Introduction

This chapter utilises the same method as the rest of the book (QCA) but with a different dataset. During the book's writing, the COVID-19 pandemic began and spread across the world. This gave me two options – I could ignore it, as the pandemic was not in the original book proposal, or I could incorporate it, and see how different health systems had responded to the challenge that it offered. I have decided on the latter, but of course any analysis I can offer is limited in that, at the time of writing, the pandemic is far from over. This has resulted in some methodological choices about what I can and cannot write about, but I hope that the chapter offers an insight into the ‘first wave’ of the pandemic and so makes a contribution to the comparative analysis of health systems.

Understanding why some countries were more successful than others in responding to the pandemic in its first wave – with the analysis here running up to mid July 2020 – gives important insights into the relative importance of the structural influences which are now known to be important in containing the virus, as well as giving an opportunity to assess the success (or otherwise) of different countries’ COVID-19 testing regimes.

Comparative studies have the potential to bring insight into how COVID-19 risk factors and testing regimes interrelate, but there are significant data limitations in terms of what can and cannot be measured in a robust way at the time of writing. This necessarily means some compromises have to be made. It is clear that policy responses such as the extent and timing of lockdown restrictions, hygiene measures, border controls, availability of protective equipment, and COVID-19 testing regimes, all have important roles to play. But achieving robust comparative data capturing these factors remains extremely difficult.

It is clear, however, that several important COVID-19 risk factors can be measured. Research over the last six months has shown clearly that older people are more susceptible to the virus and that there are increased risks through obesity (Goldacre and OpenSAFELY Collaborative, 2020).