COVID-19: explaining South Korea, explaining the US
Here’s an article purporting to explain why South Korea is doing relatively well against COVID-19:
Behind its success so far has been the most expansive and well-organized testing program in the world, combined with extensive efforts to isolate infected people and trace and quarantine their contacts. South Korea has tested more than 270,000 people, which amounts to more than 5200 tests per million inhabitants—more than any other country except tiny Bahrain, according to the Worldometer website. The United States has so far carried out 74 tests per 1 million inhabitants, data from the U.S. Centers for Disease Control and Prevention show.
But a caveat:
Yet whether the success will hold is unclear. New case numbers are declining largely because the herculean effort to investigate a massive cluster of more than 5000 cases—60% of the nation’s total—linked to the Shincheonji Church of Jesus, a secretive, messianic megachurch, is winding down. But because of that effort, “We have not looked hard in other parts of Korea,” says Oh Myoung-Don, an infectious disease specialist at Seoul National University.
New clusters are now appearing. Since last week, authorities have reported 129 new infections, most linked to a Seoul call center. “This could be the initiation of community spread,” through Seoul and its surrounding Gyeonggi province, Kim says.
So it may just be a lull, and a function of the particularly localized pattern of infection in Korea as well as the country’s mitigation efforts. We don’t know what factors are causing what effect, at least I’ve not read anything that indicates an answer.
Testing may have been especially helpful in Korea because of that initial geographic and social localization:
The surge initially overwhelmed testing capabilities and KCDC’s 130 disease detectives couldn’t keep up, Kim says. Contact tracing efforts were concentrated on the Shincheonji cluster, in which 80% of those reporting respiratory symptoms proved positive, compared with only 10% in other clusters.
I would wager that most people who read this article come away convinced that South Korea’s aggressive testing approach has made all the difference, and the US has been negligent in not testing an equivalent number of people. I agree that the glitches in the development of the US testing kits – a manufacturing error, and then slowness involving bureaucratic red tape that needed cutting – has hampered our efforts. But has it actually made all that big a difference?
For some reason – and I think it may be the early travel restrictions put in place here – the US actually has a pretty good record compared to South Korea in term of severe cases and deaths. Take a look at this chart for today, the one entitled “Confirmed Cases and Deaths by Country, Territory, or Conveyance.” It has some interesting columns, such as “active cases,” “serious, critical cases,” “total deaths,” and “new deaths,” country by country. Since all the countries involved have different populations, it has another interesting column entitled “total cases per 1 million population.”
At the moment, here are the figures for South Korea: 6789 active cases, 59 cases currently in serious or critical condition, 3 new deaths, and 84 total deaths so far out of 8413 total cases since it all began. That means that in South Korea, the number of cases per million so far has been 164, and the deaths have involved .000001632% of the population.
In the US, we have had 7708 confirmed cases so far (with much less testing, so perhaps the rates are much much higher, perhaps just slightly higher, or perhaps in-between). Our numbers are still in the climbing stage, with 1297 new cases, a total of 120 deaths, and 11 new deaths. But of the 7482 currently active cases in the US, only 12 are considered serious or critical. That’s so low that I wonder whether it’s a typo, but if it’s not it’s pretty extraordinary, and it’s much lower than Korea’s already low ratio of serious cases to active cases.
In addition, because the USA has about seven times more people than South Korea, our deaths have so far involved .0000003667 of our population. That’s a very much smaller figure than in South Korea (we also have 23 diagnosed cases per million people, only about about 14% of South Korea’s figure, although that’s almost certainly because we just haven’t tested all that many people, so I don’t place much importance on the comparison).
It’s the death figures that have gotten my attention. Why is our death rate expressed as a percentage of the total population so much lower? Is it just that we haven’t peaked, and South Korea has? Or is something else going on?
For that matter, why is our death rate per million also so much lower than that of European countries? (From Powerline):
Again, these are just the figures as of today, and we could experience a huge surge. But (and I can’t find the link for this right now, although I remember reading it) our caseload began about the same time as South Korea’s.
