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Dear Reader:Let me suggest that you compare the responses of two countries - “A” and “B” - who both experienced their first cases of Covid-19 on the same day: January 20, 2020. Give them a letter grade - A thru F - based on their response to the Covid-19 pandemic.One country gets high marks for their response and is now almost back to normal. The other has already had tens of thousands of unnecessary deaths and is expecting perhaps 40,000 more. You decide which gets what mark.Here is a graph showing the (cumulative) number of deaths from Covid-19 these two countries have experienced (updated up to 5/5/20 - note that from 4/14/20 on, country “A” reports include “probable cases” and its numbers suddenly become much higher):Quite a difference, right? Country A has had over 68,934 deaths so far, whereas country B has had only 254. That’s A having 271 times as many deaths as B. But I’ll let you grade which is better.Now, we know enough about this virus that it takes about 20 days to go from infection to death (though in most cases people recover). So the explosion of deaths in country A on March 20 reflects explosion of the disease around March 1.So when do you think either country had a chance to tamp down the growth curve? Most people would say January and February. By March, the horse is already out of the barn.Besides far fewer deaths, country B:has needed less than $10 billion infusion into its economyits stock market index is almost back to its December baselineits health care system did not come near collapseis expecting 1–2% growth in GDP this yearSo what made the difference?One was testing for the virus early on, which allows you to contain it.As a respected researcher once said: “You want to know whether you have it or not. You want to know whether the people around you have it. Because you know what? Then you could stop it.” (I find it hard to argue with that)Indeed, once you have testing, you can trace cases, their contacts, their travels, isolate or quarantine as necessary, and nip the outbreak in the bud.From The Economist: “That life in [country B] has not ground to a complete halt is mostly owing to an early and aggressive response to the Covid-19 pandemic.”But testing and containment takes time, money and above all: focus.Here are how countries A and B performed. Country A’s words are well known, so I will include more quotes from leaders of County B, which are less widely known (especially their Foreign Minister’s).Please remember - A and B both started with a first case on January 20 - the same starting line.A. CONTAINMENT (stopping the virus)B: “we acted early”B: “we found it very important to diagnose people quickly and to prevent spread to the community through isolation of infected people”January 27:B: “the third confirmed case indicates that we have reached the point where we have to get rid of passive stance and actively prepare for the worsening of the situation”B: “testing is absolutely critical with a fast-traveling virus like this” (and as early as possible)A: bans Chinese citizens from entering country “A”this was the day after China banned their citizens from going abroadCovid-19 was within country “A” alreadyover the next month 40,000 non-Chinese citizens enter country “A” from ChinaFebruary 3:B begins ambitious testing program for Covid-19“Within weeks of the outbreak in Wuhan … four [B] companies had manufactured tests from the WHO (German developed) recipe and, as a result, the country quickly had a system that could assess 10,000 people a day”meanwhile, A:was not interested in using the well-established WHO testinsisted on making their own testthis test then failedA then turned down an offer by B to use their testsleader of A then offered aid to a country that was B’s enemymid-FebruaryA was testing well under 100 samples a dayB was testing up to 5,000 per dayB’s first drive-through testing center openedFebruary 28:A has done 440 tests for the corona virusB has done 53,000 testsFebruary 29:A finally approved a commercial testa senior A advisor described this lack of early testing thus: “That is a failing. Let’s admit it … why were we not able to mobilize on a broader scale?”containment measures by B included things like:mild cases and their family members underwent self-quarantine, but with surveillance (twice a day phone calls; use of smart phone apps)sometimes publishing online the location of people who tested positive (without revealing their names)since A had done almost no testing in January and February, it had essentially missed the chance to do any containment of the outbreakMarch 1 - based on 1% mortality rate, and ~20 days from infection to death:Country A:by March 20: 150 deaths from Covid-1915,000 cases must have been present by March 169 cases identified by March 1thus, <1% of infected persons identifiedthe remaining >99% could go on to infect countless othersCountry B:March 20: 100 deaths from Covid-1910,000 cases must have been present by March 13,526 cases identified by March 1 (35%)March 5: in Country B drive-thru testing widely availableB. MITIGATION (blunting the effects of the virus)both A and B took actions promoting social distancing:by February 21: B had cancelled large gatherings around the country, put their military on lock-down, ceased non-essential travel, postponed schoolMarch: A rolls out a piecemeal and confusing series of recommendations about gatherings, schools, travel, culminating in a plan to lift restrictions by April 12, then reversing course a week laterB also did other mitigation from early on, such as:right from early on, promoting everyone to wear masks outside the home, providing masks free of charge (“an essential component of [B] social distancing strategies”)meanwhile, in country “A”:the average citizen had been worried enough by the coming pandemic that by January 31, masks had been sold out on Amazon.comcountry “A” leadership actually discouraged the public wearing masks until April 3, when it reversed its position (though its leader said he would not be wearing a mask anytime soon)C. LEADERSHIP AND PLANNINGlate January, in B: “We took an all-government approach. The Prime Minister created a task force of all government ministries and, crucially, all regional and city governments, too”January 30:the WHO declares the corona virus outbreak a “Public Health Emergency”A follows with the same declaration the next dayFebruary 26: A finally convenes a more limited commission, whose leadership changes a week later, while a parallel “shadow commission” run by the son-in-law of the leader of A is also formedOn a larger level, Country B’s leaders thought:“The key