Administrative Regions of Hong Kong and Macau, during the 14-day period preceding their entry or attempted entry into the United States. The first six confirmed deaths in the United States were reported in late February 2020 in the Pacific Northwest state of Washington. By 8 March 2020, there were 22 U.S. deaths and over 500 reported cases. A month later, on 8 April, there were 14,000 U.S. deaths and over 430,000 reported cases. The U.S. federal government's health inspectors surveyed 323 hospitals in late March, reporting "severe shortages" of test supplies, "widespread shortages" of PPE, and other strained resources due to extended patient stays while awaiting test results. Oceania- Fiji: At the beginning of February, the Government of Fiji announced a travel ban to China. As the disease started spreading to other countries, Fiji extended the travel ban to Italy, Iran and South Korea. However, on 19 March, Fiji confirmed its first case of COVID-19 in Lautoka. As a precautionary measure, the Government of Fiji announced the lockdown of the city until 7 April 2020 and the travel ban was further extended to the United States and the whole of Europe including the United Kingdom. On 26 March, the country closed its main international airport in Nadi and all local shipping services was ceased. Later on 2 April, the Government announced a lockdown of Suva, after confirmed cases in the capital. As the cases rose, Prime Minister Voreqe Bainimarama announced a nationwide curfew from 8pm to 5am and social gatherings was banned. Schools and non-essential services was closed and the public was advised to stay at home and practice good hygiene. New Zealand: On 28 January, the Ministry of Health set up the National Health Coordination Centre (NHCC) in response to the outbreak. On 3 February, the New Zealand Government announced that foreign travellers who left from China would be denied entry to New Zealand, with only New Zealand citizens and permanent residents and their family being allowed to enter. New Zealand confirmed its first case of COVID-19 on 28 February, a New Zealand citizen in his 60s who had recently visited Iran. The travel ban was extended to include Iran on the same day. -17 March: Health Minister David Clark announced that the Government would deport foreign tourists who flout self-quarantine restrictions. Immigration New Zealand placed two foreign tourists into forced quarantine for defying Government requirements to self-quarantine for two weeks. Finance Minister Grant Robertson announced a NZ$12.1 billion COVID-19 business package. Logan Park High School in Dunedin closed for 48 hours after one of its students tested positive for the coronavirus. -18 March: The Royal New Zealand Returned and Services' Association announced that all Anzac Day services, scheduled for 25 April, would be cancelled. -19 March: The government required the cancellation of mass indoor events with more than 100 people. Prime Minister Jacinda Ardern announced the closure of New Zealand's borders to all but New Zealand citizens and residents, with effect after 11:59 pm on Thursday night. -21 March: Local councils in New Zealand's main centres announced the closures of public facilities including swimming pools, libraries, recreation centres, community centres, art galleries, and museums. -23 March: Prime Minister Ardern raised the COVID-19 alert level from two to three and announced the closure of all schools beginning on that day. The Government also announced that they would raise the national alert level to four at 11:59pm on 25 March, which would lead to a nationwide lockdown, for a period of four weeks. While all sporting matches and events as well as non-essential services such as pools, bars, cafes, restaurants, playgrounds are required to close in 48 hours, essential services such as supermarkets, petrol stations, and health services will remain open. -8 June: New Zealand lifts all domestic restrictions from COVID-19 after reporting no new cases for over two weeks. However, entry to New Zealand remained restricted. -16 June: The country gets new cases of COVID after two women returned to New Zealand from the UK after they were given an exemption to travel. In response, David Clark suspended compassionate exemptions. South America- Brazil: Brazilian president Jair Bolsonaro has been criticized due to "lax handling" of the outbreak and after calling it a "fantasy". His lack of action has also prompted many protests across the country since 18 March 2020. Days before, on 15 March, Bolsonaro received harsh criticism after attending a pro-government demonstration in Brasília on which he had physical contact with more than two hundred people, against the recommendations of his own Minister of Health. Following the event, the president of the Brazilian Chamber of Deputies, Rodrigo Maia, said that Bolsonaro's acts were an "attack on public health", going against his own government guidelines, while Davi Alcolumbre, president of the Brazilian Senate, classified Bolsonaro's behaviour as "inconsequential". The Brazilian Ministry of Health has also been criticized for not providing enough test kits, which may muddle the efforts to contain the outbreak in the country Debate: The response to the pandemic has resulted in unprecedented expansion of government power. Advocates of small government worry that the state will be reluctant to give up that power once the crisis is over, as has often been the case historically.