My guess is that Trump’s much-maligned restrictions on travel from China, put into place on January 31, when there were only seven diagnosed cases in the US, made a significant part of the difference. The press, the Democrats, the left, and the NeverTrumpers were up in arms about that racist xenophobe Trump. And yet his action – as well as later restrictions on Iran and then on February 29 his adding restrictions on Italy and South Korea – seems very smart, particularly the early restriction regarding China.
The press and the Democrats have invested a lot in conveying to the American people that Trump is both a loose cannon and a racist. So when he does something the rest of the world isn’t doing, and it restricts travel from a certain country, it’s a no-brainer for them to scream “racist!,” and they convince much of America that it’s the case. Now they would like you to conveniently forget that Trump’s action was based on the idea of limiting the importation of a disease early on in order to delay its spread as much as possible in order to give the country and the health care system time to prepare, and that it probably accounts for the fact that the death rate in this country is lower than in most of the rest of the world – so far.
[NOTE: Another factor is that South Korea has supposedly had a lot of success treating patients with the antimalaria drug Chloroquine, a widely available medication that has been used in this country for ages for many things, and which is also cheap. And yet it also appears that the FDA has been setting up roadblocks on its use for COVID-19 in this country. Why, if it’s already been in use and approved and considered very safe? I’d like to hear a lot more about that. I understand that they must test it and make sure it works, but why not allow it to be used in very serious cases only, and have a big push to test it ASAP?]
NEO about chloroquine: :I understand that they must test it and make sure it works, but why not allow it to be used in very serious cases only, and have a big push to test it ASAP?] ”
IMO, worry about litigation. The nervous nellies will always bring up Thalidomide. And the lawyers will advise to play it safe.
The FDA should not be restricting the off-label use of already approved drugs. This isn’t a minor illness. When a patient is in very serious condition, why not use something that may help? This applies to the malaria drug, and to antivirals. Obviously, since chloroquine is not safe for heart patients, they won’t get it. Other patients might benefit, as might health care professionals.
Interesting that there is a false narrative circulating that the U.S. refused an offer from WHO and S. Korea for test kits.
Sorry, to say I had an unpleasant exchange with my Dear, health care professional daughter yesterday evening over this subject. She insisted on blaming Trump, despite my repeated requests that we not get into political blame. (“Why didn’t you people remove him and replace him with Pence?” So, even intelligent, and otherwise sensible and sensitive people see no problem with overturning elections.)
She is, naturally, net working widely with professional colleagues; but, is ill informed in some ways. So, I assume this is wide spread in those circles.
I did some research. The WHO spokes person stated in answer to queries that they never offered kits to the U.S. The kits that were available were offered to countries with less resources.
While trying to find information on S Korea, I stumbled on the Daily Kos. Good grief. I immediately went and washed my hands. Maybe that is where some of the Left are finding the lies that they believe. Kos does not advertise his ties to Soros, of course.
I don’t know, as of now, what the interaction with S Korea might have been with respect to test kits.
As usual, Neo is a source of sound information and sanity in an increasingly hysterical world.
Oldflyer:
I suggest you insist that your daughter read (or listen to you read to her) this as well as this and this. Those last two links appear to be the same article, at two different sites, neither of which is ordinarily pro-Trump.
Tell her that as a health care professional it behooves her to find out the facts.
I am tired of this sort of thing, in which people repeat lies and refuse to hear the evidence that would refute them. Obviously, I’m not talking about your daughter primarily – I’ve had this happen so often with friends and family that I’m just about ready to scream. I am considering taking a harder line and becoming more obnoxious and insisting that they listen to the other side.
“In the first week of March, the Ministry of the Interior also rolled out a smartphone app that can track the quarantined and collect data on symptoms.” That’s from the “Science” article quoted by Neo.
Targeted tracking, as well as widespread testing, have been the hallmarks of the Korean approach, and tracking has gone well beyond what the article suggests.
This was initially possible because health authorities were able to able to target members of the Shincheonji church in Daegu, who were the source of the outbreak.
Cell phones were used to track church members. Those who tested positive were quarantined. Cell phones were then used to track all those who came into contact with those who tested positive, and so on. It was like a giant branching network of tracking, testing, and quarantine.
Civil liberties concerns were swept aside. I don’t think that would be feasible in the US. In any event, it’s probably too late, and we don’t have a single cluster to start with.
