It’s Too Soon to Call Coronavirus Winners and Losers
Given how much remains unknown about the virus, talk of success may be premature.
The coronavirus pandemic has claimed hundreds of thousands of victims and triggered the greatest economic crisis in nearly a century. Confirmed case counts and deaths are updated daily as locked-down citizens wait anxiously for signs that the pandemic might be easing. Coronavirus statistics have quickly emerged as the ultimate indicator for national performance. The media rewards countries that successfully “flatten the curve,” and leaders have seen dramatic fluctuations in their public approval as the disease ebbs and flows. Better coronavirus response has been credited to everything including authoritarianism and women leaders.
But due caution is needed when attributing variation in coronavirus intensity to government policy. Government leaders have obvious incentives to bend statistics and paint themselves in the best light. Furthermore, we still have a limited understanding of the virus: Low case and death numbers may reflect luck rather than the skill of political leaders. Much as medical experts urge caution about unproven treatments, journalists and scholars should be skeptical about political leaders seeking to cash in from the crisis.
Governments have been quick to politicize coronavirus statistics. The Chinese government has sought to resuscitate its tarnished international reputation by emphasizing how quickly it brought the epidemic under control. U.S. President Donald Trump has deflected criticism of his dismissive approach by scapegoating the World Health Organization and China. The Democratic Party of Korea scored a landslide victory in South Korea’s parliamentary elections last month in a show of public support for President Moon Jae-in’s coronavirus response.
The political stakes are extremely high. Governments have incentives to report coronavirus statistics that paint themselves in the most favorable light possible. Reported cases can be suppressed by limiting tests. Deaths can be attributed to other causes. Autocracies such as China are notorious for manipulating economic statistics even under normal conditions. The coronavirus gained a foothold in the Chinese city of Wuhan because local officials sought to suppress information about the initial outbreak. It was telling when China closed its border with Russia to prevent an influx of cases despite official Russian statistics suggesting the outbreak was well under control. Russian doctors who spoke out are mysteriously falling out of windows to their deaths. Indirect information such as social media postings and government actions can shed some light, but there is little reason to trust official coronavirus statistics published by autocratic countries.
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Democracies have the advantage of transparency. However, even in democratic states, recent studies suggest that official statistics vastly understate coronavirus prevalence due to asymptomatic cases and limited testing. Official figures from New York appear to understate actual cases by an order of magnitude. This means comparing official coronavirus statistics across countries is unlikely to be informative: Much of the variation may be due to differing testing rates rather than actual cases.
Even if the statistics are accurate, there is a deeper problem: Countries may be confronting very different challenges based on factors we do not yet understand. This is a new virus. The science is still evolving on factors that might limit transmission or intensity of the virus. Without having a better understanding of these factors, it’s impossible to know if a country responded successfully through policy measures or just lucked out.
For example, consider two plausible but unproven explanations for reduced coronavirus prevalence: the bacillus Calmette-Guerin (BCG) vaccine and warm weather. There is some speculation that the BCG vaccine, an anti-tuberculosis vaccine commonly given to babies in some countries, may strengthen the immune system’s response to the coronavirus. Clinical trials are underway. There is some interesting circumstantial evidence: Regions with universal BCG vaccination programs appear to be experiencing less intense outbreaks compared to their immediate neighbors, such as Portugal versus Spain and East Germany versus West Germany. Similarly, there is some suggestive evidence that warm, humid weather may reduce coronavirus transmission, though probably not enough to make the virus go away during the summer months.
If these two explanations turn out to be correct, it would cast serious doubt on current narratives about the countries that responded effectively to the coronavirus. The absence of universal BCG vaccination programs is concentrated in wealthy Western countries that are being hit the hardest by the virus. If BCG reduces coronavirus transmission or intensity, it is misleading to compare policy responses in the West and in East Asia. Countries with universal BCG vaccination programs, such as China, Japan, Singapore, South Korea, and Taiwan, may be responding to a less serious challenge than such countries as Italy and the United States.
What about weather? If hot, humid weather reduces coronavirus transmission rates, it means the outbreak is less challenging in countries in equatorial regions such as India and Singapore, as well as countries in the Southern Hemisphere, including Australia and New Zealand, where it was summer during the early phases of the global pandemic. The low number of coronavirus cases in these countries may reflect good government policy, but it is also possible that they reflect nothing more than good fortune. The same could be true of the less intense outbreak in California and the U.S. South compared to New York.
These are, of course, big ifs. Brazil, for instance, is seeing over 500 deaths a day despite its warm climate. The point is not to claim that BCG and weather are the most convincing explanations for variation in coronavirus intensity across countries, but to show there is still much to learn about the virus. The media loves to cover medical pre-prints and unreviewed papers, but the work of building scientific evidence is long, slow, and grueling. Eventually, we will have a more complete picture of this virus, but for now we have, at best, an incomplete image built up over these few desperate months.
There may be reasons why coronavirus intensity varies across countries that are still unknown, like variation in virus strains. Demographics, too, could play a role if young people are not only less vulnerable to the virus but also less likely to catch it in the first place. Developed Western countries such as Italy have relatively older populations. However, so does Japan, which has weathered the pandemic fairly well. And never underestimate the power of sheer dumb luck; it may be that a few coughing travelers flying to Milan over Mumbai in the early days of the epidemic made a critical difference.
The point is that we must be extremely cautious about jumping to conclusions about national responses to the coronavirus without knowing much more about the virus. This is particularly important in the presence of propaganda campaigns by authoritarian leaders and would-be autocrats who cynically seek to take advantage of the pandemic. Much as medical experts encourage caution about unproven remedies, we must be skeptical of political leaders bearing snake oil.