(Cover Image Credit: Pixabay)
Not long ago, I was scrolling through Instagram when I saw a video of people in Perth, Australia, gathering in small crowds outdoors, no face coverings in sight. From my perspective in the United States, where an average of over 2,000 people a day were dying of COVID-19, it was a somewhat shocking image to see. But these bare-faced people were not attending a political rally or an anti-mask protest; they were at the opening of a ride/experience called “Flight” that involved “binaural audio” and hydraulic movements inside a large shipping container. The people in the video looked very happy.
A little bit of investigation revealed that, with respect to the COVID-19 pandemic, Australia was a very different place. For example, the day before I wrote this sentence (December 10) Australia (population 25.5 million) had six new cases of COVID-19 and no deaths; the United States (population 330 million) led the world with 226,762 new cases and a record 3,260 deaths.1 Adjusted for population size, Australia’s infection rate on that day was equivalent to seventy-eight new cases in the United States. What a dream that would be.
Life in the winter of 2020 was very different in Australia. The pictures below are of a meeting at the University of Technology in Sydney, Australia (population 5.2 million) on December 9. You will notice that people are a bit more spaced apart than they might have been before the pandemic, but they are indoors and not wearing masks. The university’s COVID-19 instructions advised anyone who was feeling sick to stay home and required that everyone coming to campus check in using a QR code. Smartphone apps and QR codes were commonly used when people entered buildings to facilitate contact tracing should someone be exposed to the virus. But life was going on in Australia with a kind of freedom that was impossible in the United States.
So lovely to see colleagues – say Happy Christmas and thanks for the year that was like no other @UTS_Health @UTS_GSH – and sadly some goodbyes to staff leaving 🥰#covid19slp pic.twitter.com/iMMcMPwBEB
— Prof Bronwyn Hemsley (@BronwynHemsley) December 9, 2020
Photos from a meeting at the University of Technology, Sydney, Australia, December 9, 2020. (Source: twitter)
Australia is not the only country to get beyond the virus. The epidemic has been over in China (population 1.4 billion) for months, and there have been no deaths since April. Vietnam (population 97 million) had its last death in early September. The success story in New Zealand (population 4.8 million) continues, with three deaths since late May, the last of these in mid-September.
There are many circumstances that produce the kind of results these countries have enjoyed, but one factor appears to be setting the right goal. In the United States, the Center for Disease Control and Prevention (CDC) recommended that the criterion for opening up states be a fourteen-day decline in the number of cases (Centers for Disease Control and Prevention 2020)—which was not consistently adhered to by all the states. As a result, the country never reached an average infection rate of lower than 20,000 cases per day. There were other criteria involving the number of available intensive care beds and the test positivity rates, but the country never adopted the goal of driving the daily cases to zero. In contrast, all the countries that have successfully gotten beyond the virus set a goal of complete elimination and maintained their restrictions until they had come as close to that mark as possible. These countries gave the virus no safe harbor, and as a result, they recovered their freedoms.
Successfully achieving the goal of elimination of the virus using non-pharmaceutical intervention requires a number of factors, but one clear requirement is national unity. In his new book, Apollo’s Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live, physician and sociologist Nicholas A. Christakis made the following prediction: “Some countries will undoubtedly manage it better than others, and my guess is that the nations that fare the best will be the ones with high public trust and strong science-based leadership (Christakis 2020, 101–102).
Christakis wrote that sentence back in August, and it is clear that he was on target. All the countries mentioned above that have returned to normal life mounted unified responses. China and several other Asian countries had prior experience with SARS-CoV-1, and mask use was already a common part of life. They also have far more communitarian cultures than most western countries. China achieves much of its national unity through authoritarianism, but national unity and trust of the government are common in Asian countries, making strong responses to COVID-19 possible. Nightclubs are open in Wuhan, Singapore, Taiwan, and Japan, although hours were recently shortened in Osaka. In Australia, the biggest outbreak was in Melbourne, in the southern state of Victoria, and rather than a goal of X-number of days of declining cases, the state set out to eradicate the virus. In an effort to curb the spread, transportation between states was curtailed, and compliance with the restrictions was quite good. New Zealand has had clear messaging from the beginning. In her coronavirus briefings, Prime Minister Jacinda Ardern has frequently referred to “our team of five million.”
Europe has been a more difficult location for control of the disease, but even there the effect of national unity can be seen. The Scandinavian countries all enjoy a relatively high level of trust in government (Helsingen et al. 2020), and, with the possible exception of Sweden, their response to the outbreak has been very good. Sweden famously did not impose strict lockdown rules and adopted a herd immunity approach, which led to many more deaths than in neighboring countries. In June, Sweden’s top epidemiologist expressed regret about the strategy they chose and said that in hindsight they should have employed a stronger approach (“Coronavirus: Sweden’s Tegnell Admits Too Many Died” 2020).
