Hacker News Reader

Comment by twblalock | Hacker News Reader

Any coherent explanation of this pandemic is going to need to explain why some countries that didn't do very much (e.g. Japan) ended up with far fewer deaths per capita than countries that locked down (e.g. EU countries and the United States).

Sweden is somewhere in the middle -- they are being criticized, yet other countries in Europe which locked down have ended up with a higher per capita death rate.

Why is it that Cambodia and other nations in southeast Asia have negligible deaths despite doing very little to combat the virus, while countries in the EU which locked down have way more deaths per capita?

Somehow the models about the spread and death rate of this virus seem to differ on a geographical basis, and that needs to be explained.

At this point, any analysis of the pandemic that does not attempt to tackle this problem is selectively ignorant.

View on HN

It’s not about comparing policy from the top down but rather comparing public opinion of the virus from the bottom up.

Asian cultures have take the virus much more seriously than European cultures and regardless of government policy that is going to be a major determinant of how much the virus spreads.

Put in another way, two countries can apply the exact same policy against the virus but have diverging outcomes because of public opinion of the government, of the virus, and of their fellow citizens.

How do you explain the differences in outcome between European countries, or even just between the Scandinavian countries?

Geography is part of it too. Some countries are densely populated, and some aren't.

And echoing the comment about behaviour, the difference between the culture of say, Norway and Britain, is vast in some respects.

Or even the likes of Germany and Italy, which are neighbours.

> Germany and Italy, which are neighbours.

I think Austria and Switzerland would like to have a word with you.

Yes. You're right.

But if you travel to North Italy in the summer, you see so many cars with German license plates, you wonder about the geography!

I stand, corrected.

There's even big differences on Covid death rates within Switzerland's German-speaking, Italian-speaking, and French-speaking regions. Much higher death rates in the Italian and French parts than the German part [0].

One explanation could be different cultures, or just geographical proxomit to Italy and France that were harder hit than Germany and Austria. This would also explain that Germany has higher rates in states that are close to the French border.

0: https://en.wikipedia.org/wiki/COVID-19_pandemic_in_Switzerla...

It's not strongly related to any of those things. The situation would be very bad in Norway/Denmark too if we didn't react like we did.

Compared to both Sweden and Britain, Norway reacted quicker and harder, with way more testing than most other countries. As it got out of hand, even more restrictions like shutting down a lot of business types, public transportation, schools and travel was added. Working from home was also recommended and used by basically everyone who could. Long after this happened in Norway, things where mostly as usual in both Sweden and Britain, despite the number of infections climbing fast.

> Germany and Italy, which are neighbours.

This is new to me :)

Your point stands of course..

Yeah. I shouldn't be using experiential or anecdotal evidence to inform my understanding of geographic borders!

System 1 thinking in action.

My partner (American w/ Chinese parents) strongly believes a major difference is the sense of collective responsibility in Asia. A kind of deferral of individuality to benefit society.

Fine, but how does that explain disparities in outcome between European countries?

A German college truly believes that this virus was created by Adolf Gates to enrich themselves with the pandemic while helping China destroy the German economy.

The scene around conspiracy theorists Heiko Schrang and Attila Hildmann sure is fascinating. Wearing masks is the ultimate evil to them, for some reason.

Collectivism/individualism and obedience towards the state/authorities are very different within EU as well.

There are singificant cultural differences. According to an italian friend of mine many italians disrespected the distancing measures, plus there are differences in how closely people generally interact and their living situations.

It doesn't, and it doesn't need to for it to be true.

And that's the case with Sweden too. What many foreigners, incl media abroad, does not realize is that Swedens reaction was not that different to other European countries in terms of goal. Flatten the curve. In terms of means it differed, it uses recommendations. But people trust government much more than other countries, so in practice the life of many Swedes was restricted very similar to other countries.

It's just wrong to say they are being "lax" here. If any other country would have tried the same means, it would hve failed utterly. Just as you say -- two countries doing the same policy could get very different outcomes.

