News analysis

Various factors at play in decisions to lift coronavirus lockdowns across the world

Each country has to assess its resources and trade-offs to make in effort to save lives, jobs

A vendor arranging containers with sanitiser on a street in the south Indian city of Hyderabad yesterday. The country is now easing a partial lockdown to allow millions of people to return to work.
A vendor arranging containers with sanitiser on a street in the south Indian city of Hyderabad yesterday. The country is now easing a partial lockdown to allow millions of people to return to work.PHOTO: AGENCE FRANCE-PRESSE

Some countries are lifting lockdowns, even as others are extending or reimposing theirs.

The grim numbers that have prompted these actions don't lie. But much depends on which numbers you choose to look at. And in some cases, the key numbers that shape such decisions are economic or even political ones.

Looking at global figures, the United States appears to be the worst off, with more than two million cases of Covid-19 and over 113,000 deaths; and Lesotho in Africa, with a population of two million, is the best performer with just four cases and no deaths.

But such a comparison serves no purpose, as it does not take into account a very important factor: the population size of the country.

A better comparison would be to look at the number of cases and deaths per million population.

But that too throws up some outliers - such as the Vatican City which, with 12 people infected out of a population of 801, is the third worst hit in the world with 14,981 cases per million population.

Similarly, tiny San Marino, nestled in the mountains of Italy, with about 34,000 people, has the highest mortality rate of 1,238 per million population - from 42 Covid-19 deaths.

Having said that, comparing cases and deaths as a proportion of the population does give a better picture of how different countries have fared in the face of the pandemic.

Every country has its own unique problems. South Korea had an explosion of cases arising from a secretive church group. China was the first to face the new virus, but its strict lockdown of Hubei province allowed it to contain the outbreak.

Italy and Spain were caught off guard, resulting in healthcare systems that were overwhelmed. Britain and the United States were slow to react and have large numbers of infections and deaths.


A vendor arranging containers with sanitiser on a street in the south Indian city of
Hyderabad yesterday. The country is now easing a partial lockdown to allow millions of people
to return to work. PHOTO: AGENCE FRANCE-PRESSE

However, all these countries are now lifting lockdowns - though not all have the pandemic under control. For many countries, there are other considerations at play, including social, economic and political factors.

ASIAN GIANTS: CHINA AND INDIA

Overall, China has done much better than India, which has a population that is only slightly smaller but more than double the number of cases.

India has over 267,000 people infected and more than 7,400 deaths, compared with over 83,000 cases in China and more than 4,600 deaths.

Early in the outbreak, China imposed a strict lockdown in the entire Hubei province, causing significant hardship to citizens there.

But this has paid off, with China seeing only a handful of new cases, and these, not even every day, in spite of the easing of its lockdown.

India, on the other hand, had also locked down the country. But this had unexpected repercussions.

Labourers out of work because of the closures had no income and, hence, no food on the table. Tens of thousands started the long march home - walking because public transportation had come to a standstill - and their travelling caused the virus to spread.

 
 

India is now easing a partial lockdown to allow millions of people to return to work, though concerts and sporting events are still banned - despite more than 10,000 new cases and 261 deaths on Sunday alone.

Dr Mike Ryan, head of the World Health Organisation's (WHO) emergencies programme, warned: "As India and other large countries open up and people begin to move, there is always a risk of the disease bouncing back up."

UNITED STATES

The US, which has a population that is less than a quarter that of the two Asian giants, and an economy rated First World, has fared far worse than either of the two, with its over two million infections and over 113,000 deaths. That is more than a quarter of all cases and deaths globally.

The US had its first case in January, and it was only in mid-March that the country declared a national emergency.

President Donald Trump called it a "hoax" when the first case was identified on Jan 21, continued dismissing the seriousness and did not take action till March 17, when he acknowledged the situation as a pandemic.

By then, it was too late, and the infection had spread to all 50 states by the end of March.

American epidemiologists say if measures had been taken two weeks earlier, at the start of March, many of the deaths could have been prevented.

 
 
 
 

With the surge in cases, many US hospitals were plagued by shortages of essential protective gear for their staff and ventilators for Covid-19 patients needing help in breathing, leading to a higher number of deaths.

However, pressure has piled on the government to ease restrictions. Some states have started lifting measures ahead of others, even though their numbers don't seem to warrant it, from as early as late April.

The US is still seeing thousands of new cases and hundreds of deaths from Covid-19 every day - possibly due to the early easing of measures.

It had 19,000 new infections and 586 more deaths on Monday. Of these, 2,279 were in California, followed by Texas (1,486) and New York (1,064).

New York has fared the worst so far, with its 399,892 cases adding up to almost 20 per cent of all the Covid-19 cases in the US. It also has the most deaths: 30,516.

