Having written quite extensively about the dire responses of the British government to the crises surrounding COVID-19 earlier in the year, I have held back from further criticism and writing about this for almost two months. It seems extraordinary, though, how few lessons seem to have been learnt in Europe from our experiences with COVID-19 so far, and how so many people seem to be surprised at its recent resurgence. As many of us have said for a long time, this was only to be expected, and is a direct result of the the behaviour both of individuals and also of governments. Above all, it seems to to reflect the selfish individualism, rather than communal responsibility, that has come to dominate many societies in Europe and North America in the 21st century.
The lack of research as to exactly why different countries have such varying mortality rates is also shocking (see my The influence of environmental factors on COVID-19 written in May). As a global community, very much more attention should have been given to this, so that we could by now have a better understanding of what has worked, and what has failed. Answers to these questions would enable governments now to be implementing better policies across the world to mitigate the COVID-19 related deaths that are becoming ever more numerous.
The chart below indicates the very differing numbers of deaths from COVID-19 per 100,000 population in the countries of the world that have had more than 5,000 deaths as of 21st September 2020 (data from https://coronavirus.thebaselab.com). While all such data are notoriously problematic, reported deaths from COVID-19 are more reliable than are data for case numbers (see my Data and the scandal of the UK’s COVID-19 survival rate written in April). Deaths above the usual average (excess mortality) are probably an even better measure, but are unfortunately much more difficult to obtain at a global scale. Furthermore, it must be emphasised that this sample does not include all those countries that have had far fewer deaths, and that much more research is needed in explaining why it is indeed these 25 countries that have had the most deaths in the first place.
This chart raises many unanswered questions, but does at least show two key things:
- Some countries have “performed” very much “better” and others much “worse” than average. India, Indonesia, Germany and Pakistan appear to have performed significantly better than Peru and Belgium. Why is it, for example, that Peru has 30 times more deaths per 100,000 than does Pakistan? Yet it is extremely difficult to see what either of these groups of countries might have internally in common.
- There nevertheless seems to be a broad group of very different countries including Sweden, Spain, the UK, Brazil, Chile, Ecuador and the USA that have so far had between 50 and 70 deaths per 100,000. Again, these countries are very diverse, be it in terms of size, demographic structure, political views, or government policies towards COVID-19, although most seem to be fairly right wing and individualistic. Interestingly Sweden with its much more relaxed policy towards social restrictions during COVID-19 appears to have done neither better nor worse than other countries in this group.
The challenge, of course, is to try to understand or explain these patterns but sadly too little research has been done on this in a systematic way to be able to draw any sound conclusions. Put simply, we do not yet really know why countries have had such diverse fortunes. Nevertheless, it is possible to begin to draw some tentative conclusions:
- Much has been made of the environmental factors possibly influencing the spread of COVID-19, but very little actual process-based research has satisfactorily shown how viable SARS-CoV-2 actually is under a wide range of environmental conditions (see my The influence of environmental factors on Covid-19: towards a research agenda from May). The data above serves as a cautionary warning: countries with similar broad environments tend to have very differing COVID-19 trajectories. Why, for example, are Latin American countries suffering much worse than those of Africa and Asia, although they share many environmental characteritsics in common?
- A second challenging conclusion is that the actual policies followed by governments may not be that significant in influencing the spread of COVID-19. It is thus striking that Sweden, which has followed very different policies from its neighbours, has not done significantly better or worse than them or indeed other countries such as the UK and the USA, which are widely seen to have failed in dealing with COVID-19.
- In searching for explanations, it is also pertinent to see whether these rates could in any way be related to varying levels of inequality. However, using the Gini coefficient as a measure of inequality there seems to be no significant relationship with mortality rates (R2 = 0.027).
- Religious beliefs and practices, likewise, do not seem to be particularly good at explaining these differenceces, although nominally Christian (or atheist) countries do fill the top 15 places in terms of mortality rates, before Iran in 16th place. Other countries with large percentages of Muslims, including Turkey, Egypt, Indonesia and Pakistan all have less than 10 deaths per 100,000. The difference between India and Pakistan (neighbours in South Asia) is particularly interesting, in that India (predominatly Hindu) has a mortality rate more than double that of Pakistan. No satisfactory explanation for this has yet been identified.
- There has also been some speculation that individualistic societies, where people care more about themselves than they do about being responsible for their neighbours, are having higher mortality rates than do more communal societies, and in this respect the contrasts between the USA and China are indeed very marked. It is extremelt difficult to measure individualism but correlations between the Geert Hofstede Individualism (IDV) Index and mortality rates do not have a strong correlation (R2 = 0.048).
No single explanation would simply account for all of these differences. An important conclusion must therefore be that there is indeed not a single solution (apart from a vaccine or other medical interventions) that is likely to prevent dramatic increases in the prevalance of COVID-19 in these countries, and that many more deaths are therefore certain over the next six months. As individuals, we all know what can make a difference: avoid large groups, wear masks, stay outside as much as possible, wash our hands regularly, and above all act responsibility with respect to others. At all times we mut act as if we have COVID-19, and imagine how we would feel if we were the other people with whom we were interacting, and they knew that we had COVID-19. If there is any solution to COVID-19, it must be that we act responsibly rather than selfishly (see my A differentiated, responsibilities-based approach to living with the Covid-19 pandemic written in June).
The full list of countries with >5000 deaths by 21st September and therefore included in this analysis is (in descending order of deaths per 100,000) : Peru, Belgium, Spain, Brazil, Chile, Ecuador, USA, UK, Italy, Sweden, Mexico, France, Colombia, Netherlands, Argentina, Iran, South Africa, Canada, Russia, Germany, Turkey, India, Egypt, Indonesia, Pakistan