What’s fascinating to me is the divergence in the trajectory of Germany and Italy (with Spain and France resembling more the latter than the former). Either there are multiple strains of this going around, or the Germans have working treatment protocols the rest are not applying. NB, Germany is also a society of the old. NB, Germany, France, and Italy do not differ much in the prevalence of smoking in their populations. In each country, it is between 21% and 27% of the population over 15 (v. 14% in the United States).
Regarding Art Deco’s comment about the divergence in trajectory between Germany and Italy, this may be a contributing factor: Chinese entities have purchased and operate a number of textile companies (leather goods, etc.) in northern Italy. Approximately 100,000 Chinese from in and around Wuhan have relocated there, and there are direct flights from China to northern Italy (I’m guessing Milan). I can’t recall where I read this or I would’ve posted the link.
Bob – I have also seen many references of the Italian textile trade and its connection to China. Also, there appears to be a connection between China and Iran.
About SKorea – the woman who was running around infecting everyone was patient #31. So with #31, contact tracking can take place. They connected her to the church as well as to another location, I think a restaurant or hospital since she was in a car accident, was able to check herself out to visit a friend for lunch and then readmit herself to the hospital. SK also took cell phone tracking to a new level that people in the US would object to.
I was reading the contact tracking for the cases in Singapore via the Worldometers site. They were able to find clusters, get that info out fast to their population and slow the progression. Many places in the US will not disclose who, where, etc of the sick people.
My doctor is looking in to telemed options, but she did tell us that she wants to know temp, BP, O2 and other history items. So, I’ve ordered a new BP cuff as well as a pulse oximeter for O2 levels. She liked my idea of keeping a journal of health factors as well as weight, diet, activity levels, attitudes, travel & contacts. Since the number of cases in my state is still small, the state indicated that it is still doing contact tracking.
BTW, the critical starting point in this panic was the OKC-Jazz basketball game. If you look at some videos, you can see the Thunder person running to the refs to tell them about the infected player. That decision to stop the game and then the league’s decision to suspend the season really started the cascade of sports cancellations, which triggered other cancellations.
It seems that everyone was kinda skirting around the issue of shutdowns – someone just had to be the first.
Another point re the drugs for treatment. The quinine option with zinc is supposed to be an option . The quinine impacts the cell membrane, allowing the zinc to enter. The zinc then disrupts the virus reproduction.
Zinc has been an option for impacting a cold – my doctor suggested getting zinc and gave us a dosing regiment to follow in case we start feeling bad.
So far today over half the new US cases are in New York:
New York: 3,031 +1,325
US: 8,990 +2,579
New York’s first case was fifteen days ago, March 3.
I haven’t located a good explanation why New York is being so hard hit beyond the obvious risks of a city like New York. Maybe New York is just ahead of the other states.
Hong Kong remains my favorite example of “doing COVID right.” Here’s an article comparing HK and New York.
Major events started falling. The Hong Kong marathon was canceled; schools, parks, and museums were closed; and concerts and festivals were postponed. Even Disneyland closed and offered up its land for quarantine sites.
It wasn’t just big events that were canceled. Small things changed too. Elevator buttons were covered in plastic and more frequently sanitized. Shop owners diligently scrubbed the handles of their entrances. Friends canceled dinners and parties. Restaurants and coffee shops were emptier, and some of them closed for good. “No fun stuff in Hong Kong anymore” was the refrain in my group chats.
https://www.buzzfeednews.com/article/rosalindadams/coronavirus-covid-19-hong-kong-usa-new-york
This S. Korea vs everyone else, including the U.S., contrast is fascinating. It was claimed in an article written by Korean doctors that their extraordinary response was motivated by their bad experience with the MERS outbreak. Yet Wikipedia says that S.K. had 184 cases of MERS and 38 deaths. 38??
Dr. Birx at this morning’s Whitehouse briefing stated that current testing in the U.S. actually takes something like a day or two to run the test. Soon, we’ll have rapid testing going, she said. Really? No rapid testing yet? South Korea had 6 hour test processing going many weeks ago.
