Although the pandemic is
not over yet, it is not too early to draw some conclusions.
Preparation
It became apparent very
soon that most countries, including the richest, were not prepared for a
pandemic. France
had no stocks of PPEs. Worse,
it had disposed of old stocks from the 2010 H1N1 infection and never replaced
them. The US,
both at the federal and states level, didn’t fare any better, neither did the
UK, Italy or Spain. Germany,
on the other hand, had a plan from 2012 and implemented it with the results we
know.
Response
It is ironic that the
effectiveness of the governments’ response was often inversely proportional to
their economic, financial and medical capabilities. The richest
countries did worse than the poorer ones. The following table
summarizes the mortality rates as measured against the patient and total
populations[1].
Country
|
Cases
|
Deaths
|
Death/Cases
|
Deaths/100k pop
|
USA
|
2,137,731
|
116,963
|
5.5%
|
35.8
|
UK
|
299,600
|
42,054
|
14%
|
63.2
|
France
|
194,347
|
29,550
|
15.2%
|
44.1
|
Germany
|
188,252
|
8,820
|
4.7%
|
10.6
|
S. Korea
|
12,198
|
279
|
2.3%
|
0.5
|
Morocco
|
8,931
|
212
|
2.4%
|
0.6
|
Senegal
|
5,247
|
70
|
1.3%
|
0.4
|
Greece
|
3,148
|
185
|
5.9%
|
1.7
|
Taiwan
|
445
|
7
|
1.6%
|
0.03
|
Vietnam
|
335
|
0
|
0%
|
0
|
Western countries argued
that, as democracies, they couldn’t enforce the kind of measures that autocratic
regimes did. China
and Vietnam reacted more forcefully than the US or the UK could have, that is
true; however, China’s response was also tardy and as a result excessive; both China’s[2]
and Russia’s preliminary reports don’t seem to jive with their latest results;
on the other hand, such democracies as Germany, South Korea and Taiwan did very
well.
More galling, why did
Greece and Senegal incur far less casualties than Italy and the US? More generally, why
did emerging countries do better than highly developed ones?
Extenuating circumstances?
We have some. Vietnam, Korea,
Taiwan, Japan live in a tough neighborhood, one from which many pandemics have
originated; thus, they tend to take such threats more seriously, gear up faster,
and follow sanitary directives such as wearing masks better.
In the US, we have a
population which is shockingly unhealthy; 46% of adults suffer from high blood
pressure and only half of them take treatment for it, 40% are obese, 13% have
diabetes. This
probably goes a long way to explain why our mortality rate was so high.
Emerging countries have
younger populations; these are often exposed to more infectious threats which
help them develop better immune responses (although at a cost). Finally, one
shouldn’t discard the argument that richer countries probably count their
infection cases more comprehensively and therefore show truer but worse
results.
Attributes that the winners
share
Quick and strong response: for varying reasons, the
winners launched quick and forceful action plans. Such quickness was
sometimes due to a familiarity with the kind of damage Cover-19 could bring (in
“tough neighborhood” countries) or the imperative to stop the virus very early
(in poor countries where their sparse hospital infrastructures wouldn’t cope
with a massive influx of patients).
Testing: those that built a large and
early testing capacity secured for themselves more and better policy options;
in particular, they could isolate the patients and treat them. This contrasted
with those that couldn’t identity asymptomatic patients or let the infection
expand so widely that severe and massive lockdowns became unavoidable. Such lockdowns extracted very high human
(think of uncontrolled confinement in retirement homes) and economic costs.
Flexibility: such flexibility was
displayed in enrolling a broad range of actors to fight the infection, in
resisting excessive centralization of decision, minimizing slow bureaucratic
responses, and in considering a variety of treatments.
Bootstrapping: either at the clinical unit,
regional or state level, the winners did not wait for solutions to be handed
down but actively and creatively sought ways to secure what they needed. Thus, the
Marseilles IHU found early that veterinary laboratories had the kind of
reagents that they needed to make covid-19 test kits; Senegal adapted its
dengue fever test kits to the same end and not only produced enough kits for
their own use but also for export.
Looking forward
This Covid-19 pandemic
turned into a brutal and revealing stress test. Here, in the US and
New York, we barely passed. Adjusted
for all the assets that we enjoy, we failed; the American people saw that, and
the world did too. For
our own sake, we cannot accept such a failure and do nothing. There is a domestic
and international cost for public failure; unless we learn from it, it will be
high. We have a lot of work to do:
Healthcare: it is evident that our
health insurance system does not work well enough. Healthcare insurance must be available to
all. Too many
people are not screened and treated for widespread morbidities. Some, like obesity and heart disease can be
treated at only a moderate to low cost. But
it is even more evident that better lifestyle strategies are needed. Healthier and more
widespread food programs in schools, national dietary education are needed; incentives
to be healthier, such as steeper premiums for smokers or couch potatoes do work
(see Singapore) and should be considered.
Capacity vs. Efficiency: some decades ago, Chile
had a very effective electricity dispatch system that guaranteed that the
cheapest electricity would be dispatched first; most of it was generated by
hydroelectric plants. When
snowfalls in the Andes hit a rare but pronounced low[3],
the country got into big trouble. Their system
incentivized generators to be very efficient but deterred them from building
adequate excess capacity for the bad days. Eventually, the system was
changed, and generators were also paid for providing sufficient standby capacity. We just faced similar problems in
healthcare; hospitals, states and the federal governments need to build and
maintain capacity and strategic stocks. In a $20 trillion
economy, there is no excuse not to.
A new spirit: this crisis has shown
that people could show extraordinary courage and dedication. It also highlighted
that we had lost some of the spirit which made this country great. We went through
months waiting for test kits while Senegal found a way to solve the same
problem quickly; that is hard to swallow. The federal
government couldn’t come up with a timely and effective strategy, waffling on
the advisability of activating the War Powers Act or wearing masks or other
protection. State
themselves performed very unevenly, with Washington and California near the top
and New York at the bottom.
Efficiency, excellence, as
presently defined and encouraged, provide a razor thin path to outperformance
as measured monthly or quarterly.
Just-in-time supply chains, “optimum” corporate capital structures, but
also litigiousness and diminishing accountability have steered the US into
dangerous waters
We have been drifting away,
and for a long time, from JFK’s appeal, that we “ask not what the country
can do for you, ask what you can do for the country”.
There is a cost to pay for
greater solidarity, greater focus on the essentials of life, stronger
structures, better safeguards; but the cost is even greater to look the other
way, as Covid-19 showed all of us.
[1] As of June 16, 2020.
[2] In Wuhan.
[3] This rare blow from nature was compounded by
Argentina having reneged earlier on gas exports due to distortions that its
policies had created in both its own demand and supply.
