22 Feb '21 21:401 edithttps://www.newyorker.com/magazine/2021/03/01/why-does-the-pandemic-seem-to-be-hitting-some-countries-harder-than-others?
"For many statisticians, virologists, and public-health experts, the regional
disparities in covid-19 mortality represent the greatest conundrum of the pandemic."
"...everyone accepts is the most potent variable for covid-19 severity: age.
The median age in India is twenty-eight. In Spain and Italy, it’s forty-four
and forty-seven, respectively. After the age of thirty, your chance of
dying if you get covid-19 doubles roughly every eight years"
"Mexico has a median age similar to India’s; the percentage of the
population that’s over sixty-five is within a point or two of India’s.
Yet India’s reported rate of covid-19 deaths per capita is less than a tenth of Mexico’s."
"Mobarak suspects that, in places like the United States, “the spatial distribution
of the elderly” probably also matters. Around a third of the deaths in the
United States have occurred among residents and staff of long-term nursing homes."
"The task, then, is to factor in both intrinsic vulnerabilities (such as age or
obesity) and extrinsic vulnerabilities (the structures of households,
the levels of interpersonal contact). And here you start to get a sense
of the challenges that our medical mathematicians must contend with.
There are trade-offs battling trade-offs: are the risks greater for a younger
country with a larger family size but with infrequent social contacts or
for an older country with a smaller family size but frequent contacts?"
"The surprise emerged when looking at South Asia and most of sub-Saharan Africa.
The model—which, it should be emphasized, took age differences into
account—appeared to be off, in most cases, by a staggering margin.
Pakistan, with a population of two hundred and twenty million, was
predicted to have as many as six hundred and fifty thousand deaths;
it has so far reported twelve thousand. Côte d’Ivoire was predicted to have
as many as fifty-two thousand deaths; by mid-February, a year after the
pandemic reached the continent, it had reported under two hundred."
"The researchers carefully distinguished between “probable” and “possible”
covid-19 deaths, drawing from often scant clinical records, but,
whatever the exact numbers were, it was obvious that the official
records drastically shortchanged the reality. Lawrence Mwananyanda,
a physician and global-health expert who helped lead the study,
believes that Zambia’s real death toll from covid-19 might be as
much as ten times as high as the official one. Any notion that the
pandemic has bypassed Africa is, as Christopher Gill, an infectious-disease
specialist at Boston University and another leader of the study, puts it,
a myth born of poor or absent data.” Underreporting was plainly a serious issue."
"What to do when you can’t take coroners’ reports at face value,
assuming that you even have a coroner’s report? Public-health
experts have a saying: “It’s hard to hide bodies.”"
"Is that because the number of covid deaths in the country (India)
has been vastly underestimated?” I asked.
“It’s impossible to have a decisive answer,” Shah told me.
“But the pattern of the excess deaths doesn’t really shout out covid as the cause.
It just doesn’t.” When his researchers analyzed the data by age, location,
and gender, they found that excess deaths tended to be observed in
younger cohorts, and in rural rather than in urban settings; nor was there
evidence of the usual coronavirus skew toward greater lethality in men.
“The telltale signatures of covid just aren’t there,” he said"
"Some epidemiologists argue that an accurate account of geographical
disparities must give due weight to another extrinsic factor: certain
governments have responded more effectively to the crisis than others."
"He told me that, in Mumbai, “there are plenty of infected older people
living in crowded circumstances, such that we’d expect many hundreds
or even thousands of deaths. But that’s nowhere close to what happened.”
He made another observation: “In India, we’ve found that most people
had really high levels of antibodies after an infection, and the levels don’t
decay, even among the older people. They stay on for a long period."
"The covid-19 pandemic will teach us many lessons—about virological
surveillance, immunology, vaccine development, and social policy, among other topics.
One of the lessons concerns not just epidemiology but also
epistemology: the theory of how we know what we know.
Epidemiology isn’t physics. Human bodies are not Newtonian bodies.
When it comes to a crisis that combines social and biological forces,
we’ll do well to acknowledge the causal patchwork.