to our success has been absolute transparency with the public - sharing every detail of how this virus is evolving, how it is spreading and what the government is doing about it, warts and all”“When one region ran out of hospital beds we asked other provinces to open up beds in their hospitals. When it ran out of doctors we asked doctors in other regions to help”Several other nations have approached the Covid-19 pandemic in a similar way, with results very similar to B. This now includes Germany, though it is still in the early stages of its own outbreak.What do folks in Country B think about Country A’s approach?One leader in B’s pandemic response has a daughter studying in Country A. He had this to say:“[Country A] is very late to this. And the president and the officials working on it seem to think they aren’t late. This has both national and global repercussions … [A’s leader] has spoken dismissively about testing because of his ego. As we scientist see it, he’s motivated by pride. The doctors in [Country A] all know that this sort of testing is appropriate … it’s inevitable that [Country A] become like Italy. [Country B] could have become like Italy, but we assessed the situation very quickly.”Turns out he was not far from the truth in comparing Country A to Italy, though it has since surpassed that country in number of deaths per day (updated 5/5/20 - again because after that date, country “A” data include “probable cases” and their numbers suddenly become much higher):One thing that impressed me about Country B’s attitude is their admission of failure in a previous outbreak. In 2015 another corona virus, causing a disease called MERS that carries a 30–40% death rate, broke out in Country B. In their own words: “We were hit hard by MERS because we failed to supply diagnostic kits in time.” Admitting their failure, they did the hard work of preparing much better for the next challenge. And so they did: no constant boasting, no “we’re the best,” just quiet, nose to the grindstone hard work.As Country B plans to re-open their schools in April, they are not self-congratulatory, and not over-estimating things: “This will be with us for a long time. So we all need to find a way to manage it at a status quo level” and “It doesn’t matter that my country is stabilizing and coming to grips with this … the world must overcome this together.”You the reader can decide which country - A or B - gets what kind of mark for its response to this pandemic.What I can tell you is that Country A lost 3,000 lives on September 11, 2001. Covid-19 has so far killed almost 78,000 people there.(recently, Bill Gates’ wife has graded country A’s response to the virus:Melinda Gates gives Trump administration 'D-minus' for coronavirus response)P.S.Country B was South Korea. There were a bunch of clues in the text, but not everyone noticed them.ADDENDUM A: CONTAINMENT AND MITIGATION (illustrated)1. CONTAINMENT:Containment starts with knowing who can spread the disease (25–50% of whom have no symptoms). That means testing. Without large-scale testing, you can’t contain the disease. These are the figures, up to mid-March: the time when containment could have prevented the “exponential explosion” of Covid-19.Please note: the diagram for the U.S. has a different scale (ordinate) from that for South Korea, with U.S. testing peaking at around 2,000 tests.Do you think this difference in testing could have affected the growth of the Covid-19 disease?2. MITIGATION:Google used mobile phone GPS data to observe “Mobility Change” of populations in the U.S. and around the world. The last available data is from April 30, but their graphs only go back 6 weeks, so I present two partly overlapping time frames. Compare the timing of “social distancing” in Country A with Country B:Retail & Recreation:Country A:Distancing began around March 16 …… and was continuing as of April 30 (the last date with data).Country B:Distancing began a month earlier …… and has returned to normal by the end of April.Do you think the one month lead in social distancing helped Country B?ADDENDUM B: IS POPULATION A FACTOR?It is certainly true that bigger countries have more potential entry sites for the virus, hence a proportionality to size in absolute numbers.I chose to go with raw numbers - not standardized for population - because I wanted to demonstrate - and emphasize - the pattern and speed of growth. The virus shows exponential growth whether you look at just the Seattle area, or all of Washington State, or all of the USA - or the whole world, in fact.The virus doesn’t know the population of the country it is attacking, and its exponential growth is not dependent on population size in its early stages. Population effects come into play mostly later on in what is eventually a logistical curve. Until it reaches a significant percent of the population, when herd immunity starts to affect its growth, the population size will not affect the curve.Comparing similar populations (by countries)If one remains curious about comparing similar populations, let me show some data.Four other countries have been using an approach somewhat similar to South Korea, emphasizing early testing and containment: Taiwan, Japan, Singapore and Germany. They (with South Korea) have a total population of 290.5 million, compared with the U.S. 327.2 million. Here is their graph, compared with the U.S. graph (updated 5/5/20):Deaths to date:USA: 68,934countries (total): 7,630 - 9 times lower than USAComparing similar populations (by states)Perhaps you’d like to see the data comparing South Korea to a few U.S. states (updated 4/16/20).Let’s start with the state that has had the most cases of Covid-19, and has a population (19 M) 60% smaller than South Korea’s:No - the graphs are not switched. NY has had 11,909 deaths so far, compared with South Korea’s 229, even though Korea’s population is 2.6 times larger.Let's then move on to America’s most populous state (almost 40 M) - only 23% smaller than Korea’s? Here is the comparison:The outbreak in CA started 6 weeks later than it did in South Korea, yet it is already well past Korea in deaths per day - and rising. The score so far: CA = 829 dead, South Korea 229. And that’s not even correcting for Korea’s 30% larger population.Maybe we should start with the state that was first affected by the virus. You may not find that a fair comparison, because that state has 85% fewer people than South Korea. But let’s compare anyways:Finally, a state whose numbers are near those of South Korea (though WA’s rising death rate has overtaken it). Too bad it took a state with a population 7 times smaller than Korea to find some kind of commonality.Reply