Really enjoyed this article. I do think it misses a key part of the story which is the seeming success of South East Asian, Australiasia and even European countries in supressing the virus compared to Britain and America. That really fed the narrative that the two English-speaking countries led by the hated populists had taken the virus lightly, and if we just had the common sense/determination to impose a proper lockdown then all would be well. This gets discredited as the virus spreads around Europe to the point that the UK is a middling rather than unusually bad performer, China proves to have been lying about its covid success, and other countries with the harshest lockdowns struggle to come out of them. And of course US/UK lead the world in developing and distributing vaccines. But I think in 2020 there was a real crisis of confidence in American and British science/medical communities that they had gotten this big call wrong
As someone comparing notes in cdc vs nhs in real time I can tell you they weren’t the same. Cdc was much worse. It was consistently gaslighting the American people and losing all credibility. In general the debate in America was much more stupid and American actual level of vaccination is significantly lower than in peer countries.
I am still annoyed that a lot of fomite-based Covid rules are still in practice (QR code menus, non-functional water fountains, etc)... not to mention all those stupid permanent floor stickers nagging you to stay a magical 6 feet apart.
The floor stickers still lingering around I'm guessing is just a matter of laziness/not wanting to pay to remove them, since they know everyone is just going to ignore them.
And I recall the QR code menus emerging before the pandemic as another cost saving mechanism. I don't like them myself but I can understand why some places are still trying to make them stick.
The floor stickers might be harder to remove, but I still see signs up about masking (in contexts where staff are not masking) and distancing. I don't know why. But it's not a cost issue.
I appreciate QR code menus, because it enables me to zoom in, and to see the menu in good light, even when the restaurant is dark. If done right, it should also let the restaurant stay up-to-the-moment on which items are out of stock today.
Their annoyance has been pushed out by my greater annoyance of all the increased nudges by machines to tip/donate on an increasingly higher number of purchases.
I've heard one theory about the QR code menus is it makes it easier for restaurants to increase prices without anyone noticing, since they don't need to visually modify existing menus or order new ones every time - just update the website.
I’ve been to a place where the qr menu was a low-quality scan of the paper menu. When I asked for the paper menu they gave me a printout of the file of the scan ie a clean paper on which was a big picture of a wrinkled old menu in low quality scan!
I'd believe that if there was any evidence that restaurants actually bothered to update the pricing on their web menus -- instead a bunch of restaurants I patronize are just charging you $2 to $3 more per entrée than what the web menu claims the price is. (Likewise, most restaurants don't bother to update their electronic display menus either, in my experience -- in fact a couple near my office turned off their electronic display menus in the past year and now just have crude handwritten poster boards with prices, presumably because they couldn't be arsed to figure out how to update the display.)
The first time I flew after the start of covid, I saw signs in the security line warning people to watch out for Zika while traveling. In the locker room at Texas A&M there are even still a few signs warning people to watch out for swine flu.
The fact that fomite transmission is RELATIVELY unusual doesn't mean it doesn't exist. Other common respiratory viruses, not to mention gastrointestinal pathogens, are spread that way. Covid is so extremely transmissible through airborne particles that the amount of fomite transmission might seem trivial only by comparison.
No. Far more useless than that was the (mercifully brief) insistence at my local Trader Joe's and Safeway that you weren't allowed to bring your environmentally correct shopping bag from home. You had to switch to store-provided paper/plastic bags. Because apparently the fibers might harbor virules? (But no doubt one's clothing was assumed to be pristine!).
Yes, my grocery store also shifted to one-way streets. The milk and dairy aisle seems to still be unofficially one-way because it somehow got burned into all of our brains
My new state started giving people paper straws to use on the touch pad. Then they kept doing that because they worked really well on the crappy touch screens.
I remember playing golf in TX during the Summer of 2020, walking in ~115 heat index. Because people thought COVID could survive on plastic for several days, golf courses removed both flags and water coolers. I remember needing to leave early due to heat exhaustion symptoms, having drank all the water I brought. Asinine stuff.
A memorable item in a truly shocking list of failures, whose actual extent seems to me to be under appreciated by the average American who wasn’t (and still isn’t) fully aware of how much better the health establishment of other countries functioned.
Did others actually function a lot better? I thought they all had their own special failures (especially the countries where curfews were major policy, as though the virus sleeps during the day).
failure on early testing, flip flop on masks and failure to instruct public on good masks, delayed booster approval, flip flop on vaccine mandates, failure on rapid testing....
I think only delayed booster approval mattered in the end. Only low risk people (introverted Covid hawks) followed government advice, most of which was useless anyway. I remember all the crap about double masking.
Do you think it is for want of government advice on diet and exercise that people end up obese?
So the CDC prior to Reagan was organized more like the Fed with staggered terms overlapping presidential administrations.
Reagan turned the head of the CDC into a position appointed by the President. Previously a panel of medical and public health experts nominated the candidate. This all stemmed from the CDC trying to stop HIV from becoming endemic when it was first identified in the gay community. The leadership was contradicting the White House.
My satirical comment is in reference to the change in the leadership of the CDC that made it a political appointment. This means PR and risk aversion became more important than disease control.
As Matt said, it'll be good to have a rigorous analytical breakdown of exactly what policies mattered the most, especially looking at something like cost per life saved or a similar measure.
