[WSMDiscuss] East Asia has handled the C19 crisis better than the West on nearly all metrics: are there lessons?

[Brian K Murphy]

~ apologies for crosse-postings ~ 

https://asiatimes.com/2020/05/why-east-beat-west-on-covid-19/ <https://asiatimes.com/2020/05/why-east-beat-west-on-covid-19/>
Why East beat West on Covid-19

East Asia has handled and contained the pandemic far better than the West on nearly all metrics

by Andrew Salmon <https://asiatimes.com/author/andrew-salmon/>   Asia Times, May 15, 2020
Perhaps the most startling trend visible in the global Covid-19 pandemic is the vast differential separating East Asia from the West when it comes to the disease’s impact.

The chasm is visible – indeed, is impossible not to notice – when examining infection and death rates in either gross or percentage terms.

Very clearly East Asia, defined as the Sinic or Sinic-influenced nations of China, Japan, South Korea, Taiwan and Vietnam, has done better than the West on virus management.

Why?

In Part 1 of this two-part series, Asia Times examines social habits and social culture, attitudes toward authority and privacy and recent historical and epidemic experience in weighing the discrepancy.

In Part 2, we will examine political leadership, policy responses, geographic integration, vaccines, manufacturing capacity, virus mutations, race, weather and climate as influencing factors and finally arrive at a multi-variable answer to this crucial East versus West question.

The Covid-19 riddle

Unlike most infectious diseases which register their highest mortalities in the developing world, Covid-19 has wreaked its greatest havoc among the world’s richest nations. The “East-West” cluster of nations – Europe and North America on the one hand, and Sinic East Asia on the other – represent the globe’s three key zones of economic activity.

But the reasons for the massive disparity in Eastern and Western pandemic management metrics are no simple matter to analyze. The variables are countless.

Take governance. In the East, the political structures of authoritarian China and Vietnam, on the one hand, and of democratic Japan, South Korea and Taiwan on the other, are diametrically opposed.

Or, consider policy responses. In the West these have varied from country to country, even within the supposed unity of the EU, and state to state in the United States’ federal union.

Moreover, no two countries share identical healthcare systems or demographics. And there are almost certainly discrepancies in data due to differences in test regimens, test efficiencies, reporting practices, methods of assigning cause of death to Covid-19, and so on. Yet even the briefest glance at the numbers reveals a stark macro trend. East Asia has been far more adept at pandemic management than the West. This runs across all key metrics and by massive differentials.  

The list of the top 10 nations for infections, according to data collated by Johns Hopkins University <https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6>, is a roll call of the biggest, most prosperous and influential Western countries. The US is in the number one spot, with the UK at number 3, Spain at number 4, Italy at 5, France at 7 and Germany at 8.  

The virus originated in East Asia, but no East Asian nation makes the top 10 list. The world’s most populous nation, China, is in 11th place. The East-West divergence in fatality rates is even starker.

China (population: 1.3 billion) has suffered 4,637 dead. Japan (population: 126 million) has lost 678. South Korea (population 51 million) has lost 260. Taiwan (population: 23.7 million) has lost only seven. Vietnam (population: 95.5 million) has registered zero deaths.

Western mortalities are on a vastly different order of magnitude.

The US (population: 328 million) has lost 84,118. The UK (population: 66 million) has lost 33, 264. Italy (population 60 million) has lost 31,106. Spain (population 47 million) has lost 27, 104. France (population 67 million) has lost 27, 077 and Germany (population 83 million) has lost 7,861.

In other words, Germany, at the bottom of the Western list, has nearly double the deaths of China, at the top of the East Asian list.

Or, take another metric – deaths per million of population – from a different data set, collated from JHU, the WHO and other sources by website Real Clear Politics <https://www.realclearpolitics.com/coronavirus/>. It shows a similar East-West chasm.

Spain’s mortalities per million are 580.1, Italy’s 514.7, the UK’s 499.1, France’s 404.2, the US’ 260.4 and Germany’s, 94.8. Meanwhile, Japan’s are 5.4, South Korea’s 5.0, China’s 3.3, Taiwan’s 0.3 and Vietnam’s zero.

