What really explains the Asia Covid exception?
Scientists are investigating biological, rather than policy, differences
Why has Pacific Asia “performed” so well on Covid-19? No country in this region has had an epidemic anything like as damaging as those in Europe, North America or South America — from Japan to South Korea, Australia to Taiwan.
The answer is of more than just epidemiological interest. Respect for the response of governments in this region has become a matter of political folklore — people like Jeremy Hunt talk about it all the time — and is fundamentally changing the reputation of the “Asian model” among the liberal commentariat. Where before there was scepticism and a distrust of the activist, technology-enabled, centralised control state, it is now commonly seen as having been more effective than Western democracies.
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But some scientists think there are other factors at play, and that alongside the much-talked about cultural differences, border control, superior test and trace systems and the like there are biological reasons that explain why Asia has so far fared so well. If they are right, the implications are huge and would put an end to the idea that countries like the UK could ever have had outcomes like Taiwan or South Korea (which despite its recent surge in cases is still doing much better than Europe).
Of all the Asian countries, Japan is perhaps the most mysterious — a Northern hemisphere island nation full of old and theoretically vulnerable people which has largely eschewed lockdowns and yet, even as it enters its winter surge, is seeing numbers that any European country would envy. A September study of workers at a Tokyo company suggested that the proportion of asymptomatic people showing Covid-19 antibodies had gone from 5.8% to 46.8% over the summer, and that “infection may have spread widely across the general population of Tokyo despite the very low fatality rate.”
There have recently been a spate of new studies offering explanations for the “Asian exception”, and yet none has fully provided the answer.
The first is that there is something in the genes of East Asian people that make them more resistant to this particular virus. Researchers from Australia and the US found evidence of ancient genetic adaptation specific to East Asian populations that may have come from similar pandemics between 5,000 and 25,000 years ago. “An arms race with an ancient corona-like virus may have taken place in ancestral East Asian populations,” they concluded.
To support this idea, the Centre for Disease Control in the US estimates that whereas Covid-19 infection rates are between 1.4 and 1.7 times higher in African American, Native American and Hispanic populations than the white population, the rate for the Asian American population was 0.6 times the white average. But this theory still seems far-fetched to explain such dramatic differences, and of course doesn’t explain the differences in predominantly white countries like Australia and New Zealand — as one of the study’s co-author’s, David Enard of the University of Arizona, concluded, “if there is a genetic effect, it will be small to the point of being irrelevant.”
If it’s not a genetic difference, perhaps it is a difference of resistance or immunity? Given that SARS-Cov-1 originated in the region, there could have been other related coronaviruses circulating in recent years that provided cross-immunity. Recent evidence from the University of Boston suggests that recent infection with a related common cold coronavirus could dramatically reduce the severity of a Covid-19 infection. But so far there is a lack of evidence for this idea. Just yesterday, a group of scientists including Francois Balloux published a preprint detailing their search for a virus that might have increased T-Cell immunity, but so far they have found none. As Mark Lipsitch, Professor of Epidemiology at Harvard, put it to me, “it’s an interesting hypothesis. There’s no reason to believe it yet, but there’s no reason to dismiss it either.”
The alternative is that the difference is not caused by the people, but by the virus. The New York Times ran a story last week about a particular genetic strain of Covid-19 called D14G, that was demonstrably much more prevalent in Italy in the early months of the pandemic than any Asian countries and may have helped explain why the disease took off so dramatically in that country, and from there spread around Europe and America.
Today’s interview with David Engelthaler, co-director of the T-Gen Research Institute in Phoenix, Arizona, investigates this idea. His view is that there is now “more than a suggestion, leading to really compelling evidence” that this strain replicates faster than earlier strains. It doesn’t mean the mutation is more deadly, simply that it might be more effective at transmitting, which could help explain why the virus took off so dramatically in Europe and subsequently North America. He observed that several of the early introductions to Arizona, coming from the Pacific coast straight from China, fizzled out quickly, with less effective transmission. “And then all of a sudden we started having explosive outbreaks. When we go back and look genomically, the vast majority of those cases where we had very large outbreaks were being driven by the strains that were coming from the East Coast out of Europe, which all seemed to have this particular mutation in the spike protein.”
