Bob Somerby is musing today about the surprisingly low COVID-19 mortality rate in the Asia-Pacific region. This is something I've written about before, and it's even more remarkable than it seems at first glance. Here's a chart showing cumulative deaths for every country of any size in the region. I'm using the dreaded log scale so that I can include the US and Europe without creating a chart ten feet high.
Don't let that log scale fool you! The worst Asian country, Indonesia, has a death rate ten times better than the US and Europe. The best countries are literally 1000x better or more, and you get similar results if you look at cases. The case rate in Vietnam is 3000x better than the US.
The most common explanation for this is that Asian countries developed a new culture after the SARS epidemic of 2004 and are now instantly on the alert when a new virus appears. It's also possible that some of these countries have unreliable reporting. I can buy this, but only to a certain extent. It could explain a response that's 2x better, or even 5x or 10x better—maybe. But 100x? 1000x? Or 5000x, which is the difference between Vietnam and the US?
This is not a topic that's been ignored, but the experts have mostly been unable to figure out what's going on. I'm pretty convinced that something we haven't yet isolated accounts for this, but I have no idea what.
AFAIK, covid rates among Asian-Americans aren't any different than among European-Americans, so I don't think it's something genetic. Worth figuring-out, for sure.
Agreed, AFAIK, but I have seen zero reporting on this, so AFAIK isn't very far. Research on racial differences is very politically dangerous, so most academics and scientists shy away from performing it, and most reporters shy away from reporting it.
Nonsense.
Research on racial differences is largely problematic because the macro 'cultural races' are not coherent genetic populations. African (meaning sub-Saharan), Asian are nonsense categories genetically.
There are certainly ongoing research on discrete population differences in genetics, which makes a great deal of sense genetically, unlike the culturally based macro races.
Reporters being science and math illiterates largely of course get this wrong.
I stand corrected. Change my nonsensical characterization of "politically dangerous" to "largely problematic." Either way, if I were a researcher who cared about professional advancement, I wouldn't be doing "largely problematic" research.
Except it isn't just classic "Asian" population countries. It's also Australia and New Zealand.
As Kevin notes, the difference in death rates would seem to take us off any normal set of charts. This matter hasn't necessarily been ignored by academic specialists, but it largely has been ignored by the mainstream press.
I've seen some reporting on types of immune system markers different groups have and amount of Covid. But it really is preliminary and mainly correlations at this point.
Those of us with type O blood supposedly are less likely to have severe cases, but I don't believe that we are less likely to contract it in the first place.
And also Hawaii and Tahiti.
https://www.washingtonpost.com/opinions/2021/03/11/new-zealand-covid-19-maori-indigenous-manaakitanga/
New Zealand has a cultural advantage that helped them, as explained in the item for which I placed the URL above
It is different from that of some Asian communities, like the citizens of Korean heritage in Northern Virginia, many of whom do routinely wear masks during flu season.
The biggesr help is it being an island nation.
So is the UK. Mongolia and Vietnam have land borders with China. Taiwan has extensive economic ties to the mainland; a million Taiwanese work in the PRC. The difference is in how arriving travelers were managed, not how they arrived. Testing and mandated, monitored isolation/quarantine kept community spread to very low levels.
Based on its experience with SARS-CoV-1, Taiwan developed a pandemic playbook with some sixty actions, which they have been following, very successfully.
In The Fairfax Health District of Virginia the hot spots at the peaks of outbreaks were in zip codes with large African American and Latino populations, mainly working class frontline workers, less cases in the wealthier zip codes. The large Asian American population used to be in Annandale/Falls Church but the nucleous of the local Korean American population is now in Chantilly/Centerville.
Not only do Asian countries have experience with pandemics, they also have a culture of wearing face masks during flu season, and a tradition of social cohesion and respect for authority. The US has none of these, and in fact, values just the opposite.
Michael Jackson tried to prepare us...
This occurred to me as well. One also sees individuals at all times of year wearing masks if they suspect they might have a cold. It's considered a matter of individual responsibility.
American "conservatives" refusing to wear masks, and Republican politicians refusing to impose mask mandates, and claiming it's because mask-wearing is a matter of "personal responsibility" would be hilariously ironic if it hadn't led to so much suffering and death.
