The COVID-19 pandemic has had an unprecedented effect on every aspect of humanity in general, and the global healthcare system in particular. The world today is mourning the deaths of 747,584 people (as of August 13, 2020) due to the coronavirus, which accounts for 3.59% of the overall total COVID-19 cases.
One country, Qatar, however, has caught the attention of International Development Partners (IDPs) and world leaders in the wake of the devastating economic and health effects of COVID-19.
They have lauded Qatar for its comprehensive efforts to control COVID-19. The death toll in Qatar so far has “only” been 190, accounting for just 0.17% of the total positive cases. This ratio is one of the lowest in the world. Because Qatar has been one of the leading countries in providing excellent medical care to COVID-19 patients, its recovery rate (97.09%) has been the envy of the world, as has its low death rate.
Conversely, the recovery rate in Japan accounted for 69.48% of total positive cases, which was slightly higher than those globally (65.89%) but much lower than that of Qatar. The death toll in Japan comprises 2.11% of the total Covid-19 patients, which is higher than that of Qatar although lower than that of global cases.
This is surprising in that Japan is one of the world’s leading countries in terms of spending on health care (nearly 11% of GDP, or Gross Domestic Product), above the international average (of 10%) and significantly higher than Qatar’s 4%. In per capita terms, Japan’s health spending is $4,766 USD, whereas Qatar’s per capita spending is only $1,827 USD. Japan is also the nation with the highest life expectancy (85.03 years of age average for both sexes, 88.09 for females, and 81.91 for males).
Nevertheless, Japan has underperformed in its response to COVID-19 when compared to Qatar in curbing the death toll, although its performance has remained above others globally.
An explanation as to why Japan failed to keep its death toll to a minimum despite its high spending on health care is necessary. Qatar, where one of the co-authors resides, may provide us with insights.
A Case Study in Qatar’s COVID-19 Response
Qatar has been quite successful in addressing the COVID-19 pandemic, despite its having a migrant population accounting for 89% of the total population. In addition to an engaged political leadership, which has been on top of things by maintaining a daily and close watch over the fight against COVID-19 in the country, institutional capacity appeared to be the most important factor in curbing the death toll in Qatar.
Niranjan Chandra (54) is one of the 112,092 patients (as of 07 August 2020) who recovered from coronavirus related illness there. Here is his story.
Chandra visited the local pharmacy with COVID-19 symptoms and took medicine for two days. As the symptoms worsened, he called for an ambulance and was taken to the Hamad Medical Corporation (HMC), where he was immediately attended to and diagnosed as corona positive. After 14 days of intensive treatment, he was sent to quarantine for another 11 days. He was eventually released, after two consecutive test results showing negative results. He was satisfied overall with the quality of the food, accommodations, nursing, and medical treatment at HMC and during his quarantine.
Chandra’s case illustrates how Qatar has saved the lives of coronavirus patients by ensuring timely and intensive institutional care.
An informal interview with one HMC-affiliated doctor revealed two important issues. First, Qatar used a combination of medicines that had been earlier employed against a different virus. Second, Qatar has been able to provide timely and proper medical care to patients.
Minister of Public Health Dr. Hanan Mohamed al-Kuwari added that early detection has helped Qatar keep mortality rates very low.
Institutional Response is Key
What made the real difference is the institutional preparedness and capacity to address crisis situations. Over the past few months, Qatar has set up a number of new facilities, such as field hospitals, isolation and quarantine areas, and expanded testing facilities and distribution points for sanitizers and masks for the public, as well as Personal Protection Equipment (PPE) for medical and paramedical professionals.
It is noteworthy that Qatar provided treatment to every resident, including those who may not have currently valid work permits and health cards.
Since word of the outbreak of COVID-19 in China, the Qatar Ministry of Public Health undertook various preventive and curative measures.
Distancing. One innovative approach at the time was the establishment of telemedicine facilities and home delivery of medicines for patients to limit face-to-face exposure to reduce the risk of infection spread when providing healthcare service.
