Anyone visiting the CDC.gov page on Monday morning would have seen crystal-clear information on “COVID-19: U.S. at a glance.” That information showed that this morning America had 164 confirmed cases and 11 deaths. Which is odd, because tallying up the actual information shows that at that moment, there were at least 545 confirmed cases and had been 22 deaths.
How did the CDC come to miss the target so wildly? Easy. The CDC information page on COVID-19 is only being updated Monday through Friday, and even then the information is updated only once a day with data as of 4 PM Eastern the previous day, so that it is always a day behind. In the midst of the crisis, the Trump White House is not just failing to place any importance on providing the public with up-to-date information; it’s also running a system designed to underreport the true extent of the spread of the disease.
However, there are governments in the world that are doing a much better job at both informing and protecting their citizens.
One story of the coronavirus is already familiar: China. And if you just look at a graph of cases, it would seem to be a story that’s much more hopeful than it first appeared.
Two months after the first cases near the city of Wuhan, and a month after cases of COVID-19 exploded into a period of rapid growth, China managed to flatten out that curve and all but smother the fire burning in its country. Better still, recovering cases meant that by holding down the curve, China had allowed the overstressed healthcare system in Hubei province to snap back, providing a higher quality of care to remaining patients. In each of the last three days, China has actually reported fewer new cases of novel coronavirus infection than the United States has, and while the 80,000-case count may seem daunting, it represents less than one-hundredth of 1% of the 1.39 billion Chinese population. Considering that epidemiologists have predicted that an unchecked epidemic could infect 40% to 70% of the population within a season, this has to be considered a terrific win.
However, China in no way models a response that should be emulated. Among other reasons that “Be like China” is not a winning strategy:
- To achieve that flattening, China used draconian measures that included forcibly dragging people away from their homes and placing them in poorly attended makeshift facilities that served to warehouse the infected. This absolutely resulted in a higher rate of deaths, in addition to general misery and abuse. If you haven’t seen the videos of what it was like for Chinese citizens in the area, know that it was harrowing in every way. And that’s not even including the absolute dystopian way in which China enforced curfews.
- It’s still unclear that we can trust China’s numbers.
- If China had not f#cked up spectacularly by attempting to repress news of the emergence of 2019 novel coronavirus, the whole world very well might have avoided this mess.
- Don’t be like China.
However, let’s look across the Yellow Sea for another story:
These lines show the growth of coronavirus in South Korea and Italy. Despite a curve that began earlier, and the fact that it was at one time ahead by more than 3,000 cases, on Saturday Italy actually passed up South Korea for the total number of confirmed cases. The reason for that is clear: South Korea has managed to flatten the curve on its coronavirus outbreak only about 20 days after its initial outbreak. More than that, South Korea has held down the number of deaths to 53, less than 1% of all confirmed cases, while Italy has had 366, putting case fatality there over 5%.
Why the difference? Testing. Testing. Testing.
At the first sign of an outbreak, South Korea snapped into a program of extended testing that has now tested over 200,000 people. Using reliable kits from the World Health Organization, and supplementing them with things such as sidewalk and roadway checks for fever, South Korea doggedly followed every connection for every case, expanded the testing in widening circles, and conducted a program of sampling of the populace. The result was the ability to constrain the growth of an outbreak that, from a distance, appeared to be unstoppable. It increasingly appears that South Korean officials who presented an upbeat assessment of the situation there were correct.
Even better, because of the widespread testing and follow-up, South Korea now has the best available set of data on the 2019 novel coronavirus—including showing that over 90% of all cases in that country can be traced back to the creepy Shincheonji death cult church.
But perhaps best of all, South Korea did this without taking the kind of draconian measures that were required to bring the outbreak under control in China. In fact, when members of the Shincheonji church refused to be tested, South Korea took them to court, even though that meant a delay of several days. The secret to South Korea’s effectiveness was no secret at all, because it keeps data updated and visible to the public, while being consistent on policy and messaging. It tested. It tested early. It tested often. And it practiced quarantine and isolation sensibly in response to that testing.
Contrast that with Italy. After the virus exploded there, attempts to trace back the initial cases and constrain the virus within a series of small “red zones” failed, and officials in Italy expressed concerns that it was doing too much testing—and that, as a result, it was generating numbers that made Italy look bad to tourists and other European nations. As a result, on March 4, officials in Lombardy announced they were dialing back and testing fewer people who had been in contact with known cases but were not yet sick. Scroll back up the page. Check out March 4.