Still, it's hard to deny that the US had one of the worst responses in the developed world in terms of our death rate per million. We're similar to the UK with around 3.3k deaths per million compared to Germany with 2k deaths. That compares to zero covid countries like Japan with 602 deaths/million, Taiwan with 739, and Australia with 837.
Obviously comparing raw numbers is problematic due to differing demographic profiles, but it at least gives some rough contours of the efficacy of various covid approaches.
Our death rates were vastly different by ethnicity. For ages 65-74, here are the death rates per 100k (from the CDC) by Race/Ethnicity:
Asian: 100
American Indian: 300
Black: 236
Hispanic: 300
Non-Hispanic White: 110
So most of those excess deaths come from Latino and Black populations. The age and death profiles of our White population was similar to Europe and Australia, and our Asian populations was similar to East Asia. I think it goes to show that the public policy part of the response was rather limited in effect, but personal health situations and personal precautions made a bigger difference.
Exactly why those situations and precautions differ so much, and why they might be similar to the continents of origin is obviously a whole can of worms that I personally don't understand very well. But that's what I see in the data.
This is a key point, and of course you can point out that Trumpy areas have had worse death rates after the first few months of Covid that logically hit big “blue” cities. Some of the disparities are explained by types of work and housing environments, but some of it is cultural response. If you read carefully the analysis of “mask mandates don’t work,” it’s not really about masks not working. It’s not a coincidence that in my educated DC suburb, virtually nobody I knew well got Covid in the first year because they followed the rules. As a teacher who returned to the classroom in March 2021, I witnessed the same group of kids who didn’t follow rules NEVER actually mask correctly.
Those numbers fit my anecdata, but they're fascinating nonetheless. It would be interesting to try to control for economic status--not hard to imagine that a lot of those deaths are grandparents in multi-generational homes, or whatever.
How can you be so sure that those factors are important? Especially iven the contradictions (high latino / low asian, both multi-gen)
About half of Asian-Americans are from South Asian backgrounds, which I don't think have any particular pandemic experience. Also, the previous SARs thing only lasted a few months, so surely by winter 2020 everyone had roughly equal pandemic experience.
Fwiw - in "normal times" 2018-2019 the death rate for Hispanics aged 65-74 was almost double the rate for Asians of the same age group. In other words, I think pre-existing health is a better starting point in exploring the differences.
But if not, go, google the CDC Wonder Underlying Cause of Death, group by race and hispanic origin and filter to ages 65-74. You can filter for covid only in the 110 cause of death list
I see what you're saying and wonder about that, too, but then I think, how much would that really make a difference in the 65-74 age group? In that age bracket college degrees are not so common even among whites and probably Asians, too. A degree is a decent proxy for who can work from home, and only 30% of adults have a degree, but it's more like 40% for young adults and 20% for seniors.
So I could see it being part of the discrepancy because there are probably more 65 year old White accountants working from home and more 65 year old Hispanic Taqueria workers at the shop, but at the end of the day, the median 65 year old of whatever race is a retired truck driver or mailman or something like that.
I will deny that the US had one of the worst responses in the developed world. The commonality between the successful countries you name (Japan, Taiwan, Australia, I'll add New Zealand) is that they're all islands controlled by a single government. The policy answer in those types of countries is very easy to both implement and gain public buy-in: heavy lockdowns until intra-country transmission stops combined with rigorous quarantine for new arrivals.
If you look at excess mortality by country, the US performed slightly worse than Western Europe (worse than France/Germany, better than Italy) and better than basically anywhere in Eastern Europe.
A good question to ask might be why Canada was so successful while the US was not, but I don't think there are any lessons to be learned by looking at island nations. There's a reason Madagascar is the hardest nation to beat in the Pandemic flash game.
It's notable that South Korea, while not actually an island, is functionally an island, because its only neighbor is so shut in.
Vietnam is an interesting counterexample though, of a country that is in no way an island, but still managed to do as well as the island nations for several years.
I have in-laws in Vietnam, and apparently the state hews pretty close to the Chinese model of COVID suppression: entry quarantines, enforced lockdowns, etc. One idea that's gone in and out of style to discuss is that well-managed authoritarian countries are probably better at managing disease outbreaks, since they have a robust state capacity for internal surveillance and enforcement, which also lets them make and enforce unpopular policies.
I agree that South Korea is an interesting example since it shows that a truly closed border offers the same benefits as being an island. For most countries that's not a realistic possibility; for all Trump's bluster about shutting the border with Mexico I was able to take a vacation in September 2020 with just a COVID test.
According to this Natality-by-immigrant-country-of-origin dataset I'm looking at, Vietnamese immigrants just have really good health outcomes all around, and are at the far end of the distribution in terms of being small. And according to the CDC death database, death rates for US "Asian" immigrants are much lower than I think could be explained by SES factors. Obviously "Asian" is too broad category for the death rate data, but at the same time it at least approximates Vietnamese people to some degree.
These datasets have made me much more open to the idea that genetic / environmental factors were a big driver of covid outcomes, because they seem to drive every other health outcome I'm seeing in the data
Japan didn’t have much of a different official response to other countries. But the individuals in the population seemed to implement that moderate official policy much better than those in many other countries. Somewhat like Sweden.
Yes. That makes sense in term of Japan's response leaning heavily on informal social norms rather than official rules.
OTOH, I thought the consensus was that Sweden did ok, but generally worse than its peers, suggesting that their lax approach did come at a relatively higher cost. Specifically, Sweden ended up with 2.3k Covid deaths per million, while Norway had 1k, Denmark had1.5k, and Finland had 1.8k.
