As this pandemic has spread, and
countries have undertaken measures to prevent the spread of the virus, there
has been a lot of talk about comparisons.
“Are we on the same track as Italy?” has been a common question both in
the UK and in the USA, as Italy’s health system becomes overwhelmed by patients. It is hard to put across the complex
mathematics behind modelling epidemics, and pandemics, in a few sentences. Predictions can be made, but numerous factors
have to be taken account of. As more
than one expert has remarked – we really won’t be able to make those kind of
comparisons until after the pandemic has come to an end. The simplest of the issues to explain is one
of demographics. Even countries which
border each other can have vast differences in demography, even when cultures
are similar. While the coronavirus that
causes Covid-19 does not discriminate in terms of hosts, there has been a disproportionate
rate amongst two populations – the elderly (while the definition varies the
usual statistical boundary varies between 65 years of age and 70 years of age),
and those with certain pre-existing health conditions. There is naturally some overlap – as people age
they are more likely to develop underlying health conditions which can
complicate treatment of even relatively common health problems. This is one of the areas where demographic
difference influences the way in which countries have been affects. Italy, now overtaken by the USA (as of 28/03/2020)
as having the highest number of cases, if affected by this. Using the definition of over the age of 65 Italy
has the second highest population of elderly people in the OECD – 23% - with
only Japan having a higher percentage – 27%.
The UK by contrast, while not within the top 20 nations ranked in
percentage order – 23rd overall, has 19% of the population being
over 65 – the same as Spain – which also has 19%.
Geographical area – and geographical boundaries
– may equally be a factor though this again has to be counterbalanced by the
general lack of advanced health care systems in rural areas. This is one reason of multiple reasons why rural
communities are desperate to stop the flow of second home owners seeking to escape
outbreaks in the cities moving to the countryside – placing pressure on
healthcare systems which are barely adequate in normal circumstances.
Social attitudes also play a part –
personal space being just one factor – it has been noted in previous studies
that people living in crowded cities have smaller areas of personal space –
having become socialised to smaller areas – while those living in rural areas tend
to have large boundaries. Social mores
around physical contact also play a part.
Traditional and Religious factors can also play a part – particular those
which involve hygiene - some of which are easier to change than others. One example of a change, taken relatively early in
the outbreak in the UK, was of some Anglican churches moving to the use of ‘communion in one
kind’ for Holy Communion – where only bread is used. This was viewed by many as the safest valid
option. In some cultures taboos around
the use of right and left hands for ‘clean’ and ‘unclean’ activities may impact on
the spread of certain diseases. Historically,
strict cultural rules around hygiene have been given as one factor in growing prejudice against the Romani community – since some Romani groups held (and
some still hold) to strict rules about cleanliness. In some groups individuals do not share
personal items – crockery, clothing, towels – each having their own which are
for their sole use and there is a strong taboo about even touching such things belonging to others. Furthermore in many
of these groups items must be washed only in running water (generally
considered to have been to avoid contamination from stagnant standing water). These rules made these Romani communities less
prone to infection – and their apparent immunity led to allegations of being the
cause of such outbreaks. In some cases these habits persist amongst people who have moved outside of the general Romani community and live in non-Romani populations.
In short multiple factors mean making
such comparisons during an ongoing pandemic hard – they can only be done with
any degree of accuracy, in a way that can be clearly understood, afterwards. Those predictions we do have
are based on complex mathematics in order to create working models. Some may view such predictions as alarmist –
but where these kind of outbreaks are concerned it is always better to go slightly
too far – than not far enough – especially when your mistakes are counted in
lives lost.
