A year ago, on 2019 New Year's Eve (NYE), China's health authorities notified the World Health Organization (WHO) that they had identified a cluster of cases of "pneumonia of an unknown cause" in the city of Wuhan. A year later, the streets of Wuhan were packed with crowds of people celebrating 2020 NYE, while billions around the world were left stranded inside their homes, in an attempt to curb the rapidly spreading SARS-CoV-2 virus that cause the COVID-19 disease. As 2020 comes to an end, we reflect on the lessons learned so far regarding this health pandemic.
2020 was an unprecedented year that saw the novel coronavirus spread from Wuhan, where it was originally detected, to reach each continent and corner of the globe, including Antarctica. According to Johns Hopkins University, by the end of the year, SARS-CoV-2 had infected 83 million people, and caused the deaths of 1.8 million individuals. The USA, with a population of 332 million people, had the most infections and deaths, 20 million cases and 346,000 deaths. With less than five percent of the world's population, the USA had close to a quarter of the world's total number of coronavirus cases and deaths from COVID-19. The USA had more coronavirus cases than the next three countries combined (India, Brazil and Russia).
Compared to the USA, India with four times the population (1.3 billion), had half the number of cases and deaths, 10 million cases and 148,000 deaths. And, China, with even more people (1.4 billion), had even less cases and deaths, 87,000 cases and 4,600 deaths. The figures from the USA, India and China show that the impact of the SARS-CoV-2 has been unequal. Why is the USA figure so high, and what do these numbers tell us about this deadly virus?
Where Did SARS Originate?
Before we can start analyzing the unequal toll from the disease, it is important to consider some basic questions, and sum up the lessons learned so far. The first set of questions relate to the origin of the crisis - where did SARS-CoV-2 come from? Does the origin of SARS-CoV-2 have anything in common with the the SARS virus that appeared in 2002? What are the chances of a third severe acute respiratory syndrome (SARS) virus arising in the next decade? The constant mutation of SARS viruses are also troubling. In the final weeks of 2020, there was two significant SARS-CoV-2 mutations, the UK’s B.1.1.7 and South Africa’s 501.V2. Both are more infectious than their progenitors. If we understand what is causing SARS pathogens to materialize and mutate, then we can try to prevent future pandemics from this coronavirus.
Destruction of Nature
The UN and World Health Organization suggest that, in general, pandemics result from the destruction of nature. Environmental scientists also argue that less biodiversity will eventually lead to more disease. We know that the state of biodiversity is bad, but what can we do to turn things around? For one, destructive development projects are often subsidized by governments and international monetary organizations, so this form of socialized capitalism has to end. To preserve biodiversity, it is critical to restore and respect indigenous land rights. Also, an important economic lesson that business owners in urban areas should learn is that investing some of their profits in preserving nature, forests and ecosystems will enable them to remain in business in the long run. This is because protecting biodiversity can help to prevent future health pandemics and economic crises that can result in loss of market and business failure.
Are Animal Wet Markets to Blame?
In addition to the general cause of pandemics, it would be useful to know if there was a specific vector that caused SARS-CoV-2? Did this infectious virus originate in a food animal wet market or on a particular factory farm? The exact cause of transmission is yet unknown, but if food animal production is to blame, then reducing demand for animal products has to be part of the SARS solution. However, governments and banks are expending billions of dollars to subsidize factory farms and promote carnism as part of economic growth. This funding of future pandemics has to stop. Just like we have to de-fund fossil fuel companies to stop global warming, in order to decrease the chance of more SARS pandemics arising, funding agencies must recognize that industrial animal agriculture has to be curtailed.