Well, excess mortality tells a different story, where Sweden, Norway and Finland has a cumulative excess mortality rate of around 5% during the pandemic (Denmark has 2 % and comes out on top. Denmark also have a much lower life expectancy than the other Nordic countries which probably explains some of the difference).
I wonder if there are intrinsic health differences in their population, too. Someone else suggested there could be previous immunity from prior SARS/Covid outbreaks in East Asia and I think that's ridiculous, but there could be other genetic or diet or environmental factors.
I'm studying differences in immigrant pregnancy outcomes right now and there are many variations that can't be explained by SES status or health care system (because I'm only looking at the US health care system). Immigrants from South America, Central America, South Asia, East Asia SE Asia, West Africa, East Africa, Polynesia, etc. have different rates of everything from infant mortality to gestational diabetes to frequency of twins. Not to mention height and weight.
Who knows how much covid rates were driven by these same variations?
Why would the idea that people in East Asia may have antibodies that makes a virus that began in East Asia less deadly due to previous, similar viruses that circulated arouund East Asia be ridiculous? I mean that's how virsues work
What Kenny said but yeah ... IDK. I feel like most of the early articles were critical about Japan's response being far too lax especially around the Olympics. I always took their low death rate as indicating: (1) much healthier elderly population and (2) something to the prior coronavirus antibody theory.
ok i'm an American who was living in France and then the UK (moved internationally in September 2020, woooo!) during the pandemic, and the measures put into place were about 1000x harsher than they were pretty much anywhere in the US. I couldn't have anyone over for about six months, and even after there were limits on how many people could gather inside for another several months. For months on end, my only in person social contact was walks with *one* other person, and my two best friends and I *illegally* having lunch together outside (in the cold January/February air!).
I had to quarantine inside for 50 days in total, and the quarantines were actually enforced. I remember getting called by Track and Trace every day after I came back from America for my uncle's funeral in March 2021 (one of the few reasons you were allowed to travel abroad, and yes the airports were checking proof. I had to bring my uncle's obit along with me). About the only thing that was laxer in the UK than the US was the fact that we didn't have to wear masks outside.
So it's a bit concerning that the death rates were equally high in both countries. Of course, this could be because the anti covid measures did work but the NHS's excess capacity was nonexistent, whereas the US health care system has much more capacity but little political attitude for enforcing anti covid measures.
Still, overall I was happy to be in the UK, where things felt much less polarized. We locked down more harshly, but also returned to normal more quickly than blue cities like NYC or SF. Even today, there's a marked difference in the city centres of London versus West Coast cities.
I had a similar trajectory to you - I moved to the UK in September 2021 from Finland, and the first thing I noticed was how much laxer everything seemed to be - which I think speaks to your "returned to normal more quickly" comment. The restaurants along the high street were full pretty much all the time, and basically the only thing you had to do was wear a mask in stores and on public transportation (and even that was effectively optional, as you could claim any reason you wanted for why you couldn't wear a mask). My university ditched its (basically unenforced) mask requirement in March 2022, if I remember correctly, and following that I soon stopped wearing masks altogether and haven't looked back.
The weird thing for me was that I sincerely did not understand what people meant by "lockdown" until fairly long after I arrived. Finland never had anything you could call a "lockdown" (stuff was closed, sure, and there were restrictions on gathering sizes, but there was never a "you are literally confined to your home" order) and I assumed that Western European responses were all more or less the same, so my first read was that "lockdown" was a loose synonym for "any restrictions."
Of course, I was totally wrong on that - I now know that lockdowns in the UK were worthy of the name. I imagine that they were hellish, so I'm sympathetic to people who had to live through them. Like you, though, I was also happy to be in the UK where it felt like there was more permission to leave the pandemic behind and less of the "not wearing masks all the time is literally genocide" rhetoric that was in the US among certain crowds.
>We're similar to the UK with around 3.3k deaths per million compared to Germany with 2k deaths.<
I'd argue one needs to look at excess mortality. Covid death statistics are only as good as the relevant national authorities are at identifying such deaths. I think the US looks even worse on this score, though admittedly it's been a while since I've looked.
Isn't islandness probably a pretty big confounder here? The zero covid countries you mentioned all had some combination of travel bans and quarantines that I don't think any non-island democracies managed to implement.
Social determinants of health are likely to have played a significant role. The US has a lot of people in crowded housing. We also have a lot of people who did not have paid sick leave and those were the same people who couldn't afford to miss a day of work.
“China proves to have been lying about its covid success”
I’m gonna need a cite on this one, because it seems you mean prior to late 2022?
China’s Zero COVID approach worked quite effectively against everything prior to Delta and passably against Delta.
Only when things fell apart under Omicron’s onslaught did they resort to lying about the final death toll, which will never be known, but even with their failure to use the two years they bought in the way Australia did and jab a good vaccine in the arm of anything that moved… their per capita death toll in the extreme scenarios is still likely much lower than the US.
Totally. Comparing my life to what I saw coming out of New Zealand I absolutely believed there was a better way to manage the pandemic socially and that the US was doing a uniquely bad job.
It *was* a better way to deal with covid for at least its first year. The mistake there was not buying vaccines early. NZ made a different set of good and bad calls, but it doesn’t mean there were no good and bad calls.
