A Coronavirus quiz (part II)

As promised, here are the answers to the quiz, with some commentary included.

Country A was the among the earliest to announce a travel ban on China, pending the arrival of tourists for the busy Chinese New Year celebration, and later enacted a total ban on immigration. It has only managed to ramp up to 50,000 tests a day. Its case fatality rate (hereafter CFR) hovers near one percent, and it is starting to relax restrictions on outdoor activities. New Zealand, where no one called the travel ban racist, as the Kiwis normally welcome tens of thousands of Chinese visitors for the New Year, which they were very wise to avoid. They still don’t do many tests but are among the leaders in per capita testing at 2.5%.

Nation B was among the first to ramp up viral test production, but has never completed more than 25,000 daily viral tests. It eschewed a national lockdown, and businesses and public spaces remain open. Instead, it deployed strict quarantines of areas where it detected an outbreak in progress. It also deployed a series of apps for contact tracing, and made failing to carry cell phones with these apps a crime punishable by several thousand dollar fines. South Korea, who is selling viral tests internationally despite the low daily testing level. That and the lack of a lockdown demonstrate it’s not just one thing, it’s the combination of policies which matter.

State C initially acted like the virus was “under control.” Eventually its leadership decided they had a problem on their hands and ramped up testing from nothing to hundreds of thousands daily. Its largest city is also its pandemic epicenter, and the national government is continuing to argue with state and local officials about responsibility for stringent quarantine measures. It hasn’t flattened the curve, yet, but is considering how to relax restrictions in light of the May holiday season. Call yourself Tovarisch if you ignored the false leads and guessed Russia. President Putin is staying out of the limelight and leaving the Mayor of Moscow to be the public face of the crisis. The May holidays? May (labor) Day and Victory Day!

Country D is still open for business, although without large gatherings. It has experienced several surges in cases and deaths, but its medical system has not been overwhelmed. It believes its relaxed rules and emphasis on social distancing are far more sustainable for the months-to-years before a vaccine is developed, and that it’s CFR–now higher–will eventually be the same as its neighbors who have shut their economies down. Sweden insists it is not sacrificing its vulnerable citizens and continues with its unique approach, despite withering foreign criticism and a vocal domestic minority. We won’t know who is right until all the data is in.

Nation E was the first to warn against Chinese claims on the coronavirus. It enacted strict border controls, then tightened them further! Its fines for violating quarantine or contact tracing rules continue to rise (above $10,000 US). It investigates and enforces fraudulent news coverage (such as a claimed toilet paper shortage) to the tune of US $100,000 fines. It emphasized ramping up mask production, then decreed controls on sales to ensure everyone has and wears them. It has practically eradicated the disease. The other China, Taiwan, tried to warn the WHO, but was rebuffed because, well what do they know? Turns out a lot, based on SARS and the proof in the data. Can you imagine the US with fines for “fake news?” No, me neither.

State F started out slowly, hoping to achieve herd immunity by simply protecting vulnerable populations and relying on its universal health service. As cases and deaths mounted, it engaged in a full reverse, enacting a lockdown and ramping up testing. It seems to have weathered the worst, but still has the second highest number of daily deaths. If I had said “National Health Service” it would have been obvious– the United Kingdom.

Country G was one of the world leaders in responding to the coronavirus. It enacted early and effective social distancing, restricted immigration, provided free health services, mass testing, and contact tracing. Its government is unusually effective and efficient, yet it suddenly finds itself with a spike in new cases and the most in its region. Singapore is blaming infected returning citizens for the new outbreak, but the new cases are centered in workers’ dormitories where low-skilled foreign workers are assigned to barracks-like accommodations.

Nation H is trying a little bit of everything. It has apparently past the peak in new cases and deaths, but the spread is uneven: urban areas were hard hit, while other regions not so much (yet). Some areas are reopening, while others still fear having overrun medical facilities. Testing is on the rise, but the public’s willingness to maintain strict lockdown conditions is waning. Many decry the lack of a single national policy in the place where the debate rages between “Make America Work Again” and You’ll “Make America Sick Again.”

State I enacted the first and most extensive lockdown in the Western world. Its higher CFR appears to be due to a perfect storm of older victims, inadequate emergency facilities, and the bad luck of being one of the first places hit hardest. Still, it has turned the corner on cases and deaths and is preparing to loosen restrictions. Italy tried to do everything right, and still got hammered for things no one thought were important (e.g., regional intensive care beds?).

Country J has the most cases and deaths in its region. Its leader has encouraged protests against state lockdowns, and engages in a running public debate with the press and medical officials. That leader still says it’s no worse “than the flu” and refuses to wear a facemask. J is for Brazil’s Jair Bolsonaro, the man most likely to out-trump President Trump. He is firing his health minister, leading protest rallies, and suggesting he needs to bring back martial law.

