Here's how to find out which countries are coping best with Covid

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Here's how to find out which countries are coping best with Covid

As the Covid crisis has unfolded, infection rates have fluctuated and restrictions have multiplied. But he always felt that there was one idea to cling to: that in determining which countries were doing well - and which were not - there was something to be learned.

After all, historians will surely wonder how the countries of Western Europe, with broadly similar economies, produced such radically different results. So far, at least.

We constantly use international comparisons, of course - that's one way of measuring how our own governments are doing. But even comparing the simplest data can be complex.

There may be differences in how and when death is reported, how co-morbidities are reflected on death certificates and for how long after a positive test a death is considered to be related to Covid. All of this will influence how a country's performance at any given time is measured.

For the moment, the performance gaps seem surprising.

Graph showing coronavirus cases in Spain, Belgium, UK, France, Italy and Germany

The death rate in Germany is around 11,5 deaths per 100 people, while in neighboring Belgium it is more than seven times higher at 000 per 87 people. France sits somewhere in between, at around 100 per 000, while the UK is closer to the top of the European rankings, at 48 per 100.

Each is a prosperous country with a strong health care system, and each has applied broadly similar tools to tackle the virus, with a combination of lockdowns, social distancing, and encouragement for enhanced hand hygiene. by localized curfews in certain towns.

But the more deeply you examine the data, the more difficult it becomes to explain the differences.

Lombardy and Veneto, for example, are neighboring provinces in northern Italy, but the differences between their experiences are striking - Lombardy's death rate is 167 per 100000 and Veneto's is 43.

Perhaps it is because of the difficulty in explaining the numbers that Germany's view of whether it is better than the rest is more cautious than you might imagine. It is recognized that one factor could be timing - how quickly you act can be as important as the action you take.

Influential German scientist Christian Drosten put it this way ahead of this month's World Health Summit in Berlin: “There are already speeches celebrating German success, but it is not clear where it came from. . didn't do anything particularly well, we did it earlier. "

Germany has an extensive testing system, a well-established network of public health monitoring and surveillance workers, and more places in intensive care units than most others. country.

But perhaps just as important, it has Angela Merkel - one of the few world leaders who is a scientist and who can understand and explain the data herself.


At a press conference after meeting with heads of German regional governments, for example, Merkel began a response with the words: “I just performed a calculation model”. She then spoke to her audience about the mathematics of existential growth in a pandemic, concluding with a warning that Germany should take further action. She was careful to describe the situation as "urgent" but not dramatic.

Christian Drosten argues that a population that feels well informed is more likely to comply with government instructions or requests.

As he put it: “I read 85-90% support rates, it's a huge accomplishment… everyone knows someone in their own circle who doesn't take measures but it is possible to talk to him and that's what we should. I think that's one of the biggest advantages we have in Germany. "

Professor Drosten's point is about the meeting of science and society - in other words, it's not about the nature of the tools in the toolbox, but how the country reacts when the government take out the tools.

We raised this point with Professor Yves Van Laethem, adviser to the Belgian government, who said that it was possible that his government had confused its audience by changing its message too quickly and too often.

'People wonder why'

He said that it was now necessary to take sustainable and stable measures as winter approached, but that the appetite of the Belgian people for further regulatory changes was limited - a phenomenon that can also be observed in the UK and elsewhere.

“It's a similar problem in Belgium,” he says. “The government is proposing something and this is immediately contested…. In March and April, people were so scared to comply and they didn't challenge the rules as much. But now people see that as the cases increase the death rate remains low and they wonder why they have to do all of these things. "

This may explain why Belgium has become one of the very few countries to ease a restriction as fears of a second fall wave grew.

From the end of July, it was mandatory in Belgium to wear a mask at all times, in all public spaces, indoors and outdoors - even if you were crossing a deserted park alone in the middle of the night.

Since October 1, this rule has been relaxed. Masks are still mandatory in shops and on public transport, but only in crowded public spaces outside.

In contrast, after months of resistance to promoting the use of masks, their neighbor, the Netherlands, has started tightening its rules, strongly recommending them in shops and on buses. The destination is the same - masks are a good idea in certain circumstances, but the direction of travel is very different.

Did Sweden get it right? [5 Total number of confirmed deaths in the country], [895 Total number of confirmed cases in the country] [94 The cumulative number of cases over 283 days per 57,6 population], Source: Figures correct as of 14 October 100, Image: Officials in Sweden

These questions of consistency and sustainability were linked to Anders Tegnell, Sweden's chief virologist. His advice to leave bars and restaurants open and not to require masks to be worn was questioned in the first phase of the pandemic, but is increasingly supported by evidence in the second.

It is of course a myth that the Swedish government "did nothing" in response to the crisis. He has taken steps to slow the virus, including social distancing and encouragement of increased hand hygiene. Mr. Tegnell talks about the importance of "giving a lot of influence to the people".

The Swedish political culture of calm communitarianism can make the virologist's job a little easier - and it raises an interesting question about the extent to which outcomes might be determined not only by the measures governments introduce, but also by the reaction to them once they have been announced. .

If the German and Swedish populations - on the whole - can be trusted to accept the instructions and demands of their governments, what about societies where governments are treated with more skepticism, where parties opposition, unions, populist newspapers and angry local authorities are at their worst. - the affected areas adopt a contrarian or controversial approach of the central power.

'It's too early now'

In France, for example, the national health minister, Olivier Veran, announced new rules for the populated southern coastal area around Marseille without consulting local authorities. The mini-lockdown includes the closure of restaurants and bars.

Regional president Renaud Muselier, who is a doctor, called the decision "inappropriate, one-sided and brutal", warning that it would lead to feelings of "rebellion and revolt".

This is of course not an academic debate on epidemiology. Marseille would see itself as a rival to distant Paris and it would never be difficult to arouse resentment from the central power there. But it will be interesting to see what effect, if any, the local reaction hostile to the remote central government will have.

Social distancing sign in GermanyCOPYRIGHT OF IMAGEREUTERS

There are all kinds of difficulties in making international comparisons at this point in the pandemic - even something as basic as social distancing is complex. France, Germany and the UK for example all have different social distancing measures - 1m, 1,5m and 2m respectively. But figuring out which of these is right and how the balance between risk and convenience has been measured will take months, if not years, of study.

The problems with these comparisons struck me when I was spending time in the Belgian parliament with one of the country's leading politicians, on a day when, coincidentally, British scientists and politicians praised some aspect of the Belgium in the second wave.

He was surprised. “Honestly,” he said, “you can watch TV every night and see an expert in Stockholm, or London, or Paris, say something a little different. But of course, they are all experts. It is too early now for comparison. Maybe it will be possible next year, maybe we will have to wait until the next year, but not now. "

Perhaps this leaves us with a conclusion that we can safely draw. That health outcomes in this crisis don't just depend on what our governments tell us to do and not to do. They will depend just as much if not more on the choices we choose to make about what we are told.

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