When developed countries are worse

When Covid went global, we worried in our own ways about nightmarish scenarios in India, Bangladesh, Pakistan, Nigeria, and other countries.  These are countries with huge populations, and with very little medical infrastructure.

I was practically getting panic attacks from thinking about the old country.  My sleep was getting disturbed, and no amount of playing bridge was of help.

A year into the pandemic, conditions in India and elsewhere have become a medical mystery, which Siddhartha Mukherjee writes about in The New Yorker: "While the virus has ravaged rich nations, reported death rates in poorer ones remain relatively low." 

[If] you look at the pattern of covid-19 deaths reported per capita—deaths, not infections—Belgium, Italy, Spain, the United States, and the United Kingdom are among the worst off. The reported death rate in India, which has 1.3 billion people and a rickety, ad-hoc public-health infrastructure, is roughly a tenth of what it is in the United States. In Nigeria, with a population of some two hundred million, the reported death rate is less than a hundredth of the U.S. rate. Rich countries, with sophisticated health-care systems, seem to have suffered the worst ravages of the infection. Death rates in poorer countries—particularly in South Asia and large swaths of sub-Saharan Africa—appear curiously low.

How do we explain this?

Mukherjee goes through the typical hypothesis you and I might propose--from younger population to prevalence of infectious diseases leading to immunity, to undercounting , to ... you name the possibility and Mukherjee addresses them all. It is a wonderful read, and an awesomely informative one.

Towards the end, Mukherjee writes:

The covid-19 pandemic will teach us many lessons—about virological surveillance, immunology, vaccine development, and social policy, among other topics. One of the lessons concerns not just epidemiology but also epistemology: the theory of how we know what we know. Epidemiology isn’t physics. Human bodies are not Newtonian bodies. When it comes to a crisis that combines social and biological forces, we’ll do well to acknowledge the causal patchwork.

Meanwhile, another Indian-American medical writer, Atul Gawande reports on the worst-hit county in the worst-hit state in the worst-hit country.  The county is the US.  North Dakota is the state.

Gawande writes:

When an entire community must decide how to tackle a serious problem—must choose what it is and is not willing to sacrifice—matters get more complicated. In business, the decision-maker is generally clear, and, if you don’t like the decision, too bad. The boss can insist on obedience. But that’s not how democracy works. We designate decision-makers, but the community has to live with dissent. This is why businesspeople so often make terrible government leaders. They’ve never had to manage civic conflict and endure unending battles over priorities and limits.

Keep in mind who presided over the federal government when the pandemic broke.

As of writing this post, 510,458 have died because of Covid here in the US.

I hope we will learn the lessons from this pandemic and be absolutely ready for the next one.