It fares equally badly when these are seen as a proportion of its population, with 20,556 cases and 1,569 deaths per million population.

Epidemiologists fear that the large protests now going on over the death of Mr George Floyd at the hands of the police - in cities like Washington, New York, Chicago, Los Angeles and San Francisco - could spark major waves of Covid-19 transmission.

UNITED KINGDOM

The UK is another country that is pushing ahead with its reopening from this week, even when case numbers remain comparatively high - more than 1,200 newly infected cases on Monday - and in spite of warnings by doctors and scientists that it is too soon to do so.

With 40,597 deaths, the UK has the highest number of deaths from Covid-19 in Europe, and the second highest in the world.

Easing of measures from this week varies in England, Scotland Wales and Northern Ireland, but essentially people can meet outdoors or play games with social distancing of 2m, and some schools have reopened.

Non-essential retailers will be allowed to reopen from the middle of this month. But people entering the country still need to be quarantined for 14 days.

Will this result in a large second wave of infection that many epidemiologists fear?

EAST ASIA

In contrast, South Korea lifted its measures on May 6 when its number of infections had dropped to single-digit numbers, and on some days, zero.

The country had moved fast when Covid-19 spread beyond China. By early February, it was already testing 10,000 people a day.

It has carried out more than one million tests so far, including drive-through testing for motorists.

 
 
 

School reopening was delayed from February to March. But by early March, it was reporting more than 500 cases a day.

Rapid contact tracing and quarantine, as well as strict social distancing, have reduced the transmission of the virus, allowing the country to ease restrictions last month.

The reopening of nightspots resulted in a cluster of about 120 people. But the government decided that so long as the daily numbers remain below 50, and officials were able to trace 95 per cent of all infections, there is no need to reimplement measures.

The number crossed 50 over the weekend.

Japan has managed the pandemic relatively unscathed without a lockdown. It has just over 17,000 infections and 916 deaths. Last month, it declared the emergency over but encouraged its people to continue avoiding the 3Cs: closed spaces, crowded places and close contact. It is still getting about 30 new infections a day.

Taiwan is another place in East Asia that has done well, with 443 cases and seven deaths among a population of almost 24 million.

It was the first in the world to start protecting its population from the pandemic - by screening visitors from Wuhan from Dec 31 last year, and stopping group tours from Hubei province from Jan 22.

Throughout the crisis, it was far ahead of WHO recommendations. It had sent an early warning to the world body, which was disregarded.

Dr Philip Lo, deputy director-general of the Taiwan Centres for Disease Control, said: "If we had followed guidance from the WHO, we would have fallen behind. We wanted to be on top of the virus' development right from the beginning."

Some observers have speculated that aside from rapid action by these places, the cultural practice of wearing masks when out and unwell also helped keep transmission low, with large swathes of the population almost instinctively donning masks as Covid-19 spread to other places from Wuhan in China.

SUCCESSFUL OUTCOME

Professor Teo Yik Ying, dean of the National University of Singapore's Saw Swee Hock School of Public Health, said that in dealing with the pandemic, countries have to consider the impact on their healthcare systems and on the economy, protecting the vulnerable and the wider community, and preserving the livelihoods of their populations.

The difference in performance of different countries is due partly to speed of response, and partly to different priorities.

 
 
 
 

To successfully beat the pandemic, countries need to keep deaths low while ensuring that the economic fallout does not ruin the nation.

Those which had "over-reacted" in the early phase are the least affected. Countries in Europe whose healthcare systems were overwhelmed, such as Italy and Spain, have chalked up high mortality rates.

Their older populations raised the rate of mortality even further as older people are at higher risk of more severe illness.

But countries like Sweden and the US were unwilling to take extreme measures to prevent infections and deaths. By keeping their economies going during the pandemic, they may be poised for a better recovery.

Other countries, especially those in Asia, hope that taking steps to reduce the infections and deaths now would result in better long-term outcomes as it gives researchers time to come up with a vaccine or treatment that could reduce the severity of illness or risk of death.

Which countries have made the better choices in the face of the pandemic that is not going away any time soon - only time will tell.

Each faces different circumstances and has a different population profile.

For some countries, the choices are limited.

A lockdown means no work for the majority, and for some populations, not working means no food for the people and this jeopardises not just the economy, but also their survival. Against that is the fear that a large number of people infected could push their healthcare systems over the brink.

Each country has to assess its resources and the trade-offs it is willing, or is forced by circumstances, to undertake to save both lives and livelihoods.

In the final analysis, it is not a competition where a winner emerges. It is surviving as best as possible till the end of the race.

 
A version of this article appeared in the print edition of The Straits Times on June 10, 2020, with the headline 'Various factors at play in decisions to lift lockdowns across the world'. Subscribe