By Howard White, CEO
The first cases of Covid-19 were recorded late last year and quickly grew to pandemic proportions. The impact of the virus is not equally spread. Countries with just 6% of the world’s population account for over 50% of the cases. This is in large part because of the US, which is home to 4% of the world’s people, but has 32% of the cases.
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Countries with just 6% of the world’s population account for over 50% of Covid-19 worldwide cases Source: Calculated from data from Worldometer.info and World Bank |
Of course, this distribution will change. We have yet to see the full effect of the virus in sub-Saharan Africa, where health systems are weak, and many people are malnourished or have pre-existing conditions. But we also know that other countries have successfully moved out of the crisis. The country where it began is the most notable. China now has fewer than 1,000 active cases: with around 18% of the world’s population, China has had only 3% of the world’s Covid-19 cases.
China achieved this turnaround through a strict lockdown. South Korea is noted for having had far less restriction on movement but achieving a turnaround through testing. Less well-documented is the case of Vietnam, which has also turned the virus around, as shown in the figure on the left below (Active Cases). This was achieved through testing and contact tracing, as well as lockdown. A couple of weeks ago, a former student from Vietnam sent me the figure on the right below. The government published data showing where the cases had come from, and who they had infected. Most infections came from a British pilot in a bar in Ho Chi Minh City.
| Vietnam has turned the virus around… | Through testing and contact tracing |
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Different experiences around the world
The success in East Asian countries comes from adopting science, that is, evidence-based approaches. Viruses are transmitted by being in contact with, or having proximity to, an affected person. So, isolating those who have or may have the virus will reduce its spread. And since we don’t know who has it, simply reducing social interactions limits contagion. A systematic review from 2018 showed the success of social distancing measures in the workplace in limiting the seasonal flu.
This does not bode well for the US, where people are resisting lockdown and social distancing measures. Testing remains low in per capita terms, and many people fall outside of the health and welfare system. Nearly 30 million Americans are uninsured, and over 20 million are in jobs which don’t allow paid sick leave, so many people work whilst sick so infecting others.
Outside of East Asia, other countries are also taking an interest in evidence to limit the spread of the virus. The German Chancellor, Angela Merkel gives talks which explain the science behind the measures necessary to contain the virus, with government monitoring R0 (which describes how many cases of a disease an infected person will go on to cause) to decide policy.
For some issues, there remain controversies about the evidence, masks being a good example. The COVID-END initiative website reports that 33 research groups have embarked on rapid reviews of the effectiveness of masks.
Valuable insights from social science
Despite these disagreements, there remains a tendency amongst policymakers and the public to believe the evidence comes from ‘proper science’ but not social science. This is unfortunate as the social-economic consequences of the pandemic will be greater than the impact of the pandemic itself, and last for much longer. So, it is here evidence is also really needed.
Take lockdown as an example. Across the world, there are calls for an early end to lockdown, and in the US, protests questioning whether it is necessary at all. So, is lockdown effective?
We have a natural experiment in the Nordic countries. Sweden has not adopted a lockdown, but neighbouring Finland and Norway have. The three countries are culturally similar, as are their health care systems. The first reported cases in the three countries are all within a week of each other – the end of February and early March. The case rate doesn’t seem that much different between Sweden and Norway: 1,517 per million and 1,336 per million, but we know every country’s measure of the number of cases is an under-estimate. How much of an under-estimate depends partly on testing. Norway has conducted three times as many tests per capita as Sweden. So, the more accurate measure is deaths. Covid-19 has killed five times as many people per capita in Sweden than it has in Norway, and seven times as many as in Finland. The failure to adopt social distancing is associated with at least a five-fold increase in the death rate. The current number of deaths in Sweden stands at just over 2,000. It could have been less than 400.
Where evidence synthesis can help
The discussion of the Nordic countries is quick and dirty – it’s about the numbers. But as the virus is controlled, so government attention turns to social and economic programmes to get people back to work, and to tackle mental health and other problems in the wake of the crisis. How will they decide which programmes to undertake? Should the widely-adopted cash transfers and wage subsidies be converted into minimum income programmes? Can social safety nets be strengthened? What opportunities does digitalisation offer for more remote working? How best to combat a possible resurgence in crime?
There is already evidence to help answer many of these questions. And systematic reviews have become the accepted way of summarising bodies of evidence on social and economic policy questions. Campbell reviews are recognised as the gold standard in reviews, and the journal Campbell Systematic Reviews as the global repository of reviews.
This is a time when we expect more and more people to be turning to Campbell to find out what works. To help them, we have published a blog series on the immediate response, social interventions and economic interventions.
Decisionmakers, plan now for your evidence needs ahead of time. Consult the Campbell journal to inform your spending decisions, and work with Campbell to commission reviews on questions of interest to you.
You can reach us at info@campbellcollaboration.org.