Sunday, March 15, 2020

Covid-19: Why here? Why there?

(Most recent update May 15th.)  

"It only takes a spark to get a fire going."

Fires burn down buildings as well as warm people up.  Right now a fire called Covid-19 is setting nations ablaze.  

Why does this disease break out in one city or nation, while merely simmer in another?   In this article, I discuss fourteen popular theories.  

(1) A Culture of Contact

Some say one reason the coronavirus spread so rapidly in Italy is that Italians are given to hugging and kissing.  We are told to stop shaking hands as well, for now.  A facetious debate even erupted on Facebook over whether one should adopt Japanese-style bows, fist touches, or an old-fashioned Roman salute.  Babylon Bee is, as usual, having much fun with the challenges of cutting down natural and culturally-determined human contact.  

See the source imagePluses: I don't know Italian culture well, and we'll see the touching did, in fact, play a role.  But it seems plausible enough that kissing was banned in Italy in March

Chinese are less distant physically than Japanese, having adopted our habit of shaking hands, and being fairly ready with hands on shoulder or back, though they seldom hug.  In recent years, Chinese have also adopted the custom of paying by scanning cell phone aps, such as Wechat or Zhifubao.  So no dirty yuan need to exchange hands.  

Round restaurant tables, seem likely transmission opportunities, especially since Chinese do use their chopsticks to pull food from common dishes.  Cruise ships also seem easy places to rub elbows.  Some say the virus may be spread through ventilation, but others deny this:
“'Outbreaks on ships can be sustained for multiple voyages by transmission among crew members who remain onboard or by persistent environmental contamination,” the CDC explains.
"But far as the current coronavirus outbreak goes, while the virus is more likely to spread faster via person-to-person contact in close quarters, 'there's no evidence yet that coronavirus has spread more quickly on a cruise ship than it has elsewhere,' Jeremy Brown, MD, director of the Office of Emergency Care Research at the National Institutes of Health and author of Influenza: The Hundred-Year Hunt to Cure the Deadliest Disease in History, tells Health."

(2) Bad Faith

See the source imageIn Korea, the Covid-19 outbreak began at a New Heaven and Earth Church of Jesus, often described as "doomsday" and "cult-like," said to believe (like New Atheists) that all other churches are evil.  (New Atheists just believe in one more evil church!)  

For a while, a huge percentage of South Korean cases were associated with that church in the city of Daegu, or with the hospital to which members were taken when the got sick.  Apparently church members spread the disease through close-packed prayer meetings. 

In Iran, pious Shiite Muslims were photographed licking a shrine and saying they were not afraid of the coronavirus.  I am sure the virus was delighted to hear that. 

A report from Pakistan argues that irresponsible religious behavior may be fueling spread of the epidemic in (Sunni, I suppose) Muslim countries, as well.  Some charismatic, not always very orthodox, churches in America have insisted on holding services, as Katherine Stewart pointed out in an article blaming Christians for the spread of the virus.  (Here's my rebuttal of her argument, also my explanation of her need to scapegoat others at The Stream.)  

A conference at Christian Open Door Church, an evangelical megachurch in Alsace, near the border of Germany, apparently played a large role in the outbreak of the coronavirus in France.  The disease is still heavily concentrated in eastern France.  

Jonathan Kay describes 54 "super-spreader events," of which nine seem to occur at "religious services or missionary work." 

I believe that God does miracles, but not to reward presumption.  Jesus made that clear when the Devil tempted him to jump off the temple roof to show how spiritual he was.  Jesus cited Scripture, "Do not tempt the Lord your God."  God is not a prop for showing off our spirituality.  Forcing God to save us from such presumption is not an act of true faith, but an attempt to manipulate Him and make God our servant.  

Also, for the record, it was Christian missionaries who introduced modern medicine to both China and Korea, among other countries.  

Pluses: Certainly theological presumption has brought about the deaths of some over the past months, and aided the rapid spread of Covid-19 to in some places.  

Minuses: Probably not, however, in China, Yokohama Harbor, Italy, Spain, New York City, New Orleans at Mardis Gras, or most care facilities. 

(3) Cool, Slightly Dry Weather

My friend Brad Cooper favors this theory, as did the University of Maryland authors of a paper entitled Temperature  and Latitude Analysis to Predict Potential Spread and Seasonality for Covid-19."  A more sophisticated model notes that the virus is usually spread indoors, and emphasizes its liking for low humidity, which may remain constant indoors and out.  A study from China emphasized the importance of both humidity and temperature.  More recently, the American presidential task force highlighted research that shows the virus is vulnerable to UV radiation.  

