Comparing COVID-19 Control in the Asia-Pacific and North Atlantic Regions*

Abstract

This paper was completed on 18 June 2020, in the midst of the fast-moving pandemic. At the time, the performance of the Asia-Pacific region in suppressing the epidemic was vastly superior to that of the North Atlantic region (including both North America and Western Europe). A half-year more has now passed. Rather than re-writing the paper, I have allowed the original to stand as was written, but add this postscript for an update. The basic message is clear: The early superior results of the Asia-Pacific region were maintained during the second half of 2020. These superior results were neither early anomalies (such as the particular timing of the arrival of the virus) nor temporary successes that were later overwhelmed by events. The accomplishments have persisted, and reflect a superiority of the public health measures undertaken by the governments, and the public's compliance with them, in the Asia-Pacific region compared with the North Atlantic region.Table P1 shows the most recent data (21 December 2020) regarding cases and deaths per million population. During the next phase of epidemic control (beyond the scope of this paper), the comprehensive deployment of vaccines will be an additional key component of successful public health implementation. We see clearly that the top-performing countries of the Asia-Pacific region vastly outperformed their North Atlantic counterparts considering the full year up to 21 December. Considering each region as a whole, the (unweighted) average across countries of cumulative cases per million population was 2,236.0 in the Asia-Pacific region, compared with 25,764.8 in the North Atlantic region. Table P1.Updated COVID-19 cases and deaths, Asia-Pacific and North Atlantic regions (21 December 2020)CountryTotal cases (per mil)Total deaths (per mil)New cases 7-day avg (per mil)New deaths 7-day avg (per mil)Growth rate 2020Asia-PacificAustralia1,105.835.60.9—−4.2China66.03.30.10.01.9Indonesia2,431.072.724.60.6−1.5Japan1,575.622.021.00.3−5.3Lao PDR————0.2Malaysia2,882.913.543.40.1−6.0New Zealand439.85.20.7—−6.1Philippines4,195.981.613.50.3−8.3Singapore9,986.15.02.5—−6.0South Korea986.813.619.80.3−1.9Taiwan32.20.30.2—0.0Thailand70.30.91.4—−7.1Vietnam14.50.40.0—1.6North AtlanticCanada13,559.1377.4179.13.0−7.1Denmark23,307.0178.7609.02.3−4.5Finland5,985.188.360.60.9−4.0France38,756.2929.4212.75.8−9.8Germany18,081.8315.1279.97.3−6.0Italy32,304.41,137.9258.710.1−10.6Mexico10,242.1916.878.14.7−9.0Norway8,098.774.576.50.4−2.8Spain38,439.61,046.4203.74.0−12.8Sweden36,351.1791.4665.16.8−4.7United Kingdom30,141.1994.4403.36.8−9.8United States53,911.0959.7651.87.9−4.3Regional AveragesAsia-Pacific2,236.023.510.80.1−3.3North Atlantic25,764.8650.8306.65.0−7.1Note: This table includes South Korea and New Zealand, and does not include Hong Kong, India, Saudi Arabia, and the United Arab Emirates.The Asia-Pacific successes will likely show up as superior economic outcomes as well, though such conclusions for the year 2020 will be available only in 2021. The evidence as of now (December 2020) is that the Asia-Pacific successes in suppressing the virus were achieved with lower economic losses than in the North Atlantic region, disproving the hypothesis of a tradeoff between the economy and suppressing transmission of the disease. It appears that effective deployment of nonpharmaceutical interventions (NPIs) enables both the suppression of disease and transmission and an earlier economic recovery compared with two extreme alternatives (either to do little to suppress the epidemic or to shut down the economy on a prolonged basis). The final column of the new table shows the projected 2020 GDP growth rate (in constant dollars, national currency) in the IMF's World Economic Outlook of October 2020. Although these estimates for 2020 are uncertain and preliminary, they do suggest that the Asia-Pacific's superior performance in suppressing the epidemic was achieved alongside superior economic performance as well. We note that China, Vietnam, and Lao PDR are all predicted to have positive growth rates for 2020, and Taiwan is projected as zero growth. The rest of the countries are projected to contract by varying rates, with the projected (unweighted) average decline in the Asia-Pacific far smaller (−3.5 percent) than in the North Atlantic region (−7.5 percent).There are two notable updates of the conclusions from June. First, despite the clear evidence of a large number of infectious yet asymptomatic cases (in which the infectious individual never shows symptoms) and pre-symptomatic cases (in which the infectious individual shows symptoms after becoming infectious to others), effective control of the pandemic through NPIs is nonetheless feasible. Yet suppression depends on active surveillance, meaning that the public health system actively searches for potentially infectious individuals rather than waiting passively for individuals to show up for testing. Active surveillance is mainly carried out by contact tracing, both forward (to potential new cases arising from each newly confirmed case) and backward (to identifying the likely source of infection of each newly confirmed case).Second, despite the clear evidence from the Asia-Pacific region that NPIs work effectively and at low cost, the North Atlantic region failed to carry them out systematically. This represents a serious lapse of governance, and gives evidence of a deeper and longer-term crisis of governance. There are several apparent reasons why the North Atlantic region fell far short of the potential to control the epidemic, including the following:Public health populism. Some political leaders, such as Donald Trump, used their prominent positions to downplay the seriousness of the epidemic, to the point of rejecting or undermining the public's compliance with NPIs, such as wearing face masks.Lack of regional cooperation, including effective border controls. Even though the virus was clearly national at rates, the North Atlantic countries failed to effective border and regional of A in North Atlantic public