Southeast Asia coronavirus update

Health officials praise Laos after coronavirus-free declaration (some new concerns here, so far nothing major)

Cambodia has zero reported deaths, broadly consistent with anecdotal evidence too.

Vietnam reports 14 new cases, all imported.  Broader record of zero deaths.

No new Covid cases in Thailand Tuesday.

Have you noticed that those four countries are right next to each other?  (Within southeast Asia, most cases are in the relatively distant Indonesia and Philippines.)

I genuinely do not understand why this heterogeneity is not discussed much, much more.

Those countries also have very different institutions and systems of government and state capacity.  Do you really think this is all because they are such policy geniuses?

Those countries have instituted some good policies, to be sure.  But so has Australia, where there is a major coronavirus resurgence.

Inquiring minds wish to know.  One hypothesis is that they have a less contagious strain, another is that they have accumulated T-cell immunities from previous coronaviruses.  Or perhaps both?  Or perhaps other factors are playing a role?

I do not understand why the world is not obsessed with this question.  And should you be happy if you have, in the past, traveled to these countries as a tourist?

Comments

I visited Cambodia in December 2019, right before the virus. One thing you definitely notice in Cambodia is that there are a ton of Chinese tourists. Some, I imagine, were from Wuhan.

As the tourism and garment sectors in Cambodia have shut down, newly unemployed Cambodians have largely returned to family homes in the villages.

One would expect that to spread coronavirus across the country. But one thing rural Cambodia lacks (among many things) is air-conditioned spaces.

I think Air-Conditioning and other HVAC-heavy spaces is an under-rated take on this phenomenon that has more explanatory power than folks suspect. All these SE-Asian countries tend not to have AC, and to conduct a higher % of life in "open air" in general than "treated air" like the west does. The US probably has more time spent in "treated air" than any other nation on earth. Given how little protests seem to have driven up cases and how much prisons, nursing homes, and meat packing plants have, I think it's pretty likely that HVAC-heavy countries have worse spread rates.

Thailand has more air conditioning than anywhere else I have been. Bangkok is a completely air conditioned city and March-April was hot season peak, so those ,machines were on.

Anecdotally it seems to me that some countries have much higher positive rates in their inbound traveller tests than the general population (eg Australia). Is that right? If yes it would strike me as odd and significant.

Median age in Cambodia, Vietnam, Laos is 24, 30, 23 respectively.

In Italy, Spain and the UK its 47, 45 and 40 respectively.

Covid-19 isn't such a problem when so much of the population is under 40 years old.

India's median age is 27 and it is ranked no.3 in total infections and has 20k deaths, which many believe is way below the real death counts.

> which many believe is way below the real death counts.

This is a perennial claim, usually reflexively made.

However, I'm in Mumbai, now having the 2nd highest number of cases, and there have been the usual handful of deaths in my gated community these past few months, among the elderly cohort, that are expected every year. Our security and maintenance staff reside in slums and they don't report any mass casualties. All deaths are now required to be notified immediately to the municipality. I've heard of very few cases of COVID sufferers experiencing a sudden death - there is usually some lag from symptom onset to further deterioration to critical status. The person's COVID status gets identified by then. Where are these surfeit of deaths happening?

Median age of Thailand is 40. They have a remarkable result. Median age of US is 38. We have a remarkably bad result.

"They have a remarkable result." They will also see their economy fall 10%. That may not seem so remarkable if the rest if the world is recovering and they are still pre-COVID. I do hope there is a genetic or geographic component to their safety so far

Thai economy forecast to have a 5.2% reduction over the entire year. With 58 dead. US already dropped 5% in first quarter. 130,000 dead YTD. What part of this is confusing?

Which parts of the rest of the world are "recovering" right now, in either sense?

https://www.bloomberg.com/news/articles/2020-07-06/here-s-why-thailand-s-dire-economic-outlook-is-the-worst-in-asia?srnd=premium-asia

Bank of Thailand says over 8%, which Bloomberg says s the worst in Asia.

Given that economists cite the tourism sector as between 7-20% of the economy (depends of forecaster and wherever the are counting "direct" or "indirect"), I expect it will be worse.

Wait three months, I guarantee you this will become obvious

You found your estimates, I found mine. The Dismal Science.

I give up. You're right. America is doing great. Thailand is a basket
case. I look forward to breaking 200,000 dead by the Fall, and we
can really show how well we're handing things.

I was in Thailand and I'm in America now. I'd rather be there.

I am in Bangkok now, which is what makes me so acutely aware of the pending economic downturn.

If you were here you would be walking empty streets. looking up at closed hotels, shuttered bars and restaurants, and seeing lines of people waiting for handout food.

I am very happy being here and not in the US (for dozens of reasons). I don't know why, but Thailand does seem to have avoided Covid impacts for now.

It think it is too early to say who made the right bet, but expect that the US will be soaring in recovery before Thailand even figures out what hit it.

I'm less pessimistic about the US than you are, but the future is probabilistic. One of us may be proven right or wrong and it may just be luck.

That helps explain a low mortality rate. But not a low infection rate. Young adults are not immune to the virus, they just have less serious outcomes

The lack of testing likely does explain.

The US is testing literally anyone with a mouth, and quite a few without mouths.

A bit of an exaggeration, but the US is performing a lot of tests at this point. Roughly 1% of the total US population per week.

We are the only nation (I think UK is somewhat close) doing this level of testing.

Every other country is basically saying, no tests, no cases, no deaths.

Cases don't matter in truth, deaths do, but deaths continue the downward tumble.

Victoria is doing many more tests per capita than America.

It is doing 25000 tests/day on a population of 6.5 million. America is 50 times that population, so that would be 1.25 million tests/day. And America has never come close to 1 million tests/day.

That in hard hit areas in America, testing is starting to buckle under the strain for a number of reasons.

"Victoria is doing many more tests per capita than America."

That's an apples to oranges comparison.

The US is performing more tests per capita than Canada is.

Canada is performing 1,080 per 1 million per day
The US is performing 1,923 per 1 million per day.

https://ourworldindata.org/coronavirus/country/canada?country=~CAN#the-scale-of-testing-compared-to-the-scale-of-the-outbreak

Canada also has 10x fewer cases / capita... (fewer reasons to be testing, less need for contact tracing, etc)

Lack of testing does not affect hospitalization and death counts. I assure you all of them have been tested. When you have very few or none of these, something positive (and unexplained) is happening.

I live in Thailand and do not especially trust this government. But it is true that there are no signs of Covid related pressures at hospitals, secrets deaths, etc.

The lack of testing surely kept some numbers down, but is not a core cause of the low and positive numbers

Testing and positive cases are not the important measures, as most people understand, because they are biased. Hospitalizations and deaths are what matter.

Which makes it all the less understandable that we are not doing frequent random testing of asymptomatic individuals.

Maybe because asymptomatic individuals don’t WANT to be tested, and forcing them to be tested would be fascism?

And we all have the right to infect others with a potentially fatal illness. Thank you for explaining this to us. Hopefully you won’t lose anyone you care about to Covid.

Nonsense. Testing is not readily available in the US. A friend who was very sick finally got tested last Monday but didn't get results for 5 days (they claimed 72 hr. which is still too long) and his results were positive but no one called for tracing or even to tell him not to go to work. He was too sick by that point to go to work anyway but Kaiser provided almost no information for a $1000/mo medical insurance bill.

