The West’s Failure to Vanquish Covid
“This is a national emergency, this is a war that we’re in, and instead of putting generals in positions of power, we’ve deferred to academics. Imagine in World War II, if that was how we treated it all — that we couldn’t make a single mistake” (Michael Mina, Harvard epidemiologist)
Europe – by which we refer to the 27 separate and unique nation-states which compose the European Union – is now in its third wave of the coronavirus pandemic, battling a virus which has mutated into a more transmissible and lethal form. While such a turn was not inevitable, it can happen that a virus becomes more – rather than less – lethal as time passes, and that’s what apparently has happened.
The piece we discuss in this post, “How the West Lost Covid” (David Wallace-Wells), is the best retrospective we’ve read on the almost-universal failure by the “rich West” to confront the virus successfully in the past year – and how a handful of countries bucked the trend and largely succeeded in eradicating it from the start.
There are no easy explanations, though, for how some rich countries have suffered far more than others: climate, demography, the presence or absence of nationalized health care systems, infrastructure – every example has a counter-example. Take California vs. Florida: one state imposed strict lockdowns and closures and masking requirements fairly early on, while the other partied on into late spring 2020 as if nothing was amiss. A year into the pandemic, the two states’ statistics aren’t all that different, and California was ravaged by the virus last fall, when Californians can still be outside and require neither heating nor air-conditioning.
A significant contributing factor to the West’s failure, however, was its failure to act proactively. Perhaps due to inexperience with large-scale epidemics which threaten to become pandemics (the SARS outbreak in 2003, Ebola), perhaps out of arrogance both scientific (“Our sophisticated, advanced medical infrastructure can handle it”) and cultural (“Our citizens would never submit to a total lockdown/shutdown”), the West dithered throughout January 2020, when the images from Wuhan were illustrating what our future would be like if countries didn’t take prompt action.
The “West” (= the EU and U.S. primarily) went first into denial, then into a sort of fatalistic capitulation mode, convinced that there was nothing to be done except to tough it out and hope for the magic bullet of one or more vaccines. This, however, is not how you confront a global pandemic: the attitude has to be one of full-out war against a common enemy; for the zillionth time, viruses have no respect for national borders, especially in an age of globalization. The only thing they succumb to is the total eradication approach: zero COVID.
Across the EU, with the exception of the outlier countries of Finland, Norway, and Iceland, the failure not just to eliminate but even to contain COVID is more or less a general one – and although the U.S.’s enormous caseload and number of deaths seems incomprehensible, in terms of cases/deaths per million, the U.S. is near the EU average (Spain, France, Italy; the UK, Portugal and the Czech Republic all have higher mortality rates). There are plenty of reasons to be puzzled by why the world’s wealthy West basically surrendered ab initio in a war against an unseen but deadly enemy – the war metaphor, so frequently employed with disease (“fighting cancer” “conquering polio”) is the most appropriate one in a pandemic, and countries which viewed it as such from the outset and adopted the goal of total and complete defeat (eradication, not containment) had incomparably better outcomes: South Korea, Taiwan, New Zealand, Australia.
On the other hand, it must be said that the countries which succeeded in eliminating or nearly eliminating the virus did nothing terribly different than those that failed – Peru instituted draconian measures and has been devastated by the coronavirus. And the number of factors that might be in play (including chance [stochasticity], demography, distribution of comorbidities, geography, a country’s location, its neighbors, and its place in the global travel network, climate, the presence or absence of air conditioning, residential density, blood type, ICU capacity, proximity to bats and so on) is high. But nearly every factor that would seem to have contributed to a higher infection and mortality rate in one country can be countered by the absence of that factor’s significance in another – take the case of Japan, for example, whose population is elderly and whose proximity to China seemed at best dangerous, at worst fatal: Japan has managed the pandemic successfully – perhaps not at the level of New Zealand, but its caseloads have been far lower than the West’s despite an aging population, location, an only partial lockdown and an absence of mass testing. England, like New Zealand, is an island, but is the hardest-hit country in the world. Experts can’t explain all these discrepancies.