Tracing. It used modern technology to trace coronavirus patients.
Awareness. It also undertook special measures for elderly people (55 and above) including consultancy and awareness campaign over the telephone on a daily basis.
Institutional Preparations. With the increase of COVID-19 positive cases, Qatar has been able to deploy required resources, both in terms of manpower and institutions, quickly and effectively.
It is important to note that Qatar has long been investing in health care and related social welfare facilities and has made impressive strides since the 1990s, which has resulted Qatar’s health system being ranked the 5th best in the world. Moreover, Qatar has ranked 1st for doctors per capita, and 4th for overall satisfaction with healthcare.
Lessons for Japan
The COVID-19 pandemic and the havoc that it has wreaked may be seen from the perspective of an institutional failure. While the medical reason (e.g. the absence of proper medicines or vaccines) continues to attract attention, the focus on the functioning of relevant institutions and implications of institutional factors has received limited academic attention so far.
Some research has pointed to the institutional failure to protect people from the coronavirus. Other research has examined the role of high healthcare costs, shortage of PPE, low medical capacities, and a shortage of ventilators and intensive care unit (ICU) beds, which ultimately exposed weaknesses in the delivery of patient care.
Said another way, the lack of institutional capacity including health infrastructure, human resources (doctors, nurses, lab technicians, etc.), and the non-availability of medicine and financial resources, emerged as a dominant factor for the spread of the virus and subsequent deaths.
First, Japan has an institutional capacity of 13.7 beds per 1,00,000 persons, whereas Qatar has been able to provide almost 15 times that, or more than 200 beds. According to some reports, Japan has lacked sufficient beds and suffered from staffing shortages. On the other hand, Qatar was able to provide the necessary support to all patients.
Second, it is noteworthy that Japan has more elderly people per capita than any other country in the world, and this demographic is highly vulnerable during pandemics. As mentioned before, Qatar undertook special measures for elderly people which Japan might have not been able to take, at least early on.
Third, Japan which is a country of 126 million people, has been able to identify only 50,210 cases, although this is in part because there was limited testing. Qatar, on the other hand, a country of only 2.8 million people, detected more than 100,000 cases of infection. As mentioned before, early detection has helped Qatar keep mortality rates very low which can be of reference for Japan.
In an attempt to curb the transmission of the virus, from May of this year Qatar also turned to technology. Residents are required to install a Google app called “Ehteraz” on their mobile devices and keep them on their persons when leaving home allowing the government to track if the user has been in touch with an infected person.
Japan, a highly technology-based society, also rolled out apps called “COCOA,” a COVID-19 contact-confirming application in late June, a bit later than Qatar. However, sign-ups are not mandatory, and usage has been very low in part over concerns about privacy and discrimination.
There are numerous lessons Japan can draw from Qatar, not only to address the current COVID-19 crisis, but also to start preparing for the next pandemic. Importantly, cooperation between the two countries would be a further benefit for the two countries, which have enjoyed strong relations since the establishment of diplomatic ties in 1972.
Furthermore, Japan is Qatar’s most significant trading partner (importing 21% of its total exports), and Qatar is Japan’s 6th largest partner. The opportunity presented by the COVID-19 challenges may provide a degree of economic, educational, and policy cooperation between two which would significantly benefit both countries and regions.
Authors: Muhammad Mustafizur Rahaman, Niaz Ahmed Khan and Robert D. Eldridge
Muhammad Mustafizur Rahaman, Ph.D., is currently, Counselor (Labour), at the Embassy of the People’s Republic of Bangladesh, Doha, Qatar. Niaz Ahmed Khan, Ph.D., among other positions, is a senior professor and former chairman, Department of Development Studies, University of Dhaka.Robert D. Eldridge, Ph.D., is Director, Global Risk Mitigation Foundation, Honolulu, Hawaii, and a regular contributor to JAPAN Forward and other publications.