Many countries have declared restrictive measures, such as lockdown, shelter in place, or stay at home orders, to contain the pandemic at a local level. However, the wildly differing responses and response timelines have left people wondering if authorities failed to take the situation seriously early on when they could have done more to slow down the spread of the coronavirus.

China appeared to manage the coronavirus outbreak effectively, putting in place early travel bans within the country itself. As early as January 23, Chinese authorities declared a nationwide travel ban, which, some experts suggest, may have averted over 700,000 COVID-19 cases within the country.

Earlier in April, China eased the lockdown measures in Wuhan, the original epicenter of the new coronavirus outbreak, amid celebrations that the nation had beaten the virus.

Nevertheless, a recent study assessing the likely number of COVID-19 deaths in the country suggests that the virus may have hit even harder than the authorities initially thought.

Given the development of the situation in China, many people have been questioning the appropriateness of measures that other countries around the world have taken.

Earlier in April, Japan’s Prime Minister Shinzo Abe declared a state of emergency. This allowed the authorities to ask people to stay at home, though the government has not enforced closures or restrictions.

This state of emergency should remain in place until early May, though the steady number of COVID-19 cases has reportedly moved doctors in Japan to warn of an impending breakdown in their health care system.

Japan state of emergency filled with ‘ambiguity’

People in Japan have also started to express worry that the government is not doing enough to contain the crisis.

Chris, who recently moved to Japan from Europe, has spoken to Medical News Today. He told us what the state of emergency looked like in Yokohama, where he currently lives.

“Effectively, the government has requested that businesses and schools close where possible or promote [working from home] … but it can only request, it can’t actually make it a law,” Chris told us.

“Whilst many large businesses in Yokohama (especially around the big train stations) appear to have complied with the request, the trains are still pretty cramped during rush hour, and some restaurants and cafes are remaining open,” he added.

Chris told MNT that the lack of a stricter response from the authorities means that it can be hard to comply with the advised measures.

“[Although] supermarkets are promoting social distancing measures at the tills (with spaced markers, and transparent plastic screens to protect the cashiers), within the stores themselves, with the narrow aisles, it’s impossible to keep your distance from other people,” he said.

“[L]earning the news [from] abroad [about the pandemic], I […] became more stressed [before] the announcement of the declaration [of a state of emergency] which was made in April, due to the lack of carefulness of people in Japan (for example, group-shopping at the supermarkets, social drinking, etc.),” Misato, who lives near Tokyo, also told us.

“So, around the time when the declaration was made, I got accustomed to the current lifestyle [of physical distancing] which [makes me] feel much less stress than before. [However], I [don’t] highly value the content of [the] declaration itself, due to its ambiguity, which [makes it] difficult for people in Japan to understand.”

– Misato, Japan

‘Mask gives me a sense of security, even though it doesn’t do much’

Some European countries have reacted sooner to the steep rise in COVID-19 cases than others. On March 10, Italy ordered a strict nationwide lockdown, becoming the first country in Europe to do so.

The government banned all travel in the country, and people could only leave their homes for essential reasons — such as to buy food. When going out, people had to carry declaration forms and wear face masks and disposable gloves.

Despite a slowdown in the growth of new COVID-19 cases, the Italian government has recently extended lockdown measures through May 3.

Laura, who lives in the Italian region of Friuli Venezia Giulia, told MNT: “We can’t go out or travel to other cities, […] we must stay at home. Only one family member may go out at once and only for valid reasons, such as doing the groceries, going to the pharmacy, or the post office for urgent matters.”

“I comply with the rules imposed by the government, and I only go out when I have to, wearing a mask and gloves. Now that it’s warmer outside, the mask has become a little bothersome, but it gives me a sense of security, even though I know that, in reality, it doesn’t do much.”

– Laura, Italy

Spain, another one of the European countries hit badly by the coronavirus, also announced strict lockdown measures from March 14.

Although there have been over 208,000 confirmed COVID-19 cases in the country to date, Spain’s Prime Minister Pedro Sanchez announced that Spain reached the peak of the pandemic in early April.

“Both my boyfriend and I had symptoms compatible with COVID-19 and we [self-isolated] throughout that time (nearly 10 days each), avoiding any physical contact with each other (while living together),” Susana, from Madrid, Spain, told MNT.

Susana said that she managed to stay optimistic despite the illness. Yet, like many, she is concerned about the economic and emotional impact of the lockdown in response to the pandemic: “I worry about the impact this crisis has on many families that have been highly affected and are suffering at different levels, [such as the] loss of relatives, loss of jobs and so on.”

The Spanish government appears to share such worries and is considering easing these measures in May, despite criticism that it is still unclear how the pandemic may progress in the country.

Sweden: ‘Not a true form of self-isolation’

Other European countries have put in place less stringent measures. For instance, in the United Kingdom, Prime Minister Boris Johnson announced a lockdown on March 23, though the measures have been less stringent than in other countries.

Unlike in Italy, for instance, in the U.K., people may go out without a declaration form. The acceptable reasons for leaving one’s home — “for food, health reasons or work” — has received criticism for being confusing and lacking clarity.

Some, however, relish the relative freedom that Britain’s more relaxed pandemic advice has afforded.

