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Covid control: Why the West lags the East

Paran Balakrishnan | Updated on October 28, 2020

Success story | Vietnam reacted faster than any other country in tackling Covid   -  Bloomberg

Rather than learn from East Asia’s experience on how to tackle Covid, Western nations chose to go their own way

What did the Western world get so fatally wrong in tackling Covid-19 and how did East Asian nations get it so right? Look at Vietnam, Taiwan, China, Japan, and South Korea which, for now, have minimal Covid-19 caseloads and where life’s approaching “near normal”. Then, look at the second Covid wave slamming into the US and Europe, overloading hospitals and forcing countries to close bars and restaurants and impose curfews. The stark Covid divergence between the East and West can be seen in the numbers. For instance, while South Korea had 77 new Covid cases on October 24, the US recorded an incredible 79,453 fresh infections.

For answers to the why’s behind these different performances, first consider that Asian countries already had experience tackling smaller epidemics like SARS and MERS. In short, they knew the pandemic drill: test, trace, isolate, wear masks and communicate the anti-virus message clearly, allowing them to respond rapidly with scale.

These countries also employed sophisticated technology to track contacts and enforce isolation, combing smartphone records and CCTV footage, actions resisted as intrusive in the West. Also, Asia’s population is younger and possibly more disease-resistant thanks to regular scourges like dengue and malaria. Says Dipyaman Ganguly, Indian Institute of Chemical Biology’s principal scientist: “Serious discussions are on to look into whether infection exposure in these countries may prepare immune systems to respond more efficiently” to Covid.

By contrast, the West’s been free of highly infectious maladies and many people have been in denial about Covid’s dangers. Even with tens of thousands of Covid deaths (so far, the US has notched up more than 236,000 deaths and the UK has recorded over 44,000), many in the West have rejected infection and isolation controls as infringements on entrenched freedoms.

Let’s dig deeper into what the Asian nations got right. For that, zoom in on Kashgar, capital of China’s Xinjiang province where 165 asymptomatic cases were discovered late last week. By Sunday afternoon, the government reported testing 2.8 million people. Or look at Chinese port city Qingdao which earlier this month tested nine million people in five days (that’s 1.8 million a day) after 12 Covid-19 cases were reported. It helped that China’s already got a strong test lab system thanks partly to its Human Genome Project participation. This gave China a massive head-start when it moved into mass testing. In Beijing, too, health workers descended after 250 cases erupted in June. In 10 days, 2.95 million samples were collected and the infection was stamped out.

By the looks of it, Chinese aggressive mass-testing works. Today, life’s back almost to pre-Covid days with 630 million Chinese travelling during the Golden Week holidays in early October. Some even visited Wuhan, now an unlikely tourist draw as where the pandemic originated.

The Vietnam formula

So is Chinese-scale mass testing the way forward? Possibly. Vietnam, though, offers a different, yet extremely effective Covid control method. Vietnam’s a country of 96 million people and its had only 1,168 cases and 35 deaths. It didn’t have the resources for mass testing but it did contact-tracing to the fourth-degree (i.e., contact of a contact of a contact of a contact) and diligent isolation and there was widespread tracing-app uptake.

Vietnam also shares a 1,300-km border with China and there’s big bilateral trade. But scorched by long dealings with the Chinese, Vietnam knew Beijing would underplay the outbreak and scoffed at its initial reassurances. It reacted faster than any other country, even before the World Health Organization declared the pandemic, helped by its experience of both SARS and MERS.

Laudably, for a communist country where the media’s tightly controlled, Vietnam opted to be totally frank with citizens about the outbreak. Taiwan (population 24 million) as well acted with dispatch, achieving admirable results. It’s had 550 cases and seven deaths.

So what was the West’s first reaction to the pandemic? They ignored lessons from SARS and MERS. The two worst-hit countries, the US and the UK, dismissed Covid as a threat, losing precious time to contain the disease. US President Donald Trump famously declared Covid would be gone by Easter. UK Prime Minister Boris Johnson said the tide would be turned against the virus in 12 weeks and in the meantime he’d keep shaking Covid patients’ hands.

After a summer let-up, the West is reaping more of the virus’s lethal consequences. Do the huge death tolls come down to the West’s more individualistic mindsets? Possibly Asian nations’ more collectivist culture has driven greater acceptance of infection control. Notes leading virologist Shahid Jameel: “One very important difference is East Asia has a culture of wearing masks when you’ve got a cold. That’s unlike in the West where it’s a big thing.”

The West’s initial instinct was to organise more hospital and ICU beds and ventilators while in the UK and the US contact-tracing and testing systems fell way down the agenda. Even now, the UK still has no test-and-trace system worth the name after announcing in May a £12-billion scheme derided as “test-and-waste” that awarded without tenders contracts to unqualified private-sector government backers.

In the US, Trump attempted to block test-and-trace funds and refused to endorse mask-wearing. Now, in both countries, there are new restrictions and talk of lockdowns, something which frustrates top US infectious disease expert Dr Anthony Fauci. Lockdowns occur “because of lack of implementation of simple public-health measures… it’s not rocket science,” Fauci says.

It’s been much the same story in many other Western countries except Germany which initiated counter-Covid steps February 1 and put contact-tracing into place led by the state and local governments. Says the BMJ: “Germany built on existing infrastructure and experience from the outset.” Yet even in Germany, leaders are warning the virus risks spinning out of control due to private gatherings and Covid restrictions “fatigue.”

In India, we’re holding our breath for whether the festival season will spark a new spike. Numbers are falling but virologists say a second wave may be imminent. Could Chinese-scale testing and quarantining be employed when huge outbreaks are already underway? That’s doubtful. Says Dileep Raman, co-founder of tele-ICU services Cloudphysician: “Contact-tracing needs to be done before it reaches community spread. Once that happens, it will follow viral kinetics.”

But it should be borne in mind it would probably be cheaper to spend heavily on mass-testing, tracing and isolating than to dole out huge subsidies to revive a collapsing economy unable to return to normalcy because of constant Covid outbreaks. The lesson from countries like South Korea, which just rebounded from recession with 1.9 per cent quarterly growth and China, which notched 4.9 per cent quarterly growth, is that those which control Covid fastest bounce back quickest.

Published on October 28, 2020

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