American "conservatives" are selfish, stupid children. They have no more sense of responsibility than a slow-learning 9-year-old.
I wouldn’t mind the Republican logic so much if the only people getting sick and dying were the people refusing to wear masks. The refusal to wear masks, based totally on politics, not science, is an attack on the rest of us. I would totally defend their decision otherwise.
This is an important point. Wearing of a mask provides some protection to the wearer but not a huge amount. But by preventing the stuff to which the virus is attached from being put into the air by the wearer, the mask confers a lot of protection upon others; hence the saying “my mask protects you, your mask protects me.”
So when conservatives speak of “personal responsibility” they have it exactly backwards. The choice of a conservative to exercise his “freedom” and “personal responsibility” by not wearing a mask in a community of others who do wear masks is not therefore an example of him taking a risk that only endangers himself. Rather, the choice is to endanger others but still enjoy the protection that their mask wearing gives to him.
It is worth emphasizing that large scale mask wearing has a multiplier effect in impact, so the individual scale analysis on single transmission is even more deceptive....
The Republican party's position - the radical reactionary right in the end - is one that is pure nonsense.
I don’t know about the rest of the country, but here in Colorado, it was reported that masks, social distancing, and the other COVID measures are credited with a huge decrease in the number of people hospitalized because of the flu; from the usual hundreds to .... 12, so far. So, we could keep the flu numbers that low every year if we are a lot more careful than we usually are. But we, as a society, have decided that some illness and a certain number of deaths are acceptable in order to not inconvenience us.
(I wonder if COVID-19 led to more people than usual getting the flu vaccine. After years of being hit and miss in getting a flu vaccine, I made sure this year to get a flu shot, hoping it provides some protection from COVID until I get a COVID shot.)
I won’t criticize states that open now, but I wish it would be made clear that those states have essentially decided that they are willing to accept a certain number of deaths that would not occur if restrictions had stayed in place.
I would say medieval values.
@Salamander
Facile as it is, this would be my guess, too. Unless maybe Asians and Pacific islanders are just more evolved than us.
Well Asian cultures value groups while because of the enlightenment individualism is what we value. Also their authoritarian leaders are smarter than ours.
I wish there were just a way to upvote things here, but alas. Funny thing is that flu is way down because we are, at least some of time, wearing masks here.
Bingo! A small but significant part of the US population thinks they are enforcing freedom when, in fact, they are worshipping freedum.
I'd add a couple of other factors: average age of population and obesity prevalence. I suspect there could be other co-morbidities in play and it might be fruitful to look at prevalence of the top 5 or so of known conditions that showed as higher death rates in the West.
Green tea?
Only statistic I could find, of the countries that consume the most green tea, Indonesia consumes the least,
https://www.o-cha.net/english/teacha/distribution/greentea3.html
Interesting.
Differences in societal expectations. Our American brand of defiant, in-it-for-myself individualism is rare to nonexistent. Social norms in many Asian societies emphasize doing what's best for the common good.
While I think that the various social factors cited by other commenters are an important part of this, I don't think they can be the whole story. What accounts for the success of New Zealand and Australia? There is no historical norm of wearing masks when you are sick, and their general culture is, like ours, derivative of British. (Though unlike us and the UK and the EU, they did manage to impose strict lockdowns quickly, ramp up test and trace rapidly, gain early control of the situation, and reinstitute restrictions when required later.)
I think that a part of it may be cross-immunity from some other viral agent that has previously been endemic in Asia. This is pure speculation, but the fact that the pattern is more strongly geographic than ethnic or cultural leads me in this direction.
They're both effectively island countries as well.
I think their awareness of that vulnerability made them choose to lockdown hard and stay locked down until the outbreak was under control. That, combined with taking quarantine for new arrivals seriously, is what lead them to success.
By contrast, European countries were hit incredibly hard in the initial outbreak. They rallied but then reopened way too soon. And now they’re in a vicious cycle of too short periods of confinement, followed by reopening of indoor dining and drinking, followed inevitably by another outbreak.