The worst early known outbreaks, marked by circles, were all located in a particular climactic band.  The Maryland authors argued that the temperature and humidity of this band in winter are just what made Covid-19 friskiest.  So you don't get outbreaks in the far north, where it's too cold, nor in the tropics or southern hemisphere, where it was too hot during January and February.  But the danger would, they predicted, increase in other latitudes as spring developed, while the disease was likely to go into remission in summer for most of the rest of us.  

Let me quote a few paragraphs from an online magazine which summarizes the UM paper's main points

World Temperature Map November 2018-March 2019
  • Similar winter climates with an average temperature of 41 to 52 degrees Fahrenheit (5 to 11.11 degree celsius)
  • An average humidity level of 47 to 79 percent with a narrow east-west distribution along the same 30-50 N latitude.
Wuhan in China, South Korea, Japan, Iran, Northern Italy, Seattle, and Northern California have similar weather and humidity patterns.

“Based on what we have documented so far, it appears that the virus has a harder time spreading between people in warmer, tropical climates,” said study leader Mohammad Sajadi, MD, associate professor of medicine, UMSOM, physician-scientist at IHV, and a member of GVN."

"In areas where the virus has already spread within the community, like Wuhan, Milan, and Tokyo, temperatures did not dip below the freezing mark, the researchers pointed out. They also based their predictions on a study of the novel coronavirus in the laboratory, which found that a temperature of 39 degrees Fahrenheit and humidity level of 20 to 80 percent is most conducive to the virus’ survival."
These arguments are more than a month old, now, and we can observe how the disease has developed, to verify or falsify the role of climate claimed by these various researchers, and the notion that summer will mostly end the pandemic, at least for now.   

Pluses: Some colds and flus do, it seems, die down in summer, then come back with a kick in fall.  Of course environment is as vital for a fever-causing virus as for other fires.  So at first glance, the thesis seems logical.  And most of the locations at which outbreaks had occurred by mid-to-late March, did indeed fall within those green bands.  Is that likely to be a coincidence?   

As I noted April 5 on Facebook, it does seem significant that "960,000 out of 1.2 million of announced Covid-19 cases worldwide are in what was called the First World (western Europe, Anglosphere, Japan,). (Combined population: 10% of world population.)"

A temperate climate is one possible explanation for Covid-19's apparent preference for attacking people in Western Europe and North America. But there are several possible explanations, some of which we discuss elsewhere in this article:

a. Numbers from other countries are bogus, due to under-counting or official dishonesty. (Numbers from no country are very complete, but thoroughness varies considerably among both rich and poor countries.)
b. Most "Third World" countries are in warmer or colder countries which lie outside the comfort zone for this virus (the thesis under discussion here).
c. Most "Third World" countries have younger populaces, therefore are less vulnerable.
d. This disease tends to spread in dense urban districts with subways. Poor countries tend to have larger rural communities, where such diseases are likely to spread more slowly.
e. The very sick are more likely to be tested. Countries which have been wealthy for decades host more elderly and obese residents who are more vulnerable, therefore more likely to be tested.
f. Covid-19 has spread first to metro areas with numerous direct air routes to affected areas, which again favors, or disfavors, First World towns like Milan, Barcelona, New York, etc.
g. Newly industrialized Asian nations (China, South Korea, Taiwan, India) have or have had heavy air pollution. Therefore citizens wear masks habitually, which slows spread of respiratory viruses to a slow crawl.

Minuses(1) Seven cities may have been too narrow a data set upon which to draw strong conclusions.  (And Seattle was more humid during much of this time than this model prefers -- it was a terribly rainy January, even by Seattle standards.)  

(2) Despite the fact that most known cases are in temperate, First World countries, one of the worst outbreaks has since occurred in warm New Orleans, with temperatures from the upper 60s to the mid 80s. And there have been significant outbreaks in Egypt, the Philippines and Indonesia, though not yet at the level of Western Europe or New York.   

(3) Update: Ecuador seems to be having the worst outbreak in South America so far, with thousands of deaths.  (See below for further discussion.)  
(4)  The authors of the Maryland paper overlook the fact that transmission usually occurs indoors, where temperatures are in the low 70s, not outdoors, at 39 degrees.  Elder care facilities in Kirkland, Washington, and elsewhere, are generally heated, as are cruise ships, Korean churches, and Italian cafes.  

Update: A Chinese study in early April, not yet peer-reviewed, claimed that only one out of 318 "outbreaks" of Covid-19 occurred out of doors.  This should be understood in the context of the Chinese reaction to Covid-19, which involved forcing most Chinese to remain indoors almost all of the time.  But the period studied was January 4th to February 11th, the area cities outside of Hubei.  During the early part of this period (when I was in China), people were still traveling freely.  So the low incidence of transmission outside does seem significant. 

