THE WAR AGAINST COVID-19: DOCTORS FROM AROUND THE WORLD SPEAK OUT.

As countries begin to reopen, various spikes in infection rates show that the fight against COVID-19 will be a long-fought one.

From the time Dr. Li Wenliang sounded the alarm bells after the Chinese authorities worked to hide information, the world has looked to doctors and healthcare professionals to make sense of this pandemic. Pervading headlines that mix in politics and conspiracy theories make what actual healthcare professionals have to say indelible to the international discourse.

We interviewed Medical Doctors and other healthcare professionals directly involved with COVID responses around the world, and this is what they had to say:

UNITED STATES: Dr. Lisette Bizzochi (Motefiore Medical Center, New York) and Dr. Elias Naser, MD (Presbyterian Medical Group, New Mexico)

With more than 19,000 deaths, New York emerges as the epicenter for the coronavirus outbreak in the United States. The New York Times headlines like “'There's No Way We Can Bury or Cremate Them Fast Enough’” and “‘We Ran Out of Space’: Bodies Pile Up as N.Y. Struggles to Bury Its Dead” invade the public consciousness. Dr. Lissette Bizzochi, MD in Montefiore Hospital in Bronx, New York despairs from the human struggle and the faces behind those deaths. She empathizes with all of the victims and their families: "The most difficult parts is that families are not allowed to see their loved ones.”

Positive things and uplifting human acts can also felt all around New York. Dr. Bizzochi sees New Yorkers “...are uniting to fight these unprecedented times. Most people are paying attention and quarantining per recommendation. Healthcare professionals are giving their all to help people. Many are donating PPE’s, food, and even clothing to healthcare providers so they may be able to care for their patients.”

New Mexico, in contrast, has only had more than 3,400 cases with 123 COVID-related deaths but a recent rise of cases reported beginning of May has caused road closures and curfews among hotspots in the state. Dr. Elias Nasr, noted that changes may be “too early to tell” in the state as it looks to be in a much different stage of the disease.

Which country has had the best response against COVID-19?

• Dr. Bizzochi: “Argentina has been very strict in regards to quarantining since after seeing outbreaks in Italy. People are not allowed in the streets. Period.”

• Dr. Nasr: “Besides South Korea and Germany, I’m not aware of how good the other countries are doing.”

What is the best advice you can give to people around the world?

• Dr. Bizzochi: “Don’t be selfish. Think about others. Protect the more vulnerable.”

• Dr. Nasr: “Follow the task force guidelines if your government has not established guidelines of its own.”

What is the worst or untruthful thing you’ve heard about COVID-19?

• Dr. Bizzochi: “Suggesting the use of disinfectants was the worst and most dangerous statement I have heard.”

• Dr. Nasr: “The WHO should be held accountable for its lack of early warning. You can’t play politics with the well-being of the world population. China will eventually have to come to explain and admit its error. The world will never forget what it did.”

MEXICO: Dr. Emmanuel Alejandro Garcia Lopez (Mexico City, Mexico)

Dr. Lopez had an up-close and personal battle with COVID-19 when his father contracted the disease and became "incredibly sick." He observes that it has become increasingly difficult to create a consciousness about the disease as people are still leaving their homes and not following social distancing. He continues, “because of the paranoia, depression and stress, we are not just fighting one disease here. There are other medical areas affected by COVID-19.”

The failure in information dissemination and getting people to believe and understand the disease led Dr. Lopez to surmise Mexico's biggest shortcomings. “We are struggling with ICU beds, as not all hospitals are designated as COVID hospitals."

In Mexico, policies have been applied to stop massive social interactions including closing of businesses at 2pm. The use of facemasks are obligatory in Mexico and there are a reduction of cars in the streets per day designated by the numbers on their license plates.

Much criticism has been aimed at Mexican President Andrés Manuel López Obrador. Dr. Lopez points culpability at the government “not taking the threat seriously in the beginning. He [President Obrador] was encouraging people to go outside their houses and visit public places. He was doing the same and giving the worst example for Mexicans.” He infers that with a better initial government attitude, there could have been better preparation for ventilators, PPE’s and staffing against COVID-19.