For the USA, that’s been the pattern in some states like California. But for the bulk of the time, the federal government, many state governments, and the Fox News nation were objectively pro-Covid-19.
So is Britain.
There appear to be some genetic factors at play. People with ancestry from Bangladesh appear to have greater frequency of a gene that is harmful. Perhaps there are a few protective genes with higher prevalence in some parts of Asia. Lower obesity rates are likely helping as well. There is also the possibility that a previous infection from decades ago has conferred partial immunity.
Their colds were different than our colds.
Welp! If anything can prove that COVID19 was not a plandemic event by Chinese Intelligence to deplete western population & resources while having a null effect in the Middle Kingdom, it's the fact that frienemy (at best) Vietnam did markedly better on case fatality count.
Well China is outsourcing a lot of manufacturing to Vietnam, so maybe that is part of the plan to keep the workers alive...
I think it's somewhat misleading to directly compare deaths when exponential growth is involved. If you compare the effective R in different countries you'll see that it's differing by a factor of less than 2, rather than a factor of a hundred. It's just that the difference between R of 1.2 and R of .7 results in enormous differences in number of deaths.
Culture is likely the most critical factor.
The culture of individual freedom is stronger in western countries, while sharing/contribution to the benefit of the community is stronger in eastern cultures.
During the pandemic, people in Hawaii will go out of their way to avoid passing within feet of you on the sidewalk. In the rest of America, you're more likely to have people ignore personal space and rush to cross in front of you.
In Connecticut, mask-wearing has been mandated for a year; compliance is universal in my town. Indoors or outdoors, people are keeping distanced as much as the spaces allow. I don’t think New Englanders are any less freedom-loving than other Americans, but on the other hand, there’s the communitarian tradition of the town meeting, and most of our towns are small, with many families having lived in the same place for generations.
"The culture of individual freedom is stronger in western countries..."
In the U.S., freedom is now spelled "freedumb." Right wingers have created phony issues of personal freedom and non-existent constitutional rights in deference to their cult leader.
Earlier today, I watched a video of a police officer arresting a mindless, older white woman in a Texas bank for refusing to wear a mask. She resisted arrest, yammered about "human rights," and accused the officer of police brutality.
"This is police brutality," she whined. Several other (mask-wearing) bank patrons who were witnessing the arrest can heard to respond, " No, it's not."
All this selfish, irresponsible woman had to do was put on a mask. But FREEDUMB!
I see India is missing from that chart.
The results in the following journal article suggest that the differences in performance are explained partly by differences in the tightness of social norms.
Gelfand et al., "The relationship between cultural tightness–looseness and COVID-19 cases and deaths: a global analysis." The Lancet Planetary Health, 5(3):e135–e144, 2021.
https://doi.org/10.1016/S2542-5196(20)30301-6
The virus itself. It underwent a mutation in Europe that made it much more contagious. Note that this could explain not only Australia and New Zealand, which are culturally "European," but did comparably well to Asian countries, but also the US. When we had our first outbreak, the East Coast was hit much harder than the West Coast because New York got the European variant and the West Coast got the Asian variant. Asian countries have been able to protect themselves from the more contagious European strain by controlling access. The US cannot control internal access, so the European variant spread across the country.
I skimmed a number of papers turned up by Google, and while this conjecture (more contagious and/or more deadly European mutation) is considered by several, the evidence seems to be circumstantial. I didn’t find any studies demonstrating that the differences between the two strains account for (at least a substantial part of) the higher case and fatality rates in the West. Do you have a source?
This idea could explain why Asia suffered less in the first months of the pandemic. But it doesn't explain why they *continue* to suffer less today.
If there is a super-contagious "European strain," that strain has had plenty of time to reach Asia, and you can't seriously suggest that EVERY single nation in Southeast Asia has been so diligent that not a single case slipped through the net. It only takes one.
It's all about keeping R0 low and the combination of many different effects all contribute to that.
If it's a cultural thing: Japanese wear masks during flu season and Americans don't -- then we'ld expect R0 to be lower for flu in Japan than the U.S. and that doesn't seem to be true. Population genetics, viral genetics, and weather can all contribute.
