Comment on “Health and Public Health Implications of COVID ‐19 in Asian Countries”

Abstract

Miyawaki and Tsugawa (2022) review the impacts of COVID-19 on public health, particularly in Asian countries, as well as the current knowledge about its pathogenesis, treatment, and prognosis. They report that Asian countries had more strict physical distancing policies during the early phase of the pandemic and fewer cumulative cases and deaths on average compared with those of European Union countries. Overall, this is a well-balanced review, which considers both the positive and the negative health effects of various nonpharmaceutical interventions (NPIs), and is helpful in providing information about the current scientific knowledge on COVID-19 for nonmedical readers. I would like to add several points to this review to give a more comprehensive account of the current applications and ideas. Intensive care for COVID-19 patients with severe respiratory failure needs large-scale health care resources. Shaefi et al. (2021) recently report in a multicenter cohort study that patients who received extracorporeal membrane oxygenation (ECMO) had lower in-hospital mortality rates than patients who did not. Once the efficacy and safety of intensive therapies such as ECMO are known, we need further research into the value of these services as preventive and treatment measures to support decision-making for health care resource allocation. The impact of COVID-19 on non-COVID diseases is huge. Miyawaki and Tsugawa (2022) acknowledge its impact not only on acute care, and the screening, and treatment of noncommunicable diseases, other infectious diseases, traffic accidents, and psychological distress, but also on lifestyle changes during the pandemic. Evidence has shown changes in tobacco behavior in Asia. Also, a few empirical studies have investigated alcohol consumption in the region. Martino et al. (2021) report that online marketing by food and alcohol companies became more active under the themes of isolation activities and community support. Physical distancing policies can change our habits and lifestyle, and these changes may persist even after the end of the pandemic. In that case, regulations aiming to restrict the consumption of unhealthy food, tobacco, and alcohol may require reconsideration after the pandemic. Older adults, the most vulnerable population, also experienced lifestyle changes during the pandemic, including decreased physical activity. If this will lead to higher incidence of disability among them in the future, preventive measures for COVID-19 will impact the distribution of health for COVID- as well as non-COVID-related diseases. This pandemic has caused extreme physical and mental stress on health care workers. At the same time, in Japan, smaller medical institutions have suffered from decreased demand. This indicates that a reallocation of health care workers is necessary both among and within institutions to deliver resilient health care during the pandemic. In Japan, financial incentives are provided to both institutions and health care workers. However, it is yet to be known whether these incentives are effective in motivating and retaining employees and preventing work burnout. An important question will be what measures are associated with a high level of motivation to deliver high-quality care during the pandemic. Public health interventions tend to be complex, programmatic, and context dependent. They may have outcomes for the individual, family, community, and society as a whole. As scientific evidence about the broader effects of interventions are accumulated, it is necessary to provide information about the overall value of an intervention for policymakers. For example, the Medical Research Council in the United Kingdom produced a useful guide for the development, evaluation, and implementation of complex interventions (Craig et al., 2008). It stresses that understanding not only what works but also how it works, over what time period, in what setting, and in which population group is essential to understand the process and the outcome of complex interventions such as public health interventions for COVID-19. Investigations about various public health interventions in the earlier stages of the COVID-19 pandemic will provide important lessons for the next pandemics in the future because the availability and timing of effective vaccines and treatments are always uncertain. Although evaluations of NPIs are always more difficult than those for pharmaceuticals because of their complex nature, the importance of collaborative investigations on the wider impact of NPIs cannot be exaggerated.