Starting last week and for the next few, The Tyee is tracking how six different nations have responded to one global virus.
At one extreme New Zealand strives to eliminate the virus from the population while at another Sweden continues on its controversial path to build herd immunity.
Everywhere the virus has travelled it has illuminated class, social, racial and political divisions as dangerous as the pandemic itself.
All six nations hold lessons for Canada which is still in lockdown mode. Some preliminary studies provide a potential context to the statistics below: the number of people infected by the virus is probably 10 times higher than the number of reported cases.
New Zealand: 1,436 cases; 12 deaths; 4.9 million population
New Zealand remains in a stringent national lockdown as Prime Minister Jacinda Ardern attempts to eliminate the virus completely from the country in a matter of weeks.
So far Ardern’s tough lockdown (no one leaves their neighbourhood) has had the desired effect. To date the number of new cases has fallen to single digits with no more than a dozen people in hospital. She is expected to ease restrictions this week and allow food delivery and some school reopenings. But most public places will remain closed and travel will be restricted. “The last thing we want to do is move out of level four and lose everything,” she said.
But a group of academics led by Simon Thornley, a public health expert at the University of Auckland, has started a raucous debate by accusing the government of trying to "squash a flea with a sledgehammer and bring the house down.”
Thornley argued that COVID-19 wasn’t all that bad and that older people with medical conditions were going to die sooner than later anyways. "Something was going to get them, it just happens to be this.“
Thornley proposed that the government cancel its level four emergency and let schools and universities reopen, leisure activities resume and domestic travel continue. “Those over 60 and/or with underlying health conditions and uncomfortable returning to work, could continue to work at home with support from their employer and government," added Thornley.
Critics called Thornley’s proposal a form of medical apartheid that would create more problems than it would solve. They said it wouldn’t protect Maori or Pacific peoples among whom at-risk conditions for COVID-19 are the highest. (Unlike Canada New Zealand publishes racial data on COVID-19 cases.)
Michael Baker, one of the architects of New Zealand’s elimination policy, argued that the country is now in an enviable position with actual choices. Its tough lockdown “is the least bad strategy because it gives us an exit strategy and that exit strategy seems tantalizingly close: that we can transition to a COVID-free New Zealand in the foreseeable future."
The country is now expected to roll out more testing and contact tracing to eliminate the virus combined with mandatory quarantine for travellers.
Defenders of New Zealand’s approach said relaxing measures for all but the most vulnerable would produce Sweden’s poor results protecting seniors.
Sweden: 14,777 cases; 1,580 deaths; 10.2 million population
Sweden has continued its so-called soft approach amid blistering criticism from many infectious disease experts. From the outset Anders Tegnell, the state’s chief epidemiologist, chose a radical course: gradual exposure overtime to achieve significant herd immunity which Sweden expects to reach in a couple of weeks.
Tegnell has argued that his laissez faire method might garner more deaths and infections in the short term, but could prevent a second wave or a national lockdown. Unlike its more conservative neighbours, Sweden did not shut down. Citizens over 70 were advised to stay at home while schools and many restaurants remained open with guidelines for social distancing.
Last week a group of the nation’s most prominent 22 doctors and virologists demanded that Tegnell resign. They also accused Sweden’s Public Health Agency of failing to prepare a proper strategy. Critics, too, have compared Finland’s low death rate (it locked down Helsinki) to Sweden’s (about 10 times greater) as further evidence of the failure of the “Swedish model.” Tegnell has replied that Finland is in a different phase of the pandemic, and it only has half the population of Sweden.
Virologist Lena Einhorn has taken Tegnell to task for insufficient testing and ignoring the importance of silent carriers who have been driving the pandemic everywhere. “We have no idea how widespread the coronavirus is in Sweden. And until we get the answer, we have to change our approach to this deadly epidemic,” she wrote in a local paper.
Meanwhile the virus has illuminated Sweden’s social weaknesses. It has infiltrated nearly half the country’s elderly care homes and hit immigrant populations in Stockholm hard. (Swedish ski tourists returning from the Italian Alps originally seeded the contagion.)
To date Somali-born residents in Sweden are over-represented among those in need of hospital care for COVID-19, as are people born in Africa or the Middle East. Swedes mostly live in single-person households, but multiple generations in immigrant neighborhoods share the same crowded space. About 25 per cent of Sweden’s population are of immigrant descent.
In response to the criticism the Swedish government plans to ramp up testing by 50,000-100,000 tests per week. Police officers and emergency responders will be given priority.
Although Sweden’s politicians have deferred to Tegnell’s radical plan, they passed a new law, effective till the end of June, that gives the government the authority to temporarily close businesses, shut down ports and airports, and limit public events. Prime Minister Stefan Lofven has told Swedes to prepare for thousands more deaths.
South Korea: 10,6784 cases; 236 deaths; 52 million population
While Singapore and Japan battled a new resurgence of the virus, South Korea has begun a tentative exit. Masked South Koreans filled streets, parks, restaurants and election polls last week. Even Apple reopened its store in posh Gangam district as the number of new cases fell to single digits a day last week.
But as South Koreans warily broke their isolation, Korea’s Centers for Disease Control and Prevention still urged its citizens to practise physical distancing. Due to effective infectious disease legislation and a rapid response (the country is almost always on a war footing with North Korea), South Korea is one of the few countries in the world that has contained the virus. Its feat is more impressive given that at one time it had the world’s second highest number of cases after China and never declared a lockdown.
