COVID 9: Why some countries did better?

 A year has gone by and the devastating impact of the Covid pandemic is still going on with over 100 million infections worldwide and over 2.1 million deaths we know the pandemic is far from over. The pandemic, from its source of origin, its widespread infections across the globe, to the debate over how best to combat it remains an ever present topic of our daily lives. As the roll out of various possible vaccines occurs the virus, to make its point, surges ahead in a third wave which, with reported new variants of the Covid 19 virus, reminds us the battle is far from over.

Eventually the human race will over come this deadly virus, whether through its myriad of strategies and vaccines or the virus will just mutate itself into non existence, as did SARS, remains to be seen. A year down the deadly combat with this virus it seems less likely that self mutation of the virus into non existence is a possibility. Yet we have to wonder why some countries fared better than others. 

We can look at the statistical data and come to various conclusions but the debate then gets furious as we can argue about how the death rates are determined, the relationship of testing to over all performance, the importance of recovery rates, and hospitalisation rate to positive test ratios. Either way we see it on a statistical basis countries the USA, UK, Italy, and Brazil do not come out well on the death per million criteria. Same is true for infections per million where the USA fares the worst (78,000) but India comes in with only 111 per million, highlighting that testing is important as India has only tested 13% of its population compared to the US which has 91% tests including repeat tests. Some countries like UAE have crossed 242% tests as a result of strict internal testing protocols resulting in repeat tests. Israel, Australia Iceland and Denmark have all shown over 100% test numbers following the dictum that till you do not test you don’t know the impact of the virus.

However, data is a bit confusing as some countries with high testing still have high death rates compared to others who show that high testing resulted in better identification of the spread and resulted in lower death rates. In some cases the death rate only applies to people who died within 28 days after testing positive thus ignoring people who may have died from complications arising from COVID-19 after the 28 days as is the case in UK. Thus one can argue the UK numbers are understated. 

Moving away from the debate over the statistical data one can appreciate that while no single strategy can be earmarked as successful in the fight against  the COVID-19 virus it is clearly evident that both macro and micro strategies in combination achieved a higher level of success. 

New Zealand is highlighted as a country that has successfully contained the virus thus far. Admittedly with a smaller population of 5 million some would argue it could have been easier to tackle the pandemic. Indeed a smaller population in an island country is an advantage but still the country has a few major cities with concentration of the population and to record only 25,000 cases with only 25 deaths is remarkable. Testing is high, 300% test rate, but then a lot of things were done right from the beginning.

One of the strongest factors for New Zealand was and is its leadership under Prime Minister Jacinda Arden. A key factor was communication and transparency by the prime minister herself leading the daily briefings and in a very personal style calling the 5 million people “the team” that will fight the virus. This created a togetherness with the community and backed with honest communication the harder measures were understood and accepted by New Zealanders. Last year in mid March a strict lockdown was imposed across the country with social distancing and masking compulsory when the lockdowns were eased. A state of the art contact tracing was implemented and where localised outbreaks happened curfews and lockdowns in those areas followed. The contact tracing was believed to be so good that in one case the virus was tracked to a garbage bin in a particular neighbourhood!

Indeed a complete lockdown and no entry or exit from the country all had a massive economic impact on the economy but the calculation  was that  30 to 60 days of strict measures will allow a return to normalcy faster that otherwise. This proved right and by July of last year a graduated return to normal life was seen and now with the second surge the measures from the start showed the protocols were robust. In New Zealand’s case a central policy was possible from the prime ministers office unlike say in the United States where a federal policy cannot apply uniformly in all 50 states, even though there are ways to invoke an emergency nation wide. 

The case of Africa as a whole is  more interesting with 17% of the world population only 3.5 m cases have been reported with 87,043 deaths. One could argue that low testing levels (South Africa is the highest with 13%) suggests less detection of cases. But then death rates in general on the African continent have not gone up suggesting that impact on the over all death rate since the pandemic started is negligible. It is possible that given the past experience to pandemics like Ebola some countries in Africa were better prepared and while testing may not have been widespread at ports of entry the measures were strict. In the case of Nigeria, for instance, a strict lockdown was imposed a couple of weeks before the first case was reported. Researchers also suggest that given the average age of the population to be a low 18 years, resilience to the virus could be better. (In Germany the average age of population is 40 years). An additional factor could well be that a large proportion of the population spend their time outdoors thereby reducing the spread of the virus.