Equatorial countries might well benefit from warmer more humid weather. Southern hemisphere countries were leaving summer and entering autumn during wave 1, which may have helped enough to push an R0 close to 1 to be just below 1.
If I just stepped out of a long slumber and viewed that chart with no other information I would assume that the countries doing well had some sort of past exposure to similar viruses and built some level of immunity.
Well! Having been in S.E. Asia during Jan, Feb, and March in 2020, including airports in Seoul and Tokyo, none of those countries tried to kill off their citizens nor waited for 'perfect' solutions nor stuck their heads up their, err, in the sand. They checked everywhere with infrared thermometers, provided hand sanitizer everywhere, and recommended wearing masks. In short, they worked with what they had as best they could. Of course not having a homicidal manic as leader may have helped too.
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Perhaps it is a difference in prioritization of the individual versus the collective. Of course, in at least a few of the Asian countries, being able to quite literally quarantine entire neighborhoods if not cities in ways that would lead to uprisings in even the most progressive enclaves of the West probably doesn't hurt either.
Quarantining of entire cities occurred only in China, I believe; South Korea isolated some specific clusters. I think a more widespread practice outside the PRC was thorough screening of arriving travelers, with mandated and enforced isolation or quarantine of individuals. I believe a number of countries compensated the pay of isolated persons, paid their quarantine expenses, etc., which reduced any inclination toward rebellion, including New Zealand, which is on the progressive end of Anglophone countries.
As an earlier chart you posted shows, and all data seems to support, covid deaths aren't even just age related, but overwhelmingly 85+.
Two percent of our population is 85 and over, but 32% of covid deaths were 85 and over.
If there is data on proportions of the populations in that age group in other nations that could help answer the question.
Yeah, the question is better phrased why are old people dying in US/EU?
This is interesting:
"Outbreaks of COVID‐19 infection in aged care facilities in Japan"
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7675525/
There are fewer outbreaks at aged care facilities, but even when there are, the fatality rate is not as high.
Quote:
"At the end of April 2020, the national broadcaster, NHK, reported that 550 people in aged care facilities (380 users, 170 employees) had been infected; however, just 60 people, (10%) died."
https://www.economist.com/graphic-detail/coronavirus-excess-deaths-tracker
The fact that excess deaths went negative in New Zealand during their winter shows they had strong reductions in R0. New Zealand had strong new public policy in response to Covid-19; lockdown and isolation controlled not only covid-19 but also seasonal flu.
Australia shows a similar pattern, although not as strongly.
Japan also shows negative excess deaths at the beginning of the pandemic, although things flatten out after that. South Korea doesn't particularly have much change in excess deaths suggesting they aren't particularly controlling R0 within the country.
Nitpicking, but in the same short blog post, Kevin says:
and
So which is it, 3000 or 5000? Or are they two different statistics? If so, what are they both. I assumed this post was only discussing COVID-19 deaths/population?
Part of the explanation may be that mask wearing is accepted fairly easily. When I would see groups of Asian tourists here in NY -- and I'm talking years ago in the Before Times -- most of them would be walking around wearing masks.
A lot of people seem to think that "culture" is responsible for the lower rate in Asian countries, but New Zealand and Australia have culture and people very similar to the US or even more to the UK, which is one of the few countries with worse infection rate than the US. What this suggests is that to have such low rates it would not be necessary for the US to adopt a totally different "culture" of collectivism in which the individual gives up all rights. I am sure that Australians and New Zealanders did not give up their individuality and become socialistic robots. The difference could well be in specific steps taken by all the governments, probably from an early stage. As I have said before, contrary to what Kevin has claimed, the US did not do well in running up a half-million deaths - the Asian countries did not do this. Whether the existing political framework in the US, with extreme polarization and excessive state and local autonomy, could have taken the required steps even without Trump as President is another question. If a Democratic President had ordered strict measures they might have been resisted in the red states.
Of course the explanation may be in more accidental factors, such as different virus strains or the exact timing of the start of preventive measures.
It is alleged that under the first Coronavirus task force "led" by Jared that is was determined that only areas represented by Democrats had a problem, therefore little to nothing was done.
