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The coronavirus has killed so many people in Iran that the country has resorted to mass burials, but in neighboring Iraq, the body count is less than 100.
The Dominican Republic has reported almost 7,600 cases of the virus. Across the border, Haiti has registered about 85.
In Indonesia, thousands of people are believed to have died from the coronavirus. In nearby Malaysia, a strict blockade has kept deaths to about 100.
The coronavirus has touched almost every country on earth, but its impact has seemed capricious. Global metropolises like New York, Paris and London have been devastated, while cities like Bangkok, Baghdad, New Delhi and Lagos have, until now, been largely saved.
The question of why the virus has overwhelmed some places and left others relatively intact is a puzzle that has generated numerous theories and speculations, but not definitive answers. That knowledge could have profound implications for how countries respond to the virus, to determine who is at risk, and to know when it is safe to go out again.
There are already hundreds of studies underway around the world looking at how demographics, pre-existing conditions and genetics can affect the wide variation in impact.
Doctors in Saudi Arabia are studying whether genetic differences may help explain the different levels of severity in Covid-19 cases among Saudi Arabs, while scientists in Brazil are investigating the relationship between genetics and Covid complications. -19. Teams in various countries are studying whether it is common Hypertension medications could worsen the severity of the disease and whether a particular tuberculosis vaccine could do the opposite.
Many developing nations with hot climates and young populations have escaped the worst, suggesting that temperature and demographics may be factors. But countries like Peru, Indonesia and Brazil, tropical countries in the midst of growing epidemics, throw cold water on that idea.
Draconian measures of social distancing and early closure have been clearly effective, but Myanmar and Cambodia did not and have reported few cases.
A theory that is not proven but is impossible to refute: perhaps the virus has not yet reached those countries. Russia and Turkey seemed fine until, suddenly, they were not.
Time may still be the best equalizer: The Spanish flu that broke out in the United States in 1918 seemed to die out during the summer only to return with more deadly stress in the fall and a third wave the following year. Eventually it reached remote places like the islands of Alaska and the South Pacific and infected a third of the world’s population.
“We are very early in this disease,” said Dr. Ashish Jha, director of the Harvard Institute for Global Health Research. “If this were a baseball game, it would be the second inning and there is no reason to think that in the ninth inning the rest of the world that now seems unaffected will not go elsewhere.”
Doctors studying infectious diseases around the world say they do not yet have enough data to get a complete epidemiological picture, and that the lack of information in many countries makes it dangerous to draw conclusions. The evidence is regrettable in many places, leading to a vast underestimation of the progress of the virus, and the deaths are almost certainly underestimated.
Still, the general patterns are clear. Even in places with abysmal records and broken health systems, mass burials or hospitals that reject thousands of sick people would be hard to miss, and several places just aren’t seeing them, at least not yet.
Interviews with more than two dozen infectious disease experts, health officials, epidemiologists, and academics from around the world suggest four main factors that could help explain where the virus thrives and where it doesn’t: demographics, culture, environment, and speed. of government responses.
Every possible explanation comes with considerable warnings and confusing counter-tests. If an aging population is the most vulnerable, for example, Japan should be at the top of the list. It is far from that. However, these are the factors that experts consider most persuasive.
The power of youth
Many countries that have escaped massive epidemics have relatively younger populations.
Young people are more likely to develop mild or asymptomatic cases that are less communicable to others, said Robert Bollinger, professor of infectious diseases at the Johns Hopkins School of Medicine. And they’re less likely to have certain health problems that can make coronavirus disease Covid-19 particularly deadly, according to the World Health Organization.
Africa, with around 45,000 reported cases, a small fraction of its 1.3 billion people, is the youngest continent in the world, with more than 60 percent of its population under the age of 25. In Thailand and Najaf, Iraq, local health officials found that the 20- age group up to 29 years had the highest infection rate, but often showed few symptoms.
In contrast, the national median age in Italy, one of the most affected countries, is over 45 years old. The average age of those who died from Covid-19 was around 80.