I always assumed the successful East Asian countries strongly benefited from previous related viruses. Both social antibodies (understanding by the public/institutions what to do) but also literal antibodies. As the novel coronavirus has become less novel to our immune system it’s become much less deadly.
For that to be a strong factor the number of people with previous antibodies would have to be in the high millions, if not a billion with a B. How would anything related to covid have circulated widely through East Asia but somehow missed the rest of the world? SARS-1 began to spread out of Asia right away, for example.
And even covid antibodies don't fully block transmission or infection to itself, appear to weaken over time, and are less good against different versions of covid. If something similar enough to COVID had already appeared, it would probably have caused similar kinds of infections and been noticed.
Or if not, it would have spread globally, like the 'common cold coronaviruses' or died out rapidly after a few thousand infections, like SARS-1.
You need some variable that explains why Japan, but also Cambodia and Myanmar had COVID outcomes drastically better than Switzerland or Norway or... anywhere not-Asia.
I don't need a better explanation to explain why the "previous immunity theory" can be ruled out.
But fwiw - I'm currently studying maternal and neonatal health data on immigrants from around the world, and there are vastly different results by regions of origin. Immigrants from Cambodia and Myanmar have some of the worst risk factors of any country in the data. But their natal health outcomes are really good.
Looking at this pregnancy data has given me some appreciation of how genetically diverse humans are, and it feels like a safe bet that that diversity interacted with covid and explained part of the difference results. The average mother from Myanmar is 5'1" and 125 lbs. From Nigeria it's 5'5" and 165 lbs. 1.8% of Myanmar mothers give birth to twins, 6.5% of Nigerian-born mothers have twins.
Despite Nigerian born mothers being much more highly educated than Myanmar mothers, rates of assisted ventilation for the newborn and visits to neonatal ICU units and are much higher for the former despite. Whatever it is that drives those differences in natality numbers could surely impact covid morbidity.
That sounds like interesting research! I am continually reminded (again, now, in my nursing training) that we understand biological response and genetic factors so much less deeply than I think the average person realizes. It's easy to know some stuff, or even a lot of stuff, and let that cause you to forget that any system composed literally of a gazillion adaptive nano machines operating at the level of individual molecule construction and managing subatomic particle flows is just so ferociously, stupidly complex that it's almost certainly doing a bunch of stuff that you don't really understand.
Here's a webapp I put together to explore aspects of the immigrant natal health. There's data on immigrant mothers from every country in the world: pregnancy outcomes, risk factors, SES status, total numbers, heigh / weight / disease statuses, self-id race, etc.
Just thought I'd mention it since you seemed interested. If you have any feedback I'm all ears!
The anti-bodies point would certainly point to the Japanese experience given that they never had that firm a lockdown and never had that bad a surge with covid.
The Japanese have really small households, and impressive air purification in their indoor spaces. They also pretty closely adhered to voluntary mitigation efforts. They had really explosive spread post relaxation/Omicron suggesting they were keeping it at bay before that.
The only real relaxation to speak of ahead of the Omicron surge was related to border controls, which were slightly loosened in 2021 and more so throughout 2022. There wasn't really anything else to relax given the lack of formal mask mandates etc.
Masking only fell significantly this spring when offi
Really enjoyed this article. I do think it misses a key part of the story which is the seeming success of South East Asian, Australiasia and even European countries in supressing the virus compared to Britain and America. That really fed the narrative that the two English-speaking countries led by the hated populists had taken the virus lightly, and if we just had the common sense/determination to impose a proper lockdown then all would be well. This gets discredited as the virus spreads around Europe to the point that the UK is a middling rather than unusually bad performer, China proves to have been lying about its covid success, and other countries with the harshest lockdowns struggle to come out of them. And of course US/UK lead the world in developing and distributing vaccines. But I think in 2020 there was a real crisis of confidence in American and British science/medical communities that they had gotten this big call wrong
As someone comparing notes in cdc vs nhs in real time I can tell you they weren’t the same. Cdc was much worse. It was consistently gaslighting the American people and losing all credibility. In general the debate in America was much more stupid and American actual level of vaccination is significantly lower than in peer countries.
I am still pissed the CDC kept lying about surface transmission of covid even though we knew that was not a thing by May.
I am still annoyed that a lot of fomite-based Covid rules are still in practice (QR code menus, non-functional water fountains, etc)... not to mention all those stupid permanent floor stickers nagging you to stay a magical 6 feet apart.
The floor stickers still lingering around I'm guessing is just a matter of laziness/not wanting to pay to remove them, since they know everyone is just going to ignore them.
And I recall the QR code menus emerging before the pandemic as another cost saving mechanism. I don't like them myself but I can understand why some places are still trying to make them stick.
The floor stickers might be harder to remove, but I still see signs up about masking (in contexts where staff are not masking) and distancing. I don't know why. But it's not a cost issue.
If they're sticky signs stuck onto glass (which I still see a few of too), I can understand that on the same grounds as the floor stickers.
Path dependence and laziness.
I appreciate QR code menus, because it enables me to zoom in, and to see the menu in good light, even when the restaurant is dark. If done right, it should also let the restaurant stay up-to-the-moment on which items are out of stock today.
Oh for sure. They still bug me though, and they bugged me when they went down because it was clear they’d be stuck there for 10+ years.
Their annoyance has been pushed out by my greater annoyance of all the increased nudges by machines to tip/donate on an increasingly higher number of purchases.