The first case appeared in mid-January and by late February the country was testing 10,000 people a day or 20 times more than the United States. Testing combined with rigorous contact tracing, digital tracking and isolation of the infected appears to be well on its way to stamping out the virus after cases peaked in late February around 900 day.
They have fallen ever since. The country, which has a younger population than Italy, has only seen 230 COVID-19 deaths.
Fearful of a second wave, South Korea’s government is drafting guidelines for a return to a “new normal,” including modifying quarantine procedures and social distancing measures.
But in another viral twist, Korean researchers have discovered more than 160 recovered COVID-19 cases testing positive again. Half of 36 recovered patients at a nursing home, for example, tested positive a second time suggesting their immune systems might have been too weak develop antibodies.
Many of positive cases appeared between 13 days and nearly 40 days of recovery. Researchers suspect the virus goes dormant and then reactivates under the right conditions.
Scientists don’t know whether these repeated positives can infect third parties but all have been isolated. China, India and Japan have reported similar cases of viral reactivation. “It’s clear that we don’t fully understand what it means to have immunity against this virus,” one expert told the Wall Street Journal.
Brazil: 39,983 cases; 2,504 deaths; 210 million population
Brazil has become the chaotic home to “the Bolsonaro model.” The country’s evangelical president still considers the virus “a little flu” and continues to advocate for an open economy with a to-hell-with-science approach.
Bolsonaro fired his health minister last week after Luiz Henrique Mandetta criticized his boss for flouting social distancing rules. Bolsonaro, who loves hugging his political supporters in crowded spaces during a pandemic, described the firing as a “mutual divorce.” Bolsonaro appointed a more obedient doctor at a ceremony where guests did not wear masks. Nor did they refrain from close physical contact. The president has joined protests against state governors’ lockdown decrees.
The newspaper O Globo offered one snapshot of the pandemic’s progress on April 18 in the state of Rio. There one person dies every 36 minutes, or 40 a day. The majority of the cases affect young people between the ages of 30 and 49 while only 25 per cent of the deaths have occurred among the elderly. Men typically represent the greatest number of cases and deaths.
As evidence of the virus’s prevalence, two governors have been sickened by it: Wilson Witzel of Rio de Janeiro and Helder Barbalho of Para. Witzel, who supports aggressive measures against the virus, has characterized Bolsonaro’s defiance as a “crime against humanity.”
The Asia Times reported that “The predictable health debacle in Brazil is also a direct consequence of the neoliberal economic debacle — wherein public health is not a priority and poor Brazilians have been left on their own, as well as demonized.”
Lack of government co-ordination and supplies have resulted in a dearth of testing as well as underutilized labs run by the agriculture ministry.
Meanwhile Brazilian researchers calculated that the country’s 25,000 cases represent only the tip of iceberg. They estimate that a quarter of a million people are already infected and that the country might face an Italian or Ecuadorean-like emergency by the end of April. In Ecuador, people have died in their homes and on the street by the hundreds.
South Africa: 3,158 cases; 54 deaths; 58 million population
To date the country’s draconian lockdown may have changed the trajectory of the pandemic but testing is spotty. South Africa looked like it was going to repeat England’s experience but now appears to be on a more South Korean-like track. The goal of the lockdown is to buy the country time during which the government can build more critical-care beds, prepare quarantine facilities and set up field hospitals.
But the biggest threat facing many South Africans is not COVID-19 but hunger.
In some cases the authorities have even prevented NGOs and pastors from delivering food to the poor. Violent protests have flared up in Cape Flats, the sprawling slums outside of Cape Town. In other parts of the country local gangsters armed with masks, gloves and automatic weapons have provided food to some shantytowns. In the Johannesburg suburb of Eldorado Park and in Cape Town, gangs have hired security companies to deliver pots of food and food parcels to poor communities.
The government is now sending 30,000 community health-care workers, many of whom have worked on HIV and tuberculosis campaigns, to test, track and isolate infected individuals. The government hopes to screen 10 per cent of the population (six million) by the end of the month.
The homeless in Cape Town were taken off the streets and removed to a temporary camp outside of town where the virus has spread.
Germany: 146,200 cases; 4,669 deaths; 83 million population
Although hard hit by the virus Germany is now beginning to collect more data to forge an effective exit strategy. It is easing some restrictions on shops up to 800 square metres in size; but bars, restaurants and religious services will remain verboten until May.
Unlike many other European countries, Germany tested early and broadly which helped to identify carriers and slow the virus’s progress. It also kept the number of deaths low compared to Spain and Italy. It now tests up to 120,000 citizens a day and Chancellor Angela Merkel proposes to track down “every infectious chain.”
But before the country can relax more of its restrictions, it needs to find out how people were really infected and how effective their immunity is. To that end the city of Munich has begun to randomly test 3,000 households to determine how many citizens have had the virus. Researchers will take blood samples several times over the course of year.
In addition the Robert Koch Institute, the government’s key infectious disease centre, is testing 5,000 samples from blood banks across the country every two weeks. It is also gathering antibody data from 2,000 people in four coronavirus hot zones in the country. The goal is to figure out which of the country’s interventions have played the greatest role in slowing the virus and which can be lifted.
Michael Hoelscher, who designed the Munich study and proved how contagious symptomless carriers were at the end of January, told the New York Times that Germany is at a crossroads.
“Are we going the route of loosening more and increasing immunity in the summer to slow the spread of this in the winter and gain more freedom to live public life? Or are we going to try to minimize transmissions until we have a vaccine?” he asked.