To be sure, China’s data is frequently questioned by those on the political right, and Japan’s by those on the political left, but the two countries’ Covid-19 tolls are broadly in line with East Asian (and Southeast Asian) trends, suggesting greater accuracy than doubters might like to believe.  

Culture and communalism

These data results confound expectations. On the macro level, East Asia has bigger cities and higher population densities. On the micro level, it has a culture in which food is shared from communal dishes.

Moreover, the Western nations cited above are fully developed, prosperous and middle-class – as are Japan, South Korea and Taiwan – but China and Vietnam, despite their rising economic status, are still lagging behind on a GDP per capita basis.

So what has the East done right and the West wrong? Naturally comparison demands generalities, but even detailed variables are fiendishly difficult to dissect.

Take age, a key risk factor for Covid-19. One reason Italy was believed to have suffered so severely early in the pandemic was because of its demographics: the world’s second oldest.

However, Japan, the country with the world’s oldest population, has seen a Covid-19 death rate 45 times lower that Italy’s.

Moreover, the percentage of aged persons living at home, rather than in specialist care homes, is similar in both countries: 96% in Italy and 94% in Japan, according to a study.   <https://watermark.silverchair.com/26-suppl_2-3.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAokwggKFBgkqhkiG9w0BBwagggJ2MIICcgIBADCCAmsGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQM4ijsUNcg5_kqatVoAgEQgIICPHsNJYn6cNlN-VUXDHPyMdQmLikr7VfgIamdIU7X5wq_Pz6KUo79BcoAlJcCfWgsU9WGd9e_GM0qcc8A7u8MUUqIY35UenLQNP1cjRrJ8V0QgXHgVQQ4ZhNoycrJ5zoPMwTCuhQrn9LYuXulegXrzFPILG3DPKmLAk7LD6TFkknl5wRSfTqv8aa6aacjD8njgLdA4WlyHLOBE3-r9Rh6gD8gO1enxskfyimwpiHEFyPwu_RNkWYyga4QMaNBGnJ1upmV5zS5ECMZAlq2_z2LBGrVyPSay046saPlL2ihSHRyYMK1-cqlbcHgk7eYw9Q7jP6b96uY8Gr5cwgyNYLOV9OeAk_a--IRLm0yZXzCChU8ecW6wSQQt59wE3ErzszzSkhkbKwJItKUKuMjziIkDeyyrlns1x-ErfbpNjIvpo5WKZcZh5_rhBR6jimevNG3utTWqa3C0hRPS9VrhcSW3HRH9Oz8aT15R7_kLKEfAYmHEzl040KRuLuSCmJT6xjFSYKngVPWEYw_bqJobMsT4skPkzpkGxxwJvf5H_eF0hdnCJg541-fShRrFKhcW-oMNc1ZTep-afbAVFbRyH7mFC8EF6YXiojoC9Loh3c237wpFJBJ_ZDdsLMDVRs7TwT7L-HPrZPm_vtwzYgaLSI0buexKDsiU0oB55BENynCnIyfIlr2MhQoRHHtxghH1HppJShttqhxHoasCNwx9ribLkpiMw7Gr56CJKy17vXjJUHkPKhg9c-c4226-U9T> 

Still, a range of issues – from cultural habits to attitudes toward governance, from vaccination policies to viral mutations – merit discussion.

The two main vectors of transmission for Covid-19 are airborne droplets and contact. In countering these vectors, East Asia’s social habits trump the West’s.

Due to East Asia’s air pollution and harsh influenzas, mask wearing – a simple but critical step in halting respiratory disease transmission by containing infected persons’ droplets within masks – is a common habit across the region. Likewise, masks are more widely available to buy.

“In [South] Korea, in February, people were wearing masks even when they had not been told do,” said Joe Terwilliger, a professor of genetic statistics at Columbia University in New York. And it looks similar north of the border. “Every day I watch North Korean news and everyone is wearing masks,” he said.

Moreover, there is less direct personal physical contact in East Asian behaviors, with its tradition of bowing, than in the West, with its traditions of cheek-kissing, hugging and hand-shaking.