I put to Dr Engelthaler the obvious objection that the D14G strain of the virus is now dominant and has travelled back to Asia and across the world, but their rates remain much lower. Doesn’t that remove the variable? He accepted that it might not have been the driving effect, but pointed out: “you can’t compare the original introductions of this virus in one location to a reintroduction of a virus that’s already been going through a pandemic, where you have some amount of immunity built up and a lot of practices already in place.” In other words, the fact of different strains being around different parts of the world at crucial points in the cycle of the pandemic could have had a lasting effect on how well-seeded they became in those regions.
While this theory has been challenged by other research, it is certainly an interesting contribution to the debate. Better evidence may yet emerge for one or other of these explanations for the “Asian exception” —and of course the cultural habits and public policy responses will have played their part. But for now it seems wise to be sceptical of definitive statements about “what we could have done” with reference to Asian countries as proof. Like so much about the behaviour of this virus, notwithstanding the attempts by many commentators to pretend that we have all the answers, precisely why Asia has had such a different experience remains to be seen.
Thank you for writing this article. The utter lack of curiousity on this point in the media has been both mind boggling and also completely eroded my faith in scientists. If you resolutely refuse to examine a question, but then presume to give life-and-death advice on that topic, you might as well be basing your authority on ancient writings or chicken entrails.
Cambodia and Laos have no reported deaths from Covid-19. Sure, they probably missed a few, but there clearly aren’t people dying in the streets, despite neither country enforcing (or even being capable of enforcing) lock downs, quarantines or wide spread mask use. This is a test case that clearly invalidates South Korea or Taiwan as examples of policies successfully containing the virus. It might well turn out that quarantines and lock downs are a good idea, but that shouldn’t be based on cherry picking data from East Asia.
Also the mask thing and East Asia. I think it was the early European medical people in the Far East wearing masks in clinical settings which they saw and took as very meaningful, and so masks became a talisman which wards off illness. The West is losing superstition fast, yet they also have taken up this mask talisman habit, a funny thing of the circle of an idea. Western doctor, to Chinese, Chinese back to West. We all should have been made to carry a rabbit’s foot instead, easier and cheaper.
“The West is losing superstition fast”
I don’t see why you’ve lost faith in scientists simply because most media ignore these questions.
And since March, Cambodia has had pretty strict and rigorous testing and isolation (14 days if both tests negative) for anyone entering the country.
I also doubt the idea that COVID deaths have been missed in Laos and Cambodia. If one person died from it, they must have been infected by someone else, and others probably got infected too. Those cases may have been asymptomatic and unnoticed at the time, but they’d have infected others in turn, and eventually there would most likely have been an outbreak that was noticed.
Although I generally agree with your first paragraph (and completely agree with all of your second) I would include politicians in your list. So far as scientists are concerned both the media and politicians appear to be in the thrall of a small number of scientists and refuse to countenance any deviation from the orthodoxy.
Rather than demonising all scientists it may be more productive to concentrate on what seems to be an indefensible lack of rigour amongst a small group when the facts are clearly not supporting the theory.
I am no scientist but spent a large part of my working life either comparing historic and current performance with previously presented forecasts or testing forecasts against past and current performance. Try as I might I am completely unable to reconcile SAGE forecasts with current and recent data!
What makes you think Cambodia and Laos probably missed a few COVID-19 deaths? Why wouldn’t they have been associated with outbreaks?
It would be a worrying sign of two – dimensional thinking and disregard of western values if our policy makers merely took the better Covid outcomes in East Asia as validation of their approaches. Unfortunately, that was what happened in Victoria in Australia, who took their cue from China and implemented draconian measures that even surpassed (so far) those in the UK. Perhaps the answer in that regard would be to look to the far eastern countries excluding China, and look to those that managed their outbreaks without crushing authoritarianism (such as Japan).
