Monday, March 16, 2020

Coronavirus - COVID-19: China "Sick Man" of Asia? US of Developed World?  

Get latest data Coronavirus Tracking Data from Johns Hopkins University

Data from the Johns Hopkins Coronavirus database on March 16, 2020, show a fatality rate of 3.86%. However, this is not a reliable metric as the denominator is influenced by a recent spike in numbers while the numbers of people with the virus, not confirmed or showing no symptoms, are unknown.

Research by a group of international scientists suggests that the fatality rate in China is likely to be 0.5% — 5 times the rate for the seasonal flu in the US — while a review of the Diamond Princess cruise ship, which had more than 3,000 people on board and was under quarantine at Yokohama, Japan in February show that there were almost 700 confirmed cases and 8 deaths so far. The average age of the people on board was 58 and the scientists' estimate the expected fatality rate at 1.2%.

Data from China's Hubei province, the epicentre of the crisis, show that the vulnerable people are mianly above 60 years of age, in particular people who have chronic health conditions.

This does not mean that people under 60 are not at risk from COVID-19. Some may have similar underlying health problems as the older groups. The Asthma Society of Ireland has advice here for people with asthma.

The United States spends 18% of GDP (gross domestic product) on health annually compared with 10% in several Western European countries and 11% in Germany and France. China's rate in 2018 was 6.6%.

However, as the chart on top shows, the American population is not very healthy and in a decade obesity is expected to rise to 50% of the adult population.

The health of older Chinese is impacted by a high rate of smoking and industrial pollution.

The diabetes prevalence rate in the US is 11%; 9% in China: 3% in Ireland; 5% in France, Italy and Singapore. The rate is 16% in Saudi Arabia and Qatar.

On February 3 of 2020, The Wall Street Journal published an opinion piece titled, "China is Real Sick Man of Asia" (paywall) with a byline, "Its financial markets may be even more dangerous than its wildlife markets."

China at the time was at the early stage of deploying resources from across the vast country to tackle the coronavirus outbreak in Hubei, a landlocked province in Central China. Wuhan, capital of the province with a population of about 11m is known in China as a “motor city” for being the location of car vehicle plants including those of General Motors, Honda, Nissan, Peugeot Group and Renault. Hubei has a population of 60m.

The Chinese government responded to the Journal article by expelling 3 WSJ reporters.

China was the world's biggest economy in 1820 and its remarkable rebirth in modern times as an economic power has spawned a constituency in the United States that has been forecasting its demise for decades.

Yan Fu (1854-1921), a Chinese scholar who had attended the British Royal Naval College in the 1870s, is credited with calling the crumbling Qing Dynasty, a "Sick Man" after the First Sino-Japanese War (1894-1895) when the Treaty of Shimonoseki ceded Taiwan to the Japanese. In May 1860 The New York Times in an article on the Austrian Empire noted  [The condition of Austria at the present moment is not less threatening in itself, though less alarming for the peace of the world, than was the condition of Turkey when the Czar Nicholas invited England to draw up with him the last will and testament of the "sick man of Europe."]

The United States and China are today's top economic superpowers but my focus here is on their health services and the challenges for coping with a pandemic that is a serious threat in particular to old people.

Japan and South Korea lead in hospital beds per 1,000 people at 13.0 and 12.3. China is at 4.3, Italy 3.2 and the United States 2.8.

Health care facilities in Northern Italy are swamped with over 21,000 infections reported by March 14. Italy at 23% has the largest population ratio in the EU over 65. 

Ireland has a hospital bed rate of 3.0, ahead of the UK, Denmark, Canada and Sweden. Germany has the highest rate in the EU at 8.0.

The Financial Times reports that "Italy, the country at the epicentre of the European outbreak, told the country’s only ventilator manufacturer to quadruple monthly production, even deploying members of the armed forces to help meet the new quota." 

Germany has around 28,000 intensive care beds, of which 25,000 are equipped with ventilators. France has 5,065 intensive care beds equipped with ventilators. The UK National Health Service has about 5,000 ventilators. According to The Irish Times, "nearly half of the ventilators used in acute hospitals around the globe are made in Ireland. Galway-based US firm Medtronic is one of the biggest manufacturers."