There is a lot about this disease which just seems chaotic – unpredictable, surprising, and alarming to many medical academic scientists, who seek predictability even in its absence. However, national outcomes can be classified in three broad categories:
- Europe/North America/South America: failure
- Sub-Saharan Africa / South Asia: high caseloads, low death rates (due to demographics?)
- East Asia / Southeast Asia / Oceania: resounding success
While there are variations in success within each category (Canada did better than the U.S.; Uruguay did better than Argentina, etc.), the biggest predictor of how well a country has succeeded against the virus is its location on the world map.
Consider the death rates per million in each of the three categories:
- UK: 1,800; U.S.: 1,600; Sweden: 1,300; Germany: 900
- New Zealand: 5; Australia 36
- Taiwan: 0.42; Cambodia: 0; Vietnam: 0.36; Singapore: 5; South Korea: 32; Japan: 67 (despite an elderly population and the absence of strict lockdowns)
There are two issues here worth noting: first, while the virus originated in China, its Western origin was Northern Italy – and the mutation that infected the West came from there (the U.S. Eastern seaboard was infected with the “Italian variant”). Italy was heavily and fatally infected before it even knew the virus was present. (A question which seems worth asking is: How did the virus reach Northern Italy? – it’s one Wallace-Wells doesn’t address, but we think it’s an important one.)
Secondly, the attitude towards China when it locked down Wuhan – a “super-affluent” city of 11 million people – is characterized as “pandemic Orientalism”: “The disease was dismissed as a culturally backward outgrowth of wet markets and exotic-animal cuisine, and the shutdown was seen not as a demonstration of extreme seriousness but as a sign of the reflexive authoritarianism of the Chinese regime.” In fact this wasn’t the case – China, all rumors and biases to the contrary, is not in the habit of forcing millions of people into lockdown.
One thing that would have helped in the very first stages of the virus’ trajectory: a global travel shutdown – yes, global. It would have given the West a reprieve at the very least – a chance to go into full pandemic preparation mode (to gear up for testing, tracing, and isolation, and to stock up on PPE), and if it had occurred early enough, might well have averted what followed. And it needn’t have been an endless shutdown – several weeks might well have halted the virus’ spread to the West (and the rest of the world, for that matter).
Even after COVID arrived in Europe, many European countries (and of course the U.S.) chose a state of denial. What were leaders thinking? They hesitated to impose strict lockdowns and travel bans early on, not wanting to “dis-accommodate” their residents – or, perhaps more importantly, adversely impact “business.” When COVID was first detected in the state of Washington on the West coast, the East coast dithered – despite Governor Cuomo’s reputation as a “COVID hero,” the lockdown in NYC came too late, and there was nothing that could have saved the city by that time. And states that eventually shut down all opened up too quickly – again, the goal seems to have been quasi-“suppression” or semi-“containment,” never “eradication.”
So firstly: EU countries and U.S. states acted too late. And their shutdowns (which were never total lockdowns), which advised “hand washing, social distancing, and mask-wearing,” were not accompanied by the other triplet of measures that most successful countries employed: “testing, tracing, and quarantining.” The U.S., for example, should have been testing around 25 million people a day last spring; it barely ever made it to 2 million (and seems to have given up on general population testing now). Without massive testing, contact tracing and quarantining became pointless. It’s been quite amazing to witness the second triplet of measures only partially-embraced and eventually abandoned in the U.S. (and elsewhere).
A good number of EU countries did well initially with strict, extensive lockdowns; since cases were in decline (there was no discussion about eradication) by early summer, the EU decided – too early, as it turned out – to open its borders for vacationers in July – September. Now they’re vowing to do the same thing this year, with discussion of a “Covid passport” to allow (vaccinated) vacationers to pretty much go where they please. In the EU, where vaccine supplies and consequently, vaccination rates remain alarmingly low, this sounds more like a (dangerous and deluded) pipe dream than a plan.