To show the effectiveness of the Scandinavian
response, I produced the graph in Figure 1 using the
tools of the coronavirus page of Our World in Data. Infection rates are strongly affected by testing
rates, so I plotted COVID-19 deaths adjusted for the
populations of the countries. The first wave of the
outbreak shows two distinct groups of responses. The
highest death rates were seen in the western European
group—minus Germany—and Sweden, and the lowest rates
were seen in the remaining three Scandinavian
countries. Early in the epidemic, Germany was praised
for its response, but by May anti-lockdown protests
organized by the “Querdenker” or “lateral thinking”
movement began to emerge. As the second wave took off
in late autumn, the same three Scandinavian countries
formed a group with much fewer deaths, but Germany’s
second surge was larger, placing it back in a pack
with the other European countries and Sweden.
When discussing the successful containment efforts in
Australia and New Zealand, some have pointed out that
these are island nations that benefit from the absence
of land boarders with other countries, but a wider
comparison of island countries suggests that water
barriers aren’t a deciding factor. Figure 2 shows
COVID-19 deaths per million for the island nations of
Australia, New Zealand, Japan, Singapore, Ireland, and
the United Kingdom. All but one of these countries
have done quite well. In the first wave, both Ireland
and the United Kingdom experienced a steep increase in
deaths before topping out at fourteen per million per
day, but in the second wave the picture was very
different. The United Kingdom is currently witnessing
another surge in infections and deaths, but Ireland
has avoided a substantial increase in deaths during
the second wave. A possible reason for the difference
can be seen in the politics of the two
nations.
In an article in Time magazine in June, global health policy experts Gavin Yamey and Clare Wenham pointed out that in October of 2019, just months before the coronavirus crisis emerged, the Global Health Security Index (https://www.ghsindex.org/) ranked the United States first in epidemic preparedness—out of 195 countries—and ranked the United Kingdom second. How could they have gotten it so wrong? Yamey and Wenham suggest the ranking was so glaringly off the mark because, “It did not account for the political context in which a national policy response to a pandemic is formulated and implemented.” Both countries have “illiberal populist” leaders and bitterly divided political environments. Britain has an ongoing second crisis over Brexit, which was decided by a narrow margin in a national referendum, and the United States has a gaping red-blue divide that, as I write this, can be seen most clearly in the controversy over the 2020 presidential election. In days following the election, over 70 percent of the members of the losing party reported they did not believe the election had been free and fair (Bekiempis 2020).
An interesting contrast can be seen in the political landscape in Ireland and in the Irish response to the coronavirus. Unlike the United Kingdom, Ireland remains in the European Union and has shown notable unity in recent years. Since 2015, Ireland has had two important national referenda: in 2015 to legalized gay marriage and, in 2018, to overturn the country’s thirty-five-year ban on abortion. Both these referendums spurred #HomeToVote efforts aimed at getting Irish citizens living abroad to come home to vote, and both were won but large majorities. In 2018, over 66 percent of the electorate voted to approve a constitutional amendment legalizing abortion. In the United States, it is difficult to imagine a political issue that 66 percent of the electorate could agree on. The last president to win by a popular vote margin of over 66 percent was James Monroe in 1820. Similarly, the Brexit referendum in the United Kingdom was decided by less than 4 percentage points.
Following the first wave of the coronavirus epidemic in Ireland, compliance with public health guidance has been very good. Pubs that do not serve food are closed, but pubs that serve food are open. As of early December, retail stores were preparing for a vigorous holiday shopping season.
In a statement on December 12, Ireland’s chief medical officer, Dr. Tony Holohan, singled out the important contribution made by young people:
“Ireland currently has the lowest incidence in Europe and has protected against the significant mortality and severe illness that many European countries, as well as the United States, have experienced. Our younger generation led the way, with the incidence in the 19-24 year age group reduced from 432 per 100,000 population to 41 per 100,000 population. This is an enormous achievement. We all need to recognise how well our younger generation has reduced their contacts and helped to protect the whole population. We all now need to follow this example in the weeks ahead.” —Irish Chief Medical Officer Dr. Tony Holohan
The Tragedy of Our Commons
The economic concept of the Tragedy of the Commons was first introduced in 1833 by British economic writer William Forster Lloyd but was perhaps most clearly described by biologist Garrett Hardin in 1968. Simply stated, when individuals share a resource to which they each have free access, there will be a tendency to use it all up, causing disaster for all. In the classic example, cattle farmers share a common grazing field, but the field has a limited capacity to support the herd. Under free market conditions, each farmer will get the entire benefit of adding another cow to their herd, and the cost of this action—slightly depleted grass—will be shared among the farmers. Using this calculus, it is always better to add more animals to one’s herd than not, but the end-point of all this rational self-interest is starvation for all.