Some transmission probably occurs on door handles and in cars.  But most almost certainly occur indoors.    

(3) The UM authors also overlook the domestic pattern of transmission within China, which seems to fit a model that emphasizes travel connections over latitude.

Covid-19 spread most quickly to cities near Wuhan (but less to Shiyan far in the east of the province), then to neighboring provinces, and south to Guangdong (Canton) which is considerably warmer.  A bullet train line passes through Changsha and goes on to Canton and Shenzhen across the border from Hong Kong, and it is well-traveled.  (Though early on, Henan Province to the north blocked roads and put up signs asking Henan natives not to return home!)  
(4) It is true that cold regions during the winter months were not hit hard. This may be because the virus doesn't do well in cold weather. But it also may be because the people hosting the virus don't like cold weather, either, and avoid Moscow and Harbin in winter.

(5) The Maryland authors did a bit of cherry-picking. They suppose that the disease may flourish later in  Vancouver, BC.  But Vancouver, Portland, Oregon, and Seattle are neighboring cities, with essentially the same weather.   They can't both say their model explains why the disease spread in Seattle, then say it predicts it will spread later in Vancouver.  Vancouver is slightly cooler, but not enough to explain such finely-grained differences.  

They also predict trouble ahead for London.  (Which came, including to Prime Minister Boris Johnson.  Not, however, to Vancouver or Portland yet.)  But I doubt London is much colder than Wuhan in winter, either.

(6) Data may still be incomplete in many Third World countries, which tend to be in the warmer south. Hopefully the authors are right, and the diseases simply hasn't hit the Global South that hard yet, and won't.    

Algeria Coronavirus cases by province.pngUpdated Test: One way to verify or falsify the weather hypothesis, and see if it explains data from the Third World, is to see if the disease has spread more widely in regions within "Third World" countries that are cooler and closer to the alleged ideal environment for Covid-19, such as highland Algeria (where there is a significant outbreak) and Ethiopia, Bolivia, highland New Guinea, Kashmir, and Ecuador.  

Algeria has suffered 444 deaths by April 29, according to Wikipedia.  These are concentrated along the coast, especially in Blida and Algiers, which indeed seem to have a moderate climate in the spring.  (But most the population is also concentrated in that coastal band.)  

A time lapse of the spread of Covid-19 in India does not seem to show any propensity to concentrate in the foothills of the Himalayas, as this model might predict.  

Only 123 cases are reported in Ethiopia so far, almost all in Addis Ababa, which is dry and 50-77 degrees F in March.  This data does not seem significant.  

Of Bolvia's largest cities, two, La Paz and El Alto, stand at a much higher elevation than Bolivia's other largest cities, and are subject to weather that this hypothesis suggests favor the spread of Covid-19.   Bolivia has reported 1023 cases so far.  But 525 are in Santa Cruz and 78 in Cochabamba, both in the lowlands, with only 168 in La Paz, which also includes El Alto.  So it is the hotter and less temperate cities where Covid-19 has been the most severe.

Ecuador gives an even stronger rebuf to the importance of weather.  Ecuador has two main cities of about 2.7 million: Quito, 9000 feet in the Andes, and Guayaquil, at sea level.  The former is far more temperate than the latter.   In Quito, temperatures rarely rose above 70 degrees F during the period of transmission: in Guayaquil, temperatures in February and March range from 74-90F.  This is also the wet season in both cities, with 10-12 inches of rain a month in Guayaquil, 5-7 in Quito. 

Ecuador has been hit hard by Covid-19.  While official figures show only 576 deaths in the country, many thousands have actually died, likely more than 6,000 by mid-April in one city alone.  

That city is not the temperate Quito, but the tropical Guayaquil, during the middle of the rainy season.  Neither high temperatures nor high humidity seemed to slow the rampage of the disease through the city, while Quito seems to have been hit less severely.  

By these tests of the hypothesis, it doesn't seem that temperate islands in the otherwise mostly hot "Third World" much support the "Cool, Slightly Dry Weather" hypothesis.  Meanwhile, in the USA, New Orleans got hit even harder than Detroit or Boston.  It may be that hot, rainy weather also forced people indoors, where air was conditioned and people closer together.  

Thanks to social distancing, masks, working from home, and other measures, or just because a disease eventually burns itself out, the first wave of the pandemic seems to be passing, as the weather in the Northern Hemisphere warms up.  But temperatures and humidity at best a partial and still debatable explanation for why this disease grows explosively in some places, but not others.  