Which country has had the best response against COVID-19?

• Dr. Lopez: “Those that closed their borders and quarantined in time, those testing a bigger proportion of their population, and the governments that are providing clear information. South Korea, Israel and Norway are some worth noting.”

What is the best advice you can give to people around the world?

• Dr. Lopez: “Stop watching fake news and unreliable sources and USE A FACEMASK.”

What is the worst or untruthful thing you’ve heard about COVID-19?

• Dr. Lopez: “…That breathing steam will help kill the virus in the throat or injecting Lysol or bleach will help fighting the virus.”

CANADA: Leila Haddid (McGill Hospital, Montreal Canada)

Leila Haddad, a Specialist in Infection Control and Hospital Epidemiology eyes major changes in medicine including virtual checkups becoming the norm.

When asked how Canada is doing with the rest of the world, Haddad is thankful that “Most of the European countries were 10 days ahead of Canada in having the Pandemic. Maybe this helped a bit; the government took relatively quickly drastic measures to curb the spread of the virus.”

Haddad credits Canadian government for not politicizing the pandemic and following the scientific guidelines as much as possible and it would benefit Canada to create a better response and preparedness protocol to help long term institutions.

Which country has had the best response against COVID-19?

• Haddad: “New Zealand response gave best results in curbing the spread of Covid19 and this because of the prime minister leadership.”

What is the best advice you can give to people around the world?

• Haddad: “If we all do our best to stop the spread of the virus by respecting social distancing... we can flatten the curve.”

What is the worst or untruthful thing you’ve heard about COVID-19?

• Haddad: “When president Trump started to give his medical opinion without sound proof or any medical background.”

AUSTRALIA: Dr. Kylan Pathmanathan (Perth, Australia)

Australia and its closest neighbor, New Zealand, has made strides against COVID-19. So much so that, Dr. Pathmanathan’s outlook is supportive of lifting certain restrictions. He explains, “Australia is progressing very well in terms of new cases and from a mortality perspective. Western Australia (and South Australia) has lifted certain restrictions last week; this includes social gatherings up to 10 people outside. Yesterday, there were only 9 cases detected nationwide. There’s been less than 50 daily cases nationwide for over 2 weeks now. The state of Western Australia has only had 5 cases in the last week.”

That's not to say that Australia has been perfect. Dr. Pathmanathan points out the government’s worst fumbles during the pandemic. Australia allowed the cruise ship “Ruby Princess” disembark in the midst of the pandemic without any testing. He iterates that this was the “…biggest fiasco and caused hundreds of cases with multiple deaths. There are disagreements about who to blame whether it is the cruise ship or the state or health authority. The government has actually launched a homicide investigation into it. If these passengers were forced to isolate (and tested), then multiple transmitted cases would have been stopped.”

Generally, Dr. Pathmanathan’s hopes are high for Australia. After initial delay, he credits Australia’s tight travel restrictions, stricter biosecurity laws, testing availability, and PPE’s have been ramped up adequately to respond to the crisis.

Which country has provided the best response against COVID-19?

• Dr. Pathmanathan: “Taiwan. I actually worked with an Australian/Taiwanese consultant who lives in Taiwan but works in Australia. We were discussing Taiwan’s management principles back in February prior to the large scale pandemic we see today. Early principles were implemented including limiting travel, testing, isolating and the use of masks. The Taiwanese graph is simply remarkable.”

What is the best advice you can give to people around the world?

• Dr. Pathmanathan: “Social distancing and social isolation in the event of symptoms/sufficient contact with a known case.”

What is the worst or untruthful thing you’ve heard about COVID-19?

• Dr. Pathmanathan: “Bleach. Full stop.”

PHILIPPINES: Dr. Yong Larrazabal (Cebu, Philippines)

Rich countries may have economic dexterity, but countries with more limited resources like Philippines have the true test of leadership. Dr. Yong Larrazabal, CEO and President of Cebu Doctors’ Hospital group predicts changing perspectives in medicine. He reveals that “professionally, it will make you go beyond your specialization. It has tested our leadership not just in managing our patients, but also in making sure that our healthcare works and workplace our safe.”