Anti malarial drugs may have a protective effect after all ( speculative)

The recent Henry Ford Health System study on hydroxychloroquine demonstrates the antimalarial is indeed efficacious.

And it’s fairly obvious that India’s leadership in providing these nations with hydroxychloroquine has made the difference. https://asia.nikkei.com/Politics/International-relations/India-sends-hydroxychloroquine-to-Africa-in-war-on-coronavirus

Use of HCQ for prophylaxis in India for over 342,000 healthcare workers has been startling successful. Out of 66649 close contacts of covid+ve patients, just 0.2% actually got the disease. Just as India has successfully prevented tens of thousands of high risk health care workers from getting the virus with hydroxychloroquine prophylaxis (https://indianexpress.com/article/india/vadodara-administration-drive-hcq-helping-in-containing-covid-19-cases-say-docs-as-analysis-begins-6486049/ ) so too it is working elsewhere. For example, the clear trend break in Morocco and Algeria brought on with hydroxychloroquine are notable: https://mobile.twitter.com/Covid19Crusher/status/1254176105730359300

The slow rate of decrease in deaths in the USA relative to elsewhere is mostly attributable to the collusion between state boards of health and Democrat governors to reduce nursing home populations to shore up state finances and stick a thumb in Trump’s eye, by persecuting providers who prescribe HCQ.

"A medical examiner’s report recently made public, however, has raised questions about Carsyn’s case. The Miami-Dade County Medical Examiner found that the immunocompromised teen went to a large church party with roughly 100 other children where she did not wear a mask and social distancing was not enforced. Then, after getting sick, nearly a week passed before she was taken to the hospital, and during that time her parents gave her hydroxychloroquine, an anti-malarial drug touted by President Trump that the Food and Drug Administration has issued warnings about, saying usage could cause potentially deadly heart rhythm problems.

Carsyn’s case, which gained renewed interest on Sunday after it was publicized by Florida data scientist Rebekah Jones, drew fierce backlash from critics, including a number of medical professionals, who condemned the actions taken by the teen’s family in the weeks before her death."

"Not long after the oxygen and hydroxychloroquine were administered, Carsyn’s parents took her to a local medical center. She was later transferred to the pediatric intensive care unit at a nearby children’s hospital, where she was confirmed to have the coronavirus.

Carsyn’s parents declined to have her intubated, and she instead started receiving plasma therapy, the report said. But by June 22, her condition wasn’t improving and “intubation was required,” the medical examiner wrote.

Despite “aggressive therapy and maneuvers,” Carsyn still didn’t get better, leading Brunton Davis to request “heroic efforts” even knowing that her daughter “had low chance of meaningful survival,” according to the report.

But none of the procedures worked and Carsyn continued to deteriorate. She died shortly after 1 p.m. on June 23, two days after her 17th birthday."

When I visited Thailand 25 years ago I took chloroquine but it was pretty much accepted that it wouldn't help much as the malaria in that geographic location was mostly chloroquine resistant. I doubt that locals would be taking it much, especially prophylactically, but I don't have data either way.

The coronavirus version of Godwin's law: hydroxychloroquine.

Almost no one in Cambodia is taking anti-malaria meds prophylactically. Most residents are quite poor, and people who can afford such meds live in urban areas, where the risk of malaria is nonexistent.

Certainly many tourists take them, but few of the 15 million Cambodians.

good to know

I live in Vietnam. Nobody here is taking anti-malarials. Not during corona and not during normal times either.

It’s pretty unfair how the media and these articles depict Vietnam and Laos as policy successes while Cambodia’s equal success is attributed to “luck” and “culture” and despite policy.

It seems the now Trump-controlled VOA is just trying to justify its restrictive border policies and ignores that Cambodia’s experience shows that border restrictions were totally unnecessary and disproportionate in January or February, when there were only a small number of cases flying about that could have been monitored. Remember when Cambodia allowed that cruise ship to dock, and then one of the passengers later tested positive, the media was all over itself criticizing Cambodia for its humanitarian gesture, but did not retract those criticisms after the test turned out to be a false positive. Later in March, when cases began exploding around the world, Cambodia again showed that limited and temporary border restrictions plus testing new arrivals were enough to contain the virus.

When this is all over, I will be visiting Cambodia and spending generously.

Don't think Trump cares about the Cambodian border. It's a China play.

When you go don't forget to pay their covid service charges:

https://marginalrevolution.com/marginalrevolution/2020/06/coronavirus-travel-markets-in-everything.html

As I commented on that post, those service charges are a reasonable, less restrictive alternative to banning travel. People entering the country should be tested and quarantined if positive, and this should be at the traveler’s expense. That is a fair and reasonable way of ensuring that people whose travel is important enough that they are willing to pay the costs can continue while still protecting the local population from the virus. By contrast, the US travel ban was based solely on what country the person is coming from. People from some countries were not allowed in regardless even for extremely important family or career reasons while tourists coming from other countries (or even American citizens returning from infected countries) were not tested or quarantined at all. Our travel policy was both more restrictive and less effective than Cambodia’s.

T cells or the elusive immunological dark matter (which could be T cells alone or in combination with other things) seem like the best bet.

Right now all our know comes from PCR and antibody testing, because those are the easiest things to measure. Streetlight Fallacy.

Have they not gone back and done comprehensive testing on everyone aboard the Diamond Princess? Full genome sequencing, antibody testing, T cell testing (is that a thing?), interviews re symptoms. Seems like for a few hundred million dollars you could get those passengers to sit for all those tests and it would be money well spent.

Thanks to General Secretary Bounnhang Vorachith's correct leadership, the brotherly assistance and guidance of the Socialist Republic of Vietnam and Ho Chi Minh Thought, the Laotian people, acting as one, has managed to defeat COVID-19, further the building of a prosperous socialist society and strenghten the rule of law, the principle of collective leadership and conaolidate party-to-party relations.

Hi Thiago! 😂

I know no Thiago. I am Jeremy Williams, a retired Mathematics school teacher.

Thiago my love
we have been remiss sometimes we are insensitive
which pronouns do you prefer
Love
Addie Rose Krug***

I don't think he is Thiago, but his Lao love is bizarre.

As I have mentioned, it is one of my favourite countries, but that doesn't explain why a retired math teacher would be the single hagiographer of a semi-competent backwater administrator .

There are lots of Vietnamese and Cambodians (fewer Laotians) in California. If it's birth environment or vaccination (live tb) should it show up as under represention here?

If anyone is looking...

I'm going to keep saying Sweden until I hear something other than crickets. Deaths and hospitalizations have fallen off of a cliff there, but no one seems to want to say anything other than that they've done way worse than Norway or Finland or Denmark. All of the latter three are just an Australia or an Arizona or Texas that are waiting to happen.

At least Reuters saw fit to mention Sweden in passing today, although they still harp on cases rather than focusing on hospitalizations or deaths:

https://www.reuters.com/article/us-health-coronavirus-sweden-cases/swedens-daily-tally-of-new-covid-19-cases-falls-to-lowest-since-may-idUSKBN248240

Literally lol

Sweden is a basket case. Compare to Greece, same size population, and Sweden has 73000 C-19 cases vs Greece's 3600 (GR did a hard lockdown for about two months). Further, Sweden's new cases continue to trend upwards, see: https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

Actually an impressive country is Egypt, 10x the population of Sweden, the same number of cases, and yet they are flatting the curve. I think hot weather and humidity helps fight C-19. India and Brazil however are also basket cases, like Sweden.