Warmer weather may still help over time even if a minority of transmissions occur out-of-doors.  After many generations, culling one fourth of transmissions in each generation would have a strong cumulative effect over many generations, damping the fire down significantly.   

(4) Human Petri Dish 

According to this model, large outbreaks of pestilence are likely to break out where some facility serves as an initial incubator.  Covid-19 has been said to have a transmission rate (under some conditions) of 2-3, which means the average person passes it on (no doubt under some ideally average conditions) to two or three other people.  In large groups, the number can be shockingly elevated, given a perfect storm of conditions.  

See the source image
Visiting Life Care of Kirkland, WA
The Petri Dish theory both makes sense, and covers much of the data.  An un-hygenic church, an elder care facility (a large percentage of deaths have now occurred at such facilities), cruise ships, and prisons in Shandong Province (where most cases were where I lived in China), proved among the incubators for major or minor Covid 19 outbreaks.  Mardis Gras and subways have also been plausibly implicated.

To date, residents in 250 long-term care facilities in Washington State have tested positive for Covid-19.  More than 500 deaths, some 60% of all pandemic deaths in the state, have occurred in such institutions, according to the Seattle Times.  Parallel figures are 41% in Ohio and 66% in Arizona.  

Kay argues that of the three modes of transmission for Covid-19 (large expectorations at short distances, long-distance "aerosolized" expectorations, and tactual contact, such as touching a counter or door knob), it is close-in contact in conversation, cheering, praying, and so forth, which has been most clearly implicated in most "super-spreader events."  His model is a natural fit fot the "human petri dish" hypothesis.  

This theory is closely allied with the "Culture of Contact," "Bad Faith" and "Camel Cries" (next) hypotheses, but at first glance may seem to conflict a little with the Weather model.  The petri dishes mostly seem to be indoors, and therefore at much warmer temperatures than 39 degrees.  

(5) The Sweating Camel

Buy a ticket from on-line travel company Qunar in China ("Going Where?"), and while you wait for your purchase to be confirmed, a little camel walks across the screen, sweating to show he is working hard to fill your order.  

Where do you want to go?  Walk around downtown Seoul, and you'll hear a lot of Chinese, because Korean culture has been popular in China for several years.  Numerous flights left daily from the town I lived in, to Seoul-- more than any other international destination by many times. 

Chinese tourists seem to have introduced the disease in northern Italy, which of course is a magnet for culture-loving tourists of every nation.  Then people visiting Italy spread it to Spain, New York, and many other sites.  Wikipedia lists more than 80 countries where cases related to Italy were found.  Twelve countries connected to Spain, mostly in Latin America, are also listed, including Ecuador.  (Rich Ecuadoran students returning from Spain are said to have brought the disease.)  

The three US states where Covid-19 first sprang up most ferociously, are among America's top four exporting states.  They are popular destinations for East Asian tourists, businessmen, and students alike, and contain much of America's Chinese-American population.  

It only takes a spark to get a fire going.  But all else considered, the more sparks land in one spot, the more likely that spot is to be set ablaze.  

Which is, of course, the rationale behind travel restrictions and closed borders around the world.  

Pluses: Most cases seem to fit this theory, and it makes sense.  The authorities obviously believe it.  

Minuses: Iran is not a particularly hot spot for Chinese travel.  The Diamond Princess took on one traveler who picked up the virus in Hong Kong, and that one spark was apparently enough. 

Update: Travel within the United States has dropped precipitously in recent weeks, especially on the West Coast, the Great Lakes region, and the Northeast, as a New York Times map shows.  

This seems a crude measure, however.  Getting in your car and driving to some wilderness area presents almost no threat of disease transmission.  The governors of west-coast states have shut down state and national parks, forcing those who want exercise on a beautiful spring day, to congregate on the few open trails.  

(6) The Gotham Syndrome

As a specific application of 1, 4 and 5, Covid-19 has first struck several crowded international cities particularly severely: Milan, Madrid, Barcelona, London, New York.   Frequent flights from afflicted areas, and then concentrated populations with lots of people living in apartments and taking busy subway systems (New York's subway carries seven times more people than that of Chicago, 1.6 billion a year), create an environment for the quick spread of respiratory diseases.  Wuhan is also enormous and linked by an extensive subway system, if more modern than that of New York.  Even in less-packed regions, the spread of the disease so far is largely concentrated within the commuting area of cities like Seattle, Detroit, and New Orleans. 

Furthermore, genetic research on Covid-19 transmission shows that most of the pandemic in the US was seeded from the outbreak in New York, with a much smaller portion coming from the Seattle area.  

