Week 20: Should the USA take note of what has been achieved in Asian states with very low rates of the virus?


This blog will take the US state with the lowest case load of the virus (Vermont) and compare it with places in the world with really low prevalence as well. Can anything be learned about other places?

 

 

Size Populn. in millions

Density of populn.

Gini Index

Median     age

Life expect.

Ethnicity most common, 2nd.3rd

United States

328M

35.7/K2

-41

38.2

78.9            

W63%,H15%,B13%

Vermont

0.62M

24.9/K2

.45 

42.7          

80.5           

W93%;As2%.B1.4%

Vietnam

95.5M

33.1/K2

.36

30.5

75.1

Kinh 1.4M; Tay .8M

Taiwan

23.7M

38.0/K2

.20  

39.7

79.7

36% Budd;35%Tao

Thailand

69.4M

51.3/K2

.36

40.7

76.1

Many groups

 

 

Tests

Cases

Cases/M

Dly.Cases

Deaths     

Deaths/M  

Dly.dths

United States

not all

4.43M

13,580

67K

150.7K       

447

1.46K

Vermont

91.0

1406

2.3

3

56

89.9

0

Vietnam

966.7

558

5.23

49

    0

0         

0

Taiwan

162.6

467

19.6

0

    7

7

0

Thailand

112.2

3312

47.4               

2

  58

0.83

0

 

First, does Vermont, with the lowest number of cases of the virus, show the way for the rest of the USA? (Top 2 lines). Well no, I’m afraid it does not: it emerges as a state with a very small population, elderly compared with the main USA, with an even higher Gini index (even less equality), but most importantly a highly homogeneous white population with too few blacks americans and hispanics  compared with the entire country. So it’s a poor example that cannot possibly lead the way into the future.

 

The second point is, what is happening to the United States the rest of the world thought it knew? (see top line of the lower block). The country is in free fall, and no simple change can alter that.  

 

The third comparison is between the US and the three Asian countries.  An important point to make is that the Asian countries have all experienced the SARS epidemic, and this must have helped them to recognize good sense when they hear it.  Dr Fauci is heard and respected by most Democrats and by very many Republicans. The argumentative nature of the majority of Americans is something that non-Americans admire, and have no wish to eliminate. But what Americans have lived through in the past 8 months or so has no real precedents, except maybe in Brazil.  How similar are the three chosen Asian centres? (3rd, 4th and 5th  comparisons): they clearly have a low density of people in common – and this has been found several times in earlier blogs.  

 

The most striking difference is the zero death rates for Vietnam, linked to the early nature and thoroughness of its testing procedures (3rd to 5th lines, top comparisons). They are also easily the youngest of the 3 centres.  Older readers may remember the astonishing way the Vietnamese people withstood heavy American bombing and defoliation. It was among the factors that produced the amazing obedience of the population to government directives. Despite 433 cases, they achieved zero deaths! Their response to the pandemic included prompt and inclusive testing, early contact tracing, and allowing Vietnamese citizens to enter only after this was agreed by their government. This can only have been achieved by a case finding strategy and an obedience the quarantine and social distance far exceeding what was achieved in mainland China..

 

The President of Taiwan is under political pressure from China and other places, and she seeks to develop closer ties with the US, Japan and the EU, and even refers to the “Wuhan virus”. The very low deaths per million is especially important. With fewer cases, it also achieved far fewer deaths, 7 against  58: not quite as spectacular as Vietnam, but  and  a spectacularly low Gini index, making it the least unequal population ever mentioned in my Blogs. Persons with low risk (no travel to level 3 alert areas) were sent a health declaration border pass via SMS messaging to their phones for faster immigration clearance; those with higher risk (recent travel to level 3 alert areas) were quarantined at home and tracked through their mobile phone to ensure that they remained at home during the incubation period. Taiwan enhanced COVID-19 case finding by proactively seeking out patients with severe respiratory symptoms (based on information from the National Health Insurance [NHI] database) who had tested negative for influenza and retested them for COVID-19; 1 was found of 113 cases. The toll-free number 1922 served as a hotline for citizens to report suspicious symptoms or cases in themselves or others; as the disease progressed, this hotline has reached full capacity, so each major city was asked to create its own hotline as an alternative

 

Thailand  is a large, thinly populated country – which is a good start, with a Gini index similar to Vietnam, but easily the highest number of cases per million at risk, but an enviably low number of deaths per million at risk.  The Thai government's response to the outbreak was initially based on surveillance and contact tracing, in accordance with three-stage response model. Temperature and symptom screening for coronavirus testing was implemented at international airports, as well as at hospitals for patients with travel or contact history.  Thailand had been 50 days without confirmed local transmission of the coronavirus, but two cases among foreigners last week has led to the self-isolation of more than 400 people and fears on social media of a new contagion. “This should not happened, I am really sorry that it did and I want to apologise to the public,” said the Prime Minister. Concern spread among Thais online that a second wave of infections and a new lockdown could follow in a country fast returning to normalcy after restrictions were eased. It is not clear what measures the government took to achieve their very low deaths per million.

 

 

Conclusion. Does the United States really need to follow what other low prevalence countries have done? Of course they should, but not yet.  The best advice anyone in the US could have is to get rid of Mr. Trump, as his leadership has greatly contributed to the free fall that the country is now in. A new US government might teach even the UK government: make early plans, do many tests early, set up contact tracing and quarantine arrangements that actually work, and not to leave the lockdown to the last possible minute.  If only they could. But don't count on it!

 

David Goldberg

30th July 2010, and very little chance of resuming a normal life between now and the New Year.

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