Harry, who lives in Brighton, U.K., told MNT: “Britain’s less rigid approach to the lockdown compared to other European countries is crucial to maintaining my [mental] as well as physical health. As it is, I [can] stay active, get sunlight and air, and avoid being stuck in the same place all day.”

At the same time, practitioners in the U.K.’s National Health Service (NHS) have been bracing for a severe strain on the NHS’s resources, as hospitals are cracking under the pressure of increasing numbers of COVID-19 cases.

Other European countries, such as Sweden, which have reported fewer cases of COVID-19 overall, have fewer and much less restrictive measures in place.

People who live in Sweden have been staying more or less put, mostly following their own judgment.

Simona, based in Malmö, told MNT that “Sweden does not impose any quarantine [measures], just [physical] distancing, but I have been sort of — partially — self-isolating together with my partner.”

“We do get out to shop, meet friends sometimes, or walk in the sun, so it is by no means a true form of self-isolation,” she adds.

Yet, some experts worry that the authorities have underestimated the incidence of COVID-19 in Sweden. Others suggest that the guidelines have left older citizens — one of the high-risk categories — unnecessarily exposed to the virus.

The one country that has received consistent kudos for its approach to the pandemic appears to be Finland, where Prime Minister Sanna Marin announced, on April 22, a “composite strategy.”

This strategy would involve a gradual easing of lockdown measures while increasing COVID-19 testing. Testing will ensure that anyone exposed to the coronavirus receives the care they need, while those who have not had exposure may return to their normal life, little by little.

‘I’ll never know if I had COVID-19’

The U.S. strategy in dealing with the pandemic has been the target of an increased amount of criticism since different states have adopted wildly different measures. There is a lack of consensus between the authorities and various public health organizations.

As of March 30, 30 U.S. states — including New York, California, Texas, and Washington — have directed their citizens to shelter in place or stay at home, though some have opted for less restrictive measures.

Since March 31, the Department of State has been advising all U.S. citizens “to avoid all international travel.”

Although measures in the U.S. have been, overall, less stringent than elsewhere, groups of people in 18 states have been protesting against the lockdown. They claim that the measures have been harming them financially and otherwise.

Even President Donald Trump has spoken in favor of easing the current measures, saying that the pandemic has already peaked in the U.S.

However, some medical professionals have spoken out against the protests, stressing that the protesters may well be putting other people’s lives and health in danger.

In Canada, only two provinces — Ontario and Alberta — declared a state of emergency in the first half of March, following an increase in the number of COVID-19 cases.

One reported worry among experts and the public is that Canadian authorities have not managed to capture important health data and that testing efforts for COVID-19 are falling short. The extent to which the country is being affected by the new coronavirus remains unclear.

Stephen, who lives in the Province of Ontario, told MNT that despite having had symptoms that may have been consistent with COVID-19, he did not have access to testing to verify whether that was actually the case:

“Early on during the lockdown, I was ill for a few days with cold and flu-like symptoms. The advice here is to stay home and self-isolate for 14 days if you’re ill and not to go to a clinic unless the symptoms progress. So I guess I’ll never know if I had COVID-19, though I suspect it was probably just a cold.”

Experts worry that people all over the world may be experiencing an increasing number of mental health issues.

This certainly came across loud and clear from the many responses that MNT received from people across the globe. Some people have also spoken to us about how the specific measures in their country have affected their physical health as well.

Mihai, from Romania, said that he and his family have been dealing with an increased amount of stress and physical discomfort.

“[Physical distancing] has affected both our physical and mental health,” he told MNT. “We’ve only been moving around inside the house; we’re getting backaches.”

“Mentally,” he said, “I’ve become more stressed, more irritable, I lose my patience much quicker. And [my 1-year-old son] finds it harder to fall asleep; he’s more agitated.”

Nicoleta, also from Romania, echoed the sentiment: “I think [in terms of physical health], I have been affected because I have gained a few extra kilograms [due to] sedentariness […] Mentally, there has been a lot of stress in this period. […] It’s very difficult when you can’t exercise at all, and you keep doing the same things always; it’s impossible not to be affected, at least at a subconscious level.”

‘We have no idea what would happen to our son’

Many of the people who spoke to MNT expressed worry for family members and said they felt powerless to deal with some of the risks.

“We’ve been feeling stressed not because [we are afraid that] the disease [COVID-19] would be hard to bear, but because, should we get ill, we’d have to be hospitalized in the infectious disease unit, and we have no idea what would happen [to our young son].”

– Mihai, Romania

Diana, who lives in France, also said that she was “a bit anxious, not necessarily for myself, but for the people around me, and for my family, which is far away, and I’ve felt a bit powerless.”

Some respondents have been trying hard to come to terms with grief after having lost a loved person to COVID-19.

Martina lives in Belgium, but her family is in Italy. She told us that two of her family members passed away because of the coronavirus, but she has had no opportunity to gain a sense of closure:

“I have already lost one uncle and one aunt on the two sides of the family due to COVID-19. There has been no or limited [funeral] ceremonial service, so the psychological impact of these deaths is going to be long-term and painful.”

She also told us that, while staying put during the pandemic, she has been dealing with acute mental and physical symptoms.

“I notice that I have occasional mini-anxiety attacks that are far worse than usual. I have serious issues in concentrating on my work […] But there is also a deeper feeling of uselessness,” Martina told MNT. “And my body feels weird too: menstrual pain, for example, has become unbearable.”

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