By Jerri-Lynn Scofield, who has worked as a securities lawyer and a derivatives trader. She is currently writing a book about textile artisans.
One thing I promised in my recent fundraising post is to inform the Naked Capitalism readership of facts about countries that are successfully managing the COVID-19 pandemic.
I’m looking at countries based on the number of deaths recorded – from 105 in Hong Kong for a population of 7 million; to 35 in Vietnam for its population of 100 million; to 7 in Taiwan for a population of 24 million; to 25 in New Zealand for a population of 5 million.
I am focusing on death counts rather than cases. Why? Governments are following different rules for reporting their COVID -19 cases, including only reporting symptomatic cases. Now, we know most – if not all- governments have a propensity to lie. This includes about reporting the number of Covid-19 deaths downwards as well.
But in the era of social media, it is much more difficult to manipulate death figures. Not impossible but difficult. So I am paying attention to those, as I think they are more or less accurate – although I wouldn’t hazard any guesses as to the margin of error. I am glad I am neither an epidemiologist, nor a medical doctor, nor a public health expert charged with holding a hard and fast point of view on such questions.
Now, a major right-wing talking point is that the U.S. overstates its COVID-19 deaths. I think this argument has receded as the pandemic has worsened, but not entirely. And maybe one positive consequence of the unfortunate diagnoses of the Trumps and leading Republicans as the latest victims of the disease will be the abandonment of this point.
I think it not very likely, but we can hope. As we can hope that the U.S. will finally get the mask religion that links the successful COVID-19 policies of several countries. So, please read to the end of this post for my debunking of this point about overstate U.S. death statistics. I have yet to share this with someone who’s raised the argument with me. Yet I encourage you to discuss it in comments, as well as share it if you are also subject to right-wing propaganda from people who don’t realize they are actually spreading a right-wing meme.
Hong Kong.Regular readers know I have written extensively about Hong Kong’s success, in several posts, relaying on the expertise of my Oxford friend, Canadian medical doctor Sarah Borwein, who currently practices in Hong Kong and is a veteran of the SARS crisis from her timepracticing in Beijing. I’m not going to repeat points I made in those previous posts, except to say early and comprehensive mask wearing;excellent widespread access to good, affordable medical care; and comprehensive contact tracing were all part of the mix. Interested readers can click on links to previous posts, which discuss these points at length (and there are there, but I didn’t want to overwhelm readers; if you are interested, use the Naked Capitalism search function.)
One point I have not emphasised before: Hong Kong has never had to lock down completely, but it has more or less sealed its borders. Even Hong Kong residents have faced barriers to their return, and when they did make it home, they were immediately tested. If necessary, they were subject to a quarantine.
Even essential workers who left and reentered the territory faced quarantine provisions. Sarah’s new husband is a Cathay Pacific cargo pilot, and he faced restrictions upon returning home.
Vietnam. For months, this country of 100 million people, reported no COVID-19 deaths, until it was hit with a second wave. Despite being a relatively poor country, Vietnam has benefitted from a well-developed public health system, combined with tight border controls, its testing policy, extensive contact tracing, and its quarantine policy.
Vietnam has invested heavily in its health care system, with public health expenditures per capita increasing an average rate of 9.0 percent per year between 2000 and 2016. These investments have paid off with rapidly improving health indicators. Between 1990 and 2015, life expectancy rose from 71 years to 75 years, the infant mortality rate fell from 36.9 deaths per 1,000 live births in 1990 to 16.5 deaths in 2018, and the maternal mortality ratio plummeted from 139 deaths per 100,000 live births to 54 deaths. The 2018 immunization rate for measles in children ages 12 to 23 months is over 97 percent [citattions omitted].
In addition, the country learned from its recent exposure to SARS:
Vietnam has a history of successfully managing pandemics: it was the first country recognized by the World Health Organization (WHO) to be SARS-free in 2003, and many interventions Vietnam pioneered during the SARS epidemic are being used to respond to COVID-19. Similarly, its experience with epidemic preparedness and response measures may have led to greater willingness among people in the country to comply with a central public health response. In fact, a survey conducted in late March by a public opinion research firm found that 62 percent of people in Vietnam believed the level of government response was the “right amount,” ranking higher than any of the other 45 countries surveyed.
Now, the strong role of the state in Vietnam means that it has faced little opposition from its people to its COVID-19 policies, and perhaps its model for virus control can not be replicated elsewhere – or so many have claimed. I admit I have thought less about the Vietnam example than the others I am offering today. This may be because there is comparatively less information available in English, or at least I have found so far.So these thoughts are preliminary and may be modified in future. But it is worth mentioning the country’s success – as elements of it – strong public health system, tightened border controls, extensive testing, thorough contact tracing, and quarantine for the known or presumed sick – have been practiced elsewhere and also yielded impressive results.
