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Sunday, May 03, 2020

Thoughts on the Virus and where it has spread

I am not, of course, a medical doctor or an epidemiologist, but I have always loved numbers and I've spent a lot of time playing with them--especially, although not exclusively, as they relate to baseball.  I am convinced that important facts about the covid-19 virus are hiding in available numbers, and I hope that more knowledgeable people than I are looking for them there.  I have spent some time playing with figures available at this web site, however, and I could not miss an important pattern.  Just now, New York Governor Andrew Cuomo--who has a good feel for the significance of numbers himself--made an argument in his Sunday news conference that very much fit in with what I was seeing.  I am going to share my thoughts very tentatively here.

The worldometers site I just linked gives total cases, new cases, total deaths, new deaths, total cases per million people, and total deaths per million people,  and several other statistics, for every country in the world every day.  Studying it, I decided to focus on just one of those statistics: total deaths due to the virus per million people.  That, I think, must be the most meaningful of these statistics.  Total cases at this point is still largely a function of total tests administered, a number which varies enormously from country to country (and from state to state) as a proportion of population.  Total death figures undoubtedly underestimate the number of people the virus has killed--but I would be amazed if it underestimated it by as much as a factor of 2.  And when we focus on that figure, we find that the virus is far more common in the North Atlantic World--really, in the NATO alliance--than anywhere else.  Let's begin with a few numbers.

Leaving aside a few very small countries whose percentages are not meaningful, Belgium has the most covid-19 identified deaths per million in the world, 577.  The next four countries are all in Europe, ranging from Spain (540) through Italy, the UK, and France (379.)  The Netherlands, Sweden, Ireland, and Switzerland range from 295 per million to 204, and the United States is the first significant non-European nation on that list, with 205 deaths per million as of this morning.  US deaths, however, are highly concentrated.  The state of New York shows 1,256 deaths per million people, followed by New Jersey (877), Connecticut (680), Massachusetts (563), and through Louisiana and Michigan to the District of Columbia (367.)  Rhode Island, Pennsylvania, and Maryland are the only other states whose deaths per million exceed the national average, and eighteen states have less than 50 deaths per million population.  Heading back to Europe, we find that Denmark and Germany have 84 and 81 cases per million. 

In the third world, the virus has had very little impact so far.  Ecuador leads Latin America with 89 deaths per million.  Turkey leads Asia with only 40.  Totals in Eastern Europe are very low.  China now reports only 3 deaths per million people. New Zealand and Australia have escaped almost entirely.

I didn't know what to make of these figures earlier this morning, but now, thanks to Governor Cuomo, I think I do.  It is now clear, he said, that the virus came to New York state (and evidently to the whole northeast) not from China, but from Europe.  While the Administration banned travel from China on February 1, it did not stop travel from Europe until the middle of March, and by then the virus was well established here.  It was not too long after that that travel largely shut down within the United States, and it has remained so.    COVID-19 so far is a disease of the world's wealthiest nations, because, I suspect, their citizens travel so much.  Now, two months of social distancing have apparently slowed its spread in these most affected areas--but those areas are still showing far more new cases and deaths than most of the rest of the United States where the virus hadn't gotten a foothold before interregional travel almost came to a halt.  And with the exception of China, where it looks to me now as if the spread of the virus never came close to what has happened in the major European countries and the US, it has yet to gain a significant foothold anywhere in the Third World--because there hasn't been enough travel between the North Atlantic world and the Third World to start one.  Interestingly enough, a New York Times story this morning that asks why the virus is so much more plentiful in some countries than others--and which does not reach any conclusions--added another key data point for me.  The Dominican Republic now has 30 deaths per million from COVID-19, while Haiti, on the very same island, has just 7.  The reason, I strongly suspect, is the very large Dominican minority in the northeast US--much larger than any Haitian community--and the correspondingly high rate of travel from the US to the DR.

What follows is, of course, speculative, but I will state it with relatively few disclaimers.  I am not, of course, even in touch with anyone who is investigating the virus's spread scientifically, but I suspect we will find out within a month or two whether my hypotheses are true or not.

Air travel evidently has played a critical role in the spread of the virus.  A critical question, and to my mind a very open one, is this:  did most American travelers who had been to Italy contract the virus in Italy, or did most of the contract them in airplanes?  Airplanes, like buses and subways, are enclosed spaces in which the virus could, it seems to me, easily move from one person to another through the air.  The very serious impact of the virus in nursing homes, where so many vulnerable people live so close together, suggests that proximity drives the spread.  So, alas, does the spread within hospitals, which we must do everything we can to control.  Obviously the virus has been spreading via face-to-face contact in the western European NATO countries and in the northeastern US, but the general halt to large-scale travel within the US and around the world seems to have stopped large-scale transmission elsewhere, at least for now.  The significance of travel to the virus's spread obviously could have implications for how we try to return to normal, as well.  Pressure to return to normal is mounting in some parts of the US because the virus hasn't made many inroads there.  Can those areas safely return to normal activities if they maintain some kind of quarantine from more affected areas?  That is a question for an epidemiologist, not an historian, and I don't know the answer.  I think however that we need to find out what the answer is.