What’s needed isn’t Ockham’s razor but Ockham’s quilt. "
"For many statisticians, virologists, and public-health experts, the regional
disparities in covid-19 mortality represent the greatest conundrum of the pandemic."
"...everyone accepts is the most potent variable for covid-19 severity: age.
The median age in India is twenty-eight. In Spain and Italy, it’s forty-four
and forty-seven, respectively. After the age of thirty, your chance of
dying if you get covid-19 doubles roughly every eight years"
"Mexico has a median age similar to India’s; the percentage of the
population that’s over sixty-five is within a point or two of India’s.
Yet India’s reported rate of covid-19 deaths per capita is less than a tenth of Mexico’s."
"Mobarak suspects that, in places like the United States, “the spatial distribution
of the elderly” probably also matters. Around a third of the deaths in the
United States have occurred among residents and staff of long-term nursing homes."
"The task, then, is to factor in both intrinsic vulnerabilities (such as age or
obesity) and extrinsic vulnerabilities (the structures of households,
the levels of interpersonal contact). And here you start to get a sense
of the challenges that our medical mathematicians must contend with.
There are trade-offs battling trade-offs: are the risks greater for a younger
country with a larger family size but with infrequent social contacts or
for an older country with a smaller family size but frequent contacts?"
"The surprise emerged when looking at South Asia and most of sub-Saharan Africa.
The model—which, it should be emphasized, took age differences into
account—appeared to be off, in most cases, by a staggering margin.
Pakistan, with a population of two hundred and twenty million, was
predicted to have as many as six hundred and fifty thousand deaths;
it has so far reported twelve thousand. Côte d’Ivoire was predicted to have
as many as fifty-two thousand deaths; by mid-February, a year after the
pandemic reached the continent, it had reported under two hundred."
"The researchers carefully distinguished between “probable” and “possible”
covid-19 deaths, drawing from often scant clinical records, but,
whatever the exact numbers were, it was obvious that the official
records drastically shortchanged the reality. Lawrence Mwananyanda,
a physician and global-health expert who helped lead the study,
believes that Zambia’s real death toll from covid-19 might be as
much as ten times as high as the official one. Any notion that the
pandemic has bypassed Africa is, as Christopher Gill, an infectious-disease
specialist at Boston University and another leader of the study, puts it,
a myth born of poor or absent data.” Underreporting was plainly a serious issue."
"What to do when you can’t take coroners’ reports at face value,
assuming that you even have a coroner’s report? Public-health
experts have a saying: “It’s hard to hide bodies.”"
"Is that because the number of covid deaths in the country (India)
has been vastly underestimated?” I asked.
“It’s impossible to have a decisive answer,” Shah told me.
“But the pattern of the excess deaths doesn’t really shout out covid as the cause.
It just doesn’t.” When his researchers analyzed the data by age, location,
and gender, they found that excess deaths tended to be observed in
younger cohorts, and in rural rather than in urban settings; nor was there
evidence of the usual coronavirus skew toward greater lethality in men.
“The telltale signatures of covid just aren’t there,” he said"
"Some epidemiologists argue that an accurate account of geographical
disparities must give due weight to another extrinsic factor: certain
governments have responded more effectively to the crisis than others."
"He told me that, in Mumbai, “there are plenty of infected older people
living in crowded circumstances, such that we’d expect many hundreds
or even thousands of deaths. But that’s nowhere close to what happened.”
He made another observation: “In India, we’ve found that most people
had really high levels of antibodies after an infection, and the levels don’t
decay, even among the older people. They stay on for a long period."
"The covid-19 pandemic will teach us many lessons—about virological
surveillance, immunology, vaccine development, and social policy, among other topics.
One of the lessons concerns not just epidemiology but also
epistemology: the theory of how we know what we know.
Epidemiology isn’t physics. Human bodies are not Newtonian bodies.
When it comes to a crisis that combines social and biological forces,
we’ll do well to acknowledge the causal patchwork.
What’s needed isn’t Ockham’s razor but Ockham’s quilt. "