Younger people tend to have stronger immune systems, which can lead to milder symptoms, said Josip Car, a population and global health expert at Nanyang University of Technology in Singapore.
In Singapore and Saudi Arabia, for example, most infections are from foreign migrant workers, many of whom live in tight dorms. However, many of those workers are young and fit, and have not required hospitalization.
Along with young people, relatively good health can lessen the impact of the virus among infected people, while certain pre-existing conditions, especially hypertension, diabetes and obesity, can worsen its severity, researchers in the United States say.
There are notable exceptions to demographic theory. Japan, with the oldest average population in the world, has recorded fewer than 520 deaths, although its number of cases has increased with increasing evidence.
And Harvard’s Dr. Jha cautions that some young people who don’t show symptoms are also highly contagious for reasons not well understood.
Cultural distance
Cultural factors, such as the social distancing that is built in certain societies, may give some countries more protection, epidemiologists said.
In Thailand and India, where the number of viruses is relatively low, people greet each other from a distance, palms together as in prayer. In Japan and South Korea, people bow, and long before the coronavirus arrived, they tended to wear face masks when they felt bad.
In much of the developing world, the custom of caring for the elderly at home leads to fewer nursing homes, which have been tinder for tragic outbreaks in the west.
However, there are notable exceptions to the theory of cultural distancing. In many parts of the Middle East, such as Iraq and the Persian Gulf countries, men often hug or shake hands to meet, but most do not get sick.
What might be called “national distancing” has also proved advantageous. Countries that are relatively isolated have reaped health benefits from their isolation.
Remote nations, like some in the South Pacific and parts of sub-Saharan Africa, have not been so inundated with visitors that they carry the virus with them. Health experts in Africa cite limited travel from abroad as perhaps the main reason for the continent’s relatively low infection rate.
Countries that are less accessible for political reasons, such as Venezuela, or due to conflicts, such as Syria and Libya, have also been somewhat protected by the lack of travelers, as have countries like Lebanon and Iraq, which have suffered widespread protests in the last months.
Lack of public transportation in developing countries may also have reduced the spread of the virus there.
Heat and light
The geography of the outbreak, which spread rapidly during the winter in temperate countries like Italy and the United States and was practically not seen in warmer countries like Chad or Guyana, seemed to suggest that the The virus did not get well in the heat. Other coronaviruses, such as those that cause the common cold, are less contagious in hot, humid climates.
But the researchers say the idea that warm weather can only repel the virus is an illusion.
Some of the worst outbreaks in the developing world have occurred in places like Brazil’s Amazon region, a place as tropical as any.
“The best guess is that summer conditions will help, but they are unlikely in themselves to lead to a significant slowdown in growth or a decrease in cases,” said Marc Lipsitch, director of the Center for Dynamics of Communicable Diseases at the University from Harvard.
The virus that causes Covid-19 appears to be so contagious as to mitigate any beneficial effects of heat and humidity, said Dr. Raul Rabadan, a computational biologist at Columbia University.
But other aspects of hot weather, like people who spend more time outdoors, might help.
“People who live indoors in closed environments can promote virus recirculation, increasing the chance of contracting the disease,” said Mr. Car of Nanyang University of Technology.
No scientist has proposed that radiant light inside an infected person, as President Trump suggested, would be an effective cure. And tropical conditions may have even led some people to a false sense of security.
“People were saying ‘It’s hot here, nothing will happen to me,'” said Dr. Doménica Cevallos, a medical researcher in Ecuador. “Some were even purposely going out to sunbathe, thinking it would protect them from infection.”
Early and strict locks
Countries that closed early, such as Vietnam and Greece has been able to avoid out-of-control infections, evidence of the power of strict social distancing and quarantines to contain the virus.
In Africa, countries with bitter experience with killers such as HIV, drug-resistant tuberculosis and Ebola knew the simulation and reacted quickly.
Airport staff from Sierra Leone to Uganda were taking temperatures (as this was considered to be a less effective measure) and contact details and wearing masks long before their counterparts in the United States and Europe took such precautions.
