What can we Learn from Other Countries?

Previously, we had looked at the Scandinavian countries (Norway, Sweden, and Denmark) and Germany and Austria who seem to be faring better than average to see if we could then find some best practices to improve our fight against COVID-19.  Other smaller countries such as Singapore, Taiwan, and Hong Kong should also be examined for best practices but they may be less applicable given their much smaller size and structural differences from us.  However, we made the additional argument that if the US adopted a divide and conquer approach and broke the big problem (US) down to smaller and more manageable regions (MSAs), the smaller country best practices may then be examined and adapted.  Finally, South Korea should be singled out for their excellent performance – they have their outbreak under control in record time with a very low overall mortality of 1.1%.  Their early and decisive response as well as their excellent healthcare system (12.27 hospital beds per thousand population) served them well. 

Today we want to focus on the other half of the coin:  countries that are clearly faring worse than average and see what we can learn not to do.  Italy is the prime example whose death count surpassed that of China today.  Clearly, our hope is to avoid becoming another Italy – it would be a disaster that the US may take decades to recover from.  Italians are handicapped by 2 major shortcomings: a significantly older population especially in Northern Italy where the infection started, and (2) an inadequate amount of hospital beds per million population of 3180 that quickly got overwhelmed.  Moreover, their very sociable citizenry did not adopt social distancing quickly and forcefully.  One caveat, the measured mortality rate may be higher than the actual mortality rate especially for countries with overwhelmed health systems because they fall behind in testing and less serious cases do not get counted as confirmed cases increasing the apparent measured mortality rate.  This early indicator may need to be adjusted after the peak infection has passed and the infection controlled.  

Country	Infections	Infections	Deaths	Mortality	Mortality	H Beds	Median
	/million			Coincident	Lagged5	/million	Age
Italy	677	41,035	3,405	8.3%	16.0%	3180	45.5
Switzerland	483	4,133	43	1.0%	2.7%	4530	42.4
Spain	386	18,077	831	4.6%	12.8%	2970	42.7
Norway	331	1,790	7	0.4%	0.6%	3600	39.2
Iran	220	18,407	1,284	7.0%	10.2%	1600	30.3
Denmark	199	1,151	6	0.5%	0.7%	2610	42.2
Germany	183	15,320	44	0.3%	0.9%	8000	47.1
France	169	10,995	372	3.4%	8.1%	5960	41.4
South Korea	166	8,565	91	1.1%	1.1%	12270	41.8
Sweden	143	1,439	11	0.8%	1.2%	2220	41.2
China	57	80,928	3,245	4.0%	4.0%	4340	37.4
UK	48	3,269	144	4.4%	17.4%	2500	40.5
U.S.	40	13,289	183	1.4%	6.0%	2770	38.1

Italy is not the only country with a cautionary tale to tell.  Others that appear to have double-digit mortality rates include Iran, Spain, and the UK. 

Iran is in a unique situation and no one seems to be 100% sure of their data.  We calculate a best guess lagged5 mortality rate of 10.2%, but suspect that they are hiding the full extent of their sorrows – burying their dead in huge unmarked trenches.  They do have the benefit of a very young population with a median age of 30.3 years – the lowest of all the countries we are tracking.  Two shortcomings far outweighed their relative youth: (1) an unwillingness to accept the truth until it was too late to act and (2) a poor healthcare system with only 1600 hospital beds per million population which clearly got overwhelmed. 

Spain has a lagged5 mortality rate of 12.7%.  They really had few excuses not to react more forcefully sooner.  They encountered their first case on January 31, the same day that Italy did.  And they were additionally fortunate that the outbreak did not become serious until February 25th, nearly 4 weeks later.  Spain, along with other EU countries could have been saved if they dropped the EU open border policy during that period and enforced strict travel restrictions.  They did not have to let their infection run amok.  Now their future looks as bleak as that of Italy.  Their hospital bed count is similar to Italy while their median age is younger than Italy’s. They did not take advantage of their forewarning.

Finally, the UK is another infection that need not have run amok with a mortality rate did not have to be as high as 17.4%, a lagged5 estimate that is worse than even Italy’s.  Much of the blame can be laid at Boris Johnson’s feet who decided that it was OK to adopt the “herd immunity” concept for humans.  This essentially argued that it was OK if they did nothing since after a while the remaining population would have enough people with immunity that the pandemic would stop by itself.  Those who survived would make for a stronger herd.  As soon as people realized that this is what the government was doing they rebelled and the government had no choice but to act.  To be generous, more likely they did not act quickly and when questioned searched for a viable theory for their inaction and then decided oops the theory sounded too brutal.  It really doesn’t matter - they acted way too late.  Now their low hospital bed count of 2770 per million will negatively impact their mortality rate.    

One fatal mistake that all these high mortality countries made is recognizing the problem too late and reacting too timidly.  Unfortunately, these are two mistakes we have already repeated in the US.