East Asia has handled and contained the pandemic far better than the West on nearly all metrics
Perhaps the most startling trend visible in the global Covid-19 pandemic is the vast differential separating East Asia from the West when it comes to the disease’s impact.
The chasm is visible – indeed, is impossible not to notice – when examining infection and death rates in either gross or percentage terms.
Very clearly East Asia, defined as the Sinic or Sinic-influenced nations of China, Japan, South Korea, Taiwan and Vietnam, has done better than the West on virus management.
In Part 1 of this two-part series, Asia Times examines social habits and social culture, attitudes toward authority and privacy and recent historical and epidemic experience in weighing the discrepancy.
In Part 2, we will examine political leadership, policy responses, geographic integration, vaccines, manufacturing capacity, virus mutations, race, weather and climate as influencing factors and finally arrive at a multi-variable answer to this crucial East versus West question.
Unlike most infectious diseases which register their highest mortalities in the developing world, Covid-19 has wreaked its greatest havoc among the world’s richest nations. The “East-West” cluster of nations – Europe and North America on the one hand, and Sinic East Asia on the other – represent the globe’s three key zones of economic activity.
But the reasons for the massive disparity in Eastern and Western pandemic management metrics are no simple matter to analyze. The variables are countless.
Take governance. In the East, the political structures of authoritarian China and Vietnam, on the one hand, and of democratic Japan, South Korea and Taiwan on the other, are diametrically opposed.
Or, consider policy responses. In the West these have varied from country to country, even within the supposed unity of the EU, and state to state in the United States’ federal union.
Moreover, no two countries share identical healthcare systems or demographics. And there are almost certainly discrepancies in data due to differences in test regimens, test efficiencies, reporting practices, methods of assigning cause of death to Covid-19, and so on.
Yet even the briefest glance at the numbers reveals a stark macro trend. East Asia has been far more adept at pandemic management than the West. This runs across all key metrics and by massive differentials.
The list of the top 10 nations for infections, according to data collated by Johns Hopkins University, is a roll call of the biggest, most prosperous and influential Western countries. The US is in the number one spot, with the UK at number 3, Spain at number 4, Italy at 5, France at 7 and Germany at 8.
The virus originated in East Asia, but no East Asian nation makes the top 10 list. The world’s most populous nation, China, is in 11th place. The East-West divergence in fatality rates is even starker.
China (population: 1.3 billion) has suffered 4,637 dead. Japan (population: 126 million) has lost 678. South Korea (population 51 million) has lost 260. Taiwan (population: 23.7 million) has lost only seven. Vietnam (population: 95.5 million) has registered zero deaths.
Western mortalities are on a vastly different order of magnitude.
The US (population: 328 million) has lost 84,118. The UK (population: 66 million) has lost 33, 264. Italy (population 60 million) has lost 31,106. Spain (population 47 million) has lost 27, 104. France (population 67 million) has lost 27, 077 and Germany (population 83 million) has lost 7,861.
In other words, Germany, at the bottom of the Western list, has nearly double the deaths of China, at the top of the East Asian list.
Or, take another metric – deaths per million of population – from a different data set, collated from JHU, the WHO and other sources by website Real Clear Politics. It shows a similar East-West chasm.
Spain’s mortalities per million are 580.1, Italy’s 514.7, the UK’s 499.1, France’s 404.2, the US’ 260.4 and Germany’s, 94.8. Meanwhile, Japan’s are 5.4, South Korea’s 5.0, China’s 3.3, Taiwan’s 0.3 and Vietnam’s zero.
To be sure, China’s data is frequently questioned by those on the political right, and Japan’s by those on the political left, but the two countries’ Covid-19 tolls are broadly in line with East Asian (and Southeast Asian) trends, suggesting greater accuracy than doubters might like to believe.
Culture and communalism
These data results confound expectations. On the macro level, East Asia has bigger cities and higher population densities. On the micro level, it has a culture in which food is shared from communal dishes.
Moreover, the Western nations cited above are fully developed, prosperous and middle-class – as are Japan, South Korea and Taiwan – but China and Vietnam, despite their rising economic status, are still lagging behind on a GDP per capita basis.
So what has the East done right and the West wrong? Naturally comparison demands generalities, but even detailed variables are fiendishly difficult to dissect.
Take age, a key risk factor for Covid-19. One reason Italy was believed to have suffered so severely early in the pandemic was because of its demographics: the world’s second oldest.
However, Japan, the country with the world’s oldest population, has seen a Covid-19 death rate 45 times lower that Italy’s.
Moreover, the percentage of aged persons living at home, rather than in specialist care homes, is similar in both countries: 96% in Italy and 94% in Japan, according to a study.
Still, a range of issues – from cultural habits to attitudes toward governance, from vaccination policies to viral mutations – merit discussion.
The two main vectors of transmission for Covid-19 are airborne droplets and contact. In countering these vectors, East Asia’s social habits trump the West’s
Due to East Asia’s air pollution and harsh influenzas, mask wearing – a simple but critical step in halting respiratory disease transmission by containing infected persons’ droplets within masks – is a common habit across the region. Likewise, masks are more widely available to buy.
“In [South] Korea, in February, people were wearing masks even when they had not been told do,” said Joe Terwilliger, a professor of genetic statistics at Columbia University in New York. And it looks similar north of the border. “Every day I watch North Korean news and everyone is wearing masks,” he said.
