Thread by @AdamJKucharski

One thing that has hugely shaped countries' response to COVID, and which I don't think gets enough discussion: genuine constraints and perceived constraints. A thread... 1/

Some apparent local constraints have persisted throughout the pandemic. For example if you look globally, there are still notable differences in approaches to surveillance and quarantine... 2/

https://twitter.com/AdamJKucharski/status/1256140519572484102?s=20

It's worth reading these papers on the response in Taiwan (jamanetwork.com/journals/jama/…) and Korea (jamanetwork.com/journals/jama/…). Should more countries include these data-intense approaches in future pandemic plans? Or does reluctance to date reflect an immovable constraint? 3/

In contrast, attitudes to duration/stringency of NPIs have shifted dramatically. Look back to Feb 2020 & prominent figures were raising human rights concerns about China lockdown. But by mid-March, countries had abandoned earlier perceived constraints: theconversation.com/what-we-learne… 4/

Stringency and sustainability can make big difference to outcomes. During the 1918 pandemic in US, the introduction of NPIs reduced impact - but they didn't remain in place for long and epidemics still ended with accumulation of immunity, e.g. pnas.org/content/104/18… 5/

Another topic is border measures - UK measures currently much stricter than most of Europe, but not as nearly as strict as some places as Asia Pacific. This constraint has shifted quite a lot - yet not fully in many countries. We should consider why.

https://twitter.com/AdamJKucharski/status/1389940764587745281?s=20

6/

There's also the question of scaled up testing regardless of symptoms. Places like China and South Korea did a lot early on, while others like Japan and Taiwan did relatively little (e.g. from last Aug: international.thenewslens.com/article/139685). Again, need to consider underlying reasons. 7/

As @hannahhec put it last March: "constraints may be real, but they may be moveable, either by the mobilisation of resources, or by updating the mental model about what is possible". channelnewsasia.com/news/commentar… 8/

In discussing future pandemic plans (as well as plans for COVID in coming months), it will be crucial to distinguish between what are genuine and perceived constraints - because it will be impossible to define what is optimal without this distinction. 9/9