So what was the West thinking (assuming they were thinking at all) a year ago? Essentially, the West decided to sacrifice a few million people on the altar of keeping their economies as open as possible in the hope of the rapid discovery, approval, production and distribution of a vaccine – the modern-medicine obsession (“magic bullet”) that characterizes the rich West.
On March 13, 2020, Michael Ryan, the WHO’s Executive Director of health emergencies – a man who’d spent his career fighting Ebola outbreaks – was asked what lessons he’d learned:
“What we’ve learned through the Ebola outbreaks is you need to react quickly. You need to go after the virus. You need to stop the chains of transmission. You need to engage with communities very deeply — community acceptance is hugely important. You need to be coordinated, you need to be coherent.
With respect to the coronavirus:
“Be fast. Have no regrets. You must be the first mover. The virus will always get you if you don’t move quickly… If you need to be right before you move, you will never win. Perfection is the enemy of the good when it comes to emergency management. Speed trumps perfection. And the problem in society we have at the moment is everyone is afraid of making a mistake, everyone is afraid of the consequence of error. But the greatest error is not to move. The greatest error is to be paralyzed by the fear of failure.” (Emphasis added)
In sum: what did differentiate the three broad geographic categories above was speed and intensity of response. When every day counted, the West let literally weeks – about nine, 60+ days – pass without acting decisively and in a coordinated fashion. From modern historian Adam Tooze, who is writing a book on the pandemic:
“Either you control this early on, in which case the trade-offs are relatively manageable and all sorts of conventional things make sense, or you don’t and you end up in a space which really no advanced polity’s decision-making process is very good at coping with. And so then it’s really a matter of degrees of failure across the board.”
With respect to how the U.S. in particular confronted COVID-19 in the early days, it was one PR disaster after another – and the President was by no means the only one to contribute to this. Dr. Anthony Fauci continued to insist throughout February that the virus was relatively unthreatening, like the flu, no cause for alarm, etc. – what was he imbibing, exactly? The Governor of New York has admitted that what he was most concerned about was not the virus, but panic among the populace – in other words, “Stay calm, everybody. Cuomo’s in charge.” But in fact, controlled panic is a pretty sound response to an invisible and insidious enemy – you’re under siege, and playing it cool just won’t cut it.
Fauci, Trump, and Cuomo weren’t alone in their blasé confrontation style – the media were complicit and in retrospect, the Times and Post and other major outlets should be ashamed of writing stuff like “beware the pandemic panic” (Times), “we should be wary of an aggressive government response to coronavirus” (Post), and “Coronavirus Is Scary, but the Flu Is Deadlier, More Widespread” (USA Today). Alas, to the enormous detriment of the U.S. – and at the cost of more than half a million lives in the pandemic’s first year, “the cause of the alarm was picked up not by those in positions of social authority or with the power to enact preparatory measures but by a rogues’ gallery of outsiders and contrarians” – in other words, cranks and doomsday types with no access to power.
None of the early measures that would have stopped the virus in its tracks were imposed early enough or rigorously enough to succeed – just recall the testing debacle, the failure to set up contact tracing on a massive scale, and what basically was just a theoretical wave in the direction of quarantining and/or isolation. The U.S., acting too late and too disjointedly (if there’s one justification for a national public health policy in a country like the U.S., it’s a pandemic threatening to decimate your population and destroy your economy), eventually had to employ lengthy lockdowns which succeeded only in part – this, because they were never full lockdowns, and because they were meant to be employed in conjunction with the other measures, not independent of them. The loss of life and damage to the economy (770,000 people filed new unemployment claims in the U.S. most recently, the 52nd week in a row that claims have been higher than their highest point in the 2008-2009 financial crisis / recession) is incalculable, with whole sectors knocked out – aviation, tourism and the hospitality industry, restaurants- bars, the performing arts.