has the that NPIs such as and of a of the public's to be far in the Asia-Pacific including and New Zealand, which the of epidemic The Asia-Pacific to reflect epidemic the recent with and These to effective national and to for regional cooperation, including the Western for now in The North Atlantic countries were far with epidemic of the Asia-Pacific countries including for public contact tracing, and of the North Atlantic countries to be at with and public and more potential on COVID-19 pandemic is far more than recent including and for First, the population is to the virus and is as yet or effective the transmission of the infection is with a of to in the early phase of an transmission is to control pre-symptomatic and asymptomatic individuals the the is than though the is not and in to the health and the and serious prolonged a the COVID-19 epidemic is to and the in in COVID-19 to countries with through the of and and the of the virus countries in the Asia-Pacific region, South Western and North During the epidemic in countries in the of and a in During the virus in more countries of and The of the virus is in which the of the confirmed in each with early cases to have more cumulative and deaths per million than countries with later The is that the epidemic has more to the population. is that countries with later cases from the they the to to the epidemic the confirmed a the countries with later have more effective than the countries in the of the pandemic is in an early The number of have as of the of June 2020) is far cases that these confirmed cases of the number of far be or of the population of of the population for the rate of infection to be in and in two countries the epidemic is far from in of the I note the basic rate measures an epidemic is or on or as of of the the most recent of for June in These countries have a population of or of the population. This is an but not as as countries have an to and is likely to of the the evidence is clear that most of the has not yet the transmission of the virus though most are to do this paper I the performance of countries in the These are the countries that were in the of the epidemic the later than and that have of the which data on (such as wearing face and these countries a for I note that several Asia-Pacific countries (including Lao and New are not of the and are not in the is that the Asia-Pacific region, which I as China, Hong Kong, New Zealand, and the has effectively the epidemic in with the North Atlantic region, which includes North America and the United and Western but of the countries compared in this paper are in of these two the two the Asia-Pacific region has confirmed cases and deaths per and a lower of economic as by to and The Asia-Pacific region was more effective than the North Atlantic region in the of public including of face and early on on to the arrival of from the of the epidemic, the key of an epidemic is the effective number which the average number of by an infectious At the of the epidemic, is the basic number is to be between and with a point of control measures to the transmission of the is each infectious individual than individual on and the number of active cases in the population each infectious individual more than individual on and the epidemic that a of COVID-19 infection to that a infection in that as the of the population that has the of individuals that have an and that have from a is large to to a of or The the of the far that or or percent) of the population have this is the virus at a rate the epidemic to an the COVID-19 epidemic with more than of the population will be The of the population that is in the of the epidemic is the that the COVID-19 rate is at This is the that I in this a COVID-19 by to be in the between and and with an rate of the from an epidemic be of the population. the United with million that COVID-19 deaths of million of confirmed COVID-19 in the United was or of the lower The is that the epidemic is the deaths by or the apparent rates of have to the of the despite a (such as and Donald from to downplay the of the is an effective or control mainly on public health measures to and the rate of deaths per be to be used in the of individuals from as wearing face and individuals to them from the from of such as and down and public down and to at the epidemic be and at low and that all individuals were to during the of their which is for most The pandemic to a of are of the disease. Yet as a of temporary not that the epidemic with their recovery or the epidemic is not in most and individuals is a that an effective public health The is by the that asymptomatic and pre-symptomatic individuals the This that the public health system to and individuals mainly on their contact with confirmed COVID-19 infectious are they to in in which they are likely to in the are in such that they to their basic including and in is that is not to of infectious individuals to the It is only to on a A of infectious individuals be in that on average each infectious individual than additional This is by early of individuals and by public health measures to potentially them, confirmed and the of early in and the be by most that of the face in public and an in public (such as is by is and and are more from be a to the of the epidemic, and to be in the Asia-Pacific region, countries were to Yet such measures economic to and and in do not the of the virus after the virus has are economic and Rather than the of infectious economic the of the at a Economic is in the such as and and of the such as of work and the be to from of but this is not for most and and for that at the a to shut down economic rather than on and on There are The is that public be of the public of (in and public in large of that be to and are and they have a in the such has economic but potentially second for a temporary economic is to to a public health system that and infectious countries 2020 to The countries of the Asia-Pacific region, were the to their with The epidemic in was a for these and of in and more their epidemic control Western and the United by were not mainly their were or not up to the