So have Thailand, the Philippines and Indonesia (440 million people).
They've all had fewer cases than Luxembourg so far.
I've yet to see a good explanation for it, other than maybe the premise about seasonal temps and humidity (northern vs southern hemisphere). There's no evidence they're massively lying about their numbers (which would show up in the form of a demolished hospital system and thousands dead of pneumonia). Vietnam has also done incredibly well overall, showing no indications of being crushed by cases, despite their proximity to China.
Mexico is also not being crushed at all by the virus, despite being right next to the US as Vietnam is right next to China. Mexico shares enormous trade and traffic with the US. They should be buried in pneumonia cases given their overall context (population size, economy, testing rate, healthcare system). They have just over half the cases of Finland (obviously Mexico isn't testing at a high rate, I'm sure it's more than just 600). If many thousands of people were dying of Covid in Mexico right now, it would be showing up blatantly. Latin America's case load has largely been low vs population sizes (with only a few exceptions), as with the rest of the southern hemisphere. Mexico is technically northern hemisphere, and I wonder if they don't have some of the southern hemisphere benefit (as perhaps India does), limiting the rate of infection vs nations that are further north. And will that flip at all in the coming months.
It'd be very interesting to see a comparison of avg temps and humidity among nations most affected (or least) during the outbreak timeframe. Including looking at locations such as Italy, France, Germany, Spain, NYC, Texas, Southern California, Seattle, South Korea, parts of Mexico, Thailand, and so on.
Basically, due to seasonal temps and humidity, is South Korea's task made far easier than Italy's task? Does that considerably alter the infectiousness of SARS-CoV-2 in South Korea vs Italy? Is their equation half the effort they've put in (and credit on that), and half good luck of location. Mexico sure as hell isn't avoiding being overrun by it due to maximum testing.
I spent many hours last night doing a deep dive on the latest research on the impact of humidity on viruses, infectiousness and the respiratory system. It's fascinating stuff.
I have wondered that for a while, especially since countries like Malaysia had outbreaks long before Italy. Originally I thought: https://simonsarris.com/sunlight (note: data last updated March 16)
But there are several axes that could matter just as much as quarantine/lockdowns: Humidity, sunlight (as proxy for vitamin D levels, or simply UV), pollution (which also affects sunlight), median age (47 in Italy, 30 in Malaysia, that's huge), and mask use.
Bergamo has low sunshine in Feb and March comparatively.
Places hard hit, and their average sunshine on selected months:
* Wuhan: 100 (In Feb)
* Paris: 79-129 (Feb-March, North France harder it by # of cases, cannot find death info)
* Bergamo Italy: 100-150 (Feb-March average)
* Seattle WA: 100-150 (Feb-March)
* Iran sunshine varies a lot by locale. But some places like Rasht, its very low light: 90, 78, 71, 113 for Jan, Feb, Mar, April
Places less hard hit:
* Bangkok 250-275 (Feb-March)
* Kuala Lumpur 185, 192, 208 (Jan Feb March)
* Ho Chi Minh City, 272 (March)
* Seoul: 175-200 (Feb-March) South Korea contained it of course, but their lethality numbers are also lower, and its the lethality that I find odd in all this.
I'm really starting to think there might be something to this. In the US, I keep waiting for the other shoe to drop in places like California, Texas and Florida and the days keep going by and we are not seeing anything like the death toll New York is having. California had some of the very first cases in the US and took in at least one cruise ship of infected people. Florida's governor has been openly defiant against shutting the state down and they only have 29 deaths so far. If ever there was a place in the US where virtually every single inhabitant is vitamin D deficient it is New York City, even in the summer time.
There is something to it, I just don't know why nobody is talking about it much. It's pretty painfully obvious if you start digging into the data, researching the outbreak map, and looking at the temps & humidity levels in the areas. SARS-CoV-2 appears to more or less be obeying what influenza does when it comes to seasons, temps, and humidity (along with perhaps sunsine / vitamin D as a factor).
NYC should be cranking humidifiers, pushing humidity up to 50% in every space where people exist (except hospitals). It'll dramatically slow the infectiousness of SARS-CoV-2 imo. Super low human space humidity is the best friend of a respiratory virus.
Why aren't San Antonio and Houston buried in cases? Same reason Mexico and Los Angeles are not (relatively speaking, and especially compared to eg NYC).
Las Vegas should be buried in cases, they have tons of international traffic, a zillion opportunities for the virus to be transited around, spread to casino workers and everywhere. Their ICUs should be overflowing to an epic degree. Las Vegas has an inverted humidity map, peak humidity there is November to March, and avg high temps stay up near 55 to 60 degrees (influenza at least hates temps over ~60-65+ F).
How about Santa Fe or Phoenix? Super low case loads, as with Houston and Austin and other similar locations.
Florida isn't seeing a particularly bad outbreak in its cities.
Albuquerque and Phoenix have inverted humidity seasons, their peak humidity times are roughly October/Nov to March.
Wuhan's low sunshine season is November to March. Temps are often well below 50 degrees during that period (and essentially never get to 65+), not high enough to interfere much with influenza or probably SARS-CoV-2. It gets cold enough during flu season there to require persistent indoor heating, which dries everything out, lowering indoor humidity levels dramatically, amplifying potential infectiousness.
It's a consideration. However, where is the million dead people that should be happening between these nations given the 440 million people? The virus would be destroying them at this point. We've seen what it can do in Italy, the US, Germany, France, etc. in terms of spreading and hitting ICU units, killing people. It has a 10% mortality rate despite Italy's best efforts, and a 5.7% mortality rate in France (among positive tests). France has an elite healthcare system. So with no testing, Indonesia, Thailand, Vietnam, Cambodia, Philippines - they should be falling over and buried in dead people by now. China was being ravaged by it and had to implement extreme measures rapidly.