Another aspect of culture is diet, which impacts a key Covid-19 risk factor. East Asians as a whole suffer lower rates of obesity than Westerners. 

Attitudes toward authority

Attitudes toward authority and community consciousness are nebulous concepts, but East Asia may have advantages for reasons that combine politics and culture.

In communist-led China and Vietnam, the hand of government is heavy, a factor that militates against civil disobedience. The same is true for North Korea, where no data on the pandemic is available, but where indications suggest Pyongyang has contained the virus effectively <https://asiatimes.com/2020/05/congratulate-kim-for-successful-anti-virus-push/>. 

And even democratic Japan, South Korea and Taiwan experienced dictatorial or militaristic governance within living memory.

Beyond politics lies the broader issue of culture. East Asian nations share a Sinic-influenced, Confucian culture of collectivism and group identity, bolstered by greater levels of ethnic homogeneity than exist in the West.

While politics may override culture in authoritarian Asian states, cultural factors may contribute to civic consciousness in democratic Asian states. Such attitudes are visible in low rates of street crime and in widespread acceptance of “nanny state” governance and of dirigiste economic management.

“An outbreak is a community problem,” said Dan Strickland, a US-based retired epidemiologist. “You can’t address it as individuals.”

Broadly, these various factors point to the trend of East Asians being more responsive to rules than “individualistic” Westerners. Even in South Korea, known for its lively protest culture, violence is rare. During 2016’s “million-man” anti-government protests, civic order was observed.

“In Chinese, the character for state includes ‘family,’” said Dr Jerome Kim, director-general of the International Vaccine Institute. “When something comes from Dad, the rest of the family follows along.”

Dr Keiji Fukuda, director of the School of Public Health at the University of Hong Kong agreed. In East Asia, “populations were more receptive to – and less fragmented in the face of – the measures needed to slow transmission,” he said.

This “fragmentation” is prominently seen in armed Americans defying lockdowns, but is also visible in less dramatic forms.

“Most of this [crisis] is behavioral, and people are not following the rules,” said Terwilliger, who is based in New York. “I stay home but I look out of my window – people are in the parks.”

Such defiance would be unthinkable in communist Vietnam or China, where lockdowns are enforced by neighborhood watch groups. And observers note that in South Korea, where no lockdown occurred, and Japan, where a “lockdown lite” has been instituted, dictates on avoiding large gatherings, on mask-wearing and on hand sanitization, are widely followed.

Rights to privacy

Relatedly, the prioritization of society over the individual has come into focus over rights to privacy, for a key pandemic countermeasure is contact tracing of the infected.

This process has been eased by East Asia’s high adoption rates of digital devices, and its top-tier ICT backbone. In China, tracing is further empowered by a pervasive state surveillance network.

But even in democratic Asia, where credit card and cellphone data has been used in tracing, there has been minimal pushback on the issue.

However, the issue is now in focus in South Korea, where the possibility of gays being “outed” has arisen in connection with a cluster in LBGT nightclubs. In response, authorities have guaranteed anonymous testing.

Looking West, there are high cultural barriers towards the use of personal data by governments, most notably in the US. Strickland, the retired epidemiologist based in the US, says he is puzzled by the attitude.

“I keep saying we should implement the Korean system, and people say, ‘These authoritarian measures would not work here!’” Strickland said. “I say, ‘We hand all this data over to big corporations, why not to the government? Especially if they turn off the surveillance after the outbreak.’”

Still, Terwilliger noted that not all Western nations follow the US attitude toward use of private data. “I can see Finland and Sweden agreeing to it,” he said. “It is that kind of culture.”

Experience differentials

All East Asian countries have living memories of war on their own soil.

Japan was massively bombed in World War II. China experienced a post-war Civil War in the 1950s, as did Korea in the 1950s, and Vietnam in the 1960s-70s. Today, China and Taiwan, and the two Koreas remain trapped in military face-offs.

Western nations, however, have not suffered war on their own land since 1945. Yet even in Europe, certain countries which suffered badly in World War II such as Germany and Poland have weathered the Covid-19 storm better than those which did not, such as the UK and US. 