I've heard one theory about the QR code menus is it makes it easier for restaurants to increase prices without anyone noticing, since they don't need to visually modify existing menus or order new ones every time - just update the website.
That's the very rare conspiracy theory I can get on board with.
Reagan pushed tax cuts so that he could indirectly subsidize the cocaine market so the CIA could fund the contras!
I’ve been to a place where the qr menu was a low-quality scan of the paper menu. When I asked for the paper menu they gave me a printout of the file of the scan ie a clean paper on which was a big picture of a wrinkled old menu in low quality scan!
I'd believe that if there was any evidence that restaurants actually bothered to update the pricing on their web menus -- instead a bunch of restaurants I patronize are just charging you $2 to $3 more per entrée than what the web menu claims the price is. (Likewise, most restaurants don't bother to update their electronic display menus either, in my experience -- in fact a couple near my office turned off their electronic display menus in the past year and now just have crude handwritten poster boards with prices, presumably because they couldn't be arsed to figure out how to update the display.)
There was this Greek place that had not updated their website prices since 2008. He was cheap but not 2008 cheap.
Those stickers are forever. The gym I joined has a “no phones in the locker room sign” with a 2002 Nokia as the clip art image.
The first time I flew after the start of covid, I saw signs in the security line warning people to watch out for Zika while traveling. In the locker room at Texas A&M there are even still a few signs warning people to watch out for swine flu.
Although, one fomite-based Covid change I don’t mind at all: ubiquitous free hand sanitizer 🙌🏻
The fact that fomite transmission is RELATIVELY unusual doesn't mean it doesn't exist. Other common respiratory viruses, not to mention gastrointestinal pathogens, are spread that way. Covid is so extremely transmissible through airborne particles that the amount of fomite transmission might seem trivial only by comparison.
No no no. The *most* useless was those one-way aisles at grocery stores.
No. Far more useless than that was the (mercifully brief) insistence at my local Trader Joe's and Safeway that you weren't allowed to bring your environmentally correct shopping bag from home. You had to switch to store-provided paper/plastic bags. Because apparently the fibers might harbor virules? (But no doubt one's clothing was assumed to be pristine!).
Yes, my grocery store also shifted to one-way streets. The milk and dairy aisle seems to still be unofficially one-way because it somehow got burned into all of our brains
I was Designated Pen Cleaner for an entire eight-hour election shift. Democracy dies in darkness, you know.
My new state started giving people paper straws to use on the touch pad. Then they kept doing that because they worked really well on the crappy touch screens.
I always enjoy my voting straw.
To be fair, shared pens are filthy in general, so it’s not a bad idea to clean them. Maybe not for 8 hours straight, but occasionally.
Maybe they just know their customers don’t wash their hands after wiping….
I remember playing golf in TX during the Summer of 2020, walking in ~115 heat index. Because people thought COVID could survive on plastic for several days, golf courses removed both flags and water coolers. I remember needing to leave early due to heat exhaustion symptoms, having drank all the water I brought. Asinine stuff.
I'm not familiar with this.
I am also mad that the CDC straight up lied to the public repeatedly and justified it to themselves as being for the greater good, without remorse.
A memorable item in a truly shocking list of failures, whose actual extent seems to me to be under appreciated by the average American who wasn’t (and still isn’t) fully aware of how much better the health establishment of other countries functioned.
Did others actually function a lot better? I thought they all had their own special failures (especially the countries where curfews were major policy, as though the virus sleeps during the day).
For example..?
failure on early testing, flip flop on masks and failure to instruct public on good masks, delayed booster approval, flip flop on vaccine mandates, failure on rapid testing....
I think only delayed booster approval mattered in the end. Only low risk people (introverted Covid hawks) followed government advice, most of which was useless anyway. I remember all the crap about double masking.
Do you think it is for want of government advice on diet and exercise that people end up obese?
We had the flip-flop on masks in Finland, too.
I agree. But I didn't read your comment as being about the CDC & FDA.
The flip/flop on vaccine mandates in the military was a huge mistake. It's taken by anti-vaccine types as evidence they were right.
Michael Lewis’ book The Premonition details how overly cautious and scared the CDC was, which ultimately made them look incompetent anyway.
Damn you Reagan for politicizing the CDC because you wanted gay men to die of AIDS.
So the CDC prior to Reagan was organized more like the Fed with staggered terms overlapping presidential administrations.
Reagan turned the head of the CDC into a position appointed by the President. Previously a panel of medical and public health experts nominated the candidate. This all stemmed from the CDC trying to stop HIV from becoming endemic when it was first identified in the gay community. The leadership was contradicting the White House.
My satirical comment is in reference to the change in the leadership of the CDC that made it a political appointment. This means PR and risk aversion became more important than disease control.
Outdoor masking for exercise is another one on the list!
UK government advice on Covid was still emphasising handwashing well into 2021 - they only added "fresh air" to their Covid-prevention mantra in March 2021: https://www.gov.uk/government/news/public-reminded-they-must-stay-outside-when-meeting-others-to-reduce-the-spread-of-coronavirus-covid-19
As Matt said, it'll be good to have a rigorous analytical breakdown of exactly what policies mattered the most, especially looking at something like cost per life saved or a similar measure.
Still, it's hard to deny that the US had one of the worst responses in the developed world in terms of our death rate per million. We're similar to the UK with around 3.3k deaths per million compared to Germany with 2k deaths. That compares to zero covid countries like Japan with 602 deaths/million, Taiwan with 739, and Australia with 837.
https://en.wikipedia.org/wiki/COVID-19_pandemic_death_rates_by_country
Obviously comparing raw numbers is problematic due to differing demographic profiles, but it at least gives some rough contours of the efficacy of various covid approaches.