> countries that didn't do very much (e.g. Japan)

They already had masks on when others questioned their effectiveness and to this day, 95% people wear masks outside.

They have hand sanitizers on pretty much every shop entrance and chairs are placed with certain distances apart.

They don't wear shoes at home and public spaces don't have litters all over.

They don't hug and kiss frequently like some countries do.

Some stop visiting restaurants when they read news that daily infection count goes over 100. (Not 10,000.)

Apparently they don't riot shouting in the middle of the outbreak.

How about that they have been acting clean before covid happened and government not exactly handling the situation strictly wasn't really the cause of the difference in death rates?

Also interesting is that they have a train system with packs of people squashed in a cabin but the infection rate is still low and someone needs to prove/disprove the BCG vaccine theory.

> They don't wear shoes at home and public spaces don't have litters all over.

I might be missing something, but what does this have to do with COVID?

It means, whatever you have stepped on outside, you don't just spread it all over your house... Maybe you don't step on Covid infected materials but who knows? It's just another possible source.

Stepping in something isn't going to infect you.

> They don't wear shoes at home

Who wears shoes at home? Especially their normal, outdoors, day-to-day shoes?

Pretty much all of that aside from the masks apply to Sweden as well.

Demographics of the population, when countermeasures were rolled out, how severe those were, reporting errors, reporting standards (and changes to those standards as the pandemic progressed), how wealthy / healthy the country is, how much IC capacity they had relative to the size of the population, whether they had a pandemic plan already in place, previous experience with pandemics, initial number of infections prior to planned approach, temperature, humidity, culture of handshakes, prior mask wearing, genetics and so on. This is going to be a very complex problem to get a grip on in such a way that the model does not end up to fit the available data (in other words: that it would not have much in terms of predictive ability).

> some countries that didn't do very much (e.g. Japan)

Japan had a strong preexisting culture of wearing a mask when going out in public if you're the slightest bit sick.

> countries that locked down (e.g. EU countries and the United States).

The early EU countries (Italy, France, Spain) and the US didn't lock down until far too late when their local epidemics had already spiraled out of control.

The US in particular locked down far too late, too little, and has now re-opened despite still having a huge number of active cases and community transmission. On top of that, it sounds like a large number of people there are still refusing to wear masks.

> Why is it that [...] nations in southeast Asia have negligible deaths

I'm less sure here but I'd guess it's a combination of age demographics (fewer very old people who are most likely to die of the virus), lack of testing/reporting, and higher overall death rates due to disease which masks the effect somewhat.

yeah, i think the cultural aspect can not be ignored!

The stereotypes of some cultures being more cold and wanting to keep their distances is grounded in reality. In e.g. france or italy having very close contact for example when greeting is the norm. I can imagine that it helps to spread the virus.

Others don't have to adjust too much.

Good point about greetings. Places where people get all over each others' faces to say hello have had a worse time of it than places where people bow politely from a distance.

> Sweden is somewhere in the middle -- they are being criticized, yet other countries in Europe which locked down have ended up with a higher per capita death rate.

According to this [0], Sweden is 5th in Europe but given that you have Italy (first outbreak in europe), closely followed by the second, Spain and the incompetent response of the UK Government, this only leaves Belgium, which seems to count pretty much all deaths.

In other words, not a great showing at all

[0]https://www.worldometers.info/coronavirus/#countries

Based on the ideology of the lockdowns, Sweden ought to be the worst in Europe, but it’s not. If Italy waited too long, then Sweden waited even longer! Where is the apocalypse that was predicted? Sweden being in the middle of the pack, despite not locking down when others did, is hard to explain.

This is a very complicated topic that involves things like trust in government, sense of community, etc ...

Lockdown is a last resort measure, not the first response.

All things considered, Sweden is doing remarkably well but if you compare it with its scandinavian neighbours rather than with Italy or the UK then things look appalling.

You have to look at where in the population the deaths occur in combination with policy and cultural behavior.