Four days later—and just 16 days after the outbreak began—Italy was forced to take extraordinary measures that effectively placed over 16 million Italians across the north of the country on lockdown. That included the entire Lombardy region, the same one in which complaints about “too much testing” had been centered. Overall, inconsistent policies, bad messaging, and inadequate testing are a big part of why Italy has exported cases to Albania, Andorra, Argentina, Austria, Bangladesh, Belgium, Bosnia and Herzegovina, Brazil, Chile, Colombia, Croatia, the Czech Republic, Denmark, the Dominican Republic, Estonia, Finland, France, Georgia, Germany, Gibraltar, Greece, Hungary, Iceland, Ireland, India, Israel, Jordan, Latvia, Luxembourg, Malta, Moldova, Morocco, the Netherlands, New Zealand, Norway, Oman, Poland, Portugal, Romania, Russia, Scotland, Slovakia, Slovenia, South Africa, Spain, Sweden, Thailand, Tunisia, Ukraine, the United Kingdom, the United States, and Vietnam. That’s just the cases I could track down since March 1 (and yes, perhaps I did get a bit obsessed about chasing down these cases).
So … don’t be Italy. Unfortunately, right now the United States is looking much more like Italy than like South Korea. Except worse than Italy. Which is a pretty good sign that, just as in China and Italy, inadequate testing and underplaying the early messaging will lead to a period of extensive lockdown and heavy-handed measures.
Chart time.
China continues to clear cases from that initial surge and now lists fewer than 19,000 active cases. Even so, the number of active cases is rising sharply again as China becomes a small part of a global story. Even more unsettling, deaths are up again—on Saturday, 142 deaths actually exceeded the greatest number of deaths in a single day set a few weeks earlier during the height of new cases in China. Then Sunday had 180. Around the world, the case fatality rate continues to be around 3.5%. And in fact, all the calculated rates (CFR, CFR-3, CFR-7, OM) have been trending upward over the last couple of days as infections spike in multiple countries and too many places are failing the be-like-South-Korea test when it comes to widespread testing and measured response.
To give a sense of what’s going on around the world, here’s a map with a very strange scale for shading.
The shading here is a bit erratic. But at the moment, the world can be more or less divided into those nations that have no known cases; those with a few cases; those that are threatening to explode into a regional hotspot; and those nations that already have “popped.” So the scale was somewhat tweaked to make some of these divisions more apparent. In the last couple of days, not only did Italy pass South Korea, with Iran close behind, but a number of nations in Europe also passed the 1,000-case line, with case numbers moving up in many of them at rates that look all too close to what Italy has already seen.
Also in the top-10 case list, the United States overtook Japan. despite Japan having been one of the first nations outside China to host a significant number of cases. It seemed for a number of days that Japan was on the cusp of seeing an explosion of cases—having a dozen early cases identified among Tokyo cab drivers did not seem good, and the number of cases has been moving up more rapidly over the last week. But Japan has taken some significant steps to limit gatherings and public events, which seems to be working in terms of slowing the spread there.
And then there’s this country:
While a number of states currently show only cases related to travel (and Texas gets bumped up a notch by playing host to quarantined patients), the United States is extremely likely to go the way of Italy. Though tests finally began to arrive in critical states over the weekend, there has been very inadequate testing to date, and none of the widespread screening that allowed South Korea to understand the areas of virus activity. With multiple areas of community spread, and no restrictions on movement, it seems inevitable that the scale on the U.S. map will need adjustment in the next week if it’s going to capture the range of values. If you happen to be in a light-tan or grey state, do not assume this means there is no virus out there. Assume the whole map is orange and practice recommended procedures for avoiding infection everywhere, every time.
In the midst of all this, the United States under Donald Trump has continued to be unable to find a measured approach. It didn’t test early. It hasn’t tested broadly. It’s not being transparent, and it’s not providing consistent guidance to local communities.
As a result, do not be surprised to see the United States lurch in the other direction by resorting to the kind of regional lockdowns that Italy is facing now—at a greater cost to both lives and the economy.
Note: Apologies for not getting out a coronavirus update on Sunday. It’s the first time I’ve missed since January. But I had beehives that needed tending and a large area of brambles, briars, and thistles (really, all three) that had to be cleared for my mom’s new garden. The day kind of got away from me.