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Why Does the Pandemic Seem to Be Hitting Some Countries Harder Than Others? (newyorker.com)
30 points by irtefa 12 days ago | hide | past | favorite | 68 comments

(I am not an epidemiologist)

(Edit: Please ignore below.

Checked the latest literature and cross-reactive antibodies have not demonstrated correlation with either preventing infection or hospitalization. [0] [1]

[0] https://blogs.sciencemag.org/pipeline/archives/2021/02/10/do... [1] https://www.medrxiv.org/content/10.1101/2020.11.06.20227215v... (pending publishing in Cell, but linked ArXiv for availability) )

Because pre-existing coronavirus antibodies have been proven cross-reactive to SARS-CoV-2.

And different populations have different endemic coronaviruses circulating in them.

This isn't some great mystery. This is a normal Tuesday for how human immune systems are supposed to work, as a species.

Also worth noting the extreme correlation of preexisting obesity epidemics and negative covid health outcomes.

Obesity makes you 3 times more likely to be hospitalized for covid.

When looking at the world map of obesity right next to the world map of covid mortality, the correlation/causation is startling.

America and Europe have the most obese people and the worst covid health outcomes, Africa and Asia have the least obese people, and the best covid outcomes.

Vitamin D plays a role as well, I believe (or at least weather conditions, as demonstrated by the extreme seasonality of the pandemic).

>Checked the latest literature and cross-reactive antibodies have not demonstrated correlation with either preventing infection or hospitalization. [0] [1]

The sample size of this study was only 251 people, apparently all from France, according to a comment on the study, though I could not confirm or deny that fact from searching through the source text.

In order to rule out cross reactivity, we'd need a much larger study comparing samples across many regions.

And different populations have different endemic coronaviruses circulating in them.

In this age of widespread global travel, is that true anymore?

This hypoethis is discussed in some depth in the article (search for "T cells").

TL;DR: Maybe. There is some evidence showing a link and other showing no link. Some lab studies show T cells get a response., but other studies show no statistical link.

You know, this is not quite the issue I find interesting. More intriguing to me is, with the ratio of cases and deaths differing by orders of magnitude, even between countries of similar wealth levels, age demographics, etc., why has it not been the primary topic of conversation? Australia and New Zealand have covid-19 stats more similar to the rest of east Asia than they do to the U.K. or other (more genetically similar) European-descended nations. Why is this not the overwhelming focus of our research? If it's not genetics, and it's not wealth levels, then there's something environmental in Taiwan, Japan, Australia, New Zealand, South Korea, etc. that is different than in France, U.S.A., Italy, etc. I mean their levels are more than an order of magnitude better. Why is this not our primary focus of discussion?

> If it's not genetics, and it's not wealth levels, then there's something environmental in

> Taiwan,


> Japan,


> Australia,


> New Zealand,


> South Korea

Effectively an island—peninsula with the only land access being through the most heavily militarized border in the world.

In the EU we are implementing lockdowns and curfews with moderate results.

When I suggest we should suspend all air travel except for freight and bring back border checks in the EU during lockdown, all my friends react like it's pure heresy.

In hindsight historians will look back at this as our biggest failing. Allowing for travel in the name of economy whilst prolonging economic damage plus increasing disease/deaths.

Half measures are a short distance from no measures at all in terms of virus containment.

Or it could be exactly the opposite. In this paper [0], Ioannidis (one of the most cited epidemiologists in the world) and his co-authors write:

<< In summary, we fail to find strong evidence supporting a role for more restrictive NPIs in the control of COVID in early 2020. We do not question the role of all public health interventions, or of coordinated communications about the epidemic, but we fail to find an additional benefit of stay-at-home orders and business closures.

The data cannot fully exclude the possibility of some benefits. However, even if they exist, these benefits may not match the numerous harms of these aggressive measures. More targeted public health interventions that more effectively reduce transmissions may be important for future epidemic control without the harms of highly restrictive measures. >>

[0] https://www.lifesitenews.com/news/stanford-study-lockdowns-h...