In Sweden the wast majority occurred in elderly care homes located mostly within strong mass transportation distance. (The image in the article is almost ironically capturing the wrong demographic in the wrong location in the wrong part of Sweden, in a time period after the one for which they base the article, but it is eye catching so for nytimes I guess that is the editorial guidelines that they will use).

Japan with a large portion of the population being elderly, and with a strong mass transportation system, I do wonder why they have so few deaths. Maybe they imposed very strict testing and restriction for all workers getting anywhere near such places? Maybe they use a lot of automation in elderly care resulting in significant less human contact and exposure? Cultural difference?

Finland did one thing that Sweden did not. They closed the capital. No one in, no one out. I am not sure how the elderly care homes outside that zone managed in regard to finding replacement for employees, but it seems to have been an effective measure. They also seem to have implemented rules for zero visitors.

Apart from clear differences in how people act in public spaces when sick, and countries "count" differently.

For instance, in Denmark, each and every dead person that is tested positive for Corona virus, count towards the death toll, even if they died from something obviously different. Even dead people is sometimes tested. It's not the same in all contries.

We will not have the full picture until we analyze the excess mortality rate on the other side of the pandemic. Then we can start to see what did the countries lowest excess death rate per capita do different.

> Apart from clear differences in how people act in public spaces when sick, and countries "count" differently.

The only solid metric for COVID-19 deaths is excess mortality, that is, the actual number of deaths - the statistically expected number of deaths (e.g. extrapolating from the last 2-5 years).

This metric is independent of testing capacity and malicious actors like politicians just outright lying to the public to try to save face. You can "hide" dead people, but doing so is much harder than hiding COVID-19 related deaths.

You can't conclude from this metric what the source of all these extra deaths are, but if they are not caused by COVID-19, every alternative explanation I can think of is even worse than a global pandemic.

https://ourworldindata.org/excess-mortality-covid

https://www.economist.com/graphic-detail/2020/04/16/tracking...

https://www.ft.com/content/a26fbf7e-48f8-11ea-aeb3-955839e06...

https://euromomo.eu/graphs-and-maps/

I get it that this metric sounds to be the only good one, but lockdowns surely have minimized certain other deaths (car accidents, etc.). Thoughts? (Haven't read the links, or articles, so it might be mentioned there)

The data shows that these two do not balance each other out. Otherwise there would be no excess mortality, or it would be negative, i.e., less deaths. From just looking at this metric, we can't tell - but other metrics like car accidents per month per capita do show that this is the case.

One interesting thing is that COVID-19 lowers the mortality rate in the mid-to-long term. It disproportionately targets the weakest, so in the next couple of months and years, less people than the expected average will die, because the weakest are already dead, and that will lower the mortality rate per capita for one generation at least. At some point, it will hopefully raise again, and that too will be due to COVID-19, because the reason for that will be that we wouldn't have a recent-enough COVID-19-like event.

---

Point being, one should be careful when comparing mortality rates and absolute death counts. One needs to factor in both to get the full picture, and for rate, the period over which the rate is computed is very relevant.

> Why is it that Cambodia and other nations in southeast Asia have negligible deaths despite doing very little to combat the virus, while countries in the EU which locked down have way more deaths per capita?

One possible explanation for this is the kind of strain carried by the index case(s).

There are dormant strains and there are virulent strains of the virus, so the kind each country gets determines the kind of symptoms and this in turn shapes the initial reaction of their health care system.

You may find this analysis interesting as it looks at that exact question: https://unherd.com/2020/06/karl-friston-up-to-80-not-even-su...

Any coherent explanation of this pandemic is also going to need to wait until the pandemic is finished. It is totally possible that there will be no vaccine and COVID-19 is just an ongoing thing for the next 70 years.

If that is the case, how much can the lockdowns really help? I'm on board with slowing the disease down and giving the medical community 6 months to get their bearings. But it has now been 6 months and the question is "what is going to change going forward?".

We know we can't make vaccines on demand - we still don't have one for herpes afaik.

Demographics explains most of differences. Ghettoes, density, and culture seems to explain the rest.

Reply on news.ycombinator.com