Philippines has instituted an Enhanced Community Quarantine or ECQ. Dr. Larrazabal intimates,

“Though we can see that our country is far from over, we remain optimistic. With the extended ECQ, we hope that our response could be quicker and that the general population will be more cooperative and patient on the effects of this crisis.”

Dr. Larrazabal understands the nuances that required to navigate the tandem of health and economic problems brought on by the pandemic. “We understand that this is not just a health crisis but also an economic one so we can only hope that the government will triple its socio-economic efforts for the people as well.” However, he warns against premature lifting of the ECQ. A premature lift may bring a preventable and unnecessary surge in the number of cases. He encourages the country to create a pandemic preparedness and response law to have a faster and quicker response to a crisis like this pandemic.

Which country has provided the best response against COVID-19?

• Dr. Larrazabal: “Vietnam and Taiwan are doing so well that we can immediately acknowledge the effects of their preparedness. Taiwan developed a systematic contact tracing protocol and border controls. Vietnam immediately acknowledged their limited resources thus they have enacted the less is more strategy by immediately suspending flights, closing schools closed and swiftly imposing a 21-day quarantine.”

What is the best advice you can give to people around the world?

• Dr. Larrazabal: “Please remember that it is not just about you, it is about the health and general welfare of the country and the world; thus, we all have to make a sacrifice to end this pandemic.”

What is the worst or untruthful thing you’ve heard about COVID-19?

• Dr. Larrazabal: “That because many are not cooperating, the fight is not worth it. I will differ to that because remember that we are not just doing this but we are doing what we are doing for our family, for our children, and the future of our children's children. See them every day and you will realize that it is worth it..”

QATAR: EMD. Emergency Medicine Doctor (Doha, Qatar)

Dr. EMD (Doctor has requested not release her name and asked for anonymity).

When asked about changes in how they approach medicine in Qatar, she surmises, “Medicine has definitely changed drastically. We are used to following guidelines that shape our practice and basing our clinical decisions on previous cases we've worked on but COVID is a different animal entirely we're working blind and figuring it out as we go trying treatments without any evidence based practices or clinical trials.”

Dr. EMD notes that Qatar is in the middle ground in terms of COVID response. Due to the population and size of Qatar, the cases are on par with other countries. She acknowledges "one great things that Qatar is doing is setting up quarantine facilities to take care of all patients and families testing positive for COVID-19. Business continue running with home delivery options as long as hygiene rules are followed."

Dr. EMD wishes that people “understand the concept of not coming into the Emergency Department unless they're really sick. We still have the low priority walk-ins.”

Which country has provided the best response against COVID-19?

• Dr. EMD: “Countries like UAE they've instituted full city lockdowns where if you need to go out you need a special permit. I know this seems extreme but we have one major hospital in Doha. We really cannot accommodate the entire population of the city getting sick at once.”

What is the best advice you can give to people around the world?

• Dr. EMD: “STAY HOME FOR HEAVENS SAKE!!!”

What is the worst or untruthful thing you’ve heard about COVID-19?

• Dr. EMD: “Worst advice honestly is coming from the news and whats app forwards that all moms and elderly population believe....drink garlic lemon bullshit. The most untruthful thing is that these medications that everyone is talking about work. We don’t know what works. We hope they do but we do not actually know anything. And it sucks when you're standing a foot away from your sick patient telling him I'm going to give you this medicine and he asks is it going to make him better what do you even say?”

GERMANY: Dr. Antonella Siegrist Fürst-Stirum Klinik (Bruchsal, Germany)

Germany has been a model country for others to follow on the war against COVID-19. Dr. Antonella Sigrest believes that medicine has changed for good. She opines, “Situation is unprecedented but was somehow expected since experts around the world have been predicting a pandemic for years. The medical field is facing a crisis and was not prepared at all. And day by day we are learning more about the virus and the disease that it is causing.”