I suspect though, once this is all done with, history will record natural explanations for the differing outcomes to do with the general health of the populations; their demographics and prior immunity – realising everything else (lockdowns; masks; obsessive compulsive testing), was a red herring at best or exacerbating hardships unnecessarily at worst.
Either way, policy makers shouldn’t take performance against one public health outcome alone as validation of a particular culture and reason enough to disregard their indigenous values.
This numerical difference has been one I have stated over and over where ever covid is mentioned BTL at a place I visit.
Worlodometers: Vietnam, Thailand 0.4 deaths per million, Cambodia 0! China 3 deaths per million, which is about normal for the West Pacific. France, Italy, Spain, UK, and USA? 900 deaths per million! So about 300 to 2000, TWO THOUSAND, more deaths in the West per million!
So, Freddy, why did you mention the West had a bit more problem but not drag out these AMAZING numbers? Why is all the MSM conspiring to hide these numbers?
Laos too has had no deaths from COVID so far.
Same for Mongolia.
In the West, deaths have not just been disproportionately among the old, they are almost exclusively among the already unhealthy. Outside of sumos, how many obese people does one see in Asia? How many people with behavior based diabetes are there? How many nations put the already infected into elder care facilities?
On the other hand we don’t think of Peruvians as obese, with burgeoning care homes. Yet South America has been hit really badly.
We may not think of them as obese but in 2016 (from a UCA Berkely study) “A meta-analysis conducted by the World Health Organization showed that 58.2% of adults over 18 years of age in Peru are overweight or obese; this is a public health issue that requires urgent attention, action, and programs with accountability.” The paper attributed this problem to a rapid and growing migration from high altitude manual agrarian occupations to sedentary urban lifestyles without a corresponding reduction in calorific intake and probably even an increase due to the availability of processed foods.
“…As Mark Lipsitch, Professor of Epidemiology at Harvard, put it to me, “it’s an interesting hypothesis. There’s no reason to believe it yet…”
In other words, Francois, you’re talking Balloux.
Sorry, couldn’t resist. I’ll get my coat.
Have not Australia & New Zealand, due to timing, had genuine isolationist policies therefore stopped the spread of Covid??? However, in Europe and the USA, it appears the virus was already well established in the population in early 2020, as I recall Professor Sunetra Gupta suggested in her interview with Freddie Sayers on 21 May 2020 (on You Tube).
A missing factor that has not been discussed is hydroxychloroquine. Countries that use it have death rates far lower than those that don’t. Just search a little for charts.
Most Asian countries use it, including South Korea. I don’t know for sure what is to blame for the west’s avoidance of it, even banning it, but my best guess is the pharmaceutical companies’ hard work demonizing it to preserve their profits from the expensive drugs they are developing, along with the negative reaction from those who oppose everything Donald Trump does or says. Most of the studies done in the U.S. were badly done, for example using it alone instead of with zinc or antibiotics, or giving it to patients in the late stages of the disease instead of those in the early stages.
Here’s a piece with a host of links to and discussions of studies from different countries. https://exoscientist.blogsp…
…Hydroxychloroquine got politicised early on in 2020, seemingly aided by Big Pharma, who have no interest in such an old and off-patent safe for humans drug, gaining new efficacy. In the Central Pacific where I’ve lived for the last 9 years, it’s still in use, even though there are newer drugs, which do better for infants. It’s cheap, and although effective for Malaria, its secondary use is for knocking off stray dogs, which are a menace across the whole region. Four tabs in a tin of tuna does the trick.
Yes. In Australia too, trials with hydroxychloroquine did not use zinc. Being an island was our major blessing: again!
I think the answer is much simpler. Societies in Asia are simply healthier than in the West. Countries like Spain or Italy, their citizens have eating habits that are a disaster. The United States is simply a sick society, with serious problems such as obesity and endless diseases, also a product of its terrible eating habits. You are what you eat. Today more than ever that was demonstrated. Not to mention other habits such as smoking, lack of physical exercise, stress, etc.