Likewise, newly bourgeois East Asian countries have more recent experience of economic deprivation than Western nations. And within Europe, newly prosperous Eastern European nations have largely done better than Western Europeans.

Could these issues have impacted public responsiveness to crisis messaging?

“Maybe, because of this, people are used to following leadership,” mused Kim. “In a war, the generals lead. In a pandemic, you let the authorities lead.”

Dr Kenji Shibuya, a Japanese professor of Population Health at Kings College, London, agreed. “Countries that are very good at national security are good at pandemic management: China and Taiwan; the Koreas; Israel is the same.”

“The US is usually good at that but the Centers for Disease Control (CDC) was sidelined,” he continued. “If the president had trusted the CDC, it would have done better.”

Recent disease containment experience also granted East Asia an edge in its response.

“One of the things to remember is that China, Korea, Hong Kong and Taiwan had been through this before with SARS and MERS,” said Kim. “That preparation helped.”

At the outset of Korea’s outbreak, staff at the specialist Daegu Medical Center <https://asiatimes.com/2020/02/in-koreas-viral-hot-zone-a-quiet-fear-reigns/>, for example, told Asia Times how they were both prepared and unafraid, due to prior experience. And prior experience impacted systemic response well beyond medical care.

In South Korea, a wide-ranging law passed in the wake of the MERS pandemic allowed authorities to access normally-private data, such as location information from mobile phones and credit card records, enabling accurate contact tracing and contributing to the nation’s comparative Covid-19 containment success.

*******

https://asiatimes.com/2020/05/why-east-beat-west-on-covid-19-part-2/ <https://asiatimes.com/2020/05/why-east-beat-west-on-covid-19-part-2/>
Why East beat West on Covid-19 (Part 2)

East Asia has handled the pandemic far better than the EU and US on virtually every metric. Here's why

by Andrew Salmon <https://asiatimes.com/author/andrew-salmon/>   Asia Times, May 16, 2020 
*****
It is abundantly clear that East Asia has managed the Covid-19 crisis far better than the West. So what is behind this glaring differential?
The first part of this two-part series <https://asiatimes.com/2020/05/why-east-beat-west-on-covid-19/> made statistical East-West comparisons, then dived into culture and communalism, attitudes toward authority, rights to privacy, and differentials in recent historical and epidemic experience.

In this part, Asia Times examines leadership, policy response, vaccination policy, travel and geographic integration, manufacturing capacity, viral variations, genetic vulnerabilities related to race, weather and climate, and, finally, arrogance and ignorance. 

From all that we draw certain conclusions to Covid-19’s East-West riddle. 

Leadership

Taiwan famously had the perfect leadership in place for the crisis: Vice President Chen Chien-jen was an epidemiologist. But across East Asia, bar some vacillations in Japan, leadership has largely been on point in terms of consistency of strategy and following the lead of experts.

“There is unified command and control, the messaging is singular,” said Dr. Jerome Kim, director general of the International Vaccine Institute in Seoul, South Korea. “There is no back and forth, like there was [in the US and elsewhere] on masks, there were consistent messages about the dangers.”

“The leadership, in general, has been less politicized and more effective in the East than in the West,” added Dr. Ogan Gurel, a non-practicing American neurologist who has been monitoring the pandemic from South Korea. “Name-calling and blaming and deflecting responsibility seemed inappropriate.”

Indeed, there have been policy shifts, clashes with experts and inconsistent messaging by Western leaders such as the UK’s Boris Johnson and America’s leader Donald Trump.

Conversely, East Asian leaders have set examples. 

Chinese President Xi Jinping is frequently filmed wearing a mask and Japanese Prime Minister Shinzo Abe even wears his in the Diet. Korean officials, including President Moon Jae-in, are frequently filmed wearing yellow disaster-management jackets.

“I was a bit skeptical of government officials wearing yellow jackets, as it seemed more show than substance,” said Gurel.“But in the long run, it reinforced the message that we are in this together.”

