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Covid-19 has only taken nine months to claim a million lives, a milestone that may cross tomorrow.
Given that 95 percent of these casualties occurred in the past six months, will the next million deaths come even sooner? Or will the world find a solution to stop the pandemic?
No one has the answer, but those million deaths provide some valuable advice.
More than 200,000 of them were in the United States which, with 4 percent of the world’s population, accounts for more than 20 percent of Covid-19 deaths.
Only four countries (the US, Brazil, India and Mexico) account for more than half of the deaths from Covid-19 globally. The other 480,000 deaths are spread over 190 other countries and territories.
The main factors that contribute to deaths from Covid-19 are: Age: older people who are infected have a higher risk of dying. A comparison by the U.S. Centers for Disease Control and Prevention (CDC), using 18 to 29 years as the base group, found that young children four years of age or younger are nine times less likely to die, while deaths are 630 times more likely in the elderly. 85 years and older.
Underlying medical conditions: The CDC said that regardless of age, certain medical conditions also put people at higher risk of death. They include cancer, chronic kidney disease, and heart conditions. Transplant recipients are also more susceptible, as they have weakened immune systems.
Health systems overwhelmed: More people die when health systems are overwhelmed, as some patients are unable to get the care they need to overcome illness. Infection numbers – this may be obvious, but it bears repeating. Only those who become infected with the coronavirus are at risk of dying from it.
The performance of countries in their battle against the virus has largely depended on how they have managed these four factors.
Countries that have managed to keep infection numbers low have also seen fewer deaths. They include:
• New Zealand (25 deaths out of 1,827 infected in a population of 5 million)
• Vietnam (35 deaths out of 1,069 infected in a population of 97.5 million) and
• Thailand (59 deaths out of 3,516 infected in a population of 70 million).
Countries where health systems were overwhelmed for some time also had higher mortality figures. These include various European countries such as:
• Great Britain (41,902 deaths out of 416,363 infected in a population of 68 million)
• Italy (35,781 deaths out of 304,323 infected in a population of 60 million) and
• France (31,511 deaths out of 497,237 infected in a population of 65 million).
In April, there were reports from these countries of patients being turned away for lack of beds, doctors crying because they couldn’t provide intensive care to patients who needed it, and overworked healthcare professionals working long hours.
Infections among the sick and the elderly are one reason for the high death toll in the US. US media reports say that deaths in care facilities account for at least a quarter, and perhaps as much as a third. , of the deaths from Covid-19 in the country.
The virus has spread globally and virtually no country has been spared. So why have some succeeded and others failed so miserably in dealing with this virus?
Often with a new virus, the countries that are the first to deal with it are the worst off, as it would have caught them by surprise. Furthermore, little is known about the new bug. But not with this pandemic.
China, where this new virus emerged, has done relatively well with 4,745 deaths out of 90,934 infected in a population of 1.4 billion. In fact, as the epicenter moved from Asia to Europe and then to America, the problem seemed to get worse.
Dr. Michael Ryan, Executive Director of the World Health Organization (WHO) Health Emergencies Program, gave some possible answers during NUS Medicine’s Covid-19 webinar on September 10.
He suggested that disparate performances from different countries were due to insufficient preparation, a lack of muscle memory and different levels of social cohesion.
NOT READY
Dr. Ryan, who has been at the forefront of managing acute global health risks for nearly 25 years, said the world has learned a lot from past health emergencies, “but we haven’t implemented a lot of those learnings.” .
He said that, globally, there has been a “serious underinvestment in managing and mitigating” the risks of new infectious diseases.
It is not that countries have not invested in health. But the investments tend to be in physical infrastructure: more hospitals and beds, and more laboratory facilities. He said this is a “very static preparation”, adding that “the real essence is the way data is collected and decisions are made.” It was this lack of preparation in Europe that caused the increase in cases and the saturation of hospitals.
“Much of the failure worldwide is due to a lack of preparation, not failure,” said Dr. Ryan. “Honestly, I think everyone had tried their best. Unfortunately, sometimes the best is not enough.”
Citing the example of running a marathon, he said, “No matter what my will is, no matter what my intention is, I will not finish that marathon because I have not prepared myself. Goodwill and best intentions aside, performance always It depends on your preparation. “
MUSCLE MEMORY
Only countries that have been through a health emergency, such as Sars (severe acute respiratory syndrome) for Singapore, which killed 33 of the 238 infected in 2003 and led to the closure of Tan Tock Seng Hospital, one of the busiest hospitals. here, they would have muscle memory ingrained in their psyche. Such countries would quickly collect, analyze and act on the data. They also have the ability to make decisions, create new science, and turn it into policy and action.
Dr. Ryan said that “Asian countries have a much higher sense of alert for this type of virus. It triggers a collective unrest in the community.”
In the first week of January, when the world learned of the possibility of a new virus, the number of phone calls it received from Asian countries such as Singapore, South Korea and Japan had “skyrocketed.” These countries had an immediate level of concern.
Singapore, for example, had established the multi-ministry task force before a single patient was diagnosed with Covid-19.
For the rest of the world, Dr. Ryan said, “it’s a remote concept,” causing them to be “caught off guard” when the virus hits them.
SOCIAL COHESION
The best performing countries also tend to have higher community acceptance, Dr. Ryan said.
He said such a health emergency “triggers collective unrest in the community and governments are expected to be ready to handle it.” People see government intervention as responsible action.
But in some countries, that is seen as an interference in people’s lives and an invasion of personal privacy. It boils down to differences in the social contract that people have with their government.
He said that countries where people see themselves as part of a community tend to absorb information in a positive way and act in a more sustainable way.
But in societies where the individual is seen as the most important unit of society, unlike the community, people do not feel that sense of responsibility.
He said, “Your answer is: What does it mean for me? What is the risk of transmission for me? Will the vaccine work for me? Is my travel important to me? Instead of asking the question: Does my travel behavior Is it dangerous for someone? Is attending the event dangerous for someone else? Is it important for society that I get vaccinated? “
He said: “Societies with a high level of social cohesion and group sense have done better.”
Dr. Ryan added that if you consider that social distancing, avoiding crowds and hand hygiene can slow the spread of the virus, “then your success is based almost 100 percent on the willingness of society to accept. those rules. “
POLITICAL LEADERSHIP
What does politics have to do with science and strategy to combat the virus that has disrupted lives and livelihoods globally?
More than one would think, especially in the United States and Brazil, two of the three countries most affected by the virus. In both cases, the leaders were pushing their own agenda to keep the economy open.
With his re-election campaign at stake, the president of the United States, Donald Trump, has ignored the advice of the health authorities and has downplayed the severity of the Covid-19 crisis. It even pulled the CDC, one of the world’s leading health authorities, out of the hierarchy.
Brazilian President Jair Bolsonaro even replaced his Health Minister with one willing to promote the reopening of the economy.
Professor Teo Yik Ying, dean of the NUS Saw Swee Hock School of Public Health, cautioned that it may be premature to determine the role that politics has played “in the dire situations in the United States and Brazil.”
But he added: “When country leaders choose to ignore the facts and science of Covid-19, it is when poor decisions are made that amplify the spread of the coronavirus in a country, rather than help improve the situation.”
The lessons of the past nine months are clear. Reactions to the unfolding crisis will have to be faster. Politics will have to be driven by science rather than political agendas.
And as the search for a vaccine continues, public acceptance of the Covid-19 measures will determine whether the virus claims another million lives and, if so, how quickly, or whether it will be kept at bay.
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