Dr. Siegrist applauds her country’s response to the pandemic and the decline of its reproduction rate in her country and the reopening of non-essential shops and schools. She credits the German government’s full and unmitigated cooperation with its medical experts that saw early mass testing and social distancing. Up to 500,000 people in Germany can be tested per week and without cost.

Dr. Siegrist also credits Germany’s universal health care system stating, “When people get sick, they are more likely to seek medical help since health care is free.” Germany’s healthcare system is well equipped with enough ICU beds and ventilators. She adds that its central registry helps coordinate patients across the country on a daily basis.

Which country has provided the best response against COVID-19?

• Dr. Siegrist: “Taiwan has been doing extraordinarily well in their COVID-19 response with an extremely low death and infection rate. I admire how Taiwan’s government reacted as early as December with strict border controls, temperature controls and increased production of face masks. Also South Korea has been implementing similar strategies and has been doing well. This goes to show that an early response can limit the spread of the virus.”

What is the best advice you can give to people around the world?

• Dr. Siegrist: “Practice social/physical distancing, stick to the recommended hygiene practices and hang in there. People on the frontlines are risking their lives to save patients. Staying at home is the best you can do to help those frontliners.”

What is the worst or untruthful thing you’ve heard about COVID-19?

• Dr. Siegrist: “What scares me is the fake news circulating, from drinking hot water in order to kill the virus in your throat to injecting disinfectants. Unfortunately, a lot of people are susceptible to those stories, because they are misinformed. Now, in the digital age, reliable information is just as accessible as fake news.”

UNITED KINGDOM: Dr. Sherwin Ng (Swindon, England)

Prime Minister Boris Johnson and the U.K. government showed no appetite for lockdowns and stringent protocols. The U.K. public health community was concerned about the lack of government response compared to its European counterparts and the terms “herd immunity” was thrown around. On March 16th 2020, U.K.’s “Keep Calm and Carry On” had changed its tune and in late March, Prime Minister Johnson himself fought to stay alive after a positive COVID-19 diagnosis. In May, the Prime Minister and his wife named their newborn son after the two ICU doctors who saved his life after battling complications from COVID-19.

“Not as crazy as Trump,” Dr. Ng jests when pressed about the initial views and lack of response against the virus. He applauds the drastic improvement on Britain’s response. He reveals that hospitals around the country are being redeployed to tackle the pandemic and said, “you can see ophthalmologists and dentists put into wards to help out. I think the country is doing the best it can with the resources available.”

Which country has provided the best response against COVID-19?

• Dr. Ng: “South Korea and Hong Kong have prior epidemic experience so not only does the government know what to do the citizens also know what to do.”

What is the best advice you can give to people around the world?

• Dr. Ng: “Stay strong, stay indoors and stop the spread of the virus.”

What is the worst or untruthful thing you’ve heard about COVID-19?

• Dr. Ng: “Intravenous injection of a disinfectant. It’s hilarious… but deadly.

ARGENTINA: Dr. Emilia Short (Buenos Aires, Argentina)

Dr. Emilia Short works at Sanatorium Trinidad de San Isidro in Buenos Aires. She praises the people in Buenos Aires and her team there as, “emergencies were prioritized and people did not come in to consult for trivial causes.” She notes that though PPE’s are still in short supplies, praises Argentina for enacting strict isolation protocols and a continued quarantine.

What is the best advice you can give to people around the world?

• Dr. Short: “Use all the elements of personal protection if you are going to be in contact with someone. Always be suspicious as they may be asymptomatic carriers and do not know it.”

What is the worst or untruthful thing you’ve heard about COVID-19?

• Dr. Short: “The saddest and worst thing is when people mistreat the contagion. Any of us can get sick.”

THAILAND: Dr. Suphalerk Wijaranayan (Bangkok, Thailand)

Thailand has been doing strong work with flattening the curve that the country has relaxed COVID-19 restrictions. With the easing of lockdown restriction comes new safety guidelines. Tables at restaurants are partitioned with plastic film and barriers. Safety guidelines such as face shields and face masks during barber visits are in place to prevent a resurgence of the virus.