Then she boasted that S. Korea only had 3% of all tests run that tested positive whereas the U.S. has something like 7 or 8% tested positive. See how selective we are, she implied. Wonderful. I’m sure they saved several million testing dollars as trillions (I don’t mean stock market dollars) are being lost to the economy. To be fair to Dr. Brix, I don’t think they have very many tests available, so in that environ. you don’t want to waste them people who are highly likely to test negative.
She also said something to the effect that there will be thousands of labs with Thermo-Fisher equipment that will be able to start testing very soon. That jogged my brain, that this stuff is very specific to the complex software controlled hardware it runs on. That is, you can’t run a S. Korean test setup on American hardware or vice versa.
______
The story from a few weeks ago, was that the CDC was shipping out test kits that had been verified in-house before shipment. Then at the destination labs, the kits failed their verification tests. We don’t understand it, they said. Were the kits really verified before shipment? I’m doubtful.
As I mentioned in a previous post, my family and I used to take chloroquine. Regularly. For malaria. It had side effects, but they were more noticeable for our kids than for us. But right now I need to rummage around through some old closets and see if we still have some on hand. I’m good and ready to start taking a weekly dose if I have any.
BTW, an overdose of chloroquine is lethal, as a friend of ours proved in one of our African postings. She had a lover’s quarrel with a boyfriend who refused to leave his wife for her. So she downed half a bottle of pills, then went over to his house to expire in front of him. By the time she got there the process was irreversible. A very gruesome death, and a memory I am sure he wishes he did not have.
this may be a contributing factor: Chinese entities have purchased and operate a number of textile companies (leather goods, etc.) in northern Italy
Doesn’t tell me why the mortality rate in Italy is so much higher than Germany.
Art Deco,
Italian hospitals got overwhelmed and the German ones didn’t? We know the former is/was true. I don’t know anything about Germany’s response.
I’ve been looking at the number of cases detected in Italy, and while those number are still going up strongly, the linear axis day-by-day plot is now a straight line. That is, not exponential. But unfortunately, none of the numbers lend any real certainty to our knowledge. Detected cases depend on the aggressiveness of the testing. Deaths depend on the efficacy of the healthcare system.
The FDA often misses the forest for the trees. The bureaucrats must stay employed, and MDs have long been pissed off at it, to say nothing of the ethical drug makers! It all goes back to Thalidomide, but otherwise the FDA is and has been a huge obstacle to needed more rapid medical responses. FDA, in addition to being tediously slow, is also capricious and arbitrary. Filing a NDA (New Drug Application) usually takes 5+ years and costs ~$1 billion for clinical trials, etc., if FDA approval for the drug is forthcoming. If not approved, the same amount has nevertheless been expended.
Chloroquine is not a totally benign drug, however. But then, malaria, its primary use, is not just a cold or a COVID-19 pneumonia, either.
And I surely would not bank on zinc. It is a small element, tiny compared to a single corona, and probably does not need the virus’ help to cross cell membranes.
The Chinese Belt and Road Initiative has been particularly active in Italy. And sub-Saharan Africa and Sri Lanka, all areas of economic vulnerability. Loans and loans and then Oops, cannot repay, and China seizes the collateral.
China is a great planetary danger and we have funded it thru our outsourced purchases of stuff ever since Nixon/Kissinger opened the door.
http://www.koreabiomed.com/news/articleView.html?idxno=7428
That’s a link to COVID-19 treatment guidelines used by Korean physicians. It’s a very short article. Takes less than one minute to read.
Should I start drinking tonic water (quinine) every day? This sounds more than half-crazy, but I don’t have malaria, and I don’t live in a malaria zone, so I can’t get a prescription to hydroxychloroquine or chloroquine.
On hot summer nights, I used to like gin and tonics. Health food? Or everybody’s allowed at least one vice? Beats my theory of taking saunas to melt the virus’s lipid outer coating. I’m retired, and my mind wanders.
Cornflour: The FDA loves you and cares for you.
Here’s the essence, from Cornflour’s link to the Korean Biomed. Review, 2/13/20,
a statement from the Korean COVID-19 Central Clinical Task Force:
“For the antiviral treatment, the doctors recommended lopinavir 400mg/ritonavir 100mg (Kaletra two tablets, twice a day) or chloroquine 500mg orally per day.