of suppressing the were as an to the epidemic in Yet for the to be an effective public health system be in during the in countries in the early of was to the of the The was to to but not between and the epidemic was to but more and with a of The was to the of in as not to the health the number of the the was to an of cases the number of is a between little to the infection and more to suppress the epidemic by It is a that measures the epidemic but not by to the of the virus or to a rate of a The of several countries in has to the for the The the is used as of than in the early of the the rest of the paper I the performance of countries in the First, I the of an epidemic, and show the of a to suppressing the I the performance of the countries in the The countries of the Asia-Pacific region public health early and on and rather than a these countries the epidemic control more and at lower than countries of the North Atlantic the of an epidemic, that full is an epidemic or more of the on an of a through the infection and with apparent to the The rest of the through a of A cases that be at or as an cases to Some of to the of from the disease. The in this are to have and deaths per The of to the and with of and the of for the and are by with the with each of to recent of the by the health per infection is to be which includes the of and and an and that are of all the health of the epidemic to or of these health add two the losses with the and the to The most to the is to to each a to the of a with the by at and an of million the rates of COVID-19 that to a lower a on each to the The of a in the United is at A of is to two the GDP per A of COVID-19 be on the of of from the epidemic depends on the The is to between and with a to This million deaths in a of the of deaths to or of the GDP a the to or of the The estimates in include the of longer-term that COVID-19 At this is evidence that individuals after the but is as yet comprehensive of these longer-term of and to a to such be the add the losses to to the infection as projected by with an be million million and million million and million be for individuals I will to be in the at of work for each and of work for each an rate in at million and million per and a economy in the average GDP per is for that GDP by for each the from be at or of this is likely to be a of the to these of losses the of an epidemic in the United be on the of of GDP in health of GDP in and between and of GDP in the of the of or between and of not including longer-term of the the epidemic be at a far smaller than the lower of a public health system to the epidemic are not to with the of the epidemic on early and effectively the public health is that the United as as public health per in the in to the epidemic, including contact tracing, of of of the and is a of the The be a of million individuals a of per health including both and this per or of for the public health this is a compared with the of an epidemic, that the public health measures suppress the the of an economic the I that a be to the epidemic The all than and all and and most including public and public such as and and most health in the suggest that at the of the a by the of that is in the suggest that half be carried out from including most than health and that a that of at the and of from during the the decline in be that the for or of the The for the year be a decline in an decline in the Yet a decline in GDP be to an that the temporary is used to that a suppression of the epidemic the this that the temporary results in a rate of rather than as in the that the of deaths, and work be to of the losses of the of million the be The economic losses in health and be by losses of of At a of of the temporary be a temporary to the epidemic the have to be by public health measures that the virus measures and and The two It the number of active in the for the public health system to in tracing, and and gives the to the of the public health is more of measures that the of the the and in including and a of be by the out of note that the for the population is the of the population to the estimates in the epidemic, of the deaths are to be of individuals a of deaths be through measures to the this has not The United has in and of the deaths have in and New the a in COVID-19 to the of have in the have in the of Western and the United have in the data of the half of 2020 are with more likely that a of deaths will have in the of and a rather the of in now to a of epidemic control in countries in the of the I two key measures of the epidemic and their The is the average effective number during the to June. I the estimates of by The second is deaths per million as by the COVID-19 for June. These measures are for the countries in Table from the to average Table the of the confirmed in each The final two of the table show the (unweighted) for the Asia-Pacific countries and North Atlantic The Asia-Pacific region has a lower average and far lower rate than the North Atlantic effective rate depends on a of including wearing face in and I the with on data and in the data The of these for the countries are in Table as as the for the two regions at the of the Table of countries Arab the of and (such as large and and The the performance of on a The measures the of across the economic data on the decline in to economic including and and and to The the decline in the deeper is the economic The measures the control by countries of on a from to a of the for the countries in the of the epidemic that are in the data on is of the is and is The is with individual and a The results are in Table The data are for the of the are and of the The with the by far is which wearing face and in to the varying from to to a of to is to to suppress the that the measures on wearing face and from in of these is as a of the and on a the early of the epidemic, was an in between the Asia-Pacific and the North Atlantic countries and the United as of face was than in China, Hong Kong, the and but in the United and the United shows the data on wearing face in public across the between the and Western countries in the of the to the