I'm not sure that being an island the main factor. The underlying factor is connectivity. Some islands have low connectivity while others do not -- being an island isn't, in itself, protective.

If you think about it, most countries in the world only have limited ports of entry (no matter the size of the border), and if a national government shuts off these ports of entry, the country essentially becomes an "island" whether they have a surrounding body of water or not. (assuming strong borders and no illegal traversals -- which may or may not be good assumptions depending on where you are, but it's a simplifying assumption for the sake of discussion).

Montreal is an island but its COVID rates are far worse than Toronto. There's nothing special about being an island. It's about the connectivity.

UK - Island(s).

However, up until recently very lax on air travellers and even now actually checking some.

True, but London, like New York, is a global air travel hub and none of the other are even particularly popular travel destinations.

Traffic routes in and between China, HK, Singapore and Japan all carry much more traffic than any London or NY based routes: https://en.wikipedia.org/wiki/List_of_busiest_passenger_air_...

In an alternate measure, we finally see a NY-based trip enter the list at number 8, with the countries listed above remaining much busier: https://en.wikipedia.org/wiki/List_of_busiest_passenger_air_...

Taiwan and South Korea, maybe, but Japan and Australia most certainly are popular travel dedtinstions.

So the next question is what did Japan/Australia do to mitigate the risk from tourists spreading covid.

This is what I found for Australia:

> Since March last year, Australia has essentially allowed only returning residents to enter the country, provided they complete a 14-day quarantine - usually in city hotels.


It seems they stopped allowing tourists to fly and were very strict from very early in the pandemic

An interesting hypothesis from Sir John Bell is that, some of the asian countries such as Vietnam, Cambodia, China and Thailand have a lot of bats and may have got immunity from past exposure to bat coronaviruses.


Vietnam closed their borders, kept kids home from school, had a month-long lockdown in April, and stopped COVID in its tracks. No magic immunity required, they just did the few things that were necessary to top the spread of an infectious airborne disease. They lived through SARS, everyone knows the consequences of failure to contain a new virus.

There's no need to look for explanations in exposure to bat coronaviruses when there's so much Vietnam did that the USA, UK and Europe didn't do. This isn't just about government actions, but the individual actions of the population too.

I think there is not much discussion because the answer is clear, and also unpalatable: it comes down to political and cultural differences. We never successfully implemented the kind of strict lockdowns and other measures that worked to control the virus in other countries.

I would expect lockdowns to help reducing the spread, but not the death rate.

I suspect it is a) making sure vulnerable people are really isolated (care homes for example), b) a better health system.

I would like to see a plot of death rate vs hospital beds... found this [1] that argues that it has potentially a small effect, but doesn't explain everything.

[1] https://www.health.org.uk/news-and-comment/charts-and-infogr...

Death rate is hard to measure and needs to be measured by age cohorts. It's identified deaths divided by identified infections.

If you do a worse job finding asymptomatic cases, your death rate gets higher even more people didn't die.

Institutional programming to react to SARs is one reason. Those countries enacted lockdowns quicker and had government agencies to properly regulate ventilation in public environments.

Western governments simply didnt have the ability or the desire to regulate ventilation and, at the beginning were prioritizing keeping the economy running (ironically enough).

Exponential growth is a weird thing.

All these countries worked very hard at the start of the epidemic to bring it under control and were successful.

The state of Victoria in Australia is the best example of this. After initial elimination, it started to get out of control and so they entered a very strict 112 day lockdown until community transmission went to zero.

Since then most Australian states have done similar (but shorter) lockdowns, again until community transmission is zero.

When community transmission is very low (<100 cases) things like contact tracing work, communities support short lockdowns etc.

Once it gets out of control many control processes become useless, and exponential growth takes over.

