By Harita Iswara and Zaina Padda
COVID-19 has infected the world, taken over millions of lives, and consumed minds. Still, some countries have fared better than others due to their ability to prevent or reverse many side-effects of the pandemic, for a number of different reasons. Countries including Russia and South Africa have been hit hard, while countries such as Thailand and Sri Lanka are getting by with less than five thousand cases. In the upcoming analysis, we will examine the responses of the 3 countries with the most cases and 3 countries with effective containment strategies to determine the factors leading to success and failure. We aim to determine what factors are leading to their success or failure: culture, politics, or people?
Case Fatality: 3.4%
Management of the pandemic in the United States has been extremely controversial. While some state and local governments have been dealing with the pandemic efficiently, maximizing public health and safety, the federal government has been criticized for a terribly poor system and method of managing the country during this time. The lack of communal responsibility and care for others, along with a gross politicization of the pandemic has caused the narrative and rhetoric around the pandemic to be very skewed and unproductive. According to Johns Hopkins, as of July 29th, the United States has had approximately 4,351,997 total cases, with 149,256 deaths. Though the US has the largest number of cases in the world, the attitudes toward and treatment of the pandemic have not reflected these statistics in a positive manner. The pandemic has become a debate over freedom with people enraged over enforcement of masks and other public health suggestions. This has sparked political arguments, conspiracy theories, and many other disputes over the virus. The American notion of freedom has long been a “me vs. you” attitude, with people (often hypocritically) saying that their personal freedoms are being stripped by the government. Although face coverings may restrict “personal freedoms” with interrupted social interaction, guidelines are in place to ensure the health and safety of others as masks mitigate the risk of disease transmission. The general distrust of healthcare workers has placed the United States in a unique position of citizens deciding whether or not they choose to take the disease seriously or not. We can see this in the swaths of people storming the Michigan state capitol with assault rifles to protest stay at home orders while doctors, nurses, sanitation engineers, restaurant staff and many other frontline workers risk their lives to keep this country running. In tandem with this individualistic mindset is the highly politicized concept that the country needs to recover financially, without considering the health risk to workers. President Trump, who has switched his position on the dangers of the virus, has been pushing to reopen the country, while many Americans are pleading for another round of stimulus checks and keeping restrictions in place. Additionally, school systems have to make decisions on opening for the fall and risking the lives of staff, teachers, and other employees, along with their students. The situation in the United States is volatile as cases spike, and people become restless wanting to return to pre-COVID times. While vaccine research could prove to be successful, the current situation does not present a positive outlook for what the future of the pandemic looks like. College students stuck at home, healthcare professionals working around the clock, small businesses suffering...is this the new normal?
Case Fatality: 3.6%
As of July 29th Brazil has had 2,483,191 cases of COVID-19, making it the country with the second most cases in the world. The transmission of the disease at the high rates at which it occurred in the earlier months of the virus’ presence in Brazil, was due to a spread locally within Brazil and not as a result of international travel. Though there were preventative measures, counter-practices taken, and regulations put in place in the earlier months of the pandemic, the Bolsonaro government began to repeal some of these regulations, resulting in a significant amount of backlash. Similar to the United States’ situation with the president refusing to adhere to social/physical distancing and isolation, President Bolsonaro dismissed the research and advice of medical and scientific professionals. The President contracted the disease in early July, and has intensified his rhetoric about the economic effects of the pandemic being more serious than the virus itself. The people of Brazil have been extremely critical of President Bolsonaro’s handling of the pandemic, as rural and indigenous populations struggle with poor health infrastructure and mixed messaging from state governments and the President. Premature lifting of regulations to reopen the economy also played a large role in the spread of the virus, with people being fed up with worsening financial conditions and taking advantage of the relaxed social distancing guidelines. There is some hope, though, with Brazilian scientists and medical professionals taking charge and working to develop treatments, regardless of the country’s political discourse, conspiracy theories, etc.. The Oxford vaccine is also in phase three of its trial in Brazil, with a thorough research approach and 5,000 volunteers, which brings greater hope of a COVID-19 vaccine in the foreseeable future. As the number of cases inches higher everyday, the conversation about how to combat the virus moves with it.
SARS-CoV-2 epidemiology and epidemic spread in Brazil.
Graph of daily confirmed new cases, outbreak evolution (showing only US, Brazil, India).
Case Fatality: 2.3%
As of July 29th, India has had approximately 1,483,156 cases of COVID-19. With a population of 1.35 billion, these numbers are a small percentage of the country’s total population, but the cases have been spiking, and there is a large disconnect between the cases reported and the actual number of infections. This can be attributed to the lack of large scale testing, with only 6,500 tests per million people as of early July. India seems to be an interesting case, however, because even with the uncertainty around the number of cases, India has had significantly lower deaths compared to countries with less cases, such as the UK for example. While this is somewhat positive news, there are many other concerns when it comes to public health in India. The country has been in a long and difficult battle with tuberculosis, a disease that has seen few solutions in India. A tangled healthcare bureaucracy and governmental mismanagement under Prime Minister Narendra Modi have hurt the country in its fight against TB, which brings up similar concerns for COVD-19. The worry has been that the government will be unable to handle the current pandemic properly, seeing as it has done relatively poorly with previous public health crises. The Modi government’s response to COVID-19 began with a 10 week strict lockdown of the country, which some experts believed helped stall the full effects of the pandemic. The economic and social effects of this lockdown were crippling, considering the size of the Indian economy and population. People experiencing homelessness and poverty were hit the hardest, unable to work, and migrant workers were displaced, and unable to return home. Economists predict that over 400 million people are at risk of falling deeper into poverty because of the pandemic. Additionally, the pandemic has had different effects in different regions of the country. As cities see numbers plateau, the virus has been spreading like wildfire into more rural areas. Though Indian culture prides itself on communal responsibility, similar to other Asian cultures, this has not translated into the effect of management of the pandemic. The socioeconomic, political and cultural divides between the North and the South (including language and religion) contributed to the noticeable differences between the number of cases between the two large regions earlier in the year. In late May, it was largely recognized that South India was sufficiently prepared for the onset of COVID-19 and swiftly responded, while states in North India only provided about 10 testing centers for a population of over 200 million people. Now however, the Southern states have become some of the hotspots for the virus. Nonetheless, the pandemic has taken a large toll on the country, and poses significant dangers to vulnerable populations.
