Covid-19, the Territory Anomaly

[The Atheist]

This is something that's been bugging me for some time, and the subject keeps getting lost in the general thread, so I'm posting separately to try to get some help figuring out what's going on.

There are four glaring examples of places that should be knee-deep in corpses, but aren't.

Japan, Australia, Canada & Hawaii.

Japan has had the schools closed, while Australia & Hawaii have not. All three have had far weaker social distancing/shutdown rules than almost all other territories. (I'm excluding SK, HK & Singapore, as they acted differently from the start.)

All of Hawaii, Australia & Japan are massive destinations for Chinese tourists - which is unquestionably how everywhere else has been infected, and in the case of Japan, were very early starters in the infection stakes. Canada has the same massive Chinese diaspora that led to them getting hit by SARS.

The populations of the four couldn't be more diverse, although Aussie & Canada are pretty similar. Japan & Hawaii's numbers should look like NYC, while Aussie & Canada should look more like USA, yet none of that is happening.

The infection rates in all those countries aren't rising as fast, the disease has an infinitely lower mortality rate and they are not being as badly impacted as over 100 other nations.

Canada could be a result of superior testing and tracing as in Germany & South Korea, but that's not the case for Australia, Japan & Hawaii. Aussie is testing now, but they lagged behind for ages and even let a load of infected passengers off a cruise ship, following Japan's lead, but no explosion of cases.

Nothing makes sense - different climates, different populations, different genetics, different demographics...

It seems to me the answer - if there is one - might be quite important.

Any suggestions?

[lomiller]

Just opinion/random thoughts so take it for what it’s worth

Cultural differences could play a role with Japan. Also in Japan, apparently most people are using masks, while this doesn’t offer much protection from the virus it probably does reduce the likelihood of an infected person spreading it. It may even be a more effective strategy then social distancing.

If warmer temperatures slow the virus, that could play a role in Australia and Hawaii.

Luck could also be a factor sine the initial spread outside of China was likely due to a small number of infected travelers, so where they went could make a big difference in when the virus arrived in a given country.

In all cases the extent of infections isn’t well knows, so it’s still far to early to draw any real conclusions.

ETA

Canada was hit by SARS so there would have been a greater level of preparedness in the major destinations for international travelers, particular Toronto and Montreal. At least on ER physician I heard on a podcast was specifically talking about Toronto being on a high level of alert early on in the pandemic specifically because of their experience with SARS.

[Horatius]

I think the biggest factor in how well Canada is doing relative to the US is purely down to having actual leadership. There simply isn't the same level of blame-shifting and infighting going on, and as such, the community is doing fairly well in figuring out what we need to do to combat this thing. We're not hearing 10 different things from every level of government*. We're not perfect, but we don't have people actively packing churches in defiance of medical recommendations, either.


*I'm actually getting near-daily e-mails from my local city Councillor, that includes a detailed breakdown of what every level of government is doing, from the city council right up to the Federal government. Each level has its own areas of unique concern, and they're not stepping on each other's toes, but there's also a lot of overlap, with consistent messaging in those areas. The contrast to what I see on CNN every day is stark.

[The Atheist]

Originally Posted by lomiller

Cultural differences could play a role with Japan. Also in Japan, apparently most people are using masks, while this doesn’t offer much protection from the virus it probably does reduce the likelihood of an infected person spreading it. It may even be a more effective strategy then social distancing.

Yet, they're still crushing people into trains, and the people in Japan we've had posting suggest people aren't being very careful at all.

Originally Posted by lomiller

If warmer temperatures slow the virus, that could play a role in Australia and Hawaii.

I'd certainly considered that, but Dominican Republic is warmer than either and they're a mini-Italy. There are others as well.

On the other hand, the early community spreads outside China definitely started in colder places - the ski areas in Wa. north Italy & Hokkaido, and in NYC, which was fairly chilly when it got established.

Originally Posted by lomiller

Canada was hit by SARS so there would have been a greater level of preparedness in the major destinations for international travelers, particular Toronto and Montreal. At least on ER physician I heard on a podcast was specifically talking about Toronto being on a high level of alert early on in the pandemic specifically because of their experience with SARS.

Originally Posted by Horatius

I think the biggest factor in how well Canada is doing relative to the US is purely down to having actual leadership.

I threw Canada in as a last-minute addition, and the reasons above may well be right. Canadians I've met are a touch more sensible than some other people as well.

[dann]

Originally Posted by The Atheist

Yet, they're still crushing people into trains, and the people in Japan we've had posting suggest people aren't being very careful at all.

Not a lot of hugging or touching in general, unlike Spain and Italy, for example, except for the subway. Shaking hands is probably a western habit that they've given up in this situation.

Quote:

Do not stand close to a Japanese person. Avoid touching.
Prolonged eye contact (staring) is considered rude.
Don’t show affection, such as hugging or shoulder slapping, in public.
Japan (eDiplomat)

[Ulf Nereng]

Perhaps something will come out of comparing with other, "similar" diseases such as flu and common cold? How prevalent are these in the countries you mention compared to other countries?

Perhaps vitamin D is a factor? Japanese eat a lot of fish and Australia has just had summer. Not sure about Canada, but maybe they add vitamins to staples like milk and butter. No idea about Hawai.

[JeanTate]

Echoing what's already been said, Japan seems a real outlier, but I guess we'll see in the coming week or three (maybe something like the US, but from a higher number of known cases).

Canada may only appear to be an outlier when compared with the US; in this case, it's the US which is the outlier ... due to far too little testing, the virus spread far and wide without being recognized. For how easily this happened, I saw an item on some news channel or other showing where a bunch of people on a beach in Florida (Miama?) went in the next 48 (?) hours.

Australia? Banned flights from China early (about the same time as the US, from memory), and while checking those disembarking from cruise ships was a massive fail (fixed now I think), in general haven't the Aussies been more rigorous about contact tracing? And while the Federal government hasn't "advised" closing schools etc, at least one state