I agree that obesity and diet might play a role, but I disagree with your point that Italian and Spanish eating habits are especially bad. I can assure you that Northern/Central European (especially UK) eating habits are a lot worse (on average) than Spanish, Italian or French and the consequences in terms of differences in obesity are obvious.
Italy and Spain are ranked the two most healthy countries in the world.
For what it’s worth UK ranks 19th – which is better than I would have thought. Better than both Denmark and Germany
That survey doesn’t rank the health of people in any meaningful way. Look at obesity rates:
South Korea 5%
I would disagree there completely – the methods of that take into account obesity amongst other metrics. You grossly exaggerate by saying “it’s not in any meaningful way”.
Obesity is but one (albeit important) facet. But there is little correlation between obesity and life expectancy amongst the healthier nations. If obesity was so important the life expectancy of Spain would logically be a lot worse since than Japan’s as it is 5 times higher. But it’s not (83.4 vs 84.5).
South Korea with 4 times lower obesity has a life expectancy of 82.8, lower than Spain’s or Italy’s. So how is obesity a more meaningful metric?
By the way, the number of smokers in Italy and Spain is not mentioned, and a study by Dr. John Ioannidis demonstrated the impact it had on older people in Italy. My point is, the West is not healthy, they do not eat well and have serious health problems that nobody talks about.
China has an extremely high proportion of smokers.
Extremely common among males. Women relatively unusual.
I agree that the Western diet has been deteriorating with obesity and diabetes becoming serious problems particularly in UK and USA. There is, however, a bit of a smokers paradox when it comes to Covid-19 – to quote the Centre for Evidence Based Medicine 26 May 2020:
“…some (but not all) studies of COVID-19 have detected fewer people who smoke than would be expected in hospitalised patients with COVID-19. It is unclear whether this is due to biases, confounding, misreporting, or a potential protective effect of smoking on COVID-19 outcomes. Irrespective of COVID-19, smoking is uniquely deadly. However, nicotine, the addictive component of cigarettes, can be safe when used in other forms, and there is some biological plausibility regarding a possible role of nicotine in COVID-19 infection”.
….. rampant drug taking, alcoholism, addition to pill taking for the slightest little sniffle or ache. I would think that Americans have a very low immunity to disease.
I have for a long time wondered whether SARS-MERS had a much lower fatality rate than originally thought, and whether only among symptomatic cases was the mortality high. If it, or a similar virus, had spread significantly in Asia that would be an explanation for the Asian ‘effect’.
Given Japan was actively in denial about the virus in the run-up to the Olympic games, it is phenomenal that it had an outcome so similar to South Korea.
This is a fine article Freddie.
No, Japan was not “actively in denial about the virus.” The New York Times said that Japan was in denial.
You probably know better than me, but it did appear to me (back in March), that the Japanese government was trying to carry on as usual, in the hope that the Olympics would happen.
They certainly weren’t shutting down like S Korea.
I tend to ignore what the New York Times says, because they can’t count there, an sthey don’t have any idea about basic scientific ideas, such as seasonality.
I live and work in in Japan, in a school. All schools were told they should close at the end of February. So in March, believe me, things were not ‘as usual’. The roads were empty. The schools reopened in June, mostly. Masks when not eating, disinfectant, gargling, partitions when eating, with all kids facing forwards. These measures have been adopted very thoroughly, kids have learned, teachers have struggled, and the schools have stayed open. It has been hard for everyone, but when this is over both children and teachers will be able to say they did everything they could, they fought to keep their schools running and by and large they did. This argument about whether masks do or don’t work is missing the point. If something might work, and you do it, the worst that can happen is that the effort was ultimately unnecessary. If something might have worked, but you didn’t do it, then is the fact that you were waiting for decisive evidence going to be of much use to you? You can sit around not copying people whose behaviour appears to have been relatively successful, and speculating about whether it was genetic, but it’s an awful lot like people trying to find an obesity gene in the hope it’s not their diet that’s making them fat.