Moreover, there is less direct personal physical contact in East Asian behaviors, with its tradition of bowing, than in the West, with its traditions of cheek-kissing, hugging and hand-shaking. In other words, social distancing is built into culture.
Another aspect of culture is diet, which impacts a key Covid-19 risk factor. East Asians as a whole suffer lower rates of obesity than Westerners.
Attitudes toward authority
Attitudes toward authority and community consciousness are nebulous concepts, but East Asia may have advantages for reasons that combine politics and culture.
In communist-led China and Vietnam, the hand of government is heavy, a factor that militates against civil disobedience. The same is true for North Korea, where no data on the pandemic is available, but where indications suggest Pyongyang has contained the virus effectively.
And even democratic Japan, South Korea and Taiwan experienced dictatorial or militaristic governance within living memory.
Beyond politics lies the broader issue of culture. East Asian nations share a Sinic-influenced, Confucian culture of collectivism and group identity, bolstered by greater levels of ethnic homogeneity than exist in the West.
While politics may override culture in authoritarian Asian states, cultural factors may contribute to civic consciousness in democratic Asian states. Such attitudes are visible in low rates of street crime and in widespread acceptance of “nanny state” governance and of dirigiste economic management.
“An outbreak is a community problem,” said Dan Strickland, a US-based retired epidemiologist. “You can’t address it as individuals.”
Broadly, these various factors point to the trend of East Asians being more responsive to rules than “individualistic” Westerners. Even in South Korea, known for its lively protest culture, violence is rare. During 2016’s “million-man” anti-government protests, civic order was observed.
“In Chinese, the character for state includes ‘family,’” said Dr Jerome Kim, director-general of the International Vaccine Institute. “When something comes from Dad, the rest of the family follows along.”
Dr Keiji Fukuda, director of the School of Public Health at the University of Hong Kong agreed. In East Asia, “populations were more receptive to – and less fragmented in the face of – the measures needed to slow transmission,” he said.
This “fragmentation” is prominently seen in armed Americans defying lockdowns, but is also visible in less dramatic forms.
“Most of this [crisis] is behavioral, and people are not following the rules,” said Terwilliger, who is based in New York. “I stay home but I look out of my window – people are in the parks.”
Such defiance would be unthinkable in communist Vietnam or China, where lockdowns are enforced by neighborhood watch groups. And observers note that in South Korea, where no lockdown occurred, and Japan, where a “lockdown lite” has been instituted, dictates on avoiding large gatherings, on mask-wearing and on hand sanitization, are widely followed.
Rights to privacy
Relatedly, the prioritization of society over the individual has come into focus over rights to privacy, for a key pandemic countermeasure is contact tracing of the infected.
This process has been eased by East Asia’s high adoption rates of digital devices, and its top-tier ICT backbone. In China, tracing is further empowered by a pervasive state surveillance network.
But even in democratic Asia, where credit card and cellphone data has been used in tracing, there has been minimal pushback on the issue.
However, the issue is now in focus in South Korea, where the possibility of gays being “outed” has arisen in connection with a cluster in LBGT nightclubs. In response, authorities have guaranteed anonymous testing.
Looking West, there are high cultural barriers towards the use of personal data by governments, most notably in the US. Strickland, the retired epidemiologist based in the US, says he is puzzled by the attitude.
“I keep saying we should implement the Korean system, and people say, ‘These authoritarian measures would not work here!’” Strickland said. “I say, ‘We hand all this data over to big corporations, why not to the government? Especially if they turn off the surveillance after the outbreak.’”
Still, Terwilliger noted that not all Western nations follow the US attitude toward use of private data. “I can see Finland and Sweden agreeing to it,” he said. “It is that kind of culture.”
All East Asian countries have living memories of war on their own soil.
Japan was massively bombed in World War II. China experienced a post-war Civil War in the 1950s, as did Korea in the 1950s, and Vietnam in the 1960s-70s. Today, China and Taiwan, and the two Koreas remain trapped in military face-offs.
Western nations, however, have not suffered war on their own land since 1945. Yet even in Europe, certain countries which suffered badly in World War II such as Germany and Poland have weathered the Covid-19 storm better than those which did not, such as the UK and US.
Likewise, newly bourgeois East Asian countries have more recent experience of economic deprivation than Western nations. And within Europe, newly prosperous Eastern European nations have largely done better than Western Europeans.
Could these issues have impacted public responsiveness to crisis messaging?
“Maybe, because of this, people are used to following leadership,” mused Kim. “In a war, the generals lead. In a pandemic, you let the authorities lead.”
Dr Kenji Shibuya, a Japanese professor of Population Health at Kings College, London, agreed. “Countries that are very good at national security are good at pandemic management: China and Taiwan; the Koreas; Israel is the same.”
“The US is usually good at that but the Centers for Disease Control (CDC) was sidelined,” he continued. “If the president had trusted the CDC, it would have done better.”
Recent disease containment experience also granted East Asia an edge in its response.
“One of the things to remember is that China, Korea, Hong Kong and Taiwan had been through this before with SARS and MERS,” said Kim. “That preparation helped.”
At the outset of Korea’s outbreak, staff at the specialist Daegu Medical Center, for example, told Asia Times how they were both prepared and unafraid, due to prior experience. And prior experience impacted systemic response well beyond medical care.
In South Korea, a wide-ranging law passed in the wake of the MERS pandemic allowed authorities to access normally private data, such as location information from mobile phones and credit card records, enabling accurate contact tracing and contributing to the nation’s comparative Covid-19 containment success.