Exploring the Process of Policy Overreaction: The COVID-19 Lockdown Decisions

Qualitative comparative analysis of policies implemented by 26 European countries during the 2020 great lockdown

Introduction

During the first wave of the COVID-19 pandemic in Europe, from March 1 to April 15, 2020, significant variations emerged among countries regarding the implementation of lockdown policies. During this period, viewed strictly from an epidemiological perspective, lockdown measures are considered the most effective means of containing a pandemic. However, the adoption of such measures varied, raising questions about whether the reluctance or failure of countries to implement lockdown policies reflected a disregard for epidemiological knowledge or stemmed from an inability to enforce these measures.

Methods

This article employs Qualitative Comparative Analysis (QCA) with 26 European countries as case studies to investigate under what combination of conditions a country would implement lockdown policies.

Results

The QCA results identify three distinct combinations of conditions that lead countries to implement lockdown measures. First, countries with relatively concentrated political power are more likely to implement lockdown policies. Among the 10 countries governed by a majority party or majority coalition within a two-party or moderate multi-party system, seven implemented lockdown policies. Second, in cases of relatively dispersed political power, countries facing state fragility risks are more likely to implement lockdown policies. Among the eight countries that meet both conditions, five implemented lockdown policies. Finally, factors such as political heritage, severity of the pandemic, demographic composition, healthcare access, quality standards, and the ruling party's ideology play a lesser role in the decision to enact lockdown measures.

Discussion

This article offers a novel perspective on the dynamics of party politics and state capacity in the context of decision-making during the COVID-19 pandemic. It contributes to a deeper understanding of the intricate relationship between political systems and public health crisis management, highlighting how various political and governance factors influence the adoption of public health interventions during crises.

Rural healthcare workforce preparation, response, and work during the COVID-19 pandemic in Australia: Lessons learned from in-depth interviews with rural health service leaders

BACKGROUND

Low population density, geographic spread, limited infrastructure and higher costs are unique challenges in the delivery of healthcare in rural areas. During the COVID-19 pandemic, emergency powers adopted globally to slow the spread of transmission of the virus included population-wide lockdowns and restrictions upon movement, testing, contact tracing and vaccination programs. The aim of this research was to document the experiences of rural health service leaders as they prepared for the emergency pandemic response, and to derive from this the lessons learned for workforce preparedness to inform recommendations for future policy and emergency planning.

METHODOLOGY AND METHODS

Interviews were conducted with leaders from two rural public health services in Australia, one small (500 staff) and one large (3000 staff). Data were inductively coded and analysed thematically.

PARTICIPANTS

Thirty-three participants included health service leaders in executive, clinical, and administrative roles.

FINDINGS

Six major themes were identified: Working towards a common goal, Delivery of care, Education and training, Organizational governance and leadership, Personal and psychological impacts, and Working with the Local Community. Findings informed the development of a applied framework.

CONCLUSION

The study findings emphasise the critical importance of leadership, teamwork and community engagement in preparing the emergency pandemic response in rural areas. Informed by this research, recommendations were made to guide future rural pandemic emergency responses or health crises around the world.

Is society caught up in a Death Spiral? Modeling societal demise and its reversal

Just like an army of ants caught in an ant mill, individuals, groups and even whole societies are sometimes caught up in a Death Spiral, a vicious cycle of self-reinforcing dysfunctional behavior characterized by continuous flawed decision making, myopic single-minded focus on one (set of) solution(s), denial, distrust, micromanagement, dogmatic thinking and learned helplessness. We propose the term Death Spiral Effect to describe this difficult-to-break downward spiral of societal decline. Specifically, in the current theory-building review we aim to: (a) more clearly define and describe the Death Spiral Effect; (b) model the downward spiral of societal decline as well as an upward spiral; (c) describe how and why individuals, groups and even society at large might be caught up in a Death Spiral; and (d) offer a positive way forward in terms of evidence-based solutions to escape the Death Spiral Effect. Management theory hints on the occurrence of this phenomenon and offers turn-around leadership as solution. On a societal level strengthening of democracy may be important. Prior research indicates that historically, two key factors trigger this type of societal decline: rising inequalities creating an upper layer of elites and a lower layer of masses; and dwindling (access to) resources. Historical key markers of societal decline are a steep increase in inequalities, government overreach, over-integration (interdependencies in networks) and a rapidly decreasing trust in institutions and resulting collapse of legitimacy. Important issues that we aim to shed light on are the behavioral underpinnings of decline, as well as the question if and how societal decline can be reversed. We explore the extension of these theories from the company/organization level to the society level, and make use of insights from both micro-, meso-, and macro-level theories (e.g., Complex Adaptive Systems and collapsology, the study of the risks of collapse of industrial civilization) to explain this process of societal demise. Our review furthermore draws on theories such as Social Safety Theory, Conservation of Resources Theory, and management theories that describe the decline and fall of groups, companies and societies, as well as offer ways to reverse this trend.

Consequences of the Early Phase of the COVID-19 Pandemic for Home-Healthcare Recipients in Norway: A Nursing Perspective

Municipal home-healthcare services are becoming increasingly important as growing numbers of people are receiving healthcare services in their home. The COVID-19 pandemic represented a challenge for this group, both in terms of care providers being restricted in performing their duties and care receivers declining services for fear of being infected. Furthermore, preparedness plans were not always in place. The purpose of this study is to investigate the consequences for recipients of home healthcare in Norway of the actual level of COVID-19 infection spread in the local population, as observed by licensed nurses working in home-healthcare services. Approximately 2100 nurses answered the survey. The most common adverse consequences for home-healthcare recipients were increased isolation and loneliness, increased health concerns, and the loss of respite care services. An increased burden for relatives/next of kin and fewer physical meetings with service providers were frequently observed and reported as well. This study shows that there were more adverse consequences for service users in municipalities with higher levels of contagion than in those with lower levels of contagion. This indicates that the municipalities adapted measures to the local rate of contagion, in line with local municipal preparedness strategies.