Robert Steuteville argues that "Cities Don't Increase Virus Risk."  He points out, for instance, that New Orleans is far less crowded than San Francisco, yet has been hit much harder.  He also notes that some New York suburbs have been hit harder than the city itself, even though people in NYC use subways more than people in the suburbs. 

This might seem an effective response, if one were claiming that density and use of subways were either necessary or sufficient causes for widespread transmission.  Obviously I'm not making that case.  It seems to be one rather important variable, but there are others: New Orleans was pretty packed during Mardis Gras, when social distancing was not a priority. 

(7) Sheer Size

The larger a country is, the more likely some regions of that nation will be hard-hit, all else being equal.  If you subtract Quebec from Canada, then Canada has dealt with Covid-19 quite well.   Subtract the greater Gotham megopolis, and the US has done better than Canada.  Deaths in Italy were concentrated in Lombardy, while the poorer south got off relatively easily.  (So far.)  Randomness is evened out in large nations: it is unlikely that all 50 American states will do as well as New Zealand, or as badly as Belgium, but New York City is not a great surprise, by this logic.  

Of course this doesn't explain China, where infection rates are low thanks to radical shut-down policies, or India, which I can't explain well at all.  

(8) Lack of Pollution

After initial outbreaks in Wuhan, then Daegu and the Diamond Princess in Yokohama Harbor, Japan, East Asia has weathered the storm surprisingly well.  The pandemic spread throughout eastern China in particular, and south into Guangdong and Hong Kong.  Travelers introduced it throughout East Asia, but China, South Korea (probably not the hellhole to the north), Taiwan, and Singapore quickly checked its spread.  
See the source image

One reason East Asian countries halted the spread of Covid-19 seems to have been that most these regions suffer from heavy air pollution in the winter.  A dirty cloud hangs over the North of China, and Korea, much of the time from about November through March or so.  (With occasional breaks when the wind blows for a few days.)  So inhabitants have accustomed themselves to wearing masks.  Which means local supplies were easily available on a large scale -- no need to ration for medical personnel.  Even Japan, which is less polluted these days, hosts a culture (especially among women) which is accustomed to wearing masks when people go outside.  (My wife says she didn't like to, but Nagasaki is a smaller city with clean air.  And she says masks had become fashionable.) 

Masks can turn exponential growth into linear growth.  If they cut only one transmission in two, and Covid-19 spreads on average from one person to two, then after five generations, you get five sick people instead of 31.  And five generations later, the ratio becomes 100-1.  That may well explain why places like Japan, South Korea, Hong Kong and Taiwan have kept their outbreaks under control. 

American Surgeon General Jerome Adams irresponsibly and falsely told the American people that masks are not effective for halting the spread of Covid-19.  This falsehood, the general lack of masks to begin with, and bureaucratic confusion fostered by the FDA which prevented imports, no doubt played a big role in allowing Covid-19 to spread.  More recently, China appears to have punished America for its criticism by passively-aggressively discouraging exports.   

But part of the danger may, paradoxically, be our cleaner air.  

(9) Update: Luck With Previous Pandemics

Another important paradoxical factor is that countries which have recently experienced a SARS or other pandemic, tended to be better prepared to deal with this one.  South Korea reportedly reacted poorly to the spread of previous diseases, which turned out to be useful dry runs for fending off this one.  One might say that those previous outbreaks lent a kind of institutional immunity to Covid-19, preparing government and individuals to react quickly and properly this time around.  

(10) Socialized Medicine!  

Software developer Matthew Tanous argued that while both South Korea and Italy have state health insurance, it is South Korea's far more robust supplementary private health care system that has prevented it from sliding into the abyss.  

"Although South Korea provides a basic safety net, it is also one of the closest healthcare systems in the world to a free market, outpacing to a significant degree even the US system (which includes a great number of supply-restricting regulations that only drive up costs and hurt availability). As a result, South Korean healthcare did what Italy’s already under-supplied system could not do—cope effectively with the pandemic and manage to get it under control without shutting down the entire country in the process."

Pluses: It is true that one of the biggest botches in the US, the failure to deliver test kits for several weeks, has been ascribed to government bureaucracy with a monopoly on testing.  In short, the CDC screwed up.  The US seems now to be getting the private sector more involved.  South Korea has a healthy market in private hospitals, with three times as many beds per capita as Italy, according to Tanous. 