Today, this conflict plays out two blocks from where I am sitting. The village of Stonington, Connecticut, is home to one of the last fishing fleets in the area, and the fishers are constantly at loggerheads with state regulators. The Department of Energy and Environmental Protection sets limits on the numbers of fish commercial fishers can pull from the ocean—not because they are mean but to protect the long-term viability of the fishing beds for everyone. Despite the obvious benefits of these rules, the fishers have a long-running battle with regulators to increase the allowable size of the catch. Soon after the 2016 election, the town docks were decorated with a large red sign featuring a picture of Donald Trump that said, “President Trump, Make Commercial Fishing Great Again.”
In the case of the coronavirus crisis, the common fields that we all share are the economy, the healthcare system, and the very air that we breathe. People who advocate for removing health restrictions and assert their individual freedoms to gather together without masks and to defy the health recommendations spoil those common goods for us all. Other countries pulled together to rid their countries of the virus, save lives, and restart their economies long before vaccines were available. Meanwhile, the US economy has been crippled for nine months. The unemployment rate, which had been below 4 percent in February, briefly hit 13 percent in May and remains at over 6 percent today with job growth leveling off. According to data from Yelp, Inc., 80,000 businesses shuttered between March 1 and July 25 (Ngo 2020). With cases rising in the US winter wave, these economic trends will continue until and if widespread vaccination builds herd immunity.
A House Divided
In 1858, after accepting the Illinois Republican Party’s nomination for the US Senate, Abraham Lincoln gave one of his most famous speeches beginning with the lines: “A house divided against itself, cannot stand. I believe this government cannot endure permanently half slave and half free.”
In October of 2020, Pew Research conducted an international survey of people who thought their country had done a good job confronting the coronavirus crisis (Dimock and Wike 2020). When respondents were separated by people who did and did not support the governing party, the United States had the greatest divide. Seventy-six percent of supporters of the governing party thought the nation had done a good job with the coronavirus, compared to only 29 percent of those who did not support the governing party. This 47 percent split was substantially greater than the other countries surveyed. By comparison, in both Australia and Denmark, supporters of the ruling party gave a 98 percent approval of their country’s coronavirus response and those not supporting the party gave 93 percent approval—a mere five-point split. Canada and Germany both showed eleven-point splits. All of these countries have done substantially better than the United States in combatting the pandemic.
The United States appears to be the most politically divided country in the world at this moment, and, perhaps it is just a coincidence, but we also have the largest number of coronavirus infections and deaths. There must be someone who benefits from the political divisions we see on our TV screens every day, but it isn’t the people dying from COVID-19, the business owners filing for bankruptcy, or the workers who’ve lost their jobs. In the short run, the vaccines may bring an end to the pandemic, but the damage left in its wake will not be wiped out so quickly. Meanwhile, there are new and unknown challenges ahead. As long as our house remains divided against itself, we remain vulnerable.
Note
- All coronavirus statistics in this article, apart from the graphs, are drawn from Worldometer.com.
References
- Bekiempis, Victoria. 2020. 70% of Republicans say election wasn’t “free and fair” despite no evidence of fraud—study. The Guardian (November 10). Available online at https://www.theguardian.com/us-news/2020/nov/10/election-trust-polling-study-republicans.
- Centers for Disease Control and Prevention. 2020. CDC activities and initiatives supporting the COVID-19 response and the president’s plan for opening America up again. Available online at https://www.cdc.gov/coronavirus/2019-ncov/downloads/php/cdc-activities-initiatives-for-covid-19-response.pdf.
- Christakis, Nicholas A. 2020. Apollo’s Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live. New York: Little, Brown Spark.
- Coronavirus: Sweden’s Tegnell admits too many died. 2020. BBC News (June 3). Available online at https://www.bbc.com/news/world-europe-52903717.
- Dimock, Michael, and Richard Wike. 2020. America is exceptional in the nature of its political divide. Pew Research Center (November 13). Available online at https://www.pewresearch.org/fact-tank/2020/11/13/america-is-exceptional-in-the-nature-of-its-political-divide/.
- Helsingen, Lise, Erle Refsum, Dagrun Kyte Gjøstein, et al. 2020. Trust, threats, and consequences of the COVID-19 pandemic in Norway and Sweden—a comparative survey. BMC Public Health 20: 1–10.
- Lloyd, W. F. 1833. Two Lectures on the Checks to Population. Oxford: Collingwood.
- Ngo, Madeleine. 2020. Small businesses are dying by the thousands—and no one is tracking the carnage. Bloomberg.com (August 11). Available online at https://www.bloomberg.com/news/articles/2020-08-11/small-firms-die-quietly-leaving-thousands-of-failures-uncounted.