Learning from success: how has Hungary responded to the COVID pandemic?
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COMMENTARY
Learning from success: how has Hungary responded to the COVID pandemic? Martin McKee
Received: 20 July 2020 / Accepted: 21 July 2020 # American Aging Association 2020
In 2019, an international panel of experts developed the Global Health Security Index, a measure that ranked the countries of the world in terms of their preparedness for a major threat to health, such as a pandemic (Global Health Security Index, 2019). It combined a portfolio of indicators in areas such as prevention, detection, and reporting, and ability to mount a rapid response. The choice of measures was informed by evidence of what worked and the overall ranking seemed to make sense. Yet, it has not stood the test of time. The USA was ranked first out of 195 countries, with the UK second. Yet by no stretch of the imagination could either of their responses be described as effective. Brazil was ranked in 22nd place yet the situation there is catastrophic. Hungary came in at only 35th place yet it has performed far better than many countries that were expected to do much better. Inevitably, the first question to ask when undertaking a comparison of health responses is whether the data are accurate. The accompanying paper, by Merkely and colleagues, provides reassurance that Hungary has indeed managed to control the pandemic (Merkely et al., 2020). They report a nationwide survey in which subjects were tested for the presence of the COVID-19 antigen, using PCR testing, and of antibodies. They found that evidence of COVID-19 infection was very rare. Their central estimate of those testing positive on M. McKee (*) European Public Health, London School of Hygiene & Tropical Medicine, London, UK e-mail: [email protected]
PCR was 2.9/10,000. Put another way, someone in Hungary would have to interact with, on average, 3500 others to encounter someone who is infected. Consistent with this figure, only 0.68% of the population was found to have antibodies, a marker of previous infection, far lower than the 5% or so reported from countries that were much harder hit, such as Spain (Pollán et al., 2020). Of course, none of these tests is perfect. There are false positives, as when PCRs identify fragments of viral RNA after they have ceased to have active infections, and false negatives, for example due to faulty sampling technique (Watson et al., 2020). There are many outstanding questions about the meaning of antibody tests, with evidence that they may decline in the weeks following infection in some people (Seow et al., 2020), although fortunately it now seems that this does not equate to declining immunity as responses by T cells are emerging as equally or more important, albeit more difficult to measure. Given that sampling for PCR testing is not a pleasant experience, requiring swabs to be inserted into the nasopharynx, the research team is to be applauded for achieving a response rate of 66%. As they report, this reflected a multi-faceted approach, making full use of connections to communities through general practitioners. The abil
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