Senegal and Rwanda closed their borders and announced curfews when they still had very few cases. Ministries of health began looking for contacts early.
All of this happened in a region where health ministries relied on money, staff and supplies from foreign donors, many of whom had to focus their attention on outbreaks in their own countries, said Catherine Kyobutungi, executive director of Population. and African Health. Research Center.
“The countries wake up one day and say,” OK, the weight of the country rests on our shoulders, so we must step up, “he said.” And they have. Some of the responses have been beautiful to look at, honestly. ”
Sierra Leone reused the disease monitoring protocols that had been established in the wake of the Ebola outbreak in 2014, in which almost 4,000 people died there. The government established emergency operations centers in each district and recruited 14,000 community health workers, 1,500 of whom are being trained as contact trackers, despite Sierra Leone having only around 155 confirmed cases.
However, it is unclear who will pay their wages or expenses such as motorcycles and raincoats to keep them operational during the upcoming rainy season.
Uganda, which also suffered during the Ebola spread, quickly quarantined Dubai travelers after the first coronavirus case came from there. Authorities also located 800 other people who had traveled from Dubai in the past few weeks.
Ugandan health authorities are also evaluating about 1,000 truckers a day. But many of those who tested positive have come from Tanzania and Kenya, countries that are not monitoring as aggressively, worrying that the virus will continue to penetrate porous borders.
The blockades, with bans on religious conclaves and spectator sporting events, clearly work, says the World Health Organization. More than a month after closing national borders, schools and most businesses, countries from Thailand to Jordan have seen new infections fall.
In the Middle East, the widespread closure of mosques, shrines, and churches occurred relatively early and probably helped stop the spread in many countries.
As effective as blockades are, in countries that lack a strong social safety net and where most people work in the informal economy, orders to close businesses and require people to take refuge there. difficult to maintain for a long time. When people are forced to choose between The social distancing and nutrition of their families choose the latter.
Against intuitively, some countries where the authorities reacted late and with the irregular application of the blockades seem to have been saved. Cambodia and Laos had brief episodes of infection when few social distancing measures were applied, but neither has registered a new case in approximately three weeks.
Lebanon, whose Muslim and Christian citizens often make pilgrimages respectively to Iran and Italy, places where the virus is rife, should have had a large number of infections. Does not have.
“We just didn’t see what we expected,” said Dr. Roy Nasnas, an infectious disease consultant at Geitaoui University Hospital in Beirut. “We do not know why”.
Dice Roll
Finally, most experts agree that there may not be a single reason why some countries are affected and others are not. The answer is likely to be a combination of the above factors, as well as one mentioned by the researchers: pure luck.
Countries with the same culture and climate could have very different results if an infected person attends a crowded social occasion, turning it into what researchers call a super-broadcast event.
That happened when a passenger infected 634 people on the Diamond Princess cruise ship off the coast of Japan, when an infected guest attended a grand funeral in Albany, Georgia, and when A 61-year-old woman went to church in Daegu, South Korea, spreading the disease to hundreds of congregants and then to thousands of other Koreans.
Because an infected person may experience no symptoms for a week or more, if the disease spreads under the radar, exponentially and apparently at random. If the woman in Daegu had stayed home that Sunday in February, the outbreak in South Korea could have been less than half of what it is.
Some countries that should have been flooded are not, leaving researchers scratching their heads.
Thailand reported the first confirmed case of coronavirus outside China in mid-January, from a traveler from Wuhan, the Chinese city where the pandemic is believed to have started. In those critical weeks, Thailand continued to receive an influx of Chinese visitors. For some reason, these tourists did not cause an exponential local transmission.
And when countries do everything wrong and still seem not to be as battered by the virus as might be expected, imagine.
“In Indonesia, we have a health minister who believes you can reject Covid, and we have very little evidence,” said Dr. Pandu Riono, an infectious disease specialist at the University of Indonesia. “But we are lucky to have so many islands in our country that limit travel and perhaps infection.”
“There is nothing else we are doing well,” he added.