Another issue in the U.S. (and not only) is the blinkered focus on, and worship of, scientific, individual-centered, research-driven medicine. It’s a system focused on absolute knowledge and certainty, on testing hypotheses and confirming results, rather than on broad-stroke policy decisions which rely on back-of-the-envelope calculations and rapid action, as was required. Even today, Western leaders – including medical authorities and policy gurus – would rather not act than act and be wrong. But by not acting, they’ve been wrong all along.
The precepts of (Western, enlightenment-inspired, experimentally-driven) medicine have been followed throughout the past year, rather than the precepts of public health, which is often viewed by the medical establishment as a poor (literally and metaphorically, as events proved) step-daughter of medicine. But it’s not – its values and approaches to pandemics, including dealing with masses of people are fundamentally different. The U.S. has noted that, for example, the elderly are far more vulnerable to the virus than others – but public health acknowledges and addresses the fact that one major factor that makes the elderly vulnerable on a mass scale is that so many live in congregate, enclosed, poorly-ventilated and inadequately maintained settings, viz. nursing homes and assisted care facilities. This acknowledgement demanded an entirely different approach. The same goes for all those living in congregate facilities: prisons (jails, state and federal prisons), institutions for the disabled, homeless shelters, and ICE facilities on the southern border. The wealthiest senior citizens without significant co-morbidities could afford to shelter in place and self-isolate – and most of the advice was aimed at this privileged group. For some mysterious reason, the U.S. (and other Western nations) thought that human beings could be forced into isolation, despondence, and depression for a year or more by shaming. Public health experts know that shaming doesn’t work – it may succeed with some small number of people (who didn’t need to be shamed in the first place) for a year, and with a larger number for a few months, but with each successive cycle of lockdowns and re-openings, people become less subject to shaming and therefore, less compliant. People will congregate in secret at homes, they’ll walk along a seaside promenade in droves and throw caution to the winds, they’ll attend protests, thereby counteracting the very measures their government is trying to enforce.
“[W]e have to think also a bit with sustainability in mind. How do we communicate with people? What is the goal? What is the plan? Because I think there’ve been times when it felt like we were a little aimless as a country — just sort of muddling through. At least we should, you know, have a goal” (Natalie Dean, biostatistician, Univ. of Florida)
What, exactly was the goal of the West in its confrontation of the pandemic? Eradication – certainly not, that was seen as impossible; suppression? perhaps, in a few cases; containment? maybe. But mostly it seems to this writer to have been “Let’s cross our fingers, shut our eyes tight, and hope for a vaccine.”
Now we have several vaccines – shutting one’s eyes, crossing one’s fingers and going into full denial mode seems to have worked if you ignore the loss of 538,000 U.S. lives [as of March 17, 2021] and the destruction of the U.S. economy. The EU, sclerotic to the bitter end, played it coy with advance vaccine purchases; it was slow to place orders and haggled over prices. That meant that it’s not getting the supplies it needs, and thus, the vaccination rollout is embarrassingly slow. “Vacation Europe” wants to re-open – Greece has announced it will open to foreign tourists on May 14 to take advantage of its five-month season, which it couldn’t do in 2020. Along with other summer destination countries (Spain, Italy), Greece is pressing for a COVID passport system to allow vaccinated travelers into the country.
But it’s very doubtful that at a rate of fewer than 1 million people a month being vaccinated (around 30,000 daily), Greece will be anywhere near vaccine-induced herd immunity by May – just in terms of sheer numbers, it would require 8 months to vaccinate 8 million people (out of a population of just under 11 million), putting that goal near the end of August – and that’s assuming that the vaccine supply holds steady.
In the meantime, variants are multiplying daily – and it stands to reason that one or more – perhaps many – will evade the vaccines developed to date. What then?