Dr. Wijaranayan praises Thailand’s efforts noting, “Thailand has less than 2500 cases. I think we are not doing so bad! All the citizens cooperate with the government. There is a 10:00 pm to 4 am curfew. And mandatory quarantine and city close down. People wear mandatory masks when going outside.”

Which country has provided the best response against COVID-19?

• Dr. Wijaranayan: “Taiwan, they have implemented prevention measures much sooner.”

What is the best advice you can give to people around the world?

• Dr. Wijaranayan: “Stay at home, dont go out unless you really need to, and if you do wear masks and faceshield, upon arriving home practice proper hand washing and rid of clothes in a sterile manner.”

What is the worst or untruthful thing you’ve heard about COVID-19?

• Dr. Wijaranayan: “That it will go away soon. That there is a drug that is a cure out. That it is a hoax.”

TAIWAN: Yi-Ting Hu (Taipei, Taiwan)

With a population of 23 million and only 400-plus confirmed cases, Taiwan’s COVID response has been touted as one of the best in the world. Yi-Ting, who works at a hospital in Taipei, credits the government’s leadership. In Taiwan, hospitals and businesses are “running as usual” according to Ting. She reveals that some restrictions have been noted for entrances and hospital protocol changes, but the country was well prepared for a pandemic.

Taiwan's course has been held by leadership with foresight and pro-active attitude against the virus. On December 31, 2019, Taiwan sent a letter to the WHO, warning them of a new virus . With no acknowledgement or response from the WHO, Taiwan unilaterally sent a team of experts to China despite their poor relations. The team returned with a mechanism to test, and the government quickly enacted precautionary measures all before their first confirmed case on January 21. Today, the country has no new cases.

Ting adds, “The reaction of government is very quickly and transparent. Including the quarantine policy, ensuring enough resources for hospital and the people as well, ex mask and alcohol. I’m really glad that I live in Taiwan. I feel much safer than any other country in the world. We are very close to China, and many businessman travels to both places often, but the cases here are lower than many countries, and at the same time, we can still remain the normal life, avoiding heavily economic damage.”

Which country has provided the best response against COVID-19?

• Ting: “I think Korea is quite successful for against the coronavirus. Though the infection number increase fast at first, they screened a big amount of people, and isolated them quickly to prevent spread. We can see that the epidemic has been slow down.”

What is the best advice you can give to people around the world?

• Ting: “Now, before the pandemic ends, people should keep social distance, and stay at home. If it's necessary to go out, please keep mask on your face. It might be the reason why it’s not so severe here compare to the U.S. or Europe because people wear masks more in Asia, especially Taiwan..”

What is the worst or untruthful thing you’ve heard about COVID-19?

• Ting: “WHO didn’t make the right decision at the first time, and still exclude Taiwan from participating!”

SINGAPORE: Dr. Elisse Catalan (Singapore)

Singapore’s successes that included mass testing and contact tracing have been hindered the rise of cases in overcrowded dormitories of foreign workers. Singapore system of care, however, remains top notch. Dr. Catalan, who studied at Harvard, Johns Hopkins University, Public Health at Mount Sinai, and medical doctorate at Cebu Doctors’ University has been fighting hard against the virus in Singapore. She praises the country's response, “Singapore is very methodological and applied a systems approach to manage COVID-19. Their inter agency task force is robust and ministers from all sectors were all hands on deck since the beginning. Social distancing measures and business continuity plans were employed very early. Stimulus packages for business and hard hit individuals were quickly worked one. Hospitals also got tremendous support and guidance from the MOH - ministry of health. One major blindside was the foreign worker dorms, that inflated the numbers. But I believe they are handling it decisively and swiftly to contain the spread. ”

Which country has provided the best response against COVID-19?

• Dr. Catalan: “Taiwan, South Korea, New Zealand. Their swift, decisive, and consistent effort and management paid off tremendously. They also were able to ramp up testing very quickly. A tough feat but they did very well on that aspect.”

What is the best advice you can give to people around the world?