Depends when it really took off in each country, the time from transmission to requiring hospitalisation can be fairly long, 2-3 weeks. It seems a country can probably avoid testing for a decent period of time until the wave of hospitalisations hit them.
Check the population pyramid for these countries. They have a way smaller fraction of old people, and a way larger fraction of young people. This has a big effect on fatality rates.
Thailand is older than the US or China at the median. In their case, they're not a young nation, like the Philippines is (Vietnam, Indonesia and Mexico, 30-32 at the median, are more of a mixture between the two). And of course Italy, Germany and Spain are very old nations (Germany & Italy being nearly twice the median age of the Philippines).
Youth certainly has a big impact on mortality rates with Covid, and not such a huge impact on ICU rates. Close to half of the most serious cases in eg NYC and France are of people under 50.
We'd see the system overload in places like Thailand and Mexico, as their ICUs would still flood with people over the age of ~20 (and as you note, they'd potentially have a lower mortality rate due to fewer old people as a percentage of the population; although Mexico does have a very high obesity and diabetes rate in their specific context, which might complicate their mortality factors (recently noted as a concern by one of their govt health officials)).
What about Florida (and Arizona) in the US? Those states are overrun with old people and they are actively avoiding testing and mandatory isolation. Florida has 29 deaths right now attributed to Covid-19 and their governor is being criticized daily for his poor response.
At least initially I read that Philippines didn’t even have testing capability and had to send samples to Australia to be tested. You don’t find what you don’t look for.
You wouldn't have to look for them in these situations (the context of these nations), it would show up in your intensive care system and swamp your hospitals with thousands upon thousands of ICU-level cases.
That effect even showed up somewhat in Russia, in heightened pneumonia cases (they're now admitting it's likely far more widespread than the positive case results would imply). It's not easy to hide or disregard if you have high figures, which one would expect of poorer, very vulnerable nations with huge populations so close to China - unless there's another explanation. These nations didn't implement the type of disciplined system (matched with mass testing) that South Korea followed, and there's no sign of crushed healthcare systems with many thousands dead from pneumonia.
If you look at the shape of causes of death in Russia, heart disease and pneumonia are unusually high, and life expectancy is low, even compared to China. There is a plausible way for coronavirus to sneak up on Russia until the hospitals fill up with extra pneumonia cases.
That's assuming that there is a culture of going to the hospital when you have bad flu conditions. It's safe to assume that for the vast majority of laborers in third-world countries, hospital services are not within reach. They just tough it out at home.
Italy has a very old and sick population. More of their seniors are already on life support with several other diseases. I would expect less developed countries with poorer access to healthcare to have fewer very vulnerable individuals.
Side note: when at the time of death you have 4 or more illnesses, and one of them is CV, on what basis is the cause of death attributed to just a single condition? It seems Russia has taken a different stance to the West in this regard but it's not clear to me which is correct. It doesn't seem ideal to ignore co morbidities.
What if there are multiple strands of the virus, and Europe is being dominated by the more potent one? We might not even be surprised that the more potent version ended up on the other side of the planet.
https://nextstrain.org/ncov shows there is a massive number of genetic variants. I have yet to see anyone successfully show that the variants have different behaviours, as that is hard to do. However any strains that are more contagious should dominate over other strains.
Due to international travel, and especially citizens returning home, the different strains are coexisting within the same country.
They have even used strains and genetic trees to trace individuals that transmitted the virus.
They've all had fewer cases than Luxembourg so far.
I've yet to see a good explanation for it, other than maybe the premise about seasonal temps and humidity (northern vs southern hemisphere). There's no evidence they're massively lying about their numbers (which would show up in the form of a demolished hospital system and thousands dead of pneumonia). Vietnam has also done incredibly well overall, showing no indications of being crushed by cases, despite their proximity to China.
Mexico is also not being crushed at all by the virus, despite being right next to the US as Vietnam is right next to China. Mexico shares enormous trade and traffic with the US. They should be buried in pneumonia cases given their overall context (population size, economy, testing rate, healthcare system). They have just over half the cases of Finland (obviously Mexico isn't testing at a high rate, I'm sure it's more than just 600). If many thousands of people were dying of Covid in Mexico right now, it would be showing up blatantly. Latin America's case load has largely been low vs population sizes (with only a few exceptions), as with the rest of the southern hemisphere. Mexico is technically northern hemisphere, and I wonder if they don't have some of the southern hemisphere benefit (as perhaps India does), limiting the rate of infection vs nations that are further north. And will that flip at all in the coming months.
https://i.imgur.com/EH8OkTd.png
It'd be very interesting to see a comparison of avg temps and humidity among nations most affected (or least) during the outbreak timeframe. Including looking at locations such as Italy, France, Germany, Spain, NYC, Texas, Southern California, Seattle, South Korea, parts of Mexico, Thailand, and so on.
Basically, due to seasonal temps and humidity, is South Korea's task made far easier than Italy's task? Does that considerably alter the infectiousness of SARS-CoV-2 in South Korea vs Italy? Is their equation half the effort they've put in (and credit on that), and half good luck of location. Mexico sure as hell isn't avoiding being overrun by it due to maximum testing.
I spent many hours last night doing a deep dive on the latest research on the impact of humidity on viruses, infectiousness and the respiratory system. It's fascinating stuff.