Worth noting that the US has a younger population pyramid than Japan and Germany do. On a demographic-adjusted basis, our performance is even worse.
If we are accounting for age demographics, we also need to account for us having far more obesity
Our death rates were vastly different by ethnicity. For ages 65-74, here are the death rates per 100k (from the CDC) by Race/Ethnicity:
Asian: 100
American Indian: 300
Black: 236
Hispanic: 300
Non-Hispanic White: 110
So most of those excess deaths come from Latino and Black populations. The age and death profiles of our White population was similar to Europe and Australia, and our Asian populations was similar to East Asia. I think it goes to show that the public policy part of the response was rather limited in effect, but personal health situations and personal precautions made a bigger difference.
Exactly why those situations and precautions differ so much, and why they might be similar to the continents of origin is obviously a whole can of worms that I personally don't understand very well. But that's what I see in the data.
This is a key point, and of course you can point out that Trumpy areas have had worse death rates after the first few months of Covid that logically hit big “blue” cities. Some of the disparities are explained by types of work and housing environments, but some of it is cultural response. If you read carefully the analysis of “mask mandates don’t work,” it’s not really about masks not working. It’s not a coincidence that in my educated DC suburb, virtually nobody I knew well got Covid in the first year because they followed the rules. As a teacher who returned to the classroom in March 2021, I witnessed the same group of kids who didn’t follow rules NEVER actually mask correctly.
Pet peeve of mine, but most Hispanics are White or at least mixed-race! They aren't "non-Whites"
I’m skeptical of this kind of subset analysis where you treat Europe/Australia as a kind of homogenous control for white Americans, etc.
I know data is patchy to do the kind of ‘control for ethnicity’ analysis you’d want, but minorities seem to have higher covid in general, not just USA (see figure 9): https://www.oecd-ilibrary.org/docserver/6c2a96c9-en.pdf?expires=1689018603&id=id&accname=guest&checksum=4C3662C22654D60CA3A7404AF2B040BE
To me seems akin to saying, US covid rates look good if you: take out NY, NJ and the south; or ignore the poorest 40% of population, and so on.
Those numbers fit my anecdata, but they're fascinating nonetheless. It would be interesting to try to control for economic status--not hard to imagine that a lot of those deaths are grandparents in multi-generational homes, or whatever.
Yeah - it would be. I better run this morning, but you could further group by urbanization into rural / urban / suburban counties.
How can you be so sure that those factors are important? Especially iven the contradictions (high latino / low asian, both multi-gen)
About half of Asian-Americans are from South Asian backgrounds, which I don't think have any particular pandemic experience. Also, the previous SARs thing only lasted a few months, so surely by winter 2020 everyone had roughly equal pandemic experience.
Fwiw - in "normal times" 2018-2019 the death rate for Hispanics aged 65-74 was almost double the rate for Asians of the same age group. In other words, I think pre-existing health is a better starting point in exploring the differences.
Link?
Check if this works:
https://wonder.cdc.gov/controller/saved/D158/D348F854
But if not, go, google the CDC Wonder Underlying Cause of Death, group by race and hispanic origin and filter to ages 65-74. You can filter for covid only in the 110 cause of death list
My guess would be that Whites (and Asians) are more likely to have jobs that could be done remotely and that this was a huge part of the discrepancy
I see what you're saying and wonder about that, too, but then I think, how much would that really make a difference in the 65-74 age group? In that age bracket college degrees are not so common even among whites and probably Asians, too. A degree is a decent proxy for who can work from home, and only 30% of adults have a degree, but it's more like 40% for young adults and 20% for seniors.
So I could see it being part of the discrepancy because there are probably more 65 year old White accountants working from home and more 65 year old Hispanic Taqueria workers at the shop, but at the end of the day, the median 65 year old of whatever race is a retired truck driver or mailman or something like that.
I will deny that the US had one of the worst responses in the developed world. The commonality between the successful countries you name (Japan, Taiwan, Australia, I'll add New Zealand) is that they're all islands controlled by a single government. The policy answer in those types of countries is very easy to both implement and gain public buy-in: heavy lockdowns until intra-country transmission stops combined with rigorous quarantine for new arrivals.
If you look at excess mortality by country, the US performed slightly worse than Western Europe (worse than France/Germany, better than Italy) and better than basically anywhere in Eastern Europe.
A good question to ask might be why Canada was so successful while the US was not, but I don't think there are any lessons to be learned by looking at island nations. There's a reason Madagascar is the hardest nation to beat in the Pandemic flash game.
https://ourworldindata.org/grapher/excess-deaths-cumulative-per-100k-economist
It's notable that South Korea, while not actually an island, is functionally an island, because its only neighbor is so shut in.
Vietnam is an interesting counterexample though, of a country that is in no way an island, but still managed to do as well as the island nations for several years.
I have in-laws in Vietnam, and apparently the state hews pretty close to the Chinese model of COVID suppression: entry quarantines, enforced lockdowns, etc. One idea that's gone in and out of style to discuss is that well-managed authoritarian countries are probably better at managing disease outbreaks, since they have a robust state capacity for internal surveillance and enforcement, which also lets them make and enforce unpopular policies.
