Countries selected for inclusion represented a range of Covid-19 mortality rates, health system design, economic development, and had regional coordinators that could adapt the questionnaire to the local context and champion distribution. See Table 1 for comparison of country settings.

*As of 11th July 2020.

±Start of study period (27th Mar 2020).

§End of study period (16th June 2020).

The Government response stringency index is a composite measure, proposed by Hale et al, that integrates measures of ‘[Covid-19] containment and health’, ‘economic support’, and ‘[policy] stringency’ to form an overall index that can be used to compare government policy over time in different countries. The score represents the number and strictness of government policies and should not be interpreted as an ‘effectiveness score’[30].

The UK has 66 million residents [21]. Healthcare is publicly funded through general taxation and provided free at point of delivery by the National Health Service. The gross domestic product (GDP) is $42,962 per capita [22], of which 9.6% ($3,859) is spent on healthcare [23]. The UK has 2.8 physicians and 8.2 nurses and midwifes per 1,000 people [24,25]. The first documented case of Covid-19 was on 29th January 2020 and a national lockdown was initiated on 23rd March 2020 that introduced workplace, public space and school closures. In order to increase clinical capacity measures were taken including the cessation of elective services, redeployment of staff, reconfiguration of hospitals and establishment of a series of temporary ‘Nightingale’ hospitals. As of 11 July 2020 the UK has had 288,133 Covid-19 infections and 44,650 related deaths [26].

Singapore is a city-state of 5.7 million residents. 80% of hospital care is provided by the public sector [27] and is funded through a mixed-financing model of co-funding [28]. The GDP per capita is $64,582 [22], of which 4.4% ($2,619) is spent on healthcare [23]. Singapore has 2.3 physicians [24] and 6.2 nurses and midwives per 1,000 people [25]. Singapore reported its first case of Covid-19 on 23rd January 2020. In April, a national lockdown [29] was initiated that introduced workplace, public space, and school closures. In order to increase clinical capacity, non-urgent clinical procedures were reduced. As of 11 July 2020 Singapore has had 45,613 Covid-19 infections and 26 related deaths [26].

Poland has 38 million residents [21]. Healthcare is funded through the National Health Fund, general taxation and private insurance. The GDP per capita is $15,423 [22], of which, 6.5% ($907) is spent on healthcare [23]. Poland has 2.4 physicians and 6.9 nurses and midwives per 1,000 people [25,26]. On 4th March 2020, Poland reported its first case of Covid-19 and a national lockdown was initiated on 15th March 2020, which included border closures to foreign nationals and a quarantine for returning citizens. Twenty-three hospitals were repurposed into infectious diseases hospitals for patients with suspected or confirmed COVID-19 infection. A further 67 hospitals had an infectious disease ward available. As of 11 July 2020 Poland has had 37,216 Covid-19 infections and 1,562 related deaths [26].

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