You are indeed on to something. My theory that most disease are environmental in nature with pathogens being opportunistic invaders. On their own pathogen can find it difficult to infect an organism.

>Why is this not our primary focus of discussion?

Because mainstream science also has their own set of beliefs which are dogmatic in nature. Moreover would a govt/big business come forth and say, so we introduced a new detergent formula in the market and this cause the whole outbreak? that has never voluntarily happened.

Just look at several nation with no lock downs - and there are no reports of people dying in mass numbers. In fact I doubt if there is even a new pathogen around.

Australian here. The reasons are quite simple from our perspective: socialised health care, closing international and state borders where required, having leadership that provides consistent and sensible advice, and accepting that along with rights we have responsibilities.

In countries that have had serious COVID issues such as the UK and USA we see little to none of the above. As an example there was a discussion I watched where someone from California went for a road trip to neighbouring states despite the local authorities asking interstate visitors to stay away. When challenged about visiting states asking people to stay away, their reply was basically, "I don't believe I'm doing anything wrong, and you can't legally stop me." This attitude was prevalent from the top down.

One big issue in the USA is the number of people who simply can't afford to stay home from work, and whose multiple jobs require being present in a building with lots of visitors. In Australia we've had a number of "flare ups" where people involved in the quarantine program have ended up with COVID and spread it to the community because they are the lowest paid workers in the country and need three jobs to keep food on the table (or as a security guard they had multiple shifts moving between sites). As much of a joke as our hotel quarantine has been, it's at least something we can do to limit the community transmission of COVID-19.

There's nothing magical about Asia/Oceania countries managing COVID well. You just have to accept that COVID-19 is real, the medical authorities what they're talking about, and personal liberties sometimes need to be curtailed for the benefit of everyone.

At the personal level, wear a mask in public, keep your hands clean, avoid unnecessary travel, stay away from people. Sometimes you have to exercise your responsibilities instead of your rights.

At the corporate/national level, pay (poor) people to stay home, shut borders where required to prevent community transmission. Lock down neighbourhoods with high community transmission. Make sure testing is free and widely available.

If you believe "the economy" is more important than the people, you're not going to handle pandemics particularly well.

Something that isn't talked about, but is probably a big factor, is how soon they started taking action.

Contract tracing is very effective, but its hard to "scale." The virus exponentially grows, so once the infection rate is higher than your capacity to contract trace, you've permanently lost the battle.

Only really China, South Korea, and Australia have had substantial outbreaks that were later contained. But in each, the outbreak was geographically or socially relatively contained: Wuhan, Shincheonji Church, and Victoria.

If you talk to Australians they attribute it to their lockdowns.

Of course, that's only a temporary and very blunt band-aid. They still need to vaccinate pretty much everyone above the age of 20.

Agreed, but it has worked well for us until such a time as vaccines are available.

A lot of the countries on your list are basically only accessible by air travel, so it's much easier to control and track travelers in and out of their countries.

All the Asia/Pacific countries you mentioned are islands

So is the UK.

An entire article pondering regional differences in COVID-19 mortality and severity without saying anything about differing demographics of (a) aging and its comorbidities and (b) obesity and its comorbidities.

SARS-CoV-2 is severe in old people and obese people, and very few outside that demographic. Wealthy nations have a much higher obesity rate than poorer nations. The US has ten times the number of obese individuals than India, three times as many as Nigeria. Wealthy nations have a larger proportion of the population in older age cohorts. The US has five times as many 65+ people as Nigeria.

I have no idea why the media persistently chooses to avoid these points. The research community has been turning out review papers by the score to point out, very bluntly, that COVID-19 mortality falls near entirely on the old and the obese.

A direct quote from the article that addresses that point:

When his researchers analyzed the data by age, location, and gender, they found that excess deaths tended to be observed in younger cohorts, and in rural rather than in urban settings; nor was there evidence of the usual coronavirus skew toward greater lethality in men

Because media is in a business of building narrative, not reporting on facts.