Moreover, leadership is not just a matter of “what” but also “when.”
“One of the major differences in terms of casualties is whether [governments] acted promptly,” said Dr. Kenji Shibuya, a professor of Population Health at London’s Kings College. “In the UK it took nearly six weeks, and so it did in the US. It is a timing lesson.”

And with the virus originating in the East before moving West, the policy responses have all been pioneered in East Asia.

Policy response

On the macro level, the key anti-virus strategy for centuries has been quarantine of the sick. The novel coronavirus pandemic has seen quarantine implemented on an unprecedented scale, with both the sick and the healthy “locked down” in entire cities and provinces for weeks or months.

That policy was pioneered by China, where authoritarian governance has likely enabled more effective lockdown than seen in many Western countries.  Even so, a number of Western nations have extended the Chinese model beyond cities and provinces to cover entire countries.

On the micro level, the benchmarks for the key tactics undertaken by countries worldwide — the “3Ts” (“testing, tracing, treatment”)  — are represented by the democratic East Asian nations.

Taiwan not only reacted with great speed, it provided an early gold standard for contact tracing, having integrated its health insurance, immigration and customs databases <>, then mined the resultant big data with AI.

South Korea provided a global benchmark for fast, efficient and extensive testing regimens <https://asiatimes.com/2020/03/south-korea-reveals-how-to-win-covid-19-war/> by offering free tests for the infected and pioneering drive-thru and walk-thru test sites. That enabled early discovery, isolation and treatment.

Japan has been widely critiqued for its dearth of testing. However, the country — burdened with the world’s oldest, most at-risk population and armed with a Top 10 global healthcare system (according to WHO rankings <https://www.who.int/healthinfo/paper30.pdf>) — has pioneered best-of-breed treatment for pneumonia <https://asiatimes.com/2020/03/japans-winning-its-quiet-fight-against-covid-19/>, one of Covid-19’s deadliest symptoms.

The rest of the world has largely followed these various moves and combined the 3Ts with differing degrees of success.

“I don’t think there are any single items that distinguish what Asian countries have done versus those in the West,” said Dr. Keiji Fukuda, director and clinical professor at the School of Public Health at the University of Hong Kong. “Each country has basically tried to implement many of the same approaches, but in ways that are possible given their differing cultures and domestic [circumstances].”

Underwriting policy response is quality of medical care. This varies, but most of the prosperous Western countries that have been hard hit have well-regarded medical systems. (Exceptionally, the US does not offer universal health care.) 

Gurel, who teaches medical courses around the region, suggests that East Asian health systems are more integrated than those in the West.

“In Korea, you get these screening exams that are incredible, you get a CT, a dental exam, a blood-test — everything in one morning! It is assembly-line, ultra-efficient,” said Gurel. “In a lot of Western systems, the medical care is advanced but the integration is not.”  

And integration is essential when it comes to effectively deploying the 3Ts.

“The process all has to work together. In America, they say ‘We need more testing,’ but testing without tracing and treatment is meaningless,” he said, noting, most particularly, the weakness of tracing in the US. “You learn this in Med School 101.”

Vaccination policies

Hopes for a silver bullet medicine to counter Covid-19 have so far proven unfounded. While the world awaits a dedicated Covid-19 vaccine, BCG, a 100-year-old tuberculosis vaccination that appears to train or stimulate the overall immune system, may provide a very important shield.

 “If I were to identify one factor” in the East-West conundrum, “it would be levels of BCG vaccination,” said Gurel.

Maps of the level of BCG vaccination show a strikingly-close correlation to numbers of Covid-19 casualties. According to the BCG World Atlas <http://www.bcgatlas.org/>, most of Western Europe including France, Spain and the UK had past national BCG vaccination policies. In Italy and the United States, BCG was only recommended for select groups. 

Most of Eastern Europe and Asia, which have weathered the crisis more effectively, maintain ongoing national BCG vaccination programs.

Differences between neighbors are striking. Spain suffered high infection and mortality rates, while Portugal (which has a BCG program) did not, despite their shared border, Gurel noted. Moreover, Covid-19 rates in western Germany were higher in the country’s east, which previously had BCG vaccinations, he said. 

He is not alone in focusing on BCG.