BTW the metric I think is important--TC and CatInTheHat disagree--is not deaths but new cases. Who wants to catch this disease and take their chances they won't be adversely affected (20% are)? Nobody in their right mind.

Cases have several problems:
1. Not as true now but at the beginning testing was spotty and less common, so the number of cases found reflected the testing frequency and availability rather than the precise incidence.
2. We’re at a stage with the reopening where the demographics of the infected are skewing much younger ( Fauci said the average age of the infected went from 48 at the beginning to 33 now). Obviously this will results in less severe cases, less hospitalizations, less ICU admissions, less deaths. In most countries including the US the daily death rate is much lower.
3. In addition , improvement in treatments like dexamethasone and perhaps Remdesivir (when available, it’s in short supply), coupled with better understanding of he run away immune response and better strategies for oxygenation saves more lives; perhaps a 30% improvement.
4. The ideal situation is when the not vulnerable group gets infected but the vulnerable group doesn’t. This is not that easy to do, but I believe we’re approximating this now because the nursing homes are better protected and the other old people at home are more careful and protect themselves quite well.
5. So you might have a boatload of cases now but comparatively, they lead to ¼ the death rate or less as before and trending down from here.
6. The optics of high daily cases look bad and the media has a field day with this, politicizing it and predicting doom and what not but it’s really not that bad. I think if we moderate the bar scene and restaurant scene , we’re ok.

“ Per million people, Sweden has suffered 40 percent more deaths than the United States, 12 times more than Norway, seven times more than Finland and six times more than Denmark.” By ⁦@petersgoodman⁩ https://t.co/8TnneGwQ0c

I've been thinking about this chart
https://www.statista.com/statistics/1115707/sweden-number-of-deaths-per-week/

What's interesting to me is that Sweden started this year seeing less death per week than the average of 2015-2019. Who knows why, perhaps their demographics shifted slightly younger, perhaps they improved something in public health or maybe it was just good luck.

Then Sweden shot way up far above trend and has now slightly above trend. In other words Sweden swapped being below trend in death for being above trend (sorry all you guys in the Mountain of Death along the way).

A few things I think about with Sweden:
1. 40% of households just have a single person in them.
2. Stockholm is their major city but other than that it's largely rural.
3. A lot of Stockholm has done a partial lockdown. Huge events are banned, people are going out less and using masks more from reports.

This would be consistent then with a huge burn in Stockholm initially now being replaced with a slow burn everywhere else due to the 3 factors above.

87% of Sweden's population live in urban areas. And "large events are banned and people are going out less" is not a partial lockdown. They didn't close schools (except for high school) and the restaurants, bars, and businesses all remained open throughout. Yes, people worked from home more and avoided public transit, but what they do, or refrain from doing, voluntarily is not a "lockdown".

So it turns out that Sweden is just another typical European country? Similar time frame, similar high death rate, similar ability to get the virus under control after a couple of months without even coming close to any definition of herd immunity?

Yep, Sweden is boring. Even its epidemiologists were no better at predicting the course of the disease than anyone else's.

Long term, who knows how Sweden will compare to the UK or France or Germany in a year or two, but as of today, compared to its neighbors, Sweden looks like a failed model on how to handle the pandemic. You do know the Australian 'resurgence' is fewer than 1000 total cases in the past week? Sweden can match that in a couple of days, no problem, even with a population of 10 million, compared to Australia's 25 million.

So here's a 'herd immunity' play.

Gov't figures out who is at lowest risk, those people are assigned to 'infection camps' for a month. Two weeks to get it and two weeks to pass it (or die in a few cases). Children too. Goal is to get as many people to clear the virus super fast and then use those who have cleared it to surround people who are vulnerable. For example, the first people to clear 'infection camp' would be assigned to work at nursing homes. Once we get around 50-70% of the population thru it, you got close to 'herd immunity'.

Herd immunity is not a magic spell. People will still get infected but outbreaks will be like camp fires in a very damp forest, they will burn but not spread into anything dramatic.

Sweden essentially did 'lockdown lite' and got lighter carnage out of it. Not much to say about an 'alternative path'.

But they did not get what they wanted using lockdown lite. "Anders Tegnell, the country's chief epidemiologist, told the Financial Times in April that he expected 40% of people in Stockholm, the capital, to be immune to Covid-19 by the end of May."

The rate is somewhere around 25% at the end of June, to be generous. Regardless of what they expected, this epidemiological framework was also flawed.

I'm not sure why everyone is fixated on what percentage of people have antibodies as if hitting the arbitrary number of 70% were somehow the ultimate goal. Surely the goal is to have serious and fatal cases dwindle to negligible levels. Who cares if community spread of mild cases continues indefinitely once you have that result.

Anders Tegnell expected 40% by the end of May in Stockholm. He got around half that.

'Surely the goal is to have serious and fatal cases dwindle to negligible levels.' The Finns, Norwegians, and Danes would say the real goal is to never have serious and fatal cases rise beyond the absolute minimum. From this short term perspective, where all four countries have now had their serious and fatal cases dwindle to negligible levels, Sweden failed.

The Swedish model turned out, till now, to basically be a dud. However, Tegnell is not stupid, and given the chance to do it over, he has said that changes would be made. Lots of mistakes have been made in a number of countries, for a number of reasons - NZ letting people out of quarantine without testing was a colossal screw up, for example. As was Australia letting the passengers of a cruise ship spread the virus widely. Sweden had a strategy, they followed it, and it turned out to be considerably less than hoped to this point. Which is the biggest reason it is not particularly relevant. Nobody is going to slavishly imitate Sweden in all details, and that includes the Swedes. The longer term is still open, so who knows? That was a trick question - the real answer is absolutely no one knows what next July will look like regarding this pandemic.

The goal is to have fatal and serious cases hover around, or dwindle to, nothing *while having a functioning economy and society*. Denmark, Norway, and Finland are now trying the latter. Let's see if their strategy pans out.

Sweden's economy looks no better than Denmark's or Finland's. (Norway is too dependent on oil to be very comparable.)

Denmark - -5.2
Finland - -6,3
Sweden - -5.3

ec.europa.eu/info/business-economy-euro/economic-performance-and-forecasts/economic-performance-country_en The Commission publishes a full set of macroeconomic forecasts for the EU and its Member States in spring (May) and autumn (November) and publishes interim forecasts updating GDP and inflation figures in winter (February) and summer (July). These forecasts are produced by the Directorate-General for Economic and Financial Affairs (DG ECFIN).

hey harvard
mandatory government infection camps!
why not just give em infected blankets

The reason is pretty simple -- all these SE Asia countries strongly distrust China and closed their borders to China early in the pandemic. Indonesia and the Philippines are relatively more open to Chinese travel

But it's not the case that they've had zero cases. And once you've had a few cases the virus doesn't need to be imported from abroad. It's going to spread locally. Also there's pretty good evidence that the virus was spreading late last year even before the Wuhan outbreak lit up the news

That’s not true at all. Cambodia never closed its border to China and is very China-friendly. Thailand also had a late border closure. And Laos is also a communist country aligned with China. Vietnam is the only Southeast Asian country that really has conflicts with China and closed its border early, yet it did no better than Cambodia or Laos.

Hot, humid, and no AC?

It's a mystery, since the Philippines is also hot, humid and no AC, though Manila actually has the best dry weather in all of PH. Possibly the TB vaccine and different strains is the answer, and possibly even under-reporting. My hot PH girl half my age got a "flu" about a month ago, but she recovered and was not tested. What is she had C-19? We'll never know.