Failure of Herd-immunity
One vital lesson of 2020 relates to the failure of an open economic policy and trying to develop natural immunity to a SARS virus in the general population. Sweden (pop. 10 million) followed a herd-immunity plan with little official restrictions. By the end of the year, this national approach resulted in 437K infections and 8,700 deaths from COVID-19. Sweden's neighbors had much lower COVID-19 death figures in 2020. For example, there were only 450 deaths in Norway, and 1,400 in Denmark. In comparison, Australia (pop. 25 million) with double the population of Sweden, implemented strong lockdown measures, like business and school closures and mandatory mask-wearing. By the end of the year, Australia's response resulted in far lower infections and fatalities, 28K cases and 900 deaths from COVID-19. Sweden's policy was irresponsible since it resulted in 15 times the number of SARS-CoV-2 cases and 10 times the number of COVID-19 fatalities as Australia. This shows that trying to achieve natural herd-immunity is a poor response to SARS viruses, with deadly consequences.
Strong Lockdowns Work
An important lesson learned in 2020 relates to the effectiveness of strong lockdown policies. To stop infections from getting out of control, it is important to immediately address the problem by shutting down the economy and halting the movement of people. Countries that had the most success in limiting the number of SARS-CoV-2 infections in 2020, like China (87K), Australia (28K), New Zealand (2,181) and Taiwan (812), did so with strong lockdown measures. And, regions that had the least success in limiting the rise in SARS-CoV-2 cases by the end of the year, like Europe, North America and South American, implemented limited lockdown measures, with fewer business and school closures.
Another lesson learned from 2020, is that as SARS-CoV-2 spreads in a country, it becomes increasingly deadly. This is evident in the nationally reported figures on COVID-19 deaths. Although countrywide levels of testing and transparency vary, we can learn a lot by looking at COVID-19 fatalities per million people in 2020. The number of deaths in the European Union (EU), US, Mexico and South America are far beyond the figures in Asian countries that have managed to limit the spread of the virus. Let's examine the numbers.
In Depth: European Union
Many Western European countries experienced an infection surge in the Spring, and implemented strong lockdown measures. Most states were fully reopened a few months later after flattening the SARS-CoV-2 curve. But, after the Summer lull, cases began to rise again with deadly consequences by the end of 2020. For example, France (pop. 67 million) had 2.6 million total SARS-CoV-2 infections and 988 deaths per million people from COVID-19. At one point during the Spring peak, France had around 975 deaths per day. But this number dropped during the Summer to as few as 8 deaths per day. At the end of the year, the fatality rate was back up, and above the Spring peak. The UK (pop. 66 million) had 2.7 million cases in total, and a fatality rate of 1070. Italy (pop. 60 million) had 2.1 million infections and 1217 deaths per one million people. Italy was among EU countries with the highest fatality rate from the virus. And, Spain (pop. 47 million) had 1.9 million cases and a COVID-19 fatality rate of 1084 by the end of 2020.
Most Central and Eastern Europe states avoided the worst of the first coronavirus wave in the Spring. However, at the end of 2020, these nations were experiencing some of the most rapid spread of SARS-CoV-2 in the world. For example, Slovenia (pop. 2 million) had a total of 150 COVID-19 deaths as of October 1st, but then, over the next 10 weeks, that figure jumped to over 2,000. As the year closed, the country had 125K infections, 2.8K deaths, and a high fatality rate of 1,365 deaths per million people.
Compared to these high SARS-CoV-2 case numbers and morbidity rates, some EU countries maintained preventive measures throughout the Summer and Fall, which resulted in less infections and deaths. For example, Germany (pop. 83 million) had 1.7 million cases and a fatality rate of 396 deaths per million people. Denmark (pop. 6 million) had 170K cases and a fatality rate of 216. And, Norway (pop. 5 million) had 51K infections and 80 deaths per million people from COVID-19. Germany, Denmark and Norway implemented stronger lockdowns measures for longer periods of time, which reduced their numbers, compared to EU countries with higher fatality rates. This trend suggest that more open policies results in more deaths from this pandemic.