the with the next is the economic by the of the decline in to economic A full meaning a in by to the This is a far from down to than This that an economic is at a more and public health and be tracing, and has a of This a to but the is with and the is as a The data rate countries on a from I to that to The United for is a of 21 but in was little and contact in most of the United at the the for and was as as that the COVID-19 epidemic was control in was the as as and of the of the have a of that they to epidemic control economic This for the are to infection but are asymptomatic or have and are likely to the virus to and of a of that the of by a a The early control of infectious a later control of infectious little transmission has at large to the COVID-19 the countries to at on the were the with the of the year the was Hong Kong, the and Vietnam, the Asia-Pacific the message or the of potentially infectious individuals from final is the which shows a of by or This a in the rate of transmission per the point is that in from to the two of The is the of individuals in the as a of the population has This is likely to be a of the at that only a of the population has by this The second is the of that are not by the individuals are to from potentially infectious is to a of each of the epidemic control I do this by the and on by their and the to their to the of each The is for the This is in the final column of Table We see that the Asia-Pacific countries show the on the of control to note the Asia-Pacific is to all the countries that and the economic than during the from June. countries this all in Vietnam, Hong Kong, South and next to the of the COVID-19 in the rate on the in the epidemic, by the of in the and the per of The COVID-19 rate depends on the that are undertaken to the data on such that countries in their on COVID-19 deaths, to the It is for that is including more deaths in COVID-19 than including deaths of COVID-19 not confirmed by testing. of this I all countries in the cases by with the available rather than only the countries in the There as a countries in the for COVID-19 deaths per million is as deaths per million are as of in with the available on The from a low of confirmed COVID-19 deaths in and to a of deaths per million in the Asia-Pacific countries far lower rates than North Atlantic per million in the Asia-Pacific and per million in the North Atlantic region. is the average during the June. The is the of the population of or are per population. is of the confirmed is a are in We deaths per million to be in countries with a average per and earlier arrival more for the virus to is to be an for the see in Table all are at the The on that the between a with an average of and for a of deaths per This is a little than a of the between the two with New deaths per million and the United deaths per million as of June. The of on that the in between with population of Vietnam, with of the population for a of deaths per more than half of the of Vietnam, with deaths and with deaths per The of on that the of per in the United and per in for deaths per million in the United than in out of an of deaths per and Korea have the per and and the A in arrival of is with a of deaths per is to have deaths per million than by the of this is to is an Table of of per to tracing, per of The is with and constant are by on is notable that the Asia-Pacific region has achieved superior results compared with the North Atlantic region in and in a low rate despite a lower on economic The key of the Asia-Pacific is the to control the epidemic through and of infectious individuals rather than on economic countries have results in suppressing the virus and deaths rates per million These include China, Hong Kong, Lao New Zealand, and the transmission of the virus by asymptomatic and pre-symptomatic has an and as to suppression of the epidemic is through public health or economic have to more or a is or is The of the Asia-Pacific region evidence that is to and to suppress the epidemic through public health by only economic This is and from the United little has of the of the Asia-Pacific region in suppressing the to in than this note the countries have and and their public health be and by the rest of the The next of will be to more the of control measures as as the reasons for the of COVID-19 rates per million across the is a public and data COVID-19 to their of the and that to health with that them and the of the used in the data for this paper are more or to the COVID-19 of in each the is the of or COVID-19 public of in each they public COVID-19 a face in public of in each they a face in public COVID-19 to of in each they to work by from COVID-19 of in each they COVID-19 from in of in each they from in public to to has in to at The by across of such as and and and data show and of at compared to a are the of and data used to show for in for each are compared to a for that of the is the for the of the during the 2020. The data show several with the most recent data is to the data data are in the depends on and the is not is not to show a for the a for and that are to as as to these on data from have to for their the data represents a of with all this or not the of a of used in the and from and from from from from from for and tracing, and of COVID-19 on several that have to to the pandemic on such as and It now has data from more than The data are used to a that at countries of the World for on these are and is available in the data be used for are on these see for COVID-19 per per and COVID-19 is a of the COVID-19 data maintained by World in It is and includes data on confirmed deaths, and as as of potential cases and data from the for and The cases deaths is the number of cases or deaths by the the and a does not the number on that This is of the that between a new and in This that in cases and deaths a a to the the number of data are each during the GDP GDP is the of GDP that be at by The data in Table are the rather than on the for GDP and that GDP during the is of the Table of GDP during GDP GDP GDP with and and and

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