What can health systems learn from COVID-19?

Coronavirus disease 2019 (COVID-19) is a severe respiratory disease from SARS-CoV-2. The first official cases were noticed in December 2019 in Wuhan, China, and spread fast causing a world pandemic. All countries in the world have been somehow hit either directly or indirectly by the effects of the disease and faced significant loss in terms of human lives, gross domestic product (GDP) and jobs. At the end of the third quarter of 2020, COVID-19 has affected more than 28 million people around the world of which 70% in Western economies. Europe totaled 4.796 million cases with Spain (566,326), United Kingdom (365,1789), France (353,986), Italy (286,297) and Germany (259,428) in the top five positions. The total registered deaths for coronavirus worldwide and in Europe were 917,417 and 225,494 with a Case/Death Fatality (CDF) ratio of 3.2% and 4.7% respectively. Among the top five positions, the highest CDF ratio at the country level has been observed in Italy (12.4%) and UK (11.4%) while the lowest in Germany (3.8%). The most hit country worldwide is United States, counting 6.4 million total cases, 192,612 deaths and a CDF ratio of 3%. Governments have been operating in a context of high uncertainty and have been struggling with difficult trade-offs given the health, economic and social challenges COVID-19 raised. Beyond the health and human tragedy of the coronavirus, it is now widely recognized that the pandemic triggered the most serious economic crisis in a century. Healthcare systems organization and governance are fundamental assets in public health emergencies, but much can be done to improve their effectiveness and efficiency. We believe that COVID-19 did not create new problems but violently brought to the surface many of the challenges healthcare systems have been facing for a long time.