“If something might work, and you do it, the worst that can happen is that the effort was ultimately unnecessary. “
With or without a mask one breathes in and out the same volume of air. Masks divert your exhalations from directly in front of you to the edges of the mask, where they exit (some do a bit of filtering for breath that exits in front). Hence, when two people are directly in front of one another the masks are helping prevent one from infecting the other. When those two people are side-by-side the masks are ENHANCING the amount of infection by directing their breath at each other. Hence, wearing a mask may make one believe one is safe from people nearby when in fact when you are next to someone who is infected you are getting infected.
So, doing something that appears harmless may in fact be worse than doing nothing at all.
“If something might work, and you do it, the worst that can happen is that the effort was ultimately unnecessary”.
Except Japan has seen a significant rise in suicides, including 2,153 in October alone which was more than the total deaths it experienced from coronavirus since mid-February. The suicides included a massive rise of 83% among women. Women in Japan are more likely to be working in industries affected by the economic fallout of Government Covid policies. Government interventions have been not been harmless, as we will continue to find out in coming months & years.
You might add something about old people’s homes. As I understand it, old people have been quarantined inside their homes and family have only seen them on the other side of a window.
I go with the correlation theory of causation. Chopsticks. Everywhere they eat with chopsticks gets a free pass. That and the fact they have the elusive ‘Dark Matter Immunity’
When the Europeans went to the new world the diseases they carried wiped the natives out. This is the same thing happening. The why part is the dark matter, you know it exists, every fact shows it must, but it is hard to pin down. It is also very convenient that this is true if you hold with any conspiracies.
Could Operations Moonshot or Warpspeed design and test chopsticks in time? Would their use be an infringement of fundamental human rights?
I really needed that!
Why is no one asking a very basic question:
We started tracking COV2 in Dec 19. Since then, China has had a total of 3 deaths/million attributed to COV2. Korea and Japan are in teens/million range. India is around 100/mill. All of the Western world is at high hundreds/million range now.
1) What if this virus or its predecessor circulated in Asia over the last 1-2 years.
2) It caused deaths but they were counted along with flu deaths.
3) Until the whistleblower spoke in Dec 19 in China, they were just trying to go on with business-as-usual.
4) The whistleblower spoke up and China had to say “hey we are going to do a lockdown”. So the 3/mill that China reports is the residual deaths after they had to start tracking.
5) Does anyone really believe that an airborne virus can not spread in China now that its winter there as well (and no lockdown there currently).
So if we are just counting residual deaths, post the peak season in Asia over the last 1-2 years, it would explain it.
What’s the point of your point 5? Has anyone suggested airborne viruses cannot spread in China?
What if the first strain was indeed circulating much earlier than originally thought – the strain that does not kill many people.
Was the second strain a natural mutation or an artificial development?
It may well be that the alarm bells only really started ringing when the second strain was out there.
Why would the second strain make its appearance in Europe and US (East Coast) and not where the first strain had clearly been circulating?
We don’t know all the facts and maybe never will. But theories around the virus being developed in the lab, getting out accidentally / deliberately with a first strain near the lab and the second strain being a lab enhancement which was then deliberately targeted at those in greatest economic competition with China do bear serious consideration
There is an interesting statistic that the total population of less developed countries is half the global population and they have suffered 2 percent of the global Covid deaths. Poverty brings with it many factors which may naturally shield these countries. The average life span is atleast 20 years less than the West so very few are above the age of 80. Care homes virtually dont exist. Globalisation and travel generally is unaffordable. Well food is unaffordble ! So in India obesity is 5% whereas in the UK its 28%.
Too much is talked about government policies and too little about the vastly different world that exists in the West. The Swedes had said upfront that whatever strategy countries take the death rate in the end will be fairly similar in comparable socioeconomic countries.
