Italian Alarm

From February 24, 2020

While the global picture continues to improve, I do have some concerns about COVID-19 at national levels. My biggest concern is the 215 cases in Italy.

One advantage of a strong central government in an outbreak situation is the ability to quickly enact policies to mitigate the spread of the virus. The rate at which hospitals were built in China was truly amazing as well.

Another reason I was a little less concerned about the disease in Asia is that respiratory hygiene measures such as mask use are now a part of the culture. This had started in Japan in 1918 during the Spanish Flu for obvious reasons, was reinforced by the Great Kanto Earthquake which led to a massive inferno in the city which resulted in smoke and ash that remained in the air for weeks. The influenza pandemic of 1934 further made mask use a common practice.

This was also spread by eastern medicine and philosophy, where “qi” is considered an essential element of health, which is tied to concepts of air, atmosphere, odor, etc. The use of masks quickly spread across eastern Asia for these reasons.

While eastern countries embrace the common good, in the west individualism and libertarian ideas make dealing with disease spread much more difficult. For example, think about how the antivax movement is causing a resurgence of measles in the US, which has been completely eliminated in 2000 as a result of vaccination efforts. Last year, there were 1282 cases in the US, which is a direct result of the antivax movement.

What people don’t seem to understand is that globally, measles has a case fatality rate of 15%, and about 0.2% in the US. In addition, about 25% of those infected with measles develop neurological damage.
https://www.cdc.gov/vaccin…/pubs/pinkbook/downloads/meas.pdf

The other point I will add on this topic is that herd immunity is crucial in preventing disease spread. Among those vaccinated for measles, about 10% do not develop adequate antibody protection, and thus are susceptible. Herd immunity protects both that group of the population as well as those who have true medical contraindications to the vaccine.

Hence, the West is likely less prepared to deal with a large cluster of cases in some countries because of these philosophical differences and resistance to some basic public health interventions.

Disclaimer: This commentary is my own interpretation and does not represent the analysis by the government or my employer. The data is from the Johns Hopkins University’s Center for Systems Science and Engineering.