Ontario has struggled with COVID-19 data and testing. Places that mastered both are now lifting lockdowns

While Canada has endured more than a month of physical distancing measures, some countries around the world are beginning to ease up on restrictions in the hope of returning to something resembling normalcy.

In Germany, South Korea, Taiwan and Norway, aggressive measures were implemented by local governments early in the crisis and each employed accurate, timely data collection. It's an area where some Canadian provinces, including Ontario, have fallen short.

Many experts interviewed by the Star throughout the COVID-19 fight have said that shortcoming led to a sluggish reaction and a muddy picture of where we go from here.

Here's a look at how the countries that got ahead of the game managed the pandemic.

Germany

An early response in Germany meant that despite a high case load - a cumulative 153,584 confirmed cases of the virus as of Friday - the death rate has stayed relatively low.

Prof. Erica Di Ruggiero, director of the Centre for Global Health at the Dalla Lana School of Public Health, said this can be attributed to the country's quick, decisive action.

"They've done far more testing to really establish whether individuals are currently infected than any other major European countries," Di Ruggiero said. Germany moved faster than France or Italy, giving it the ability to identify positive cases early in the pandemic. "It gave them the authority to be able to act," she explained.

To date, the country of 83 million has recorded 5,577 deaths. Canada, meanwhile, a country less than half of Germany's size, had recorded 2,294 as of April 24.

Germany's laboratory capacity, capable of processing a large number of COVID-19 tests, also contributed to its ability to respond quickly.

"That goes hand in hand with testing," Di Ruggiero said, adding that because the government values scientific research - Chancellor Angela Merkel holds a doctorate in quantum chemistry - it was well-positioned to weather the pandemic.

"Germany " acted very decisively," Di Ruggerio added, calling the country's approach "data driven" with early findings feeding back up the chain of decision-making and influencing how the country would adapt to the virus.

South Korea

South Korea is being held up by many experts as the model to follow when it comes to flattening the curve. While other countries barely had the new coronavirus on their radar, South Korea was in planning mode: setting up electronic monitoring infrastructure, increasing public messaging and ramping up production of test kits.

After an initial spike in late February, the rate of new cases took a nosedive and has continued on this trajectory. On Friday, the country reported just six new cases and no deaths in the last 24 hours. Despite a population almost 11/2 times larger than Canada's, South Korea has 10,708 confirmed COVID-19 cases, just a quarter of Canada's total, and 240 deaths - roughly a tenth of the Canadian toll.

So how did South Korea do it? Experts say it was a combination of jumping on the problem early, voluminous testing, extensive contact tracing, aggressive isolation of mild cases and electronic surveillance.

"Everyone is electronically tracked. It's not just cellphone tracking. They're also tracking payments you make with Interac or credit card," said Amir Attaran, a professor at the University of Ottawa's law faculty and school of epidemiology and public health. "If you'd gone to the grocery store and someone from the grocery store tested positive at 11 a.m. when you were there " you would get an alert saying, 'Go isolate yourself. You may be infected.' That happens automatically."

Colin Furness, an infection control epidemiologist and assistant professor at U of T's faculty of information, noted that South Korea is somewhat of an outlier in that it had previous experience in 2015 dealing with the Middle East Respiratory Syndrome (MERS) that infected 186 and killed 38.

"They were ready to scale testing when nobody else was," Furness said.

Taiwan

Also quick to act, Taiwan had just 428 cases of COVID-19 as of Friday, and only six deaths linked to the virus. Like Germany, Taiwan faced the pandemic head-on in its early days.

What sets Taiwan apart is its use of data. The country was able to "look at different sources of data to give them a " real-time picture of who was getting sick and where they had travelled," Di Ruggiero said.

The country has imposed strict quarantine measures on those who are sick, and has collected data such as travel history or visits to the doctor to trace the movements of those who might be infected.

"That has something to do with how they were able to merge and combine different data sources that are typically collected by different parts of the government," Di Ruggiero explained, which allowed for a uniform response rather than one that pieced together decisions by different levels of government.

"That's a challenge even here in Canada, given the plurality of our health systems. Because of our provincial/territorial decision-making structure " you have data being collected by multiple agencies. So to be able to integrate that is a challenge, I think, for any country."

Norway

In a move of cautious optimism, primary school students in Norway will return to classes on Monday following a month of what are generally viewed as successful restrictions aided by excellent data collection and analysis.

The country of 5.3 million has seen a downward trend in hospitalizations and patients on respirators due to COVID-19 in recent weeks, with 7,444 confirmed cases and 199 deaths to date.

Social distancing measures, including a border closure to everyone except Norwegian citizens and residents, as well as transparent use of population behaviour data are being credited with allowing for a relaxing of restrictions this early.

Every day the Norwegian Institute of Public Health releases a detailed, transparent epidemiological model that the University of Ottawa's Attaran says "any epidemiologist in the world can grasp instantly" and that could be published in a peer-reviewed journal.

The report includes cellphone tracking data so that Norway knows how effective its social distancing and isolation measures are working.

"They are then able to use that information to refine their epidemiological model to say: How much more movement could we permit?" he said.

In addition to providing the public with all the data it is using, the institute shows its methodology and the assumptions used in modelling, and discloses the names of all contributors from both the public and private sectors.

"Collaboration, transparency, excellent science. That's why they can open up and they're confident they're not going to kill people; Canada has none of this," said Attaran.

"If you have data, you can not only understand where you are, but you can also better predict where you will be," he added.

"If you don't have those data, you just can't make those decisions. You're flying by the seat of your pants. You're taking your little sailboat out into the Caribbean during hurricane season and saying, 'Well, I'll just look at the sky here and see what's coming.'"

Jenna Moon is a breaking news reporter for the Star and is based in Toronto. Follow her on Twitter: @_jennamoon

Kenyon Wallace is a Toronto-based investigative reporter for the Star. Follow him on Twitter: @KenyonWallace or reach him via email: kwallace@thestar.ca