When a SARS-like virus, later named as coronavirus disease 2019 (COVID-19), first appeared in China in late 2019, it was predicted that, other than China, Taiwan would be one of the most affected countries, given its geographic proximity to and close people-to-people exchanges with China. Yet even as the disease continues to spread around the globe, Taiwan has been able to contain the pandemic and minimize its impact on people’s daily lives. The transparency and honesty with which Taiwan has implemented prevention measures is a democratic model of excellence in fighting disease. This webpage shares the Taiwan Model for combating the pandemic, as well as links to related international media coverage and video clips. The materials found here also help explain the different aspects of Taiwan’s epidemic prevention work, and how Taiwan is helping the international community.
Once again, well-known public health measures — rapid and ample testing, extensive quarantines- combined with a healthy dose of transparency about policy, and some reliance on technology, have led to Taiwan’s success so far. It has entered a second wave, but since it starts from such a low baseline, an uptick in infections is manageable.
Constantly tightening and relaxing the leash of a quarantine according to changing risk factors — and testing — are key in pandemic travel restrictions for Taiwan in its effort to strike a balance between economic interests and the need to protect its border from the threats of a global pandemic.
As of Monday, Taiwan recorded a total of just 509 confirmed cases — with seven deaths.
“Quarantine of arrivals is a major strategy for handling cross-border transmission,” said Chen Shih-chung, Taiwan’s Health and Welfare Minister and head of its Central Epidemic Command Center. “Strict border-control measures will remain in place for the foreseeable future.”
Since March 19, all inbound travellers to the island — citizens or not — must undergo a two-week mandatory quarantine.
Visitors can only board an inbound flight if they can provide negative COVID test results from within three days before boarding. Taiwanese nationals, temporary residents, migrant workers, international students and diplomats are exempted.
Well, the most important technology is soap and alcohol hand sanitizers. But in Taiwan, we see democracy itself as a technology. And the counter-pandemic effort is mostly about getting people understanding the science and the epidemiology so that people can innovate and wash their hands more vigorously, wear a mask to remind oneself to keep their unwashed hands away from their faces, and making sure that each pharmacy has sufficient supply. And of course, there’s also the border quarantine.
I only have space to quote part of the interview with digital minister Audrey Tang, but I encourage readers to click on the link and read the entire thing; it’s well worth it. Here she discusses the all-important border quarantine:
Yes. Anyone returning to Taiwan has two choices. Either they go to a quarantine hotel for 14 days, in which case they’re physically barred from leaving; or, if they live in a place with their own bathroom and with no vulnerable group of people, they can also choose to digitally quarantine, placing their phone into the digital fence. In that case, the nearby cellphone tower will measure the signal strength, as they always do, and send out an SMS whenever the phone runs out of battery or breaks out of the 50-meter or so radius. So, the idea is that during those 14 days, we pay each person in quarantine about $33 a day as a stipend. But if they break out of the quarantine, then they pay us back a thousand times that. So, very few people break the quarantine.
And also access to mask. In Taiwan, a citizen helped democratise access to masks. Compare that to popular agitation about the the mask situation in the U.S. or the UK or even Germany:
There was a person named Howard Wu in Tainan city who developed a map so that people could see the nearby places and exactly how many masks there are in stock. So, we very quickly supplied them, every 30 seconds, the real-time mask levels of all the pharmacies, and later on convenience stores, so that people who queue in line can keep this system accountable.
While most of the global economy is still reeling, damage to the hospitality and tourism sectors in parts of Asia has been offset by swelling demand for technology goods, according to economic researchers at JPMorgan. That surge is particularly powerful in Taiwan, where manufacturing production is almost a mirror image of the US.
The country’s economy is benefiting from the demand for technology that powers 5G servers and artificial intelligence, and it’s been turbocharged by home-schooling and work-from-home trends around the world. Taiwan’s GDP will grow 1% this year, according to JPMorgan, one of the very few economies that’s expected to expand. The US and German economies are forecast to shrink more than 4%, while those of France and the UK may contract more than 8%.
“Taiwan stands out for its scant evidence that a global pandemic has even occurred,” JPMorgan’s economists wrote.
New Zealand. One major advantage NZ has it’s at the end of the earth and shares no land borders with other counties. So it was able to quickly isolate itself. Its cases have come from overseas. The Ministry of Health (MoH) has an aggressive contact tracing program, for two types of contacts: close contacts and casual contacts. According to the Ministry of Health’s online circular, Contact tracing for COVID-19:
If you have been identified as a close contact of someone with COVID-19, you can expect to be contacted by the Ministry of Health or your local district health board’s public health unit (PHU).
We call this ‘contact tracing’. Contact tracing involves a phone call from the Ministry or PHU providing you with advice on self-isolation and checking on your health and wellbeing. The Ministry call centre staff will identify themselves and inform you that they are calling from the National Close Contact Service. They will also verify your name and contact details. These calls from Ministry call centre staff will usually come from 09 801 3009 or 09 306 8748.