Nation K was initially hard hit, but enforced a tight regional lockdown and now has no deaths, officially. It fears a recurrence due to foreign visitors, which it is tightly controlling, and questions the account that the virus originated in China. C’mon, it’s a gimmee, the only nation questioning where the virus began is the People’s Republic of China, although they are clever enough to trumpet it in domestic news, but only whisper it in translation.

State L’s leaders insist they are fully prepared in terms of tests, ventilators, and hospital beds due to a national health system. However, their case count and deaths continue to rise, and hospital workers have been especially hard hit. The largest city is the pandemic epicenter, but their leader has only reluctantly given up his well-attended political rallies. This is how we coronavirus in the home of Corona beer–Mexico.

Country M is a world leader in testing per capita and total tests. It is in the top five for total numbers of cases, but has the best CFR among them. It attributes its success to younger initial victims, more testing, and well-resourced hospitals. The national lockdown is strongly supported, but more than a thousand protestors gathered in the capital city last week against it. The Germans demonstrated the same ruthless efficiency they always do, along with a little luck this time.

Nation N has an older, more densely situated population, making it very vulnerable. But it is also known for high technology and cultural compliance, so its early low infection and death rates seemed to indicate success at limiting movement and using contact tracing. But it wasn’t testing very much, and now its daily deaths are increasing, causing its leaders to fear they missed an opportunity to avoid a tragedy. I’ll publicly withdraw my earlier criticism that Japan was suppressing their data to avoid postponing the Olympics; it seems they were just lucky in fewer Chinese visitors, fewer international visitors, and a population lacking the complications which lead to deaths. But the virus never sleeps, and Japan’s luck has run out.

State O was late to the game but acted boldly, enacting a nationwide shutdown, which immediately backfired as millions of poor migrants began walking hundreds of miles to return home from the cities where they worked. The government fears that official data hides the magnitude of the crisis, and is preparing to blame a religious minority if a catastrophe ensues. It’s never a good time to be poor and Muslim in India, but the sight of millions of people walking the roadways home was one for the ages!

How did you do? Any perfect or near-perfect scores? Take credit! Any particularly difficult clues? Any quibbles? Sound off!

What do we take from all this? There are no silver bullets. Some countries went all in on testing, but no major country has gotten above 4% of per capita testing (Iceland has 13%). Some invoked electronic monitoring and contact tracing measures that no advanced Western nation would stomach, due to civil liberties concerns. Some added physical restraint to the mix (Google “China violently quarantines its citizens” for the shocking videos). Some had more masks on hand and insisted everyone wear them; those without enough masks took to dissuading citizens from hoarding them in place of medical users (bad move, if understandable).

Remember when ventilators were the main topic of American discussion (who has them, why won’t the federal government release them, how do we use the DPA to build thousands more)? Well, even New York City didn’t use half what it asked for, and the data from one study suggests they weren’t the lifesavers we were lead to believe (under normal circumstances, half of all ventilator patients die; with CoVid19, 88% of such patients died).

Because this is the first true pandemic in one-hundred years, we’re witnessing a real-time experiment with hundreds of variables and approaches. Some lessons are obvious; in other cases data points out a discrepancy that is not yet explicable. What has proved important?

• Early social distancing/mask wearing/limited quarantine of the sick. Anything to slow the spread of infection, enabling time for all other measures. Note the word limited: full scale stay at home orders can only last so long; enact them too early, and you will have people breaking out before the curve has flattened.
• Open exchange of data. Whether it is on cases, symptoms, therapies, clinical approaches, or vaccines, everyone does better when the data is correct, openly-shared, and correctly reported. And being honest about what’s being counted: there are several ways to make data errors which don’t involve nefarious intent. Leaders should not hawk cures or treatments; anybody notice the number of news accounts leaking preliminary study results? Yeah, same thing.
• Expanding local/regional intensive care facilities. The type of health system (universal/national or not) and the quality of its doctors were less important than numbers of intensive care beds. We may not use all of them, but one way to avoid avoidable deaths is to ensure one has enough treatment facilities for the worst cases. Hardly a cognitive breakthrough, but one worth repeating that the benefits far outweigh the costs.
• Protecting nursing homes. Even countries with exemplary care standards have experienced extreme death rates at nursing homes. The combination of vulnerable populations kept close together with staffs rotating between homes has proven deadly. Everywhere.
• Geography and the interplay with demography. Have more old people? Bad. Have more obese people? Bad. Have more international travel connections? Bad. Greece is like Italy, but hasn’t suffered the same. Mexico is much like the US, but hasn’t suffered the same. The differences don’t point to policies as much as other factors (perhaps climate?) yet to be explained.
• Recent experience with severe contagion: Taiwan (MERS, 2012) and South Korea (H1N1, 2009) are among the best, despite not doing mass testing or total lockdowns. In fact, low-level testing works fine if started early enough. And people being inclined to wear facemasks. And the country being a more compact one. Oh, and being suspicious of the People’s Republic of China plays a role, too.

Hope you enjoyed this testing exercise as much as I did creating it!