10 million Chinese tourists visited Thailand last year. China has consistently the biggest source country of foreign tourists in Thailand for several years now. Some of the earliest cases of covid-19 outside of China were Chinese visitors in Thailand and a Bangkok taxi driver who had contact with one of the infected visitors.

I agree with Tyler there is a mystery here.

Living in Bangkok, I can say that the Thais adopted mask wearing quite early. Perhaps that’s been a positive factor.

Most of these countries are very friendly towards China. Vietnam has serious territorial issues with China and a conflict on one level, but Chinese business is active as you would expect from a giant neighbour.

Thailand had more flights out of Wuhan on the eve of the pandemic than any other single foreign destination.

Thailand has pivoted to a close relationship with China over the past 5 years. One of the closer ones in Asia.

I think heterogeneity is a difference between applying the long run model to short runs. In the long run, R0 implies a society will get infected up until it hits its herd immunity rate (R0-1)/R0.

This is the cup of coffee model. You pour some milk in a cup of coffee and it turns from black to sort of beige grey. Pour some more and it turns more beige. This happens within seconds so you don't think about heterogeneity and the time it takes.

Consider the hot chocolate model though. You have hot chocolate with marshmallows in it. If you wait a long time it will eventually turn into a mushy uniform mess. But that's not a fun way to drink it. Instead you drink it and heterogeneity prevails. Sometimes you take a sip and get just the liquid. Other times you get a super sweet marshmallow in your mouth.

Esp. near the beginning of a pandemic, outbreaks will be in hubs and random. They will be like marshmallows and for a while it may appear they are uniquely isolated. The temptation will be to say they are special....NYC is just more international a city than any other, all of Italy, well it has a lot of old people. Except over time the marshmallows will melt and the entire cup begins to become more like the coffee model.

It's at this point you start to notice the results of taking it seriously versus not taking it seriously. It's amazing how insidious this virus is not because of its death rate but because of its long incubation period. Just long enough to mentally disconnect policy from results in the human mind.

Given how the virus seems to hurt children less (in the US), and how children have been exposed to more coronaviruses recently than in the past, I'm surprised people haven't given more attention to the "other coronaviruses provide some protection" theory. (Maybe some have, but google doesn't turn up a ton.) I'm also surprised that we don't have more robust stats on demographic breakdowns?

For instance, I'd like to know how impacted parents of small school-aged children (say 7-12 or so) have been. Presumably they would have similar immunity to their kids, and would stick out on a chart of 30-40ish parents of small children vs. 30-40ish single people. Cowpox provided immunity from Smallpox, after all.

There's been outbreaks linked to open schools in Israel and daycare centers in Texas opened with children and adults getting infected. The idea that maybe schools are ok because kids have some type of immunity and won't spread it looks like shit now.

No, there are many papers showing children are underrepresented in cases. Just look in medarxiv.
Also in the serology studies, in Vo Italy, Iceland and most recently Spain.
The fact there were some over publicized outbreaks in some schools doesn’t change that.

Yes it does. Learn how risk works. If you're looking for cases turning up in hospitals, that doesn't tell you whether children can get it and can spread it....esp. since many places closed schools.

If, however, you have even a single school open and it spreads all over then yea children can get it and spread it. OK children won't die at the rates adults die, that's all well and good if all the children are shipped away to live at Hogwarts for their schooling but that's not how most are set up.

Don't be lazy and read the research. Vo ( Nature paper , June 30), Spain ( Lancet July 6), Iceland study (NEJM , June 11). They all say it.
In addition many papers on the MedArxiv. Somehow right now MR won't let me post if I add links

Iceland I recall had only 100 known cases in the entire country before they shut down schools. How is that a test of whether large groups of children can get and transmit it?

Israel closed their schools after discovering huge outbreaks. 130 in one school alone.

Does it make sense that children would be incapable of transmitting it? Not really.

Have we really tested the idea that large groups of kids have some special immunity that you don't see in offices, business meetings, subways, conventions etc? Not really.

I know the NYT piece I cited below also feels kids are less likely to transmit but even there it's assumed schools would reopen with more precautions.

https://www.npr.org/sections/coronavirus-live-updates/2020/06/03/868507524/israel-orders-schools-to-close-when-covid-19-cases-are-discovered

Concerning a 'resurgence' of less than a thousand diagnosed cases in the past week. Health officials in Texas or Florida or Arizona would likely do anything to have the same sort of major corona resurgence - in just one day. The language is getting so strange. South Korea has an explosion of new cases when it is a couple of hundred, whereas the U.S. is having an uptick when new cases go from 48,000 to 51,000.

It is quite easy to understand why the world is not obsessed with this 'question'. In places where the pandemic is filling up hospitals, people have more immediate concerns on their minds. And in those places where the virus is currently under control, no one cares.

What would be interesting is seeing just how high the GRE scores of people from those countries are, considering the stellar epidemiological work demonstrated till now.

If we’re going to talk about the relatively low caseloads making up Australia’s resurgence, we should also discuss their response.

Melbourne and Victoria state are back under a 6 week lockdown, estimated to cost $1bil a week. Troops have been deployed to enforce the borders between states. The public housing tower at the epicenter is on complete lockdown, trapping many low income residents without notice.

If these are the steps required to control the disease, they are completely unrealistic in the US.

I live 50 metres from said 5 of the towers (there are 9 of them with about 3000 residents). and knew about the outbreak 72 hours before the lockdown. I actually sick atm awaiting a covid test (mild cold symptoms).
The outbreak was known about locally 72 hours before it was officially announced and the towers shutdown Ive also many residents did not go home when the "hard" lockdown" was announced.
I think the horse has bolted already and this action is likely for show more than real public policy reasons.

Yep, the only cure for Victoria is to get the reproduction rate well below one again for weeks to come. All thanks to state government incompetence. This is the second major episode of incompetence the the current Vic government, and I'm not talking about the corruption scandal, which we in other states take as given.

But, the $1,500 payment for workers and $750 payment for others for undertaking the two weeks quarantine may have tempted many back whose fist impulse would have been to bolt.

Closer to home, we may wonder what Wisconsin has done to produce a much lower death rate than every state surrounding it, especially given its proximity to Chicago and the fact that it suffered more than average deaths early. Ad oh yeah, remember the Wisconsin election? Anyway, Minnesota is a train wreck by comparison.

It's the 🧀!

It's the milk!

It's the beer!

It's the brauts!

Deaths per capita

Illinois ________.0006
Minnesota_____ .0003
Iowa___________ .0002
Wisconsin_____ .0001
S. Dakota______ .0001

I agree that this should be discussed much much more.
Probable factors include they have a less contagious strain, they have accumulated T-cell immunities from previous coronaviruses, anti malaria drugs do help, and younger population seem like the big potential factors to me.

What I don't think it is, "govt policy". Govt policy and people behavior may change the timing of the virus impact's but is way overstated and discussed way tooooooooo much. Either because we would like to think humans can control mother nature or its good political fodder. I'm very tired of that discussion.

Blah you should just go out and share dirty needles with junkies and have lots of random unprotected sex in gay bathhouses then. I mean you can't control 'mother nature', you'll HIV spreads so at most you're just altering the timing of its spread.

>I genuinely do not understand why this heterogeneity is not discussed much, much more.

That's because if there's one thing you hate, it's learning new things.