Any sudden revival of world and interregional travel would evidently open up new danger of spread.  We need competent authorities (such as the WHO, from whom President Trump is trying to take away funding) to study these questions and make recommendations.  I do think we can say now, however, that we aren't facing a virus that is spreading around the world at a steady exponential rate.  It spread very rapidly in certain very rich areas before travel restrictions, and it seems not to have spread over long distances very rapidly since then.  That, it seems to me, must be an important clue to a solution.


Unknown said...

It strikes me that COVID-19 deaths could be seriously under-reported in developing nations.
In developed nations, most people die in hospitals and if the patient has COVID symptoms, the patient will have been tested.

However, is that the case in less developed nations? Do hospitals have tests? And if most people die at home and never see a hospital?

Gloucon X said...

It seems to me that our leaders are following the Katrina response model, an ideological based model of slow and minimal national action and planning. Frankly, I think this amounts to criminal negligence and a violation of their oaths of office by which they have sworn to a constitution established to provide for the common defense and promote the general welfare.

We have a fascinating and damning contrast when comparing our response to that of Taiwan. There are several interesting articles available on the web, including one by Time Magazine, on how and why they were so successful in stopping the virus through early and thorough action. The USA is only 4.2% only of the world’s population yet we have 33.3% of the global cases and 27.5% of the deaths. The data raises questions about how and why we have done so poorly. Below is a shocking comparison of Taiwan and a combination of three US states with an equivalent total population, as of 5/3/2020:

Taiwan population: 23.7 m
NY/Conn/RI population: 24.0 m.
Taiwan cases / deaths: 432 / 6
NY/Conn/RI cases / deaths: 362,647 / 27,463‬

Bozon said...


"A critical question, and to my mind a very open one, is this: did most American travelers who had been to Italy contract the virus in Italy, or did most of the contract them in airplanes?"

Great point!

No one wants to talk about it much, or do stories on airline air systems, now that they are sutting down anyway.

I had made a few remarks, well before the pandemic, because I found out how they have come to handle cabin air in recent years.

My MD allergist also noted it, who started wearing masks for air travel years ago himself.

In my judgment, those grounded planes cannot now be retrofitted to go back to fresh air intake systems.

All the best

Bozon said...

My allergist does not even have allergies.
He was concerned about viruses and bacteria in strictly recycled cabin air!

All the best

Bozon said...

They probably came from China to Italy first.
From China also to everywhere else as well directly.
There are plenty of both rich and poor Chinese in Italy, for a lot of reasons.
See my site.
All the best.

Unknown said...

As I put it on a history forum... COVID-19 seemed to first hit people best fitting the "frequent flyer" profile of executives, heirs, entertainers, academics, and traveling salespeople... jetliners are easy places for infectious diseases to spread because people are packed in tight and the same air is recirculating around. But then it started to find its way onto airport limousines (often really buses), trains, trams, and buses. The NHL and NBA ended seasons because the teams would be exposed to travel by air.

The New York City subway system probably did more to spread COVID-19. It is going to be a while before I use a jetliner or any form of mass transit for a while. Rural America, where I live (if you call it living) may be a cultural desert in which entertainment is cable or satellite TV, the Internet, or video rentals and information is from the limited library... that rules out any trip to any big city until mass transit is safe again.

COVID-19 has brought back the 1930's with a lack of social life but fully-modern technology. It is the social life, and not technology, that makes life human.

PJ Cats said...

Dear Prof Kaiser,

Oh yes, I remember, in the beginning of the pandemic, listening to some airline spokesmen saying that planes were perfectly safe, because 'the air gets filtered'. Of particles the size of viruses? I don't think there's a filter for that. I'd think that if you recirculate the air, you recirculate the virus. But allright, I don't really know, do I?
Another matter is how relevant the point is. Today's Guardian has a good article (in my view) that sums up some things. It seems to me your valid point falls into category four, checks at borders. That leaves another seven. Here it is: https://www.theguardian.com/commentisfree/2020/may/04/eight-lessons-controlling-coronavirus-east-asian-nations-pandemic-public-health
All the best, stay healthy.

Jude Hammerle said...

Dear Dr. Kaiser,

Thanks for this.

Also it might be nice to know whether some aspect of health care policy or normative social behavior is protecting Germans.

For instance, have more Germans chosen to receive pneumonia or other vaccines having beneficial "off-target" effects. Please see this for more: https://www.nytimes.com/2020/04/03/health/coronavirus-bcg-vaccine.html

All the best,

Jude Hammerle

Unknown said...

Going back to India -- this BBC article details some of the points that I was trying to make earlier. https://www.bbc.com/news/world-asia-india-52435463

In particular:

"Since most deaths occur at home - and will be for the foreseeable future - in India, other systems are needed," Dr Jha told me.

Around 80% of deaths in India still happen at home, including deaths from infections like malaria and pneumonia. Maternal deaths, and deaths from sudden coronary attacks and accidents are more often reported from hospitals. "A lot of people get some medical attention over time, return and die at home in India," says Dr Jha.

Clearly, counting hospital deaths alone is not going to be sufficient enough to get an accurate number of Covid-19 fatalities"

Jenny Genser White

Unknown said...

In the several weeks since this was posted, I believe that the numbers coming out of South America (particularly Brazil) and India show that this virus is not largely confined to the developed world.

Jenny Genser White