The United Arab Emirates was also one of the countries that showed a remarkable response to the virus. With a population of 9.7 million it acted quickly to force a lockdown and for a few weeks a nightly curfew  during which period streets and public places were disinfected regularly. While limited flights in and out were allowed there were protocols for testing and tracing. Masking and social distancing were quickly implemented and remain in force even a year later. While in December 2020 there has been an uptick in the numbers it has been accompanied by higher recoveries and mass roll out of vaccinations. 

Across Asia results of strategies against the virus vary. China, given its highly centralised government, initially may not have been forth coming about its numbers, even though it was quick to share the genetic structure of the virus with scientists around the world, it nevertheless enforced a total curfew in Wuhan, the source of the virus, and across much of China. It’s contact tracing systems remain one of the best and it would seem they have contained the virus. Mass roll out of their vaccine has been going on for a couple of months and cooperation with other countries is in the rise. South Korea, Taiwan, Vietnam and Japan all have fared better then their western counterparts as their is a better level of acceptance of government policies on the pandemic. In addition face masks have been long accepted in some of these societies since over two decades which could explain why infection rates were relatively low in their countries even though lockdowns were not that severe. 

Elsewhere in Asia both India and Pakistan seem still to develop a comprehensive strategy against the pandemic. Low levels of testing, 13% and 3.4% respectively suggests either a lack of resources or willingness to examine the extent of the pandemic. With the availability of the vaccine both governments seem to follow a strategy of vaccinations to cover as many people as they can. Mask wearing has been only successful in a limited sense and mass gatherings have not been curtailed. It would seem their best bet is in the vaccine now with a acceptance that the vaccine may prevent the spread of the virus as government policy was an abysmal failure.

In the West the United Kingdom and the United States both present interesting case studies. 

In the UK the strategy has been a mixed confusion of decisions aimed to sound politically correct and the resulting measures have been ill conceived and ineffective. A year ago the government tried to calm nerves by insisting they had a strategy in place when in fact all Boris Johnson wanted was to avoid a lockdown that would effect the economy. Measure like social distancing and face masks were more suggestions then mandatory policies. Contact tracing was considered a violation of civil liberties and never really implemented. The NHS was not given the equipment and resources in time to deal with the first wave of infections and a year on some doctors complain of shortages of key supplies. 

When lockdowns did finally c9me into place, some ten months into the pandemic, they were tiered into different levels, a good thing, but then no testing for people moving from one tier to the other. The government has tried to be transparent but is briefings seem to just present the statistics but not explain the effect of the measures and why some are working and some are not. Ministers who have appeared in the media have not been able to defend  their policy and worse not been able to answer the most basic questions.

The United States response, for a leading western nation, has been far short of any expectations. A lack of leadership was compounded by the politicalisation of the Covid 19 issue with the then President, Donald Trump, not taking the lead to fight the pandemic. No effort was made to make social distancing and face masks a policy priority so much so that the President himself did not wear masks and encouraged events that contributed to the spread of the virus. Politics rather than science governed the response and supporters of the President took pride in not wearing the mask. 

Given the size of the country and the complex demographics one would have expected more coordinated policies between the various states under a federal government umbrella. States like New York and California while implementing reasonably sound strategies the lack of a national policy on testing inter state travel or have contact tracing meant that efforts of state governments were constantly eroded. Perhaps the greatest short  coming in the United States was not only the lack of transparency but the conspiracy theories about the virus and misinformation from the highest levels of public office. 

In conclusion the following are the lessons we have learned thus far from the way various countries have responded to the virus.

• Quick and early governmental action on lockdowns, face masks and social distancing.
• Honest and transparent communication on the virus, the measures being taken and possible outcomes. Such communication directly from the head of government and senior ministers was essential in building trust.
• Establishing a social mandate of trust and confidence with the community.
• Follow the science and not the politics.
• Establishing contact tracing so that the spread of the virus can be monitored and then contained.
• Widen the testing regime.
• Where a tier system of lockdowns are implemented testing of people moving between different tiers  to be obligatory.
• International travel to be eased in phased manner between countries with similar success rate in fighting the pandemic.
• As vaccinations roll put so too should the state of preparedness be improved as most likely a new variant of the Covid-19 will emerge or in a few years a new coronavirus will spread.