Let's try to teach you one:

Next time you wonder why a piece of information is not "being discuseed," ask "Does this info help to defeat Trump?"

The answer is always no. See? It's not difficult.

And yet.... you won't get it.

+1
-there is what is being mostly discussed by media morons like fredo/cuomo (spin the virus for political advantage and there is what is being discussed by scientists. it makes for a uniquely low signal to noise ratio for a serious subject

So, Trump doesn't talk about the low rates in Vietnam, et al, because it would defeat him.

Tyler doesn't make the headlines like Trump so it merely seems like he's not talking about it, because compared to Trump he's nobody, thus "nobody" is talking about it.

Indeed this is entirely a fugazi.

The fugazi on hydroxychloroquine was especially gualing as it demonstrated that the mind virus went into "the most important" sections of academia, but it had to happen sooner or later.

The effort to understand the coronavirus has devolved into a contest between countries to develop a vaccine, and let's not let the facts get in the way of nationalism. https://www.politico.com/news/magazine/2020/07/07/vaccine-race-covid-national-pride-348072

A reminder that Trump has put all of his/our chips on genetic engineering to find a vaccine. Trump has boasted that his science advisors have been impressed by his understanding of the complexity of viruses. I'm not so sure. What do Cowen and Tabarrok think about putting all of Trump's/our chips on genetic engineering.

Perfect example of the compulsion amor some commenters to make uo any little irrelevant thing about Trump and then try to make the conversation about that.

The post topic is Southeast Asia coronavirus update, not Repository for trite and vacuous anti-Trump drivel

Is healthcare good enough in all of those countries that testing is thorough? That seems like one significant difference between them and Australia.

Maybe it's just sealed buildings that are the problem? All these countries have relatively "outdoor" lifestyles with little in the way of air conditioning or need for heating in the winter. Coronavirus is also surging in those states where air conditioning is widely used. This also explains why the Floyd protests didn't seem to cause any major outbreaks unto themselves.

This would make sense considering the huge surge of cases in Arizona, Florida, and Texas can be narrowly attributed to reopening too quickly (and badly)

Regarding Tyler’s question at the end.
I was in Vietnam and Cambodia in January, and I am happy, but I don’t understand the correlation with current infection rates.

I agree with the rest of the post. We should obsess over the reasons for the low infection rates in these countries, particularly when one considers the high number of Chinese tourists there. The Vietnam figures are most striking. Would be interesting to compare to infection rates among Vietnamese in the US.

"I genuinely do not understand why this heterogeneity is not discussed much, much more."

Because the political class is certain that they play a central role in everything, and central planning is incompatible with localized information. Even for something like the coronavirus, where the relevant population groups are those people within a 6-ft radius outdoors and within the same room indoors, the political class still insists on grouping people by political concepts: countries, states, Red vs Blue states, etc.

Thanks for continuing to focus on the heterogeneity even if no one else is. Everyone wants to prove that their policy prescriptions were/are correct and so they look to explain everything by policy. But it’s clear policy can’t explain more than a tiny fraction of the variance here.

The only lesson I’ve taken from the past month is that the people who originally claimed that as a respiratory virus, COVID-19 was going to be heavily influenced by climate were proven correct. Temperate latitudes are doing well in their summer. And other temperate regions that were doing well in summer are suddenly doing poor in their winter. Equatorial regions – especially those without AC – are doing well overall. Even the southern US is a confirmation of this: to a respiratory virus, summer in Texas is the same as winter in New England – all the possible hosts are stuck inside in dry 70° air.

I think a lot of people claiming victory for their policies right now are celebrating prematurely simply because the weather is now in their favor.

'Temperate latitudes are doing well in their summer'

You missed Josh’s subsequent sentences. People in Texas and Florida move from one air-conditioned space to another 24/7.

What explains Philippines versus Thailand then? Thailand is a somewhat wealthier country and would expect more people on average to have air conditioning. Both have similar climates with heat and humidity year-round. Yet Thailand seems to have largely beaten the virus while the Philippines has lately been registering about 1,000 new cases per day.

Caloocan, Manila, the slums...highest density in the world, beats even Tokyo. But still, Bangkok has density too, and the difference is striking.

Prevalence of hemaglobin E?

I measurement consistent across countries?

Yunnan province, where the coronavirus most likely came from borders Laos. It's possible that people in Yunnan and these SE asian countries have already been exposed to similar bat coronaviruses and have some T cell cross reactivity. See - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7148670/

Laos and Thailand have rich bat biodiversity - http://www.batcon.org/why-bats/bats-are/bats-are-everywhere#:~:text=Global%20Bat%20Species%20Richness&text=With%20at%20least%20219%20species,species%20than%20any%20other%20country.&text=This%20is%20owed%20in%20large,the%20equator%20throughout%20Southeast%20Asia.

This explanation is only one that makes sense to me and also distinguishes it from other humid, poor regions. Cow pox saves you from small pox; rando coronavirus saves you from Wuhan coronavirus.

A family member in El Salvador has had two deaths of next door neighbors from Covid-19. But the government says there are almost no deaths....

Massive death undercount in numerous countries. Mexico, Brazil, Russia, Iran, India, Pakistan, are all ridiculous. Others will be too.

The simplest theory would be that the factors relevant to the spread are latent. The things we are measuring (public health policy response, demographic factors) are only somewhat correlated with the spread.

The things we aren't/can't measure may be more important:
- Baseline public compliance with public health policy
- Baseline norms (mask wearing)
- Structure of social interaction (outdoor gatherings vs indoor gathering; large vs small groups)
- Structure of labor (enclosed vs open space)
- Transportation (public vs private transit, average distances traveled from normal day to day)

Texas prides itself on its individualism and Germans follow rules.

Consider the curious case of Rhode Island. Rhode Island had an early bad outbreak, with about 1.6% of the population PCR confirmed. Now restaurants are open, with dining levels at about 100% of last year from Open Table data, indoor dining allowed, etcetera, yet no uptick.

Assuming the PCR + Antibody + T-Cell theory, herd immunity is reached at about 2% of the population PCR confirmed. Math is as follows: the antibody to PCR rate is ~15x, the T-Cell to antibody rate is about 2x. So for RI, that's 1.6% of the population PCR * 15 antibody * 2 T Cell = 48% of the population is immune. Even rather relaxed behavioral mitigation (masks/distance) gets you the rest of the way to a controlled outbreak.

Just a theory. The above is highly speculative. And if wrong, very consequential!

For the much younger countries that math should be pretty similar, except you would sub in a higher antibody to pcr ratio, since less people would come forward for tests assuming lower symptoms due to lower age, and presumably, the income level would make tests much less available, compounding the issue.

https://ig.ft.com/coronavirus-chart/?areas=usa&areas=gbr&areas=can&areas=fra&areasRegional=usca&areasRegional=usco&areasRegional=usfl&areasRegional=usnj&areasRegional=usri&areasRegional=usme&cumulative=1&logScale=0&perMillion=1&values=cases
https://flowingdata.com/2020/07/02/restaurant-reopenings/

Living in Thailand, I can offer a few comments

These countries all deal with lots of infectious diseases (except influenza - my Ph.D. Thai colleagues, many educated in the west, don't know what "flue season" is.) This meant they had good public health tracking systems in place to spot the disease. Thailand was the first country to spot the disease outside China, I am sure Singapore had it first, but didn't spot it.

