Monday, March 30, 2020

Asia Covid-19: Lessons learned from past epidemics and high income helps

Kuala Lumpur: Coronavirus data for March 30th show that Japan (including the Diamond Princess cruise ship) with a population of 127m is just behind Ireland (population 5m) with 2,578 infections and 64 deaths; South Korea with a population of 52m has 9,661 and 158 deaths; Taiwan with a population of 23m has 298 and 3 deaths; Hong Kong (Special Administrative Region of China) with a population of 7.4m has 642 and 4 deaths; Singapore with a population of 5.7m has 844 and 3 deaths.

The health per capita spending as shown in the chart above (Taiwan's spending is $2,700) highlights how low the level is in several Asian countries.

The high-income Asian countries have low infection and death rates compared with comparable countries in Europe but several of the low-income countries are low as well — very likely because they have little testing in public hospitals because of lack of kits.

Japan may be an outlier among Asian high income countries with a low rate as it has had a low level of testing, while infection numbers have recently risen. The authorities may have been hoping to keep a low rate to avoid imperilling the Olympics, which were postponed last week.

One private hospital in Kuala Lumpur is charging RM800 (€170) for a test in a country where the median earnings (half above and half below) is RM2,400 (€504).

Myanmar (Burma) with a population of 53m has 10 infections and no deaths — see country rankings.

Malaysia has a population of 32m and its rates are 2,480 and 35 deaths.

During political turmoil earlier in the month, a 3-day religious conference was held in Kuala Lumpur. There were about 16,000 attendees with 1,500 from overseas.

Infection rates spiked after the event and the authorities had problems in tracking down the attendees.

Asian epidemics

According to the World Health Organisation (WHO), in May 1997 a 3-year-old boy died of respiratory failure in a Hong Kong hospital. The cause was given as viral pneumonia "of unknown etiology," but 3 months later the infection was identified as H5N1 avian influenza. While the virus had been detected in geese the previous year in China’s Guangdong province (just north of Hong Kong) and chickens in Hong Kong in March and May 1997, this was the first evidence that H5N1 had jumped the species barrier to threaten humans.

"Despite the cull, H5N1 started surfacing around the globe. The virus has infected wild birds and domestic flocks in at least 55 countries in Asia, the Middle East, Africa and Europe. As of 13 November 2006, there had been 258 confirmed cases of human infection killing 153 people."

In early 2003, a mysterious outbreak of pneumonia occurred in Guangdong province which was given the name, severe acute respiratory syndrome (SARS).

According to the WHO, "a total of 8,098 people worldwide became sick with SARS during the 2003 outbreak. Of these, 774 died. In the United States, only eight people had laboratory evidence of SARS-CoV infection. All of these people had travelled to other parts of the world where SARS was spreading."

The symptoms of SARS were similar to the current outbreak.

In Hong Kong a SARS Expert Review recommended in 2003, the "establishment of the Center for Health Protection (CHP) under the Department of Health to increase the capacity to deal with future resurgences of SARS and other diseases. The functions of the CHP include comprehensive public health surveillance related to communicable diseases, contingency planning for disease outbreaks, and building capacity and professional expertise.

In 2007 scientists at the University of Hong Kong in a paper warned, that "The presence of a large reservoir of SARS-CoV-like viruses in horseshoe bats, together with the culture of eating exotic mammals in southern China, is a time bomb."

Taiwan also established a central command centre for epidemics.

In 2015 Middle East Respiratory Syndrome (MERS) a virus like SARS emerged in the Middle East.

South Korea had over 100 infections and 9 deaths and it was recognised that lax quarantine of those infected and people who had contact with them was a key failure to be rectified.

When SARS hit Singapore in 2003, healthcare staff were unprepared for the epidemic.

However, a recent study by Harvard University’s Centre for Communicable Disease Dynamics reported that Singapore is identifying three times more cases than other countries due to its disease surveillance and contact-tracing capacity.

The city-state has a sophisticated tracking system while in South Korea tracing is aided by smartphone footprints.

Taiwan has about 3m citizens working in China and before the start of the Chinese Lunar New Year in January, incoming flights from China were boarded to check the health status of passengers.

Countries outside of Asia, in particular rich ones, are likely to be better prepared for the next pandemic.

ASEAN is the Association of Southeast Asian nations. Nominal 2019 GDP per capita in China was $10,260; Japam $41,000 and South Korea $33,300.