In Depth: North and South America
During this unprecedented year, in general, countries in North and South America remained mostly open with limited lockdowns, which resulted in higher COVID-19 fatality rates. For example, the USA (pop. 330 million) had 20 million SARS-CoV-2 cases and a COVID-19 fatality rate of 1034 deaths per million people. Brazil (pop. 210 million) had 7.7 million infections and a fatality rate of 912. Columbia (pop. 50 million) had 1.7 million cases and a death rate of 843. Argentina (pop. 45 million) had 1.6 million cases and a fatality rate of 961. Mexico (pop. 126 million) had 1.4 million cases and a death rate of 968. Peru (pop. 32 million) had 1 million infections and a fatality rate of 1139. And, Bolivia (pop. 11 million) had 167K cases and 783 deaths per million people.
Fatality rates in the Western Hemisphere are as high as those in the worse EU countries, but there are a few exceptions. Like Germany, Canada (pop. 37 million) took strong lockdown and preventative measures, which resulted in 610K cases and a fatality rate of 410. The states with the first and second highest number of total COVID-19 deaths are both in the Western Hemisphere - the USA (350K) and Brazil (195K). Tellingly, the machismo leaders of both countries downplayed the SARS-CoV-2 pandemic and resisted lockdowns. Their inaction show that doing little to slow the spread of SARS viruses leads to more deaths.
In Depth: Asia
In the East, where SARS-CoV-2 supposedly originated, COVID-19 fatality rates are far lower than those in the West. Asian countries have more experience in dealing with infectious disease, compared to the West. For example, a SARS-associated coronavirus, originated in China in 2002, and killed more than 800 people around the world by 2003. Asian countries have prior experience with the SARS virus, so there is more health compliance, like avoiding contact, mask-wearing and isolation. One exception is India, which has the third highest COVID-19 deaths (178K). With 107 deaths per million people, India also has the highest COVID-19 fatality rate in Asia. One main reason is that India's strong lockdown policy triggered a mass migration of laborers from urban areas that spread the virus to rural areas. Better planning and support for workers could have limited the spread, but India's death rate is still almost 10 times less than that of the UK and US.
Although Asian countries have larger populations, their SARS-CoV-2 case and morbidity numbers in 2020 were much lower than countries in the West. For example, the Philippines (pop. 106 million) had 475K cases, 9K deaths, and a COVID-19 fatality rate of 84 deaths per million people. Indonesia (pop. 267 million) had 770K infections, 22K deaths and a death rate of 80. Nepal (pop. 28 million) had 262K cases, 1.8K deaths, and a fatality rate of 63. Myanmar (pop. 54 million) had 126K infections, 2.7K fatalities, and a rate of 48 deaths per million people.
In Bangladesh (pop. 161 million), there were 516K cases of SARS-CoV-2, 7.5K deaths from COVID-19, and a fatality rate of 45. Pakistan (pop. 212 million) had 490K infections, 10.5K deaths and a fatality rate of 46. Japan (pop. 126 million) had 243K cases, 3.5K fatalities and a rate of 25 deaths per million people. South Korea (pop. 51 million) had 64K infections, 1K deaths and a fatality rate of 17, and China had 3 deaths per million people. In Oceania, the rates of death from the virus are lower still. Australia's COVID-19 fatality rate was 35, and New Zealand (pop. 5 million) had 2.1K infections, 25 deaths and a fatality rate of 5 deaths per million people. These figures show that lockdowns and preventive measures were effective in reducing morbidity rates in the East.
In Depth: West Asia and Africa
West Asia was slow to implement lockdown measures in 2020, and many restrictions were not followed or enforced. There is an uneven distribution of COVID-19 fatality rates per million people across the region. For example, in Iran (pop. 82 million), there were 1.2 million infections of SARS-CoV-2, 55K deaths from COVID-19, and a high fatality rate of 650 deaths per million people. Turkey (pop. 82 million) had 2.2 million cases, 21K deaths, and a fatality rate of 250. Saudi Arabia (pop. 33 million) had 363K infections, 6.2K deaths, and a fatality rate of 175. In Egypt (pop. 98 million), there were 143K cases, 7.8K deaths, and a low fatality rate of 76.