Cumulative confirmed COVID-19 cases in Rwanda, New Zealand and Taiwan
Case Fatality: 1.4%
New Zealand has a significantly smaller population than the countries listed above with higher case counts, but that’s not the only reason for their low number of cases. Government leadership in New Zealand has assumed a direct role in reducing the number of cases and deaths in the country. At the onset of the Coronavirus outbreak, when there had been 100 positive tests, rigid lockdown measures were put in place. The greater population of New Zealand was admittedly supportive of this decision and willing to follow all imposed guidelines. People were urged to stay home, to not leave their house until absolutely necessary, and told to only directly communicate with people living in their own homes. In the wealthy country with an already thriving health system, testing was widely available, and thousands of tests were processed every day. The information provided by the World Health Organization was valued and always taken into account. Unfortunately, it’s widely recognized that the response to coronavirus in New Zealand would be very difficult to replicate in countries with larger, or more dense, populations. Jacinda Ardern, prime minister of New Zealand, was openly prideful of being a “coronavirus-free” country, and since that statement New Zealand has only encountered a small number of cases. Even with their extremely low number of cases, the people of New Zealand have remained attentive to the outbreaks throughout the world. New Zealand’s population is widespread and the government has effective control over who can enter and leave the isolated island. The Parliament in New Zealand quickly created tax reforms that would directly benefit small businesses. Government leaders also took significant temporary 20% pay cuts in light of the pandemic, to benefit their citizens.
Case Fatality: 1.5%
As of July 29, less than five hundred people had contracted COVID-19 and seven people had died in Taiwan, a small island composed of over 23 million people. In 2003, Taiwan had been devastated by Severe Acute Respiratory Syndrome (SARS) accounting for 346 of the 8,000 cases worldwide and 37 deaths. Taiwan’s government was prompted to create the National Health Command Center (NHCC), to facilitate an efficient and effective infectious disease response for the future. Taiwanese citizens also saw SARS as a learning opportunity for what coronavirus could become as one preventable death in Taiwan was one death too many. The Vice President at the time, Chen Chien-jen, having studied epidemiology at Johns Hopkins, was at the front lines for all of the government’s responses to the virus. This title provided him the opportunity to have political influence to help the greater population curb the number of cases. Chien-jen not only wants to help Taiwan, but he hopes to inform surrounding countries and governments of how dangerous this disease can be. Taiwan has been applauded for their rapid response to the outbreak, with the swift installation of testing facilities, regulation of temperature checks upon entry into hospitals and other public buildings, and the mandate of face masks. The 2003 SARS outbreak normalized wearing masks in public, so the recent mask mandate was not met with uproar, but rather seen as a sign of respect for one another. The Taiwanese government also took the responsibility of tracking individual’s travel history and sharing results with health officials for more comprehensive contact tracing through an application on their phones using “civic technology”, essentially allowing citizens to decide if they would like to participate or not. This software also provided the greater population with the ability to track down protective gear such as masks. Asian countries are known to have a stronger sense of communal responsibility, as demonstrated by high usage of this app, which is what made Taiwan’s outbreak controllable and created far less problems.
Case Fatality: 0.5%
Rwanda, a small Eastern African country of 13 million, has suffered a total of 5 coronavirus deaths. Rwanda is Africa’s most densely populated continental country, housing 1,000 people per square mile, and their economy had just started to slowly build, so how were they able to curb the amount of deaths from the global pandemic? Robots (yes, you read that right) and extensive contact-tracing. Before free nationwide testing was readily available, Rwandan citizens were placed in a lockdown to reduce disease transmission. Similar to Taiwan, Rwanda was ready to fight off coronavirus head-on due to their past actions fighting the Ebola epidemic. Handwashing stations were reimplemented outside of bus stations, and all border checkpoints were secured, to ensure there was no additional entry into Rwanda. Robots are used in “COVID-19 clinics” to ensure all people are wearing masks, to check patient’s temperatures, and to deliver food and other necessities to people quarantining-- effectively minimizing unnecessary human contact. In some laboratories, testing results can come back within a matter of hours. The Rwandan president, Paul Kegame, and government reacted to the coronavirus outbreak swifty and strictly, dramatically decreasing the number of cases and deaths of the population he rules over. In general, it’s been recognized that Rwandan citizens have complied with government restrictions in that they wear masks, don’t leave their homes for unnecessary travel, and practice basic hygiene.
In our decision to narrow down which countries to research, we chose countries, on both ends of the spectrum, based on how many cases they had. We faced issues on whether to discuss case-fatality rates, which is calculated individually for each country and is difficult to compare for countries with large populations versus small populations. We eventually found that having a higher population had no correlation to a larger number of cases, as demonstrated by the origin of the virus, China, who has a population of 2 billion, but has only encountered 86,990 cases. We concluded that the reason for larger or smaller COVID-19 case numbers is due to a mix of cultural and political implications as well as how the general population reacted.