Minuses: This argument that depends upon comparing two countries, provides a fairly weak evidential foundation on which to lay a universal claim.  (The cool, moderately dry weather hypothesis at least mentioned seven cities.)  While there are private hospitals in China (I went to one for acupuncture in Qingdao, a much more pleasant experience than state hospitals), the bulk of the successful response to Covid-19 in China appears to have been public.  Also, while a drought of hospital beds may contribute to Italy's high death rate, this would do less to explain why so many Italians caught the disease in the first place, which is our main question here.  (Though lack of beds may force some patients to stay home and infect others, one might surmise.)  

This is an interesting thesis, and may help explain success or failure in two countries or even a general point about monopolies.  It is well worth objective and careful investigation.  But coming from someone with little expertise in any obviously relevant field, and with probable political bias, it should probably be taken with a grain of salt pending further study.  

Update: Italy is no longer the hardest-hit country in the western world.  If you have a political ax to grind, you'll need to start with Belgium, which is.  And keep Italy, Spain, Holland, the UK, and the New York metro area in mind.  

(11) The Donald (and other politicians)

It is political season in America, and Donald Trump is a polarizing figure, at the best of times.  In this heated season, the sparks are flying, and to some, he is a very devil from hell, while to others, an angel sent to save America from doom.  

Trump is blamed for, variously, down-talking the plague for political purposes, cutting funds for the CVC, firing important officials, pushing unproven drugs (or weird other treatments), and generally tweeting or press-conferencing embarrassing and counter-productive comments.  Maybe he is secretly trying make a killing on the disease, somehow. Certainly he only cares about his ego and reelection.  Perhaps the testing-kits botch was his fault.  And he is ignoring the experts.  

Trump is credited for, variously, far-sightedly shutting down flights from China (by himself, on an almost daily basis), appointing a high level panel to get things done, and all manner of brilliance.  I was one of those Americans who rejoiced that the news was finally not all about Donald Trump -- for about ten minutes, until it was again, somehow. 

The problem with both theories is that the US has not been that outstanding either in bold response or in bad luck with this disease.  We're not as hardly hit as Europe yet, thank God.  (A month on: we're catching up fast, but not quite there yet.) 

The most serious early outbreak in the US has with great probability been traced to a single case that arrived in Seattle from China on January 15.  (I came in the same day, though probably not on the same flight.  I don't recall being asked about the virus, which was only known to have infected a few dozen people so far.).  In some ways, it seems, both that patient and the doctors and scientists in the Seattle area did everything right.  He got checked up as soon as symptoms became serious, was put in isolation, and his contacts were tracked down and interviewed.  But the virus got loose not only to begin a petri-dish outbreak in Seattle, but also on The Grand Princess in California.  

In short, this disease is not about Donald Trump.  Thank God for small mercies.  

Some blame other politians for severe outbreaks.  The New Yorker published a scathing and deadly critique of Mayor De Blasio's stewardship of New York City, for instance (contrasting leaders in Seattle, and also taking a poke at The Donald.)  

(12) Cultural Arrogance

Bruno Macaes, a senior fellow at Hudson Institute, posted a fascinating article on Quillette arguing that Europeans (and Americans by extension) failed to adequately prepare to combat Covid-19 out of arrogance.  They tend to see China as still backwards, and casually assumed it couldn't happen to advanced European countries with free social welfare systems.  

"The director of a hospital in Madrid was unusually forthcoming. Still traumatized by the images of the emergency care unit where he works, Santiago Moreno confessed that 'we have sinned from too much confidence.'  As he explained it, everyone in Spain thought an epidemic such as the novel coronavirus could spread in a place like China, but not 'in a country like ours.'  It is simple, really. People in Europe still think of China as a developing country. When news started to arrive of the outbreak in Wuhan, they imagined filthy Chinese markets and hospitals, they thought of the spitting and the lack of doctors, and they trembled. They feared for the Chinese people, not for themselves. This perception explains why, as mainstream opinion lambasted China for mismanaging the outbreak, there was remarkably little concern that the mismanagement could have consequences for Europe and other parts of the developed world. There was effectively no planning or preparation."

As a China scholar, I appreciated the following point:

"I should note here that the very limited number of people who have been publicly alert to the great danger facing the world—and who grew increasingly angry at the lack of seriousness in Europe or America—were almost invariably those with some knowledge of contemporary China. If you know what progress China has made and how the country is now ahead of the West on many dimensions of what constitutes a modern society, you are very unlikely to shrug with indifference when Chinese authorities lock down a major megapolis."

In addition, the tendency of some public officials to downplay the disease, encouraging people to party as usual, in dismissing possible cures because they were promoted by opposing politicians, etc, may also arise from arrogance, with its brothers, presumption and stupidity, riding shotgun.    