There will always be outliers. Australia is one and i wonder how much is due to its draconian policies and how much is due to the fact that it could afford to virtually close its borders to the world.
Its just such a simplistic view that these half baked lockdowns and masking policies will make a real difference in the West when the risk factors we possess are so heavily in the virus’ favour!
This is one of the best comments I’ve seen on here, and yes, it does seem as if Western governments are doing everything they can not to address the actual problem. As you say, lockdowns and masking may not make a real difference, and I worry that we’re vulnerable to a much more virulent pandemic, and having had a dress rehearsal, so to speak, for the deadly pandemic everyone from Neil Ferguson to Nassim Taleb has said can and will come, we’re no better prepared.
(I’m reading Taleb at the moment, and I’m struck that, just as he says that the Bush administration did everything after 9/11 except blame Saudi Arabia, governments are doing everything except blame China. I mean, there’s some criticism, but just as we’re too dependent on Saudi oil, we’re too dependent on cheap stuff from China. Trump, to his credit, tried rocking that boat at least.)
You forgot to mention the not insignificant fact that there is a distinct lack of fatties in Japan.
If the body weight is really why the Westerners have had 300 – 2000 times more deaths per million than the Far East places, well that was always known, the obesity situation and so diabetes, heart, and so on comorbidity.
This means, to a conspiracy loon such as myself, that it is even more likely the release of covid from a bio-lab was to target the Western economies, as it shows just what was going to happen to the (Pu ss *) Westerners who react to everything now by mass hysteria and panic and self destructive ways.
The modern snowflake Westerner is happy to wreck the future of the youth because the very old and fragile are getting ill. If today’s people were on the Titanic it would have been the very old and frail they reserved the lifeboats for and the young and healthy sent to a watery grave.
What about Africa? Surely another exception to the pretend “rules” on how to handle the virus. We have a BAME study showing how hard hit Blacks in particular have been. Last time I checked Africa was the continent that had the largest majority of Blacks.
I am sure well after the time when it would have made a difference to the economic damage we have done to ourselves irreparably damaging our children’s futures we will get the right answers, but they will probably be swept under the carpet as inconvenient to a number of foolish politicians.
It’s more than likely that Africa is underreporting. South Africa, with comparatively good stats infrastructure, has higher covid numbers than most of the continent.
Africa is a special case given a much younger population. Seniors in Africa are often better off economically than others.
You can’t be saying that it is possible to protect the elderly in Africa but impossible here. Yes median age in most African countries is about half that of UK. The worst hit South American country – Peru also has a relatively young population compared to US and Europe.
I’m surprised that you don’t mention either the much higher intake of Vitamin D due to climate and the much lower levels of obesity due to diet and lifestyle – certainly in the Asian countries – these plus the ‘activist, technology-enabled, centralised control state’ might have something to do with it.
China and Korea have much higher vitamin D intakes due to climate than Europe or North America?
Australia, (most of) New Zealand, China, Japan and Korea are closer to the equator than (most of) Europe. Seoul and Beijing have latitudes in the high 30s. People in those countries get more intense sun.
Japan is the great mystery as the virus has been around for a long time now and never been eliminated(like NZ and Australia). They never locked down and though mass
Testing was a waste of resources. Yet very low deaths. Japan had an extremely bad flu season in 2019 with hospital overloads, school closures etc. season was longer than usual(same pattern in Australia as well, not sure re rest of Asia). Is it possible that this severe “flu” season in 2019 contained other viruses(maybe covid or related) that now provide protection against getting sick from covid? As if you look at infections numbers in japan, one could assume they have passed some herd immunity threshold(cross reactivity driven).
Or was it that Japan had Covid in 2019 when it was such a bad ‘flu’ season.
Subeditor pleeez, “..a genetic strain of Covid-19 called D14G”!
The graphics show it as 614G – if this is any indication of the writer’s acuity it doss not encouraging trust in the remainder of this cut’n’paste piece.
There is simple reason why mortality doesn’t increased in Japan – doctors state real cause of death.
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