“As chloroquine is not available in Korea, doctors could consider hydroxychloroquine 400mg orally per day, they said. There is no evidence that using lopinavir/ritonavir with chloroquine is more effective than monotherapies, they added.”
The -vir drugs are anti-HIV.
I’ve never been clear how serious gin and tonics were for malaria and not an excuse to get buzzed.
But I’ve never liked gin or tonic water either.
I’m drinking heartbreak motor oil and Bombay gin
I’ll sleep when I’m dead
Straight from the bottle, twisted again
I’ll sleep when I’m dead
–Warren Zevon, “I’ll Sleep When I’m Dead”
https://www.youtube.com/watch?v=SO1QUy-HTHQ
Cornflour:
I read somewhere that tonic has way too little quinine to have any effect. Also, my guess is that the shelves have been stripped bare of it.
Here’s the best explanation I’ve read (H/T Powerline) for the Chinese numbers (assuming they are not lying fabulously) which continue to bother me. Read the whole thing.
…I decided to take a deeper look at the numbers in the hope of reaching some conclusion,” Levitt explained. “The rate of infection of the virus in the Hubei province increased by 30% each day — that is a scary statistic. I am not an influenza expert but I can analyze numbers and that is exponential growth.”
Had the growth continued at that rate, the whole world would have become infected within 90 days. But as Levitt continued to process the numbers, the pattern changed. On February 1, when he first looked at the statistics, Hubei Province had 1,800 new cases a day. By February 6, that number had reached 4,700 new cases a day.
But on February 7, something changed. “The number of new infections started to drop linearly and did not stop,” Levitt said. “A week later, the same happened with the number of the deaths. This dramatic change in the curve marked the median point and enabled better prediction of when the pandemic will end. Based on that, I concluded that the situation in all of China will improve within two weeks. And, indeed, now there are very few new infection cases.”
https://www.jpost.com/HEALTH-SCIENCE/Israeli-nobel-laureate-Coronavirus-spread-is-slowing-621145
“New York’s first case was fifteen days ago, March 3. I haven’t located a good explanation why New York is being so hard hit beyond the obvious risks of a city like New York.” Huxley
We were in NYC and flew home on 2/23. That was the exact time people started returning from Italy because coronavirus blew up there. One of Ace’s commenters wrote a post about her early return. She flew into JFK as did many. She made a point that there were no questions asked at customs. The timing certainly fits.
Interesting note. A bank where I have some of my money sent me an e-mail today. They are allowing those who are affected by the coronavirus temporary work stoppage (and that’s what it is a temporary event – we are assured by Dr. Fauci) to defer payments on auto and home loans for 120 days without penalty. I don’t know how many other banks are getting on this bandwagon, but it strikes me as eminently sensible. The banks are well capitalized, the Fed is willing to back them up, and the federal and state governments are going to put unemployment benefits and cash into the hands of those laid off. If you look at it as a month long vacation (or even three month long vacation) for the people in the 1/3 of the economy that is affected, it doesn’t look quite so disastrous, especially if most of those laid off have some money to pay their bills and/or get some forbearance from their creditors.
The Fed is going to help the corporations (airlines, cruise lines, and hotels) with loans and most restaurants/other small businesses will get loans from the SBA. Actually, we might be able to get back to the business of America in three months and start recovering.
This should be a good lesson for everyone. Don’t get too leveraged. Six months of expenses in savings is a good rule for anyone. Do that before you put a dime in the stock market.
I wonder if the ROKs were so well-prepared because they’ve been expecting an NK biowar attack for years.
Art Deco, I have also wondered about the huge gulf in mortality between Germany and Italy. German *cases* are now going up significantly but the death toll is still minuscule. Maybe there will be a lag effect but when Italy had about the same number of cases as Germany does now they already had hundreds of deaths vs. under 30, for now, for Germany.
I literally just posted on Facebook about the different “serious” rates per active cases before I came over here. Italy’s rate is so much higher that I was wondering if maybe they were panicking and over-classifying anybody who was breathing hard as “serious”.
From the responses, it would appear that most people I know are incapable of understanding even simple math. :-\
That aside, the most likely suggestions were:
1. Italy has a much older population, and cases are more likely to be “serious” in the older demographics;
2. Italy’s epidemic has been going on longer than other countries, and serious cases take longer to treat, so they’ve been building up (of course, I can’t find any historical data on the proportion of serious cases);
3. Italy’s medical system is more overwhelmed than others, so medium cases are more likely to turn serious due to lack of care.