The case fatality rates are not that different country to country (and for some Asian countries like Indonesia) were substantially higher than the US. The primary difference is apparently in the number of infections.
At this point one can go in two directions.
One direction is "biological differences, that either "Asians" find it much more difficult to catch Covid (far fewer cases) or when they catch it it's usually no big deal (so it looks like very few cases, the high apparent mortality is scoped to the very few people who actually found a reason to seek medical help).
A second direction is to assume essentially the same biology and to ask why it was so much easier to contract covid in the West. My working assumption is that this is is the case, and that the reason is, quite simply. the privacy hysteria in the US, which has existed for a long time (HIPAA is 1996) but which ramped into overdrive in the past five years.
What Asian countries did was
(a) find out who was infected. Requires insisting various people be subjected to various tests even if they don't want to be.
(b) track their contacts. Requires asking questions and using techno-assistance like tracking apps on your phone.
(c) force all candidates into forced quarantine.
The US (but not just the US, all of the west) did essentially none of these. I know people who tested positive in the US. NOTHING happened as a result of that test; no contract tracing, no enforced quarantine. Meanwhile even as poor a country as Myanmar engaged in contact tracing and did a very good job of it. While the west dithered for months about techno-solutions, eventually settling on this bluetooth anonymized (and voluntary) stuff that appears to be utterly useless, a country like Taiwan requires that you have a SIM that can be tracked, and uses this to enforce things like contract tracing and home quarantine.
The mainstream media is not going to like this analysis because it puts the blame squarely on them, not Trump, not "the politicians". The West as a whole failed, and IMHO the common element across the west as a whole is techno-hysteria and related issues like an elevation of rights ("I have a right to avoid testing, to avoid quarantine, to avoid vaccination if I so choose") over responsibilities ("you have a duty to quarantine if there is a reasonable chance you are infected, even though quarantine is boring and a hassle"). The same people who are willing to condemn anti-vaxxers or mask-shirkers are still techno-hysterics.
Asia chose a different tradeoff on the techno-hysteria and rights-vs-responsibilities axes, and reaped the benefit.
I honestly don't think the West (and so most readers of this comment) are ready right now to analyze seriously what went wrong. It's still taboo to consider that what is called "right to privacy" may in fact have been techno-hysteria. People are still not ready to rethink rights vs responsibilities. Any attempt to rethink these issues has one immediately branded as a lackey of Facebook, or a fascist, or some similarly idiotic term.
To me it feels like, 20 years after 9/11 much (not most) of the US is finally willing to look at that rationally, in part because no-one gives a fsck anymore. The battles are about Trump and Woke, not about what the US should be doing in Afghanistan and Iraq. Progress, yes. But this also suggests to me that it won't be till about 2041 that people are able to consider what went wrong in 2020 without losing their minds and immediately retreating to political slogans.
I agree openness to tech surveillance helped - in Taiwan medical records systems could talk to each other and suggest COVID tests for certain patients. Singapore invested heavily in tech for early identification of cases among vulnerable people - they distributed 20,000 pulse oximeters last March to migrant workers and gave away Bluetooth devices for contact tracing to elders who didn't have smartphones.
^^^It's also possible that some of these countries have unreliable reporting. I can buy this, but only to a certain extent. It could explain a response that's 2x better, or even 5x or 10x better—maybe. But 100x? 1000x?^^^
Developing countries have (often much, much) younger populations and their people tend to spend more times outdoors. That's a big part of it. I also don't know why underreporting -- maybe even massive underreporting -- seems like such an implausible part of the picture, too. At least in some of these countries.
In some Asian countries, police would get sent out to make sure people were home if their smartphones pinged them elsewhere and would arrest those who had been outside their apts. There has been no enforcement in MA of travel restrictions, quarantine, etc. There have been no consequences for refusing to participate in contact tracing (e.g. hockey coaches refusing to give names of players when teammate tested positive for COVID).
If someone in the US is told they need to quarantine, their first step probably is to do all their shopping (supermarkets, pharmacies) and then go home. Some countries (incl Hong Kong I believe) would deliver groceries and supplies so that people actually could go straight home and stay there.