A Covid Thriller – The New York Occasions
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Good Morning. Why was Covid’s toll surprisingly low in much of Africa and Asia?
It is one of the biggest puzzles about Covid-19: Why was the death toll relatively low in much of Africa and Asia?
The virus has killed a fraction of as many people on these continents – despite their relative lack of resources – as it did in Europe or the US:
This is not usually how public health emergencies work. They tend to do their worst damage in poorer places, which is indeed what happens in the US, where the toll has been higher in many minority and low-income communities.
However, Covid was different worldwide. In a recent New York article, physician and Pulitzer Prize-winning author Siddhartha Mukherjee described it as “an epidemiological entity”.
In contrast to Mukherjee’s article, the pattern has received surprisingly little attention in the United States. It’s one of those times when good news is overlooked. I would like to dedicate today’s newsletter to the mystery and its most plausible explanations.
Is it a statistical illusion?
Almost certainly not. Part of the pattern is likely due to underreporting of deaths from less developed medical systems. But much of the pattern is real, believe many epidemiologists.
In India, for example, big cities keep statistics on all-cause mortality, regardless of the cause, and it has increased less than in many richer countries. The data suggests that both Delhi and Mumbai “have much lower Covid death rates than the US,” Dr. Prabhat Jha, who heads the Center for Global Health Research at St. Michael’s Hospital in Toronto.
In Mukherjee’s article, he described a makeshift hospital that local Mumbai officials set up in Dharavi, a sprawling slum, last year. They closed it after Dharavi suffered far fewer deaths than expected.
The poorer countries are younger
Covid is usually more difficult for the elderly: More than 80 percent of deaths in the United States have occurred in people aged 65 and over.
Across Africa and much of Asia, the population is younger. Birth rates are higher and other health problems are more likely to kill people before they reach old age. In sub-Saharan Africa, only 3 percent of the population are 65 years of age or older. In Pakistan it is only 4 percent. In the USA the proportion is 16 percent and in the European Union 20 percent.
A related factor could be the fact that nursing homes – where Covid has often spread from one resident to the next – are more common in western countries. Outside the West, the elderly often live in multi-generational households.
Still, age doesn’t seem like the complete answer. Statistical models that include age still find unexpectedly low death rates in many poor countries.
Fresh air helps
In warmer, lower-income countries, daily life tends to be better ventilated. People spend more time outdoors and the windows are often open. Covid spreads less easily in these environments than in poorly ventilated indoor spaces.
There is a lesson here for Americans: Schools, shops, and workplaces can reduce the spread of Covid by improving their ventilation.
Immunity may not be uniform
Many researchers suggest that this is an important part of the answer. If previous coronaviruses continue to spread in some countries, people’s immune systems may be better prepared to fight Covid. “There is a lot of evidence,” South African epidemiologist Salim Abdool Karim told Reuters, “but there is no smoking weapon.”
Similarly, a team of Indian researchers has argued that deaths “are lower in countries with higher populations that are exposed to a variety of microbes,” as the BBC’s Soutik Biswas wrote. The large proportion of asymptomatic infections in India is consistent with this hypothesis, said Dr. Gagandeep Kang, a virologist in the southern town of Vellore, told the Financial Times.
If the hypothesis is correct, it could explain why deaths in Africa and Asia are lower than in much of Latin America.
Rwanda quickly and aggressively enforced social distancing, mask-wearing, contact tracing, and mass testing. Several Asian countries too. Ghana, Vietnam and other countries restricted entry at their borders. And a consortium of African nations worked together to hand out medical masks and quick Covid tests.
“Africa is doing many things right, the rest of the world is not,” said Gayle Smith, a former Obama administration official.
However, this again probably doesn’t seem to be the main cause of the relatively low death toll in Covid. Several Asian and African countries, including India, have had much more diverse political responses – like the US and Europe.
The full answer to this puzzle certainly involves several explanations. Whatever they are, it’s one of the few ways Covid hasn’t been as bad as many feared. Hundreds of thousands of people in Africa and Asia have still died from this terrible disease. But many others are alive today for obscure and wonderful reasons.
The media equation: They had a fun pandemic and you can read about it in print.
From the opinion: Gail Collins and Bret Stephens discuss Cuomo’s problems.
Lived life: He was the hockey dad who taught his son to “walk where the puck goes, not where it has been”. And when an aneurysm robbed him of his memories, he rebuilt his life with family and friends. Walter Gretzky died at the age of 82.
ART AND IDEAS
Why Pop Star Documentaries Feel Safe
Last month, Apple TV + released Billie Eilish: The World Is a Little Blurry, a documentary showing the singer’s rise and the making of her Grammy-winning debut album. Other recent documentaries about pop stars like Justin Bieber, Beyoncé and the girl group Blackpink follow.
The artists or their labels helped with the production of all these films, which promise an unvarnished glimpse into the lives of the actors. That’s not quite what they deliver.
Celebrities have long used documentaries to manage their images, even when the production team is technically independent. Music labels are often involved in the documentaries, partly because “Directors have no choice: Films about musicians need music, and licenses can be prohibitively expensive,” writes Danny Funt in the Columbia Journalism Review.
Perhaps the best way to approach celebrity documentaries is to enjoy them for what they are: carefully constructed entertainment. In Eilish’s case, the documentary often feels “almost observational, like a nature film,” writes Times critic Jon Caramanica in a review. Still, he says, “There’s never anything else in this footage but a sense of security.”
As Simran Hans writes in The Guardian, “Artists continue to use the documentary form as an abbreviation for truth – but that truth is yet another construction.”
PLAY, WATCH, EAT
What to cook
Spelling Bee’s pangram on Friday was a matriarch. Here is today’s puzzle – or you can play online.