I agree that South Korea is an interesting example since it shows that a truly closed border offers the same benefits as being an island. For most countries that's not a realistic possibility; for all Trump's bluster about shutting the border with Mexico I was able to take a vacation in September 2020 with just a COVID test.
According to this Natality-by-immigrant-country-of-origin dataset I'm looking at, Vietnamese immigrants just have really good health outcomes all around, and are at the far end of the distribution in terms of being small. And according to the CDC death database, death rates for US "Asian" immigrants are much lower than I think could be explained by SES factors. Obviously "Asian" is too broad category for the death rate data, but at the same time it at least approximates Vietnamese people to some degree.
These datasets have made me much more open to the idea that genetic / environmental factors were a big driver of covid outcomes, because they seem to drive every other health outcome I'm seeing in the data
There's just no reasonable way to call Japan a "zero covid country".
Fair. That was sloppy wording. Maybe something like an effective response within the country that effectively contained the spread of COVID?
Japan didn’t have much of a different official response to other countries. But the individuals in the population seemed to implement that moderate official policy much better than those in many other countries. Somewhat like Sweden.
Yes. That makes sense in term of Japan's response leaning heavily on informal social norms rather than official rules.
OTOH, I thought the consensus was that Sweden did ok, but generally worse than its peers, suggesting that their lax approach did come at a relatively higher cost. Specifically, Sweden ended up with 2.3k Covid deaths per million, while Norway had 1k, Denmark had1.5k, and Finland had 1.8k.
Well, excess mortality tells a different story, where Sweden, Norway and Finland has a cumulative excess mortality rate of around 5% during the pandemic (Denmark has 2 % and comes out on top. Denmark also have a much lower life expectancy than the other Nordic countries which probably explains some of the difference).
Se link here:
https://ourworldindata.org/grapher/cumulative-excess-mortality-p-scores-projected-baseline
I wonder if there are intrinsic health differences in their population, too. Someone else suggested there could be previous immunity from prior SARS/Covid outbreaks in East Asia and I think that's ridiculous, but there could be other genetic or diet or environmental factors.
I'm studying differences in immigrant pregnancy outcomes right now and there are many variations that can't be explained by SES status or health care system (because I'm only looking at the US health care system). Immigrants from South America, Central America, South Asia, East Asia SE Asia, West Africa, East Africa, Polynesia, etc. have different rates of everything from infant mortality to gestational diabetes to frequency of twins. Not to mention height and weight.
Who knows how much covid rates were driven by these same variations?
Why would the idea that people in East Asia may have antibodies that makes a virus that began in East Asia less deadly due to previous, similar viruses that circulated arouund East Asia be ridiculous? I mean that's how virsues work
What Kenny said but yeah ... IDK. I feel like most of the early articles were critical about Japan's response being far too lax especially around the Olympics. I always took their low death rate as indicating: (1) much healthier elderly population and (2) something to the prior coronavirus antibody theory.
ok i'm an American who was living in France and then the UK (moved internationally in September 2020, woooo!) during the pandemic, and the measures put into place were about 1000x harsher than they were pretty much anywhere in the US. I couldn't have anyone over for about six months, and even after there were limits on how many people could gather inside for another several months. For months on end, my only in person social contact was walks with *one* other person, and my two best friends and I *illegally* having lunch together outside (in the cold January/February air!).
I had to quarantine inside for 50 days in total, and the quarantines were actually enforced. I remember getting called by Track and Trace every day after I came back from America for my uncle's funeral in March 2021 (one of the few reasons you were allowed to travel abroad, and yes the airports were checking proof. I had to bring my uncle's obit along with me). About the only thing that was laxer in the UK than the US was the fact that we didn't have to wear masks outside.
So it's a bit concerning that the death rates were equally high in both countries. Of course, this could be because the anti covid measures did work but the NHS's excess capacity was nonexistent, whereas the US health care system has much more capacity but little political attitude for enforcing anti covid measures.
Still, overall I was happy to be in the UK, where things felt much less polarized. We locked down more harshly, but also returned to normal more quickly than blue cities like NYC or SF. Even today, there's a marked difference in the city centres of London versus West Coast cities.
I had a similar trajectory to you - I moved to the UK in September 2021 from Finland, and the first thing I noticed was how much laxer everything seemed to be - which I think speaks to your "returned to normal more quickly" comment. The restaurants along the high street were full pretty much all the time, and basically the only thing you had to do was wear a mask in stores and on public transportation (and even that was effectively optional, as you could claim any reason you wanted for why you couldn't wear a mask). My university ditched its (basically unenforced) mask requirement in March 2022, if I remember correctly, and following that I soon stopped wearing masks altogether and haven't looked back.
The weird thing for me was that I sincerely did not understand what people meant by "lockdown" until fairly long after I arrived. Finland never had anything you could call a "lockdown" (stuff was closed, sure, and there were restrictions on gathering sizes, but there was never a "you are literally confined to your home" order) and I assumed that Western European responses were all more or less the same, so my first read was that "lockdown" was a loose synonym for "any restrictions."
Of course, I was totally wrong on that - I now know that lockdowns in the UK were worthy of the name. I imagine that they were hellish, so I'm sympathetic to people who had to live through them. Like you, though, I was also happy to be in the UK where it felt like there was more permission to leave the pandemic behind and less of the "not wearing masks all the time is literally genocide" rhetoric that was in the US among certain crowds.