New York governor Andrew Cuomo reportedly even admitted to "arrogance" in the run up to the disaster: 

“Excuse our arrogance as New Yorkers — I speak for the mayor also on this one — we think we have the best health care system on the planet right here in New York,” Cuomo said. “So, when you’re saying, what happened in other countries versus what happened here, we don’t even think it’s going to be as bad as it was in other countries.”
By some accounts, Mayor De Blasio was in fact guilty of an arrogance that likely cost thousands of lives.  

Mark Levine, head of New York City health committee, urged fellow New Yorkers to party with him at Chinese New Years, and also boasted: 
“NYC has a world-class public health system, particularly in the area of infectious disease control . . . NYCers should take comfort in that as we face this challenge as a city.”

Pluses: "Pride comes before a fall."  From ancient Greek playwrights to Old Testament prophets, this is a familiar enough pattern, not unknown in every-day life.  Put your nose up in the air, and you're liable to slip on a banana peel.  

(13)  Dr. Jeckyl and Mr. Hyde strains of Covid-19  (Update)
A new hypothesis is that Covid-19 has two strains of very different virulence.  The G strain which infected New York came from Europe, and has glycine at one point on the viral spike protein, while the D strain on the West Coast (roughly speaking) contains aspartic acid.  The G strain is said to be fair more "virulent," and may therefore be partly responsible for the much higher death rates on America's East Coast, as opposed to California, Oregon and Washington, which have so far weathered the storm far better.  

I am skeptical of this theory, and reports of it in the press, for a few reasons.  

First, note that the term "virulence" is ambiguous, and sometimes that ambiguity is not recognized.  Virulence can mean the virus is easily transmitted, or it can mean that it is more deadly.  In this case, the authors of the study in question seem to mean the G strain both spreads more rapidly, and is more fatal.  But that ambiguity is not always recognized in reports in the media, and as we will see, it makes a difference.  

Secondly, the map provided in the article of virus strains does not seem to support the thesis of the paper well.  It accurately shows a big circle representing D strain dominance in the Seattle area, but shows a far more ecclectic mix of strains in California.  Which raises questions.  Why in fact have more Seattlites died, per capita, than Californians?  Shouldn't the California mix prove far more deadly.  And shouldn't the more "virulent" strains out-breed their lazier competition, and quickly take over?  

True, a case can be made that there is a difference in mortality between East and West coasts, or at least New York City and Santa Clara County, in the Bay Area.  

An Stanford antibody study alleged that Covid-19 is far more prevalent in Santa Clara County in the Bay Area than was known.  This suggests that CA death rates have remained low.  This low death rate seems to contrast sharply with New York, where antibody prevalence has also been tested, suggesting a likely death rate of more than 1% in New York City.  

But some scientists have thrown cold water on the Stanford study, pointing out that its actual positive rate (before correction) of 1.5% was not far from the margin of error.  Columbia statistician Andrew Gelman writes in exasperation: 

"We wasted time and effort discussing this paper whose main selling point was some numbers that were essentially the product of a statistical error."  

Ed Yong throws more cold water on this hypothesis in The Atlantic.  The differences do not, he argues, even rise to the status of a new strain.  

But the question will no doubt be clarified with further testing.  If the Jeckyl & Hyde hypothesis proves correct, "virulence" should probably be defined by morbidity / case, more than by prevalence in a community.  But if you were to project Santa Clara percentages onto Seattle, given the Seattle death rate, you would expect some 800,000 cases in Seattle.  It would actually need to be higher, because Seattle has a stronger prevalence of the D strain than the Bay Area.  So more than 20% of people in the Seattle area would have the D strain to yield the low mortality rates alleged of Santa Clara.  (Though those have risen.)  Yet tests even of those likely to have the disease in WA state is now yielding about 5% , implying a far lower percentage for the population at large.  Positives peaked at over 10,%, but well below 20%.  

So however you look at it, either the D strain actually is quite virulent in the sense of spreading rapidly, or it is virulent in the sense of a much higher morbidity rate than the Stanford study suggests.  And the G strain does not seem to have spread beyond commuting patterns on the East Coast much more quickly than the D strain on the West Coast.  Maine and Vermont haven't been hit hard.  So the Jeckyl & Hyde hypothesis may help explain the differences, but quicker reaction on the West Coast (as highlighted in the New Yorker article, but I would say on the part of individuals even more than government), along with the special hazards of New York City mentioned in other items above, probably explain much more.  