Lockdowns and restrictions were uneven in Africa as well. And fatality rates per million people vary widely on the vast African continent, from high to low. For example, South Africa (pop. 58 million) had 1.1 million SARS-CoV-2 infections, 30K deaths from COVID-19, and Africa's highest fatality rate at 472 deaths per million people. Tunisia (pop. 12 million) had 144K cases, 4.8K deaths and a fatality rate of 390. Morocco (pop. 36 million) had 430K infections, 7.5K deaths and a fatality rate of 199. In contrast, Kenya (pop. 51 million) had 95K cases, 1.5K deaths, and a fatality rate of 31 COVID-19 deaths per million people. And Ghana (pop. 30 million) had 55K infections, 335 deaths and a fatality rate of 10 deaths per million people. Unlike West Asian states, most African countries have managed to limit their number of infections and deaths. Many African countries have decades of experience dealing with infectious disease, like hepatitis, HIV, Ebola and cholera, so there is greater health compliance, like mask-wearing and isolation.
A third basic question from 2020 relates to comorbidities and other issues that can lead to higher COVID-19 fatality rates. The Center for Disease Control (CDC) state that some pre-existing health conditions can increase the likelihood of illness and death from the disease. For example, cancer, chronic obstructive pulmonary disease, heart disease, chronic kidney disease, and severe obesity can lead to more severe symptoms and outcomes. Age and sex are factors important as well. The length and amount of exposure to the virus is significant, and the weather is a key driver, as colder Winter temperatures have resulted in higher transmission and morbidity rates.
Higher GDP Equals More Deaths
One other lesson we can learn about the difference in the death rates per million people in countries and regions across the globe is that Western and developed nations have higher death rates than Eastern states and those that are less developed. This is shown is a chart comparing death rates and gross domestic production (GDP). On the GDP chart, the countries with higher fatality rates skew towards the top-right, consisting of high GDP states in the EU, like Belgium, Germany, Ireland, Denmark, and France, plus the USA and Canada. On the other hand, countries with lower death rates per million people skew towards the bottom-left, consisting of low GDP states in Africa and Asia, like Liberia, Ghana, Afghanistan and Vietnam.
Is this GDP and morbidity difference similar to the distinction between higher fatalities in Western states and lower fatalities in Eastern countries that have more experience with infectious diseases and compliance to health regulations? On the chart, many Asian countries are on the right in terms of GDP and in the middle in regards to mortality, for example, Japan, Malaysia and Singapore. These Asian countries are more similar to Western states than lower GDP countries in Africa with lower fatality rates per million people.
Carnism and Comorbidities
The co-relation between higher GDPs and higher fatality rates per million people is surprising. Higher GDP countries have advanced medical resources and care, with more doctors, nurses, ICU beds, ventilators, etc., than lower GDP states. So the death rates in rich nations should be lower, not higher. One explanation for the higher death rates relates to diet. Specifically the over-consumption of animal products in higher GDP countries leads to obesity and comorbidities that increase the risk of more severe illness and death from COVID-19. For example, the CDC state that over 40% of adults in the US are obese. The UN FAO chart on meat consumption show that countries with higher food animal consumption are countries with higher GDP, like the US, Canada and the UK. The USA is the top consumer of food animals, and it also has the most COVID-19 deaths.
Food animal consumption is linked to the origin of deadly SARS viruses, and also to higher fatality rates. Yet, there no calls to reduce animal consumption. If the over-consumption rates of the wealthiest nations are not curbed, this will lead to increasing obesity and more COVID-19 deaths. There is little evidence that food animal consumption is slowing, and average GDP countries are starting to follow the same trend as high GDP nations in terms of diet and disease.
Moses Seenarine is the author of Meat Climate Change: The 2nd Leading Cause of Global Warming (2016). Xpyr Press, 348 pages ISBN: 0692641157 http://amzn.to/2yn7XrC
 Staff. 2020. Coronavirus Resource Center, Johns Hopkins University of Medicine. Dec. 31.
 Staff. 2020. Our World in Data. Global Change Data Lab, University of Oxford.
 Ogden, Cynthia. 2015. "Prevalence of Obesity Among Adults and Youth: United States, 2011–2014." CDC. November
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