Journal of Modern Medical

Introduction
The crises such as the COVID-19 pandemic, are one of the most challenging conditions for the health system that require immediate decision-making and management. In dealing with the COVID-19 pandemic, most countries developed policies to control the disease, and as a result, gained different experiences regarding their measures. In some countries, such as New Zealand and Scandinavian countries, South Korea, China, Japan, Taiwan, and Singapore, these policies were applied in a balanced and centralized way throughout the country, and public support and social participation were used to control the disease. 
However, in some countries such as Italy, Spain, India, Pakistan, and some other countries in the Middle East, no coherent approach was observed. In Iran, with the increase in the number of infected cases and hospital admissions, the government imposed preventive measures such as quarantine, travel bans and closure of all non-essential organizations with a delay, which led to a severe disease pandemic. While other countries had dealt with the spread of the virus and the treatment of infected cases with comprehensive and precise planning and coordination between people and government, in Iran, we witnessed chaos in the decision-making and people’s lack of attention to the preventive regulations and lack of trust on official statistics, resulted in the spread of the disease. This research aims to investigate and compare the measures against the COVID-19 pandemic used in Iran and selected countries (US, New Zealand, Italy, Egypt, China).

Methods
This is a qualitative-quantitative study using an inductive approach. In the qualitative phase, after reviewing the related articles, the concepts related to the research questions and objectives were extracted. A checklist with 82 main themes, 13 organizing themes, and 3 inclusive themes was provided to 16 specialists and professors in the fields of management and medicine in three Delphi rounds. In the end, the panel of experts reached a consensus and 76 themes in three dimensions and 13 components were extracted. Face validity was assessed by experts, and the content validity ratio was measured using the Lawshe method. To determine the consensus among the experts, in addition to the mean, median and standard deviation indicators, Kendall’s rank correlation coefficient was used.
In the quantitative phase, the questionnaire was presented to a larger group including 250 employees and managers of Kashan University of Medical Sciences, Islamic Azad University (Khorasgan Branch) and University of Kashan. The reliability for the overall questionnaire was obtained at 0.824 using Cronbach’s α coefficient. All data were analyzed in SPSS software, version 26 and AMOUS using Friedman’s test and chi-square test. 

Results
According to the World Health Organization (WHO) report, Iran had the highest mortality rate (19.13%) and the US ranked second (10.88%), while New Zealand had the lowest mortality rate (1.13%). Italy had the highest infection rate (41.52%), followed by New Zealand (38.97%). China and New Zealand had the highest rate of recovery, followed by US and Italy, while Egypt and Iran had the lowest recovery rate. In terms of prevention, New Zealand and China controlled the outbreak with timely vaccination. Quarantine and vaccination were not paid enough attention to in the US. After the spread of the disease, special attention was paid to issues related to the pandemic. Iran, Italy and Egypt delayed the vaccination programs, which led to the pandemic and reduced the economic status. 
New Zealand and China imposed quarantine and screened travelers coming from abroad on time in a serious manner, while the US did not take it seriously at first; with the further spread of the disease, the state officials imposed the measures. This was also done with delays in Italy, Egypt and Iran. In the field of disease control, China and New Zealand were able to control the disease by vaccination, expanding medical centers and equipping facilities and human resources, while other countries could not reduce the transmission of the disease in the first wave. In the second wave, the US and Italy applied the measures of self-isolation and quarantine. Iran and Egypt applied quarantine and vaccination after the second and third waves. China and New Zealand had high disease control, the US and Italy had moderate control due to their more moderate policies and Egypt and Iran had weak control.

Conclusion
Epidemiological parameters of six countries (Iran, US, New Zealand, Italy, Egypt, China) showed that they had different spread rates and very different recovery and mortality rates. China and New Zealand managed to control the pandemic with timely measures and vaccination and due to the high infection rate, their recovery rate was high. On the other hand, the lack of travel restrictions, resistance to vaccination, and not applying the self-isolation policy in the US and Italy caused the infection rate to increase, but they experienced a lower recovery rate. Egypt and Iran carried out self-isolation and vaccination programs with great delay, which led to unfortunate consequences in terms of infection and mortality rates.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Research Council of Isfahan Branch (Khorasgan), Islamic Azad University, Isfahan, Iran.(Code: IR.IAU.KHUISF.REC.1402.099).

Funding
This study was taken from the PhD dissertation of Manijeh Kadkhodaei, approved by the Department of Public Management, Islamic Governance and Management, Isfahan Branch (Khorasgan), Islamic Azad University, Isfahan, Iran.

Authors' contributions
Conceptualization, methodology and supervision: All authors; Resources, Investigation and writing: Manijeh Kadkhodaei.

Conflicts of interest
The authors declared no conflict of interest.



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