by Peter Chow
The most startling trend visible in the global Covid-19 pandemic is the vast differential separating East Asia from the West when it comes to the disease’s impact.
The chasm is impossible not to notice – when examining infection and death rates in either gross or percentage terms.
Very clearly, East Asia, defined as the nations of China, Japan, South Korea, Taiwan and Vietnam, has done better than the West on virus management.
Unlike most infectious diseases which register their highest mortalities in the developing world, Covid-19 has wreaked its greatest havoc among the world’s richest nations.
Even the briefest glance at the numbers reveals a stark disparity. East Asia has been far more adept at pandemic management than the West. This runs across all key metrics and by massive differentials.
The list of the top nations for infections, according to data collated by Johns Hopkins University, is a roll call of the biggest, most prosperous and influential Western countries, with the US in the number one spot.
The virus originated in East Asia, but no East Asian nation makes the top 10 list. The world’s most populous nation, China, is highest, in 49th place, for total number of Covid-19 cases.
China had 21 new cases on Oct. 9, South Korea 54, Japan 519, Taiwan 3 and Vietnam 5 cases.
The East-West divergence in fatality rates is even starker.
China (population: 1.4 billion) has suffered 4,637 dead. Japan (population: 126 million) has lost 678. South Korea (population 51 million) has lost 430. Taiwan (population: 23.7 million) has lost only 7. Vietnam (population: 95.5 million) has registered 35 deaths.
Western mortalities are on a vastly different order of magnitude.
The US (population: 328 million) has lost 218,900. The UK (population: 66 million) has lost 42,600. Italy (population 60 million) has lost 36,100. Spain (population 47 million) has lost 32,900. France (population 67 million) has lost 32,500 and Germany (population 83 million) has lost 9,700.
In other words, Germany, at the bottom of the Western list, has nearly double the deaths of China, at the top of the East Asian list.
Or, take another metric – deaths per million of population. It shows a similar East-West chasm.
Spain’s mortalities per million are 580.1, Italy’s 514.7, the UK’s 499.1, France’s 404.2, the US’ 260.4 and Germany’s, 94.8. Meanwhile, Japan’s are 5.4, South Korea’s 5.0, China’s 3.3, Taiwan’s 0.3 and Vietnam’s 0.4.
China’s data is frequently questioned by those on the political right, and Japan’s by those on the political left, but the two countries’ Covid-19 tolls are broadly in line with East Asian trends, suggesting greater accuracy than doubters might like to believe.
These data results confound expectations.
On the macro level, East Asia has vastly bigger cities and much higher population densities.
On the micro level, it has a culture in which food is shared from communal dishes.
Moreover, the Western nations cited above are fully developed, prosperous and middle-class – as are Japan, South Korea and Taiwan – but China and Vietnam, despite their rising economic status, are still lagging behind on a GDP per capita basis.
So what has the East done right and the West wrong? Naturally comparison demands generalities, but even detailed variables are difficult to dissect.
Take age, a key risk factor for Covid-19.
One reason Italy was believed to have suffered so severely early in the pandemic was because of its demographics: the world’s second oldest.
However, Japan, the country with the world’s oldest population, has seen a Covid-19 death rate 45 times lower that Italy’s.
Moreover, the percentage of aged persons living at home, rather than in specialist care homes, is similar in both countries: 96% in Italy and 94% in Japan, according to a study.
Still, a range of issues – from cultural habits to attitudes toward governance, from vaccination policies to viral mutations – merit discussion.
The two main vectors of transmission for Covid-19 are airborne droplets and contact. In countering these vectors, East Asia’s social habits trump the West’s.
Due to East Asia’s air pollution and harsh influenzas, mask wearing – a simple but critical step in halting respiratory disease transmission by containing infected persons’ droplets within masks – is a common habit across the region.
In South Korea, in February, people were already wearing masks even when they had not been told to do so. Across East Asia, mask wearing is routine during cold and flu season.
Moreover, there is less direct personal physical contact in East Asian behaviours, with its tradition of bowing, than in the West, with its traditions of cheek-kissing, hugging and hand-shaking.
In other words, social distancing is built into culture.
Another aspect of culture is diet, which impacts a key Covid-19 risk factor. East Asians as a whole suffer much lower rates of obesity than Westerners.
Attitudes toward authority and community consciousness are nebulous concepts, but East Asia may have advantages for reasons that combine politics and culture.
In communist-led China and Vietnam, the hand of government is heavy, a factor that militates against civil disobedience. The same is true for North Korea, where no data on the pandemic is available, but where indications suggest Pyongyang has contained the virus effectively.
And even democratic Japan, South Korea and Taiwan experienced dictatorial or militaristic governance within living memory.
Beyond politics lies the broader issue of culture. East Asian nations share a Chinese-influenced, Confucian culture of collectivism and group identity.
While politics may override culture in authoritarian Asian states, cultural factors contribute to civic consciousness in democratic Asian states. Such attitudes are visible in low rates of street crime and in widespread acceptance of “nanny state” governance and of central government economic management.