“There are countries trying to encourage BCG vaccination,” said Kim. But there is a complicating factor: “Every country has a different brand of BCG.” 

Early findings in Japan are that the Japanese and ex-Soviet variants may be the most efficacious in preventing mortality said Jake Adelstein, a US reporter in Japan who has investigated the issue. 

Movement and integration  

The EU and the US are internally borderless, permitting free and easy movement of people, goods — and, in the early stages before barriers rose, viruses.

Indeed, of the world’s Top 10 destinations for international tourism arrivals in 2018 <https://www.e-unwto.org/doi/pdf/10.18111/9789284421152>, most were in the West: France was in first place, Spain in second, the US in third, Italy in fifth, Germany in eighth and the UK in the 10th spot. 

The only East Asian destination (in fourth place) was China.

Regarding outbound tourism, the top 10 sources of travelers were predominantly Western: Americans (second), Germans (third), British (fourth), French (fifth), and Italians (tenth). However, Chinese were in the top spot, and South Koreans were ninth on the list.

In East Asia, there exists neither a free trade area nor a federation of states that permit borderless movement. Moreover, Taiwan and Japan are island nations, as is — de facto — South Korea, which is separated from continental Asia by North Korea. 

Swift border closures by Vietnam and Taiwan — two countries that are politically wary of China — to Chinese citizens have been assessed as key reasons for pandemic control by those two countries.

Manufacturing capacity

China is “the workshop of the world” and all Northeast Asia economies boast powerhouse manufacturing sectors, from light industry to high technology.  

East Asia’s manufacturing muscle, combined with prior experiences with pandemics and its social habits of mask-wearing, has allowed regional economies to churn out massive quantities of masks, personal protective equipment (PPE) and test kits.

Western economies which have shifted heavily toward services have suffered shortages of test kits, of PPE for medical workers and even the most basic, low-tech anti-virus supplies for their populaces.

“Masks have been an issue here, not being able to get them,” said London-based professor Terri Kim, a South Korean native. “I gave some masks from Korea to my neighbors.”

China, Korea, Taiwan and Vietnam are all net exporters of virus-related products and are engaged in “mask diplomacy” by deploying cargos to favored nations. (Quality issues have arisen over Chinese gear in locations as diverse as Czechoslovakia, Spain and the UK.)

A related issue is that overbearing US medical device and pharmaceutical manufacturers have off-shored production.

“In the US, the manufacturing of medical items is done by a few companies that have monopolies and many have sub-contracted their manufacturing overseas,” said Dan Strickland, a US-based retired epidemiologist. “And small manufacturers are blocked from jumping into the arena by big businesses which have the monopoly.”

Virus variants

Could the variant of the virus in the West be deadlier than the version that emerged in the East? Viruses mutate, and according to research published by Los Alamos National Laboratory published on April 30,  <https://www.biorxiv.org/content/10.1101/2020.04.29.069054v1> a mutation that appeared in Europe in February then spread to the US is more infectious than the original.

“Los Alamos looked at all the sequences around the world in March…the outbreak is now dominated by this form of the virus,” said Kim of the IVI.

However, he cautioned that the research has not yet been peer-reviewed and its findings are nascent. “It is more transmissible, but is it associated with higher death rates?” Kim wondered. “These are early, initial findings.”

Still, if the variant in the West is more dangerous than that in the East, it could help explain why two nations that are largely “Western” in their systems and practices but are physically in the East — Australia and New Zealand — have been relatively unaffected.

Genetic vulnerabilities  

In the past, peoples of different ethnicities who had little or no contact with other peoples built up resistance to different diseases. When different peoples met, catastrophe was often unleashed.

Most notoriously, in the “Columbian Exchange” a range of Old World diseases wiped out 80-95% of the native population of the New World within 150 years, including in the US.

Could ethnic Asians today have more in-built resistance to this disease than ethnic Westerners? Experts hedge on the issue.

“The SARS-CoV-2 is a new creature in a family of similar creatures, so maybe there is some crossover immunity,” said Strickland. “In East Asia there were other coronavirus so there might be some sort of cross immunity,” added Shibuya, though he said he was skeptical.