Thailand gets the most Chinese tourists of any country in the world, but Chinese tourists to SE Asia differ from others. Wealthy (English speaking) Chinese tourists go to France or the U.S., or for shorter trips Japan or Korea. Budget tourists, especially first time ones, go to Thailand. They don't speak English (or Thai) so they bunch up in tour buses, where 90% of their interactions are with each other. And when they do get sick, it is easy to trace them, since they are part of a tour group with a very set itinerary.

Summer in SE Asia starts in March, and it gets really hot and wet. It runs until early June. So just when the Wuhan Flu was spiking elsewhere, the conditions became unfavorable for transmission.

Finally, speaking only for Bangkok, NOBODY thought the government was competent, or trustworthy. When reported cases hit 300 or so (early March), I gave a midterm exam. 58 students - 58 students wearing masks. Thailand hasn't had a new domestic transmission case in three weeks, and I would estimate mask wearing in Bangkok is still above 90%.

You make some good points.

Comparing Bangkok, Manila and Singapore, it is tough to see any obvious explanation for the differences between these places. All have similar climates and Singapore by far has the most competent government. Philippines had the one of the strictest lockdowns in Asia outside of China (as well as mandatory mask-wearing outside since April) and it is one place where there is a fairly obvious correlation between the start and finish of the lockdown and when new cases slowed down and sped up again. Singapore was hit hard by cases in its workers' dormitories despite the government's best efforts to control the virus.

Is there AC in the dorms?

Yes, but at the Rangsit campus not central, it is still single unit (in old U.S. terminology "window units" though they are not in the windows anymore). The Thaphrachan campus has no dorms. I believe this is representative of universities as a whole - no central air in dorms, and less than 30% of students in dorms.

At least some of the difference would disappear, if you compared Singapore to Bangkok and Manila, as opposed to Thailand or the Philippians. Ohh wait you did :) Glad I reread your post before I commented.

Bangkok street sellers and outdoor markets never disappeared, so many people - myself included - were buying food outdoors as opposed to central air malls/grocery stores. They were checking temperatures and providing sanitizers and cleaning stations. I would agree with you that that doesn't really seem a plausible for how big the gap was....

It might have been different strains of the virus - Singapore got their's from Europe, Thailand from China. But the whole liturature about the strains with different Rs or fatality rates is still young, I don't really know.

I don’t mean to correct someone who lives in BK, but March-June is the hot season, July-October is the rainy season. I was in BK from March til June and the number of rainy days could have been counted on one hand.

While mask adherence was decent among educated and middle class, it was weak among the poor. Also people wear masks very poorly and a lot of face touching. Very crowded mass transportation. Large numbers of high density migrant workers (which caused real problems in Singapore), yet no problems in BK. Many factor was strict border controls, both internally and international borders.

Policies are ok but unremarkable. There is something else going on and it’s not obvious what.

Should have said muggy/humid. Not a lot of rain, but
Arizona it ain't :) As to the mask adherence, yes it was better in the wealthy/middle class, but in many ways that is a proxy for Bangkok - the one area of the country that really needed it. The Wuhan Flue never really penetrated far into the provinces, except Pattaya and Phuket, which were tourist destinations.

But more broadly, I think this was actually a huge advantage of the Thai approach. Nobody ever argued that a mask would grant 100% protection, or that using a mask was harmful because it would give a false sense of security. They used it like seat belts or motorcycle helmets, (most of them do wear them now, a huge change from 15 years ago), not a guarantee, but a reasonable precaution. 95% of pretty good is better than 40% of perfect.

test: posts not posting

As you seem to be discovering.

I am curious if anyone knows of studies tracking if COVID-19 transmission correlates strongly with central air system usage? At a cursory glance, areas where it was very cold in the US when the virus initially hit ended up having larger case loads, versus warmer states. This despite a wide range in responses. I'm in Arizona, we effectively took the Sweden approach, and even after orders were in place people... really didn't follow them; compared to California's lockdown. Yet both states had lower case loads early on; certainly compared to NY for instance. Yet, once temperatures warmed, a switch was made from central heating to air conditioning, and...we saw a huge bump in cases in warm states, and a drop in cases in cooler states. Along these same lines, a lot of poorer countries, which had huge ranges of responses, seem to have lower case loads now. I wonder if they simply have less central air heating/ cooling units, and thus a major mechanism for spreading the virus is eliminated. If this is the case, it would suggest that targeting some method to kill the virus in the central heating/ cooling unit would be highly valuable (the recent report on UV-c light killing the virus could be fairly easily implemented).

Also, if this is the case, I would predict that states that dont use air conditioning predominately will have cases drop despite various policies; thus humid areas or temperate areas. But, in the winter, colder states will have an earlier resurgence compared to warmer states, again despite different laws and social trends. I also expect this trend to hold for wealthier countries, and for poorer countries where wide spread availability of central heating or cooling is unavailable to approximately have a steady, low, case load.

This has been mentioned. If it’s really hot outdoors, then people gather in public places indoors ( which are air conditioned in AZ and similar states).
Indoor places , especially bars where people are close to each other and talk loudly are very propitious for infection.
In Europe, lots of people in cafes now, but they are on the sidewalk, few inside since inside doesn’t feel comfortable without air conditioning. AC is not common in Europe.

SE Asia has almost no central air in residential property, a majority of businesses/universities/schools/government offices don't have it either. Malls and some hospitals, do.

Nearly every residential home I’ve been in in BK had stand-alone a/c unit(s). Most businesses and offices also. Again, middle class type places not old shophouses. A/C in some form is prevalent outside of high density poorer housing.

Yep. Early on, the media reported cases of a Thai national getting it, and then the whole family got it, and then those reports just sorta dried up. A/C is prevalent at this point, but outside of malls and new government buildings, rare. The big issue here is hospitals, older ones either have no a/c, or it is not central - but some newer ones in Bangkok are central. Again, the provinces are different..

It's fun to draw conclusions, but it isn't over yet. What seems like a big truth today may disappear soon... that has happened repeatedly in this whole Covid experience.

Four learnings about the virus. In brief:

1. The virus is vascular not lung based. The 1918 flu model is incomplete. The virus enters you like the flu but it primarily attaches to the walls of your blood vessels. This is why we've seen strokes, discolored 'covid toes' etc. It also means other organs beyond lungs are impacted such as kidneys.
2. There's already been a major mutation. The original China mutation and the Italy mutation. The Italian mutation appears to be better at infecting people than the original one.
3. Outdoors appear to be much safer, indoors are about 20 times better at transmitting the virus.
4. Kids do not appear very good at transmitting the virus. This one is good news for schools to reopen but I'm thinking of the stories about Israel's school outbreak and outbreaks in Texas daycares.

https://www.nytimes.com/2020/07/06/podcasts/the-daily/coronavirus-science-indoor-infection.html

I would wonder if the statistics are accurate. Are they not reporting old people who die from "the flu" ? What are the excess deaths?

Anecdotally, the clinics in Cambodia in March were packed with people suffering from diarrhea because drinking large amounts of lime juice was widely rumored to prevent coronavirus.

There’s your miracle cure. *

* It’s not a miracle cure.

hey harvard
isn't it hypothesized that the new world was more immunologically susceptible to small pox from "away" because it was a "novel" virus.
isn't it possible the u.s. is more susceptible to the new novel virus
for the same reason compared to countries geographically and immunologically similar to china.
the idea that it is a policy/political difference should be towards the bottom of the list

I was in Singapore March-June and have spent a lot of time in Thailand and the Philippines, although less in Vietnam or Cambodia.