Following this initial phone call, your details may be passed onto Healthline who will make follow up calls during your isolation period to check how you are doing. The calls from Healthline will usually come from 09 306 8748. There may be a delay before your call is connected. If you are concerned that a call from Healthline isn’t genuine, you can email Healthline and request a call back.
It is important to answer your phone, so the PHU, Ministry and Healthline can get in touch with you during this time.
Now, once the Ministry of Health traces a contact, close contacts need testing – which is rapid and is readily available – and self-isolation for 14 days, whereas casual contacts require to test and see-isolate only if they are symptomatic. Per the circular::
We are tracing all close contacts of cases, and getting them tested for COVID-19. All close contacts will remain in self-isolation for 14 days.
Most casual contacts do not need to self-isolate and only need to be tested if they develop symptoms.
In some specific situations, usually early on in an investigation, some casual contacts may be asked by health officials to get tested and self-isolate until they have returned a negative test.
In all situations, if a casual or close contact later develops symptoms, they should get tested, even if they had an earlier test, and self-isolate while awaiting the test result.
One important point: NZ has ac contact tracing app, but it is largely an after-thought, rather than a core part of their strategy. Again, over to the MoHcircular:
NZ COVID Tracer is a Ministry of Health app that supports fast and effective contact tracing by creating a digital diary of the places you visit.
You Cannot Monetize Contact Tracing: It Does Not Lend Itself to a Neo-Liberal Approach
First off, countries with contact tracing success have not tried to monetize the process. And I believe you can’t. It’s a net cost. Like so much of public health. And to do it properly, it will be a drain on public resources – not a gain.
No less an authority than our own Ignacio agrees with this (as I previously quoted in my fundraising post). Also, it cannot be done properly via app alone:
An app to do massive contract tracing is equal to laziness or unwillingness to do the right thing. But you know contracting people to do the good work is not in the neolib agenda. Importantly, it was expected to fail, so it is a failure by design.
I note the irony that Hong Kong – which IIRC has always been a low-regulation jurisdiction – even realises that public health – and health care – are indeed state functions. We could debate whether spending ample money on public health actually ends up saving the state in the long-run. It certainly seems to be the case in Taiwan. But I do not want to go there.We should just accept that adequate public health spend9ing is a net cost and cannot be monetised.
Also I don’t see obvious constraints on civil liberties in Taiwan.
The NYT article also highlights greater public trust and rapid testing as keys to success. These are both things we can do something about.
I also suggest the reason for failure is the unwillingness to recognise to recognise that proper contact tracing comes at a cost. It’s not and never will be a profit centre. We have a lot of work to do in purging the neo-liberal mindset, which persists despite the severity of the global pandemic.
We could have such trust too. By setting up known numbers for contact tracing calls. And coming down hard on anyone who uses that number to scam people.
Maybe there are difficulties here I do not see. But have the countries that have failed at contact tracing actually tried? And been willing to spend real public resources in doing so?
No, instead, they’ve give us neo-liberal talking points. And my right-wing friends continue to scream it’s all China’s fault.
Well, so what if it is? Who cares who is at fault for starting the pandemic? Or the initial slow response of much of the world community? Shouldn’t we now deploy our vast resources in mitigating the spread of COVID-19, and cleaning up the mess? Instead of using this as yet another convenient stick with which to beat China.
Finally, I close with another right-wing talking point I heard repeated often earlier this year, before the huge rise in US deaths. It was that the US overcounted its COVID-19 deaths for the following reason.
Suppose you had terminal cancer, and were expected to die within a couple of months. When you actually did die, your death would be attributed to COVID-19, rather than cancer, if you indeed had COVID-19 when you passed away.
And that, I suggest, is as it should be.
But it was a steady right-wing claim that this was a travesty. Well, is it?
Consider the following example. You and 20 other hospice patients go on a picnic. On the way back, your vehicle has an accident. Everyone dies. What is your cause of death?
Why, the vehicle accident of course. Until that happened, you may or may not have succumbed to your terminal illness that landed you in the hospice. When you would die was not known. If you had terminal cancer, for example, you may have ended up being one of these lucky patients who survived longer than expected despite a terminal diagnosis. Until you died, we cannot accurately predict your cause of death.
Same thing with Covid-19. For many elderly people, with or without a terminal diagnosis, a run-in with the virus was equivalent to having a traffic accident.
These Rules are Publicly Available
To paraphrase that fierce S & C partner who was renowned for reminding associates who didn’t bother to read the SEC rule before opining on an aspect of basic securities law: these rules are publicly available. So also for some of the basics of pandemic control. Some Asian countries learned them again or for the first time during the SARS crisis. And they have stood them in good stead even today.