Check out the pandemic in Australia’s neighbourhood, the world can learn something

Europe is having a second wave of Covid19. But what can we learn from our neighbours in East Asia? Quite a lot, we should pay more attention to them.

The world is full of tough news about a second wave of Covid, particularly in Europe. But I thought it was worth drawing your attention to our own part of the world, which gets much less reporting. Below I’ve shown a graph of some of the key countries in East Asia that have managed Covid19 very well. This set of countries includes islands, and countries with land borders. It includes very rich countries (eg Australia and Japan) and very poor countries such as Vietnam. The worst outbreak of all the countries was in Singapore, in May/June when the daily confirmed cases per million people got above 100 for a few weeks when they had an outbreak in migrant worker hostels. But Vietnam, at its worst in August, had under 0.4 cases per million people. And while we are looking at our part of the world, on a worldwide scale, despite the tough times in Victoria, Australia as a whole (including Victoria) is doing pretty well too, with the highest level of 21 cases per million people, and now back down to under 1 case per million people.

What have all those countries done right? Pretty much what the WHO suggested. Testing, contact tracing, quarantining arrivals, consistent and clear communication and, in most countries, mask wearing in public places. This article from a WHO special envoy outlines the strategy.

a) People are encouraged to adopt all precautions all the time.  As Tedros of WHO says: ‘Do it All’: physical distancing, proper face-masking, hand/cough/surface hygiene, self-isolating when ill and shielding those most at risk.  There should be no exceptions anywhere.  This is best achieved through engaging people and trusting them rather than coercion if at all possible.

b) Public health services are organized to offer locally-integrated support for interrupting transmission and suppressing clusters.  This means test-trace-isolate-protect services everywhere, with clearly justified performance metrics.  It is important there is enough testing capacity to pick up where the virus is, to detect spikes and manage surges.  From time to time it will be necessary briefly to restrict movement locally to enable suppression of outbreaks.  [NB Building public health capacity is not the same as implementing lockdowns.  It is about building up the capability of public health services to interrupt transmission in localities.  Experience around the world shows that this capability is key to a successful COVID responses.  Lockdowns just freeze the virus in pace they do not lead to elimination].

c) Messaging is consistent and clear within and between nations.  If leaders are not consistent in their requests and advocacy, their people will be confused, perhaps frustrated.  In that context the virus is unforgiving and may well spread massively.

In contrast, a similar graph for Europe shows a much scarier picture, which we hear a lot more about, here in Australia, despite it being further away. Its a combination of dramatic (and bad) news being more interesting, and a surprising reluctance of Australians to recognise sensible public policy outside Europe and the US.

This week Europe’s outbreak is unquestionably a second wave. Our world in data shows here the cases per million people in a selection of European countries (and the European Union). I’ve chosen the linear scale, to give you a sense of how quickly it is rising in some of the worst hit countries. And if you look closely at the two graphs you will notice that the small bump in March/April in the worst hit parts of Europe (when most cases were not being identified) is higher than Singapore at its worst from the graph above. The Czech Republic is building a field hospital at a disused fairground.

Links

A paper from Canada uses a natural experiment with different provinces to conclude that mask wearing (without any other interventions) reduces the spread of Covid19.

Our identification approach exploits variation in the timing of indoor face mask mandates staggered over two months in the 34 public health regions in Ontario, Canada’s most populous province. We find that, in the first few weeks after implementation, mask mandates are associated with a reduction of 25 percent in the weekly number of new COVID-19 cases….Counterfactual policy simulations suggest that mandating indoor masks nationwide in early July could have reduced the weekly number of new cases in Canada by 25 to 40 percent in mid-August

I feel very fortunate that here in Australia, reopening of schools has been both a priority (over other parts of the economy) and not all that risky for schools and teachers (compared with how worried I was in April when I wrote this). The US has not been so fortunate. Emily Oster, an economist who has specialised in looking at evidence for many parenting decisions, has been gathering data and writing about it.  Here is her latest article from the Atlantic

Our data on almost 200,000 kids in 47 states from the last two weeks of September revealed an infection rate of 0.13 percent among students and 0.24 percent among staff. That’s about 1.3 infections over two weeks in a school of 1,000 kids, or 2.2 infections over two weeks in a group of 1,000 staff. Even in high-risk areas of the country, the student rates were well under half a percent. (You can see all the data here.)

School-based data from other sources show similarly low rates. Texas reported 1,490 cases among students for the week ending on September 27, with 1,080,317 students estimated at school—a rate of about 0.14 percent. The staff rate was lower, about 0.10 percent.

These numbers are not zero, which for some people means the numbers are not good enough. But zero was never a realistic expectation. We know that children can get COVID-19, even if they do tend to have less serious cases. Even if there were no spread in schools, we’d see some cases, because students and teachers can contract the disease off campus. But the numbers are small—smaller than what many had forecasted.

And here are a couple of bonus links for the actuaries in my audience:

Nature did an analysis of excess deaths (ie deaths from all causes compared with average, not just reported Covid19 deaths) in 21 different countries (including Australia) showing that the worst outcomes out of the countries they analysed were in Spain, England and Wales.

And here in Australia, I was coauthor on an analysis of the latest Australian statistics (to June), showing that deaths have continued to be lower than normal for this time of year, with flu deaths down to zero, and deaths from other causes also significantly lower than the long term averages for June.

Life Glimpses

In more musical news (skip if you are sick of it!) my choir has moved to a slightly more in person type of rehearsal – up to 4 people gather together in one house and zoom together. Despite our lack of the full set of parts (two tenors and two altos) it was surprisingly enjoyable to be with others. And we could also talk amongst ourselves on mute while the sopranos were learning their part- normally we get strongly shushed when we do that!

Bit of Beauty

On my walk to North Head this week, my fellow walkers pandered to my interest in all things pandemic and we took a detour to the cemetery of the Quarantine Station. For non Sydneysiders, the Quarantine station was used to quarantine sick overseas travellers back in the days when most arrived by ship so that they didn’t bring diseases into Sydney.

From the 1830s until 1984, migrant ships arriving in Sydney with suspected contagious disease stopped inside North head and offloaded passengers and crew into quarantine to protect local residents.

Sadly, some of the passengers (and carers – one of the graves in the picture was a nurse in the 1918 spanish flu outbreak) ended up in the cemetery before they made it out to Sydney. Despite the sadness, it is a beautiful, peaceful place.