>We're similar to the UK with around 3.3k deaths per million compared to Germany with 2k deaths.<
I'd argue one needs to look at excess mortality. Covid death statistics are only as good as the relevant national authorities are at identifying such deaths. I think the US looks even worse on this score, though admittedly it's been a while since I've looked.
Fair point, although I think recently the gap between excess mortality and covid deaths seems to be closing, at least in the US.
Currently, it looks like total excess deaths in the US are 1.27 million versus Covid deaths at 1.13 million.
https://ourworldindata.org/grapher/cumulative-excess-deaths-covid
https://covid.cdc.gov/covid-data-tracker/#datatracker-home
I agree, otherwise you get weird results showing things like Mexico or Russia's COVID response is better than the USA's.
The USA has 3,970 dpm vs. 2,220 in France and 3,000 in Germany, using The Economist's numbers. https://ourworldindata.org/grapher/excess-deaths-cumulative-per-100k-economist
Isn't islandness probably a pretty big confounder here? The zero covid countries you mentioned all had some combination of travel bans and quarantines that I don't think any non-island democracies managed to implement.
Social determinants of health are likely to have played a significant role. The US has a lot of people in crowded housing. We also have a lot of people who did not have paid sick leave and those were the same people who couldn't afford to miss a day of work.
“China proves to have been lying about its covid success”
I’m gonna need a cite on this one, because it seems you mean prior to late 2022?
China’s Zero COVID approach worked quite effectively against everything prior to Delta and passably against Delta.
Only when things fell apart under Omicron’s onslaught did they resort to lying about the final death toll, which will never be known, but even with their failure to use the two years they bought in the way Australia did and jab a good vaccine in the arm of anything that moved… their per capita death toll in the extreme scenarios is still likely much lower than the US.
Totally. Comparing my life to what I saw coming out of New Zealand I absolutely believed there was a better way to manage the pandemic socially and that the US was doing a uniquely bad job.
if only america were a remote island with five million inhabitants, the Kiwi policies might have worked.
It *was* a better way to deal with covid for at least its first year. The mistake there was not buying vaccines early. NZ made a different set of good and bad calls, but it doesn’t mean there were no good and bad calls.
I always assumed the successful East Asian countries strongly benefited from previous related viruses. Both social antibodies (understanding by the public/institutions what to do) but also literal antibodies. As the novel coronavirus has become less novel to our immune system it’s become much less deadly.
For that to be a strong factor the number of people with previous antibodies would have to be in the high millions, if not a billion with a B. How would anything related to covid have circulated widely through East Asia but somehow missed the rest of the world? SARS-1 began to spread out of Asia right away, for example.
And even covid antibodies don't fully block transmission or infection to itself, appear to weaken over time, and are less good against different versions of covid. If something similar enough to COVID had already appeared, it would probably have caused similar kinds of infections and been noticed.
Or if not, it would have spread globally, like the 'common cold coronaviruses' or died out rapidly after a few thousand infections, like SARS-1.
You need some variable that explains why Japan, but also Cambodia and Myanmar had COVID outcomes drastically better than Switzerland or Norway or... anywhere not-Asia.
I don't need a better explanation to explain why the "previous immunity theory" can be ruled out.
But fwiw - I'm currently studying maternal and neonatal health data on immigrants from around the world, and there are vastly different results by regions of origin. Immigrants from Cambodia and Myanmar have some of the worst risk factors of any country in the data. But their natal health outcomes are really good.
Looking at this pregnancy data has given me some appreciation of how genetically diverse humans are, and it feels like a safe bet that that diversity interacted with covid and explained part of the difference results. The average mother from Myanmar is 5'1" and 125 lbs. From Nigeria it's 5'5" and 165 lbs. 1.8% of Myanmar mothers give birth to twins, 6.5% of Nigerian-born mothers have twins.
Despite Nigerian born mothers being much more highly educated than Myanmar mothers, rates of assisted ventilation for the newborn and visits to neonatal ICU units and are much higher for the former despite. Whatever it is that drives those differences in natality numbers could surely impact covid morbidity.
That sounds like interesting research! I am continually reminded (again, now, in my nursing training) that we understand biological response and genetic factors so much less deeply than I think the average person realizes. It's easy to know some stuff, or even a lot of stuff, and let that cause you to forget that any system composed literally of a gazillion adaptive nano machines operating at the level of individual molecule construction and managing subatomic particle flows is just so ferociously, stupidly complex that it's almost certainly doing a bunch of stuff that you don't really understand.
Here's a webapp I put together to explore aspects of the immigrant natal health. There's data on immigrant mothers from every country in the world: pregnancy outcomes, risk factors, SES status, total numbers, heigh / weight / disease statuses, self-id race, etc.
Just thought I'd mention it since you seemed interested. If you have any feedback I'm all ears!
https://theusaindata.pythonanywhere.com/immigrant_paradox
The anti-bodies point would certainly point to the Japanese experience given that they never had that firm a lockdown and never had that bad a surge with covid.
The Japanese have really small households, and impressive air purification in their indoor spaces. They also pretty closely adhered to voluntary mitigation efforts. They had really explosive spread post relaxation/Omicron suggesting they were keeping it at bay before that.
The only real relaxation to speak of ahead of the Omicron surge was related to border controls, which were slightly loosened in 2021 and more so throughout 2022. There wasn't really anything else to relax given the lack of formal mask mandates etc.
Masking only fell significantly this spring when offi