I hate to say this but after reading the whole article I feel I like I wasted my time. The article is way too long and reads more like a novel than an informative piece. Unfortunately, the article does not contain any new or interesting revelations or insights, nor does it go into more depth on individual aspects that its title might promise.

Its conclusion can probably summarized as "We don't really know yet, probably population, health standards and living conditions, government policy and communication, maybe T-Cells, definitely poor data".

I am really sorry but I think it is almost factually incorrect to say that the article does not contain new insights. Unfortunately I also cannot parse your sentence that "does it go into more depth on individual aspects that its title might promise" in a way that rhymes with what I just read - maybe you can elaborate?

The article is about the ways scientists are attacking an intriguing scientific question with enormous societal importance. It certainly does not have the answer to the question in the title, and if you kept reading while expecting one then maybe you missed the phrase "the greatest conundrum of the pandemic" in the introduction?

Altogether your comment, and the support it gets here, make me despair a bit for the popularization of science in general. Is such a well-written report on the scientific process itself dismissed so easily? Do we really only care about the answers?

> the article does not contain any new or interesting revelations or insights,

I don't know what exactly you mean by "new", but remember it's not published in a scientific journal. It isn't supposed to contain anything fully original.

For us common folk- I think there were lots of new & interesting stuff there.

You can't really expect anything more insightful at this time, especially from a pop science article. It will likely take years, if not decades, before we truly understand covid-19 in-depth.

It would be nice to see an enumeration of the currently running hypothesises.

One takeaway for me was the possible importance of how prevalent is the congregate senior living in rich countries. Although it seems to me the most probable is still plain old gaps in testing and reporting.

It’s a story that doesn’t go anywhere. I like the New Yorker but this writing isn’t up to their usual standards IMO.

> The article is way too long and reads more like a novel than an informative piece

That is what is expected from the New Yorker

I know that's the New Yorker's style, it's just not my cup of tee. My comment is completely subjective and my personal opinion, I only read it because I thought the title was interesting and I expected the question to be addressed with some new insights.

I read your comment first and then checked if the submission was from the NewYorker.com domain ...

The bit I found most interesting:

They found that the total number of “all cause” deaths reported between May and August almost doubled in India compared with the same period in each of the past five years.

“Is that because the number of covid deaths in the country has been vastly underestimated?” I asked.

“It’s impossible to have a decisive answer,” Shah told me. “But the pattern of the excess deaths doesn’t really shout out covid as the cause. It just doesn’t... The telltale signatures of covid just aren’t there,” he said. He won’t venture any hypotheses about the cause of the excess deaths. But among the possible candidates are indirect consequences of the pandemic: wage loss, displacement, malnourishment, forced migration, and disruptions in health care...

don't tell the NY Times. They are eager to attribute any and all excess deaths to COVID. Otherwise, their strong support of the lockdowns would have no reasonable basis.

Occam's Razor, the data is bad, and bad in different ways between countries.

They tackle that explicitly on multiple levels. “Probably not” is the best tl;dr.

We must have read different articles. Quoting...

>With respect to the raw numbers, underreporting is an enormous problem; differences in age distribution, too, make a very deep cut, and perhaps the models must further calibrate their weightings here.

They go on with the complex speculation about other causes, but obviously bad data is a huge driver of this anamoly. Bad data we can be sure of, the rest is speculative narrative.

The implication of your first comment was that the answer is straightforward.

The article makes a strong case that bad data only closes the gap partially.

I'm surprised this article doesn't discuss obesity, as it's clearly correlated with worse COVID-19 outcomes [1]. America's high obesity rate (>40%) seems like a pretty plausible cause for increased deaths and hospitalizations from the pandemic.

[1] https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA....

It's got to be something demographic / socio economic.

The fact that the one place in Africa that got hit hard also happens to be the most industrialized/westernized place can't be a coincidence.