(14) The Judgement of God

"Pain is God's megaphone to rouse a deaf world," wrote C. S. Lewis.  The prophet Isaiah makes it clear that God rules over all human history and all nations, and that the good and evil that seem to come from other sources, are planned or allowed by our Creator.  In our increasingly prosperous and self-satisfied society, maybe we should consider the possibility that God allowed this virus, in part, to shake our complacency, and remind us to seek higher things.

Judgement is closely allied to Arrogance.  Pride is "the Great Sin" (Lewis again).  "He who thinks he is standing, take heed lest he fall."  (St. Paul)  Societies, like individuals, give in to the sin of hubris, and take it on the chin, often as a natural consequence of sticking our noses too high in the air, like slipping on a banana peel

But God alone knows his plans in this disaster.  Covid-19 has been like a stone tossed in a well, or better yet a meteror throne into the ocean, whose waves grow as they spread concentrically from the center: physical sickness, economic collapse, growing national debt, a possible new Cold War.  The horses of a mini-apocalypse seem saddled and ready to ride.  It is wise to consider the purposes of God.

A single effect is usually the fruit of many causes.  Fruit itself comes of earth, rain, sun, and seed.  Pandemics also require a seed -- a little spark -- then feed on what they find in the environment, to wreak havoc, if they can.  It is possible, then, that there is an element of truth in most of these models, different causes complementing one another.   Arrogance leads to presumptuous faith, encouraging foolish contact, without masks, in a "petri dish" environment with those who have recently traveled, especially in large cities and welcoming climactic conditions.  For all we know, God may be working through all that, or allowing the Evil One to try us and remember our own mortality.


Brad Cooper said...

In summary: According to statistics available within the past hour, more than 90% of all confirmed cases of COVID-19 fall within the 30-50 N' latitude lines. If we add in five European countries (Denmark, Norway, Netherlands, Sweden and Britain) that lie just above the 50 N' latitude line but are surrounded by the Atlantic Ocean and its associated seas, etc. (which serve to even out their climates), the total is more than 95%.

All major epicenters fall within these lines.

Brad Cooper said...

NOTE: The analysis below is from data available March 14.
Let's look at it this way, using the top 36 most populous cities in the world for comparison to simplify the analysis (and note that these are all cities with significant international travel):
(1) 100% of the areas that have been severely hit by the virus have large cities near a coast in the 32-47 latitude of the north temperate zone: Wuhan, Europe, Seoul, Tokyo, Tehran, Seattle, Santa Clara County and surrounding area (California), New York City.
(2) There are many large coastal cities outside this zone that have reported relatively few cases:
*Mexico City (only 15 cases in all of Mexico: population 129 million)
*Lagos (only 2 confirmed cases in all of Nigeria: population 191 million)
*Mumbai (only 4 cases in Mumbai: population 21 million); Kolkata (# of cases unavailable: population 14.9 million); Chennai (# of cases unavailable: population 9.9 million); (only 87 cases in all of India: population 1.339 billion)
*Manila (only 98 cases in all of the Philippines: population 105 million)
*Karachi, Pakistan (only 28 cases in all of Pakistan: population of Karachi 16.6 million)
*Buenos Aires (only 34 confirmed cases in all of Arentina: population 44 million)
*Sao Paulo & Rio de Janeiro (151 cases in all of Brazil: population 209 million)
*Kinshasa (only 2 confirmed cases in all of Congo: population 81 million)
*Jakarta (only 96 cases in all of Indonesia: population 264 million)
*Lima (only 38 cases in all of Peru: population 32 million)
*Bogota (only 16 cases in all of Colombia: population 49 million)
*Johannesburg (only 38 cases in all of South Africa: population 56.7 million)
*Bangkok (only 82 cases in all of Thailand: population 69 million)
**One could also compare the densely populated areas in Florida (76 cases: population 21.3 million) and Texas (50 cases: population 28.7 million)
(3) Large cities within the northern temperate zone but far from the coasts of any oceans or seas affected by ocean currents:
*Moscow (only 47 confirmed cases in all of Russia: population 144.5 million)
*Chicago (only 47 cases in all of Illinois: population of the greater Chicago area is ~10 million)

Brad Cooper said...

Well, I have run out of time to respond to this more fully. I hope to respond to your objections later (though I have already responded to part of them elsewhere).

David B Marshall said...

Thanks, Brad. But please do read my post for what it is actually intended to argue. My goal was NOT to refute any one of these theories.

There may be some correlation, I admitted. I'll be interested to see your response to my objections.

Thecurious said...

Is it any country in the world that is not effected by coronavirus?

David B Marshall said...

I don't think we can trust reports of any. Some countries in Africa, they may not be testing. And testing is imperfect everywhere.