While nearly every country on the planet is now fighting the same virus from largely similar starting points, there will over time, be very different outcomes. For instance, less than 3 months into this worldwide disaster, we could already see that the COVID-19 per capita death rate was running at 22 for every 100,000 people in the UK, while in South Korea it was 0.45 per 100,000. Or to put that more simply, for every one person that had died in South Korea 55 people had died in the UK. So with the same virus and similar starting points but with different government policies in response, we see very different outcomes.
As startling as that is, from a scientific perspective it is bad practice to simply compare those two figures without accounting for other variables, before drawing any sort of conclusion.
For instance it might be that South Koreans are just healthier than UK citizens. Or perhaps South Korea as a country spends significantly more per person on its healthcare than the UK. Or even South Korea is a much richer country that simply has more money to spend on responding to such a catastrophe. So before you start pointing the finger you really need to start by trying to take into consideration all of the other variables, including the different government policies that have been enacted in response to the outbreak.
To this end, for the last month I have been using the Johns Hopkins COVID-19 mapping function to track a series of measures, specifically the number of confirmed cases and death toll in the UK, USA, Germany, Spain and South Korea. I have then used the World Banks figures for the total population, life expectancy, Gross National Income (GNI), % of GDP spent on healthcare and the GINI coefficient measure of inequality for each country to compare them against.
The reason that I have been doing this is because the figures being reported by the UK government and large sections of the media appear to be tracking so very differently to similar metrics in other countries. Of course, trying to reach a like-for-like comparison will never be absolutely possible because there are so many variables at play.
But if we are to understand the impact of government policies on the number of deaths directly and indirectly related to COVID-19, the job losses, the number of failed businesses, and the wider mental and general health issues that will inevitably come out over time, we do need to start monitoring and measuring all of the variables as they are occurring in order to study them more closely later.
One of the most important reasons for doing this, second to being better prepared for when it happens next time, is so that we as a population can effectively review the performance of the politicians, media, private sector, civil service, health service, emergency services, research facilities, and the military and police forces, who are apparently working so very hard to protect all of us. Put simply we, and all of them, need to learn from our mistakes. Even if our mistake was simply in trusting the wrong people.
One of the reasons for preparing properly before just such a performance review is that if and when it comes to light that they have failed or fallen short, they will inevitably try to shift the blame away from their own government policies. We need to be able to clearly demonstrate exactly how much of this is due to their decisions.
To that end, the first thing to take into consideration is that the absolute number of confirmed cases and deaths in different countries can not be compared without first taking into account the size of the populations that they are occurring within.
For instance, according to the World Bank, Spain has a population of 46.8 million people while Germany has a population of 82.9 million. So to compare the actual death tolls of each country tells us very little without first changing them into a percentage of their relative populations, a per capita figure. Which according to my calculations, puts the death toll in Spain on 23rd April at 0.0464% of the population, while in Germany it was 0.0064%. Or to put it more simply, for every 100,000 people 46.4 Spanish people have died while only 6.41 German people have died.
We now know that as it currently stands the ratio of per capita deaths from COVID-19 between Germany and Spain is currently running at roughly 1:7.5. But even this doesn’t tell the whole story. After all, the people living in Spain and Germany are in very different positions economically. Firstly, Spain has a Gross National Income (GNI) of US$29,430 per person, while Germany has a GNI of US$47,090 per person. By this measure alone Germany is far richer than Spain is.
But this is an overall figure, and doesn’t really tell us how that money is apportioned among the population. For that you need to compare the GINI coefficients for each country. Germany’s GINI is 31.9 while Spain’s is 34.7. Therefore, not only is Germany richer as a country overall, but that increased wealth is shared out more equally across the population. Therefore individuals living in Germany are in a much stronger economic position than individuals living in Spain, on average.
But that can’t be the whole story either. Consider the case of Vietnam. With a population of 95.5 million, a GINI coefficient of 35.7 and a GNI of US$2,360, is more populated, vastly poorer and has greater inequality than both Germany and Spain. However, as of the 23rd April it has had no confirmed COVID-19 deaths. And that is without even taking into consideration the fact that it shares a land-border with China and is therefore thousands of miles closer to the initial outbreak as well.
So if it is not about the relative wealth between and within the countries, then is it worth comparing the health of the populations and the relative states of their healthcare systems before the outbreak?
In 2017 Germany as a country was spending 11.25% of GDP on healthcare, while in that same year Spain was spending 8.87% of GDP on healthcare. However, even this alone doesn’t give the full picture. Even when combining the greater inequality and lower overall wealth of Spain with a lower proportion being spent on healthcare the Spanish were still living on average 2.3 years longer than the Germans.
But again it is worth comparing these figures with Vietnam, which has a life expectancy of 75.3 years, while only spending 5.53% of a much lower GDP on healthcare. By both metrics Vietnam comes out worst, with a life expectancy of over 5 years less than Germany, while spending vastly less than both countries on its healthcare. Yet still it has managed to weather the COVID-19 storm far more effectively. Put simply, the stats alone do not explain how Vietnam has managed to outperform, so significantly, both Germany and Spain. This suggests that there is still yet another key variable at play.
While all three countries responded very differently to one another in the weeks and months following the outbreak, for this article I am going to focus on comparing Spain with Germany because they are are both European Union countries that describe themselves as capitalist democracies, and that share a region of the world, a political and economic outlook, and a similar intellectual, spiritual, legal and cultural history. While there are many variables that distinguish Vietnam from either of the other two countries, those same variables simply do not apply when comparing them to one another.
An article in the Guardian on 22nd March 2020, suggests that one of the possible differences that led to the effectiveness of Germany’s COVID-19 response was in the government policies that were put in place in the weeks and months following the outbreak. From very early on the German government began extensive testing and sporadic contact tracing, while reallocating staff and resources across the health and care services. The same can not be said for the Spanish government.
In Spain a lot has been made about the impact of the bailout of the banks as the cause for the health service being unable to cope with the spread of COVID-19. And while that is very likely to have played into this, the fact is that the pre-COVID-19 mortality rate in Spain was significantly higher than that of Germany works against that argument. However, one of the key differences between the two countries has been in their response to the outbreak. The Spanish national government, like in many countries, simply refused to move quickly on testing and contact tracing, or to even recognise the potential severity of the pandemic.
In the case of Germany there is now a good deal of evidence to suggest that the policies enacted by the government has kept over 15,000 Germans alive that would now be dead if they were unlucky enough to have lived in Spain. That is 15,000 families and communities across Spain that have been torn apart because of the decisions made by their government.
The reason I am focussing on this now is because people are losing their lives through the policy decisions of our governments. Understanding how these decisions have been reached and the subsequent impact of those decisions is going to be paramount in terms of us being able to prepare for the next catastrophe.