The two I came up with were:
4. In Western Europe and Japan, the 70-90 demographic grew up with wartime and postwar privations, and therefore had poor early years nutrition (but that doesn’t explain Germany);
5. Different countries have different criteria for “serious” and “critical”, and therefore that whole column on the chart is GIGO (that could very well explain Germany).
The US and S. Korea have serious/active proportions of 0.7% and 0.9% respectively. But since Korea has been testing widely, they’ve presumably turned up a large number of mild unhospitalized cases, making the denominator of that fraction larger. But the US has mostly just tested people sick enough to go to the hospital, so presumably if we tested widely the denominator would go up and our 0.9% “serious” rate would go down.
There’s no historical data on the “serious” rate available on Worldometers to be able to compare, for instance, Italy D+14 vs. Korea D+14 vs. US D+14, so I’m going to keep taking daily snapshots every few days and see what the rate does. The “serious cases accumulate faster than overall active cases” hypothesis seems the most likely right now.
Had to listen to Zevon’s more popular song, Lawyers, Guns & Money:
https://www.youtube.com/watch?v=lP5Xv7QqXiM&list=PLv2lHsd2e5YqIk5lb-arTyflj1brIKNMQ
And then, Roland the Headless Thomson Gunner.
Funny how little is now discussed Biafra.
https://www.youtube.com/watch?v=wRWCK9zGynA
It looks like the OECD countries with enough health capacity can contain & treat small outbreaks – the social distancing is to keep the outbreaks small.
Some encouraging news?
https://nypost.com/2020/03/18/japanese-flu-drug-clearly-effective-in-treating-coronavirus-officials-say/
If you have a country like Korea where the vast majority of people will dutifully march in polite and careful lockstep to get tested and potentially quarantined, a system like this would be very effective.
That is not the case in this country. Never mind ordering shelter in place or mandatory testing and quarantines, Baltimore’s mayor simply pled with his constituents to stop shooting each other in the streets long enough to maximize the city’s hospitals for those potentially ill with the virus (https://baltimore.cbslocal.com/2020/03/18/we-need-those-beds-baltimore-mayor-urges-people-to-put-down-guns-after-violence-continues-during-covid-19-pandemic/)
Oops! A small clinical trial reported last night in NEJM online says the Korean report of benefit to using those anti-HIV drugs does not pan out for COVID. Did no good.
Median days of illness was 15.
Richard Saunders on March 19, 2020 at 12:25 am said:
I wonder if the ROKs were so well-prepared because they’ve been expecting an NK biowar attack for years.
* * *
Interesting idea.
In re Italy vs Germany recovery rates: the difference has been reported to be dependent on the number of acute care and even just regular hospital beds available.
Of course, I can’t find that particular article now, but here are some informational ones that support that suggestion.
Bar graphs of beds available 2 years ago, mouse over each bar for country name & number per 100K population. In 2017, Germany had about 600, Italy only 262.
https://ec.europa.eu/eurostat/statistics-explained/index.php/Healthcare_resource_statistics_-_beds
Wikipedia tracks everything pretty close to real time.
Again, German hospitals have way more beds per capita than do Italian ones.
It may not make you feel better to know that Italy has more than we do.
Top ranked 1-4: Japan, South Korea, Russia, and Germany.
However, Germany has way more intensive & critical care beds than most countries, and we have more than they do. Top number for those is Turkey, BION.
Very interesting numbers in this chart, which do not (of course) match up with the first source I linked.
https://en.wikipedia.org/wiki/List_of_countries_by_hospital_beds
A model of when the number of patients will exceed the number of beds, for the geeks in the house. Only covers Germany and Washington state, but the methodology was quasi-plausibe: there is an awful lot of guessing in models.
(Assume all chickens are spherical, if you happen to know that joke.)
However, it does show clearly why we are panicking now, before the beds start getting filled up.
https://medium.com/@trentmc0/when-does-hospital-capacity-get-overwhelmed-in-usa-germany-a06cf2835f89