• Dr. Catalan: “Above all else, leaders should prioritize gaining the public's trust. Communication should be clear, concise and in line with the public's health literacy. It enables better cooperation and hence success in managing this pandemic.”

What is the worst or untruthful thing you’ve heard about COVID-19?

• Dr. Catalan: “Haha! Many! But the worst one is ‘it's just like a flu’. It minimizes the complexity and possible detrimental effects of this virus. Also this misconception affects health seeking behavior. If people think it’s just a flu, then it's harder to detect the cases early and isolate them.”

ICELAND: Wendill Viejo, Reykjavik, Iceland.

Headlines in early May praised, “With testing, Iceland Claims Major Success Against COVID-19”. Iceland’s testing and methodology against COVID 19 spell a clear win for a small country of 360,000 people. The country boasts only 10 COVID-related deaths out of 1,8000 cases. As of this article, the United States has 1.21 million cases and 69,575 deaths, which makes the death rate at around 5.76%. That death rate is gigantic difference to Iceland’s 0.5% death rate.

There are; however, challenges for the frontliners. Wendill Viejo, at the front lines in an Intensive Care Unit in Reykjavik attests, “COVID-19 has made a huge impact in the daily lives of healthcare professionals especially in the Intensive Care Unit. Working in a very demanding environment and wearing PPE all throughout the shift makes it harder. Observing new guidelines for intubation to avoid contamination, giving symptomatic treatments to patients because there are no readily available drugs to treat COVID-19 are just some of the major obstacles that we faced in the ICU.”

Viejo credits Iceland’s higher testing proportion. No country in the entire world has done more testing per capita than Iceland. Viejo exclaims that Iceland’s strategy has “yielded valuable insights into the virus.”

What is the best advice you can give to people around the world?

Viejo: “Stay at home and avoid unnecessary interactions with other people. Adhere to social distancing rules and do proper handwashing.”

What is the worst or untruthful thing you’ve heard about COVID-19?

Viejo: “People should be honest of their travel history and inform the medical professionals when making appointments in the clinics or hospitals.”

PUERTO RICO: Dr. Hector Flores (San Juan, Puerto Rico).

As an unincorporated territory of the United States, Puerto Rico has more than 3 million people with 1,800 confirmed cases. Dr. Hector Flores, a pulmonologist, highlights a changing face of medicine, “There has been minimal face to face contact. Most physicians are doing telemedicine, all elective procedures have been cancelled. In the island hospitals are basically empty as patients are urged to stay home unless the need for hospitalization is imperative.” He credits good handling to the local government that instituted strict lock down procedures with 12 hour curfew as soon as the first cases were identified. Like California, Puerto Rico has instituted, “an extremely strict lock down. Only grocery stores and pharmacies are open. Restaurants can only operate carry-out.”

Puerto Rico, as an island, has the advantage of screening all incoming passengers. However, Dr. Flores expresses concern, “The airport has been testing all the inbound pax who agree to be tested, I feel that those who refuse should be placed on forced quarantine, at their own expense, since infected patients are flying into the island to seek medical treatment.”

Which country has provided the best response against COVID-19?

• Dr. Flores: “New Zealand because they enforced strict immigration rules as well as distancing.”

What is the best advice you can give to people around the world?

• Dr. Flores: “Do not listen to laymen or Facebook 'advice'. Listen carefully to trained medical professionals and do not assume you will not get infected.”

What is the worst or untruthful thing you’ve heard about COVID-19?

• Dr. Flores: “That it's a hoax.”

Pandemics have happened throughout human history. From the Bubonic plague to the 1918 Flu Pandemic, this is not the first time that the world will face a crisis like this, nor will it be the last.

Just as the past has faced some truly mind-boggling superstitions and conspiracy theories, so does the present.

As a society, it's up to us to decide whether to listen to evidence-based medicine or to allow conspiracy theories and anecdotal falsehoods to pervade the discourse.

It has become clear that this may not just be a war against the virus. This is a war against misinformation, misconceptions, and mistruths. It is time for the ones on the front-lines to speak up. Will you listen?