“It seems unlikely, the interconnectedness of the world is why this is not feasible today,” Strickland said.

Even so, research from the UK’s National Statistics Office <https://www.nursingtimes.net/news/research-and-innovation/latest-figures-on-covid-19-deaths-spark-fresh-calls-to-protect-bme-population-07-05-2020/> on the vulnerabilities of different racial groups found that the only ethnicity with potentially lower risks of fatality than Caucasians, apart from mixed race persons, were “Chinese.” 

However, it is hugely difficult to disentangle the various factors beyond race built into the data.

“We may see something,” in ethnic genes offering more resistance, said Kim of the IVI, but there are other health issues such as hyper-tension, diabetes and cardio-vascular diseases. “How do you separate this out? You have to control for ethnicity, demographics and risk factors.”

 Socio-cultural issues are also in the mix.

“In New York, it is disproportionately minority populations suffering the most,” said Joe Terwilliger a genetic statistician at New York’s Columbia University. “They are lower on the economic scale and work at crap jobs. And Hispanics often live in multi-generation families, so it spreads like wildfire.”

Yet Terwilliger did not rule out ethnic vulnerability. “With infectious diseases, you never know,” he said. “It would not surprise me if there was ethnic variation, but you can’t say there is, there is no data.”

Weather and climate

The outliers among “Western” nations are Australia and New Zealand, which do not lie in the geographic West. Though they share similar systems of governance and social culture with Western Europe and the US, they have been far less impacted by the pandemic.

Setting aside policy responses, did their location assist? The pandemic struck in the Austral summer, and some believe that the virus is less dangerous in hot weather.

Climate, perhaps in combination with Asian cultural and/or genetic characteristics, could potentially also help explain the low death tolls in Southeast Asia, which have warmer climates but are less prosperous than the West. 

Vietnam claims zero deaths from Covid-19. Malaysia has suffered just 111 dead, Singapore 21 and Thailand 56. The toll is heavier in Indonesia, with 1,028 deaths, but the country also has a vast population of 267.7 million, giving it a death per million ratio of 3.8, broadly similar to the countries of East Asia.

Arrogance and ignorance

Since the 19th century, East Asia has looked up to the West in multiple sectors, from science and technology to governance systems and popular culture.

Despite the post-war economic ascent of the East, the West has not reciprocated with similar levels of interest. As a result, Western barriers to adopting Eastern models may exist, combined with disinclination toward critical introspection.

“The East-West dichotomy, in terms of perception, imagination and real politics has become again very dominant in media discourse and people’s conversation during the pandemic,” said Terri Kim, a London-based professor. 

“The National Health Service in the UK is a sacred institution, and I even had a tiff with a friend, critical comments and comparative perspectives are not accepted! People don’t even know that Korea has a universal healthcare system.”

This cultural superiority complex has extended to actual abuse. For the first time in her three decades in London, Kim said she had experienced racial prejudice when a white woman in a shop told her to “go home.” Amid the pandemic, other Asians have suffered verbal abuse and physical assault in Western nations.

And the answer is…

The crisis is not over as clusters continue to emerge and concerns rise of a “second wave” as lockdowns worldwide are eased. Even so: Why has East Asia so clearly outdone the West in the early stage of pandemic management?

One temptingly simple answer would be that the more authoritarian a nation, the more effective pandemic response has been. This would explain Vietnam and China’s low per-million death rates, though questions linger about the accuracy of both nations’ data.

Democratic Japan, South Korea and Taiwan only partly contradict the authoritarian argument, for as noted in Part One, their populations may be more culturally-conditioned than Western nationals to follow rules from above and to prioritize society before individual. 

But experts rightly warn against such glib interpretations, given that the East-West disparity combines a bewildering multiplicity of facets.

“It’s a mystery,” said Shibuya. “The simple answer is, ‘It’s complex’,” added Gurel.

Experts also advise against assigning any single factor or jumping to hasty conclusions. 

“It’s the whole package,” said Strickland. “It will take us years to figure this out. If I were young and in mid-career, I would be drooling over this.”

********
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