On Sunday Anne O'Connor, Chief Operations Officer of the HSE (Irish Health Service Executive), said there will be a "significant" surge in the number of people to be tested for Covid-19 over the coming week.

Speaking on RTÉ Radio she said currently there are more than 500 ventilators and 1,000 other respiratory machines in the health service, but talks are ongoing to provide a continuous supply.

The Center for Health Security at Johns Hopkins recently estimated that there were about 160,000 ventilators available for patient care.

About 60% of all Americans have at least one chronic health condition, and 40% have more than one. (The figures include the elderly.) "Heart disease, cancer, diabetes — these diseases can make the symptoms of coronavirus infection worse, studies show, raising the odds of severe disease and death.

The World Health Organization report on China’s outbreak following a February visit to China found that while patients who reported no prior chronic conditions had a 1.4% fatality rate, it was at 13.2% of those with cardiovascular disease, 9.2% for diabetes, 8.4% for hypertension, 8.0% for chronic respiratory disease, and 7.6% for cancer.

In recent years China has achieved almost full health insurance coverage of its population while in the US in 2018 27.5m people were without health coverage representing 8.5% of Americans, up from 7.9% in 2017, according to the census data. The percentage increase is the first since one from 2008 to 2009 and these mainly poor people would be reluctant to visit a hospital.

President Trump and his Republican allies want to close down the Obamacare system and not provide cover for pre-existing conditions.

The US also has about 11m illegal immigrants who will not risk deportation.

Yesterday, Eduardo Porter, an economics reporter for The New York Times, wrote that racism explains why the United States lacks the safety net its citizens deserve:

"Racism has forever been a forbidding obstacle to the development of a welfare state, at least of the sort that Europe enjoys and many Americans aspire to. By standing in the way of solidarity, it has produced an exceptional country that accepts without flinching the most extreme wealth alongside deprivation that has no place in the industrialized world.

Why does the United States suffer the highest poverty rate among wealthy nations? Why does it have the highest teen pregnancy rate? Why are so many Americans addled by opioids? We blame globalization and technology. But these forces affect everybody — the French and the Canadians and the Japanese as much as us.

The United States alone has crumpled because it showed no interest in building the safeguards erected in other advanced countries to protect those on the wrong side of these changes. Why? Because we couldn’t be moved to build a safety net that cut across our divisions of ethnicity and race."

China is short of doctors, with 1.8 physician — both general practitioners and specialists — for every 1,000 people. That is lower than 2.4 in the US; 2.8 in the UK; 2.4 in Japan; 2.3 in Singapore; 3.1 in Ireland; 4.1 in Italy, and 3.8 in the 19-country Euro Area, according to the World Bank.

Healthcare rationing will be inevitable if infection numbers continue to spike in the coming weeks.

Scenes of chaos at airports in the United States were common at the weekend — the image below is via Twitter from Chicago's O'Hare International Airport. The traveller who took the photo said it was a 6-hour wait for bags then on to customs for 2-4 more of waiting in shoulder-to-shoulder crowds.


On Wednesday The New York Times (March 18) reported on a report issued by the Centers for Disease Control and Prevention which showed that in the US the incidence of younger people being infected was higher than expected. "It found that — as in other countries — the oldest patients had the greatest likelihood of dying and of being hospitalized. But of the 508 patients known to have been hospitalized, 38% were notably younger — between 20 and 54. And nearly half of the 121 patients who were admitted to intensive care units were adults under 65, the CDC reported."

“I think everyone should be paying attention to this,” said Stephen S. Morse, a professor of epidemiology at Columbia University’s Mailman School of Public Health. “It’s not just going to be the elderly. There will be people age 20 and up. They do have to be careful, even if they think that they’re young and healthy.”

In 2007, 4 scientists at the University of Hong Kong wrote in a paper:

"Coronaviruses are well known to undergo genetic recombination, which may lead to new genotypes and outbreaks. 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. The possibility of the reemergence of SARS and other novel viruses from animals or laboratories and therefore the need for preparedness should not be ignored."

China was both negligent in waiting to take action in Wuhan against the coronavirus for 7 weeks after news of the first outbreak in Dec 2019, and disastrous negligence after the SARS-1 outbreak in 2003.