That leaves a lot of options though. Diet? Obesity? Social habits? Ability to travel internationally? Pollution of some sort? Plastics? Could be anything

Last year I read a theory that there was correlation between antibiotics in food and the death rate, the hardest hit areas of Italy and Spain make lots of preserved meats using a lot of antibiotics, meaning there's more of antibiotic-resistant bacterias (if their diet has a lot of antibiotics, it would follow that they're evolving the toughest bacterias), and that the super-bacterial (secondary) infection kill the people who've been weakened by the viruses.

In Norwegian: https://www.aftenposten.no/meninger/kronikk/i/awEP27/derfor-...

Without actually knowing the situation on the ground, I'd say there's less antibiotics in food production in India/there's more bacteria going around that Indian immune systems are better prepared to fight the bacterias or antibiotics work better to kill them.

But well, it's another theory...

Poor countries don’t have half of their country suffering from obesity.

Would be interesting to see covid deaths per country in relationship to how many carry risk factors (age, obecity, etc.) in each country.

And don't forget that countries have different ways to count COVID deaths. In the UK it's everyone who dies of any cause within 28 days of a positive test. Some other countries only consider COVID deaths if the patients had pneumonia.

And depending on the testing (availability, sensitivity) the death counts could be underestimated as well.

It will be an interesting challenge to get compatible statistics from different countries.

> In the UK it's everyone who dies of any cause within 28 days of a positive test

But not everyone who has 'coronavirus' on the death certificate... Just to be clear here, if excess death rates are to be believed, it's likely that the UK is under reporting deaths.

PS: The "any cause" thing is also untrue, as far as I can see. Apparently, 88% of COVID patients who die do so within 28 days, so you can sort of guess at the undercounting going on here.

I would also check if there is a correlation with mask usage, like you grab pictures from public places and count the mask wearing percentage, you could maybe(I could be wrong) the level of solidarity/cooperation (or insert your preferred term here ) and see if this variable correlates at all.

Absolutely, I think that would help policymakers get a better grasp of what measures help best in reducing the scope of these outbreaks.

It is well understood that age, hypertension (stress?) and obesity are major driving factors of covid-19 hospitalizations [0]. I would love to see governments spending as much money/resources on stimulating a healthy lifestyle as the do on vaccines and lockdowns.

[0] https://www.cdc.gov/mmwr/volumes/69/wr/mm6915e3.htm

- China: lock the fuck down - The West: this is anti human! - China: the pandemic is gone - The West: they must be hiding the real numbers - The West: we should lockdown - The West: we should not lockdown - The West: we should lockdown - The West: China Virus! - The West: we should not lockdown - The West: we should lockdown - The West: we should not lockdown - The West: China Virus! ... - The West: why can't we control the pandemic

The explanation the article doesn't give: 1) The category "country" is useless for this comparison. Monaco, Taiwan, New Zealand and China are all countries. 2) Population clustering, movement, demographics and culture, public policy. Move those dials in random directions, add exponential contagion and luck.

I have noticed differing levels of mask compliance between population groups.

Pathogenic priming, immune "enhancement" brought about by too many flu vaccinations?


Interesting outlook. When those poor nations become wealthy nations soon afterward, would you wish death upon them instead? Or will they somehow be absolved of the guilt that wealth seems to imply?

I guess you'll be first in line to sacrifice your life to end 'modern imperialism'?

How do you envision wealth being transferred between the newly less populous wealthy countries and the poorer countries? It seems like a more likely outcome of what you're discussing is a concentration of wealth into fewer hands in the wealthy countries.

No it wouldn't. "The modern imperialism" made kings of mere 200 years ago look poor in comparison with today's tradesmen in many respects such as transport, healthcare, heating and many more. Hundreds became billionaires, billions got out of mud huts.

Somewhat tangent, a virus killing even 20% of the West (and spare the rest) would spell unimaginable doom on said rest by second-order economic effects.

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