“An outbreak is a community problem,” said one epidemiologist. “You can’t address it as individuals.”
Broadly, these various factors point to the trend of East Asians being more responsive to rules than “individualistic” Westerners.
In East Asia, populations were more receptive to – and less fragmented in the face of – the measures needed to slow transmission.
This fragmentation is most prominently seen in armed Americans defying lockdowns, but is also visible in less dramatic forms.
Most of this crisis in Western countries is behavioural.
Such defiance would be unthinkable in Vietnam or China, where lockdowns are enforced by neighborhood watch groups. And observers note that in South Korea, where no lockdown occurred, and Japan, where a “lockdown lite” has been instituted, dictates on avoiding large gatherings, on mask-wearing and on hand sanitization, are widely followed.
Likewise, the prioritization of society over the individual has come into focus over rights to privacy, as a key pandemic countermeasure is contact tracing of the infected.
This process has been eased by East Asia’s high adoption rates of cellphones. In China, tracing is further empowered by a pervasive state surveillance network.
But even in democratic Asia, where credit card and cellphone data has been used in tracing, there has been minimal pushback on the issue.
In South Korea, a wide-ranging law passed in the wake of their recent MERS pandemic allowed authorities to access normally private data, such as location information from mobile phones and credit card records, enabling accurate contact tracing and contributing to the nation’s comparative Covid-19 containment success.
Looking West, there are high cultural barriers towards the use of personal data by governments, most notably in the US.
We should implement the Korean system, but people say, ‘These authoritarian measures would not work here!’” But we hand all this data over to big corporations, why not to the government?
Recent disease containment experience also granted East Asia an edge in its response.
One of the things to remember is that China, Korea, Hong Kong and Taiwan had been through this before, recently, with SARS and MERS.
That preparation helped.
At the outset of Korea’s outbreak, they were both prepared and unafraid, due to prior experience. And prior experience impacted systemic response well beyond medical care.
Taiwan famously had the perfect leadership in place for the crisis: Vice-President Chen Chien-jen was an epidemiologist.
Across East Asia leadership has largely been on point in terms of consistency of strategy and following the lead of experts. There has been unified command and control; the messaging has been consistent. There is no back and forth, like there was in the US and elsewhere on masks.
The leadership, in general, has been less politicized and more effective in the East than in the West. Name calling and blaming and deflecting responsibility seemed inappropriate.
Moreover, leadership is not just a matter of “what” but also “when.”
One of the major differences in terms of casualties is whether governments acted promptly. In the US and Canada and the UK, it took nearly six weeks. It was too late.
Taiwan not only reacted with great speed; it provided an early gold standard for contact tracing, having integrated its health insurance, immigration and customs databases, then mined the resultant big data with AI.
South Korea provided a global benchmark for fast, efficient and extensive testing regimens by offering free tests for the infected and pioneering drive-thru and walk-thru test sites. That enabled early discovery, isolation and treatment.
In America, they say ‘We need more testing,’ but testing without tracing and treatment is meaningless, noting the weakness of tracing and quarantining in the US. You learn this in Med School 101.
While the world awaits a dedicated Covid-19 vaccine, BCG, a 100-year-old tuberculosis vaccination that appears to train or stimulate the overall immune system, may be providing a very important shield.
“If I were to identify one factor” in the East-West conundrum, “it would be levels of BCG vaccination,” said one virologist.
Maps of the level of BCG vaccination show a strikingly close correlation to numbers of Covid-19 casualties. In Italy and the United States, BCG was only recommended for select groups.
Most of Eastern Europe and Asia and Africa, which have weathered the crisis more effectively, maintain ongoing national BCG vaccination programs.
Differences between neighbours are striking. Spain, with no national BCG program, suffered high infection and mortality rates, while Portugal, which has a BCG program, did not, despite their shared border. Moreover, Covid-19 rates in western Germany were higher in the country’s east, which previously had BCG vaccinations.
The variant of the virus in the West might be deadlier than the version that emerged in the East. Viruses mutate, and according to research published by Los Alamos National Laboratory published on April 30, the mutation that appeared in Europe in February and then spread to the US is more infectious than the original.
If the variant in the West is more dangerous than that in the East, it could help explain why two nations that are largely “Western” in their systems and practices but are physically in the East – Australia and New Zealand – have been relatively mildly affected.
Since the 19th century, East Asia has looked up to the West in multiple sectors, from science and technology to governance systems and popular culture.
Despite the economic ascent of the East, the West has not reciprocated with similar levels of interest. As a result, Western barriers to adopting Eastern models unfortunately exist, combined with disinclination toward critical introspection.
This cultural superiority complex has extended to actual abuse.
Amid the pandemic, East Asians have suffered racial prejudice, verbal abuse, being told to “go home”, and physical assault in Western nations.
The crisis is not over as concerns rise of a “second wave” as lockdowns worldwide are eased and winter and flu season approach.
We should learn from East Asia on how it has so clearly outdone the West in pandemic management.