I don't think this is as big a mystery as people are making it out to be. The virus spread is *extremely* dependent on the average behavior of residents (i.e. what drives R) as well as how quickly the government locks down travel (i.e. how many fires are started in the early stages). People don't seem to like that answer because it isn't "one weird trick to stop the coronavirus" and is instead an accumulation of factors and requires real diligence and work.

Nevertheless, the consistent theme is earlier travel restrictions + greater mask coverage + fewer people living on top of each other + fewer people being loud idiots spitting infected droplets everywhere + warmer weather.

The Singapore experience is instructive. In the early stages, they ban travel from China (limit # of fires) and everyone is very diligent about mask wearing so R is ~1 or even 1 and at the same time many fires are lit. The virus spreads extensively across the community during this period.

Then in April the government bans foreign tourism and institutes mandatory 14 day stay home (which is like quarantine lite) for all inbound travelers and residents go back to ~100% mask coverage. In addition, a "circuit breaker" (i.e. lockdown) is instituted with extensive social distancing. Lo and behold, R <>> 1 and tens of thousands of people are infected. But the government fences off the dorms which protects the broader community.

All of the other success stories, such as Taiwan, Vietnam, Thailand, etc. have a similar pattern of early travel restrictions + diligent behavior by residents to wear masks and not shout droplets in each other's faces. Philippines does worse than Thailand because they live more on top of each other and are less diligent about wearing masks. The lockdown is "more severe" on paper, but in practice its the Philippines and so lots of people break the rules and it is less effective. Duterte gets so upset at people breaking the quarantine rules that he threatens to start shooting people. Indonesia I don't know as I haven't been there but is probably a similar story to ph. Vietnam / Laos are more like Thailand.

Warm weather also seems to help, perhaps because it reduces the baseline level of coughing, sneezing, etc. That doesn't explain Ph vs. Thailand but it does help explain Manila vs. NYC.

As a final example, the first day I'm back in the US in June I go to Safeway (a California grocery chain) and one of the cashiers is a loud idiot half wearing a cloth mask shouting conversation to the other cashiers and some customers because she is bored. That type of behavior adds up and would NEVER happen in Singapore (or Thailand, Vietnam, Taiwan, etc.).

https://www.youtube.com/watch?v=v6yg4ImnYwA is a brief documentary on life in Australia if you need some hints as to why they haven't done as well as Thailand. NZ I'm less familiar with.

Hmm my comment above is missing several sentences at semi-random and is partially unreadable.

The fourth paragraph is missing a sentence that says the virus spread was low until March when global infection outside of China made the China-only travel ban ineffective + residents got complacent and stopped wearing masks.

The fifth paragraph is chopped between > and is missing a sentence stating that the April measures worked, except in the dorms where people are too packed on top of one another and weren't wearing masks.

Up until today, Singapore is still registering 100-200 new cases every day. A quick search shows that the government is doing a decent job of contact tracing for these cases and the source is no longer workers' dormitories but other clusters that have popped up since.

At this point, it is looking like all of the common factors people like to cite -- lockdowns, mask wearing, density, public transit usage, hygiene, social norms, etc. -- may together be about half of a country's success. The other half is due to unobservable factors or simple luck. The narrative to explain Singapore, Bangkok, Manila, Tokyo, Taipei, Phnom Penh, Seoul, Jakarta and Hong Kong has to get increasingly long-winded and complex, which is a sign that we really don't know why all of these cities have had such wildly different experiences.

SE Asians combat infectious disease as a matter of course.

The reproductive rate of a virus (Ro) is a socially determined number (new cases per case) and if that is less than one, the virus doesn't spread. It is determined by the number of interactions per day times the probability of transfer of the virus per interaction.

In a hospital where people wear masks and change outer garments frequently, the culture has created a "Ro" of O.O5 and the virus doesn't easily spread from all the incoming infected people to the staff. Mask use works to protect the workers.

Mask use and sanitizing masks and outer garments by heating to greater than 140ºF for more than 30 minutes for inactivation of virus particles on your clothing and masks stop the transmission and allows reuse. These countries all have people who use masks in their own self-interest.

Our officials are lying to us about masks and their effectiveness as they took N-95 masks away from industrial workers in hazardous environments to provide more health care workers. They then created the myth that wearing a mask was to protect the other guy when in hospital use and regulation it is always to protect the user of the mask.

Protect you own ass, use a mask.

Tyler I am fascinated by this post. I am married to a Thai woman and we just got back to NYC from Bangkok on February 8th. My wife is a nurse in NY and has been telling me Thailand has been better about it. Initial reaction was disbelief but watching the resulting response and data from South East Asia its hard to ignore that they may have an immunity of some kind. I wasn't fascinated before but I am now.

Asia also has lowest levels of Type A blood in population. Type A seems (very clearly) to be linked to developing a severe cases of covid-19. Also very low %wise is the second gene sequence that seem to be linked to severe cases. And they have better cultural compliance. (And are not led by a maniac politicizing the virus.)

I don’t know about the prevalence of Type A, but the mortality difference by blood type is very real.

Why has nobody mentioned the Neanderthal business?

https://www.biorxiv.org/content/10.1101/2020.07.03.186296v1.full.pdf

A good comment. A few dats ago I took another look at my 23 and Me results. They tell you where you compare in terms of percentage of Neanderthal genes vs. total population, which interested me. Worth checking out.

Perhaps you will understand by reading:

https://www.voanews.com/science-health/coronavirus-outbreak/vietnam-imposes-hefty-fines-going-maskless

Masks are the key to stopping transmission, not lockdowns. You can take transmission down 95% or so, but you can't decrease the number of interactions by more than 50% or so and that crashes the economy. The transmission is the product of the number of interactions time the probability of transfer.

All these countries are Buddhist. (just saying)

A well know nominal GDP level targeting advocate did mention "historically" Catholic as an interesting variable. So that would explain Philippines doing worse than the Buddhists. It also explains Quebec.

Also Sri Lanka and Myanmar, sticking with SE Asian Buddhists -- low official tallies, if they are to be believed (Sri Lanka closed down early, shut the international airport). Myanmar has all kinds of other problems of course. Apart from everything else, Rohingya refugees from there are being accused by Bangladesh of being covid-spreaders (untrue, as far as once can judge from recent reports).

Could there be race based differences in average susceptibility? Is that a thing for any other diseases?

I can't think of any other explanation, also ppl would be extremely uncomfortable with it and therefore wouldn't talk about it.

My China-centric take is this. Most of the cases in these countries must have originated from Europe. China didn’t ban people from leaving the country, but they did ban tour groups from leaving China. Not sure what share of tourists that equates to, but for Japan it would be pretty close to 100%. A lot of tourist visas for a Chinese are only realistically attainable if they are part of a tour group. I think that’s less true in the case of these countries, but I think there is a continued preference among Chinese to to book tours and not travel independently.

Same thing with Taiwan, except different reasoning. Because it was an election year and things were heating up, the mainland banned independent travel to Taiwan. I think it was pretty mush impossible to visit as a tourist. So they just were dealing with a lot less seed cases.

I don’t think this is the explanation, but I think it is part of the story, and a part that many people wouldn’t even think to consider.

Recently 23andMe has a large sample (200K+) survey and reaffirmed the early Wuhan study with small sample size back in Jan that blood group A is more susceptibility to COVID19.

In general Asian countries have about mid 20s % of blood group A except Japan at about 40% (might be due to the native Ainu pop) and Thailand at surprisingly low at 17%. The anti-trends are the Latin Americas where % group A (pop demographic) is correlated with national GDP.

https://i.ibb.co/TTbMKX0/corblda.png

Country | Pop | O | A | B | AB
Cambodia | 16077172 | 46.7 | 27.2 | 18.5 | 4.9
China | 1388251023 | 47.7 | 27.8 | 18.9 | 5.0
HongKong | 7402115 | 41.5 | 26.13 | 25.34 | 6.35
Indonesia | 263519317 | 36.82 | 25.87 | 28.85 | 7.96
Japan | 126044340 | 29.9 | 39.8 | 19.9 | 9.9
SouthKorea | 50748307 | 27.9 | 33.87 | 26.92 | 10.98
Malaysia | 31165480 | 34.32 | 30.35 | 27.37 | 7.46
Myanmar | 53507932 | 35.7 | 23.8 | 32.7 | 6.95
Philippines | 103801747 | 45.9 | 22.9 | 24.9 | 5.97
Singapore | 5784819 | 43.6 | 23.9 | 24.4 | 6.0
Taiwan | 23234936 | 43.9 | 25.9 | 23.9 | 6.0
Thailand | 68298027 | 40.8 | 16.9 | 36.8 | 4.97
Vietnam | 95414640 | 41.7 | 21.9 | 30.8 | 4.98

Wuhan has relatively higher blood group A (32%) because of the descendants of the ancient assimilated notherners while the rest of China the dominant is group O (48%) which is least susceptible. Malaysia has relatively higher group A because of the native aborigins.

The Japanese relatively high clade 20s infection rate is most probably because of the high blood group A for the Japanese, 40% vs about 28% for the Chinese, US 36% (from wikipedia). Still that does not explain the 0% clade 20s infection for Korean who have 34% blood group A and the Koreans do not ban international flights. Those infected are already a selected small group which might not be a representative of the general population.

PS: I could have spoken too soon. Yesterday there was a report from Korea about the new SARSCoV2 strain there and it was GISAID strain GH or the Nextstrain clade 20A and 20C, i.e. D614G mutated strain. The Koreans have difficulty controlling that with only testing and contact tracing and no lockdown. Beijing was able to contain that within a week with hard lockdown even the active pool initiated from the frozen salmons had jumped more than 100x from a very low base. With the restrictions now relaxed for social/economic reasons and international flights resumed, Beijing might require 3 more month to return to the previous acceptable level.

Australia was previously mentioned as one of those countries that had licked the virus. Singapore too, until that changed. California was supposed to be the model of how a US state could prevent a serious outbreak, only to be having its serious outbreak right now.

Japan was thought to be a model response, then had completely dropped the ball, now things seem fine again.

South Korea had the virus completely under control until patient 31 was a superspreader.

In light of all that, at least one significant possibility (and probably my default assumptions) is that there are stochastic effects at play, and any of these countries are likely to have major outbreaks at any time.

Well, Australia had only licked the virus in certain areas, such as my state. The virus has been eliminated here and while precautions are still being taken there's nothing that really affects most people.

The big populous states were still in the "long tail" where the last cases in the general population were slowly disappearing. Until we discovered that the Victorian government had allowed the companies doing security at quarantine hotels to let security guards hang around sick people and then go home because they didn't want to pay to isolate them. That idiocy has cost us dearly.

I think the United State's probably may be basically this times 50.

Only major if you consider a couple of thousand cases over a couple of weeks major.

I think it is important to avoid treating this like play-by-play commentary in a sports match. Most countries have had "serious" outbreaks of one sort or another and so there is nothing anomalous about what is happening in Melbourne now. The only thing that matters is whether the country can re-flatten the curve within the next 4 weeks. Taiwan, South Korea and Singapore have had worrying outbreaks but, so far, these did not lead to exponential spread. Whether or not you have an outbreak is probably highly random but whether that outbreak is suppressed or leads to exponential growth is probably where behavior and policy come in. One of the best predictors of your country's mortality rate seems to be the mortality rates of neighboring countries so it certainly looks like reservoirs of the virus randomly built up in different parts of the world and then semi(?)-randomly flare up over time.

Responding to your comment about countries bordering each other, and to Tyler's original comment about SE Asia....

SE Asia is odd bird in these regards, it is "10 countries in SE Asia, that all think they share a border with England, France, or the U.S."

Far more of my Thai students (not a representative sample, but still) have been to Europe or the U.S., than have ever been to one of the neighboring countries. SE Asia is a purely geographic concept.

Keep in mind that in India, only a one-third of all deaths are accurately registered, and for only one-third of them a cause of death is recorded.

I just don’t buy these sort of out of hand assertions. Whenever a developing country posts good results, people claim it’s because of fudge. No, I can think of quite a few more interesting reasons. I’m sure there is some fudge, but if there is a huge discrepancy, people will notice.

I would semi-concur. Thailand where I live, has great results. Even given the downwards fudge that all native Thai assume - still great results. That said, I believe nothing out of Iran.

True that. I feel like that is one where we have some indicators that contradict the official line.

See also: gradient in Europe, with cases and deaths decreasing roughly from West to East, weirdly consistent (though Sweden's lack of lockdown seems to have had some impact on its numbers). Also unexplained, though as with South East Asia some Eastern European countries have been praised more than others, presumably due to prior cultural preconceptions.

The preconception that Germany is hypercompetent has led to a great deal of praise being lavished on it, despite it doing significantly worse than all of its Eastern neighbours.

Germany is thought to have done well relative to its natural degree of connectivity to Italy.

The Eastern European response was good, I agree, but there's a difference between countries that responded well in a technocratic sense and despite high natural connectivity that would introduce many infections, and the Eastern European countries that simply closed down and weren't very connected to high infection locations to begin withn.

There is a (south) west to (north) east gradient within Germany. However, just as with the difference between Germany and Eastern Europe, the cultural aspect does not involve competence, it involves Karnival.

Great question, though I really suspect we need good "Excess all cause mortality" information on this one.

Still, the difference between reality and the reported stats can't be that large.

The darkest possibility I can think that endemic infections in SE Asia are particularly good at historically "picking off" those who are vulnerable to Covid19. Harvesting. Can't have excess mortality if people already dead...

There's more heterogeneity than that though.

The Australian outbreak's local to Melbourne - the new cases outside of Victoria have largely been traced back there. So, why is Melbourne having an outbreak atm but not Sydney? They have very similar populations and demographics, and had been implementing the same policies until now.

Further, how much should we expect any heterogeneity to be driven by chance, rather than having a clear cause in policy/demographics/weather/something else? At least from what I've seen (from further north, away from both major cities), the Sydney/Melbourne heterogeneity is pretty random. Sydney will probably see community transmission soon, but from spread from Victoria rather than anything intrinsic to big Australian cities at large.

There's probably less random stuff involved in the heterogeneity between Australia and SE Asia, but any conclusions we make have to set themselves apart from whatever amount of random stuff we ought to expect.

Perhaps places like the US with the highest rates and deaths have the greatest number of frail people kept alive through medical intervention. In other countries, these people would already be dead. The average age of death from C19 in the US is what..upwards of 75 years old?

In some circles, the issue of healthy vs less healthy populations is discussed. And in the US, lots of unhealthy people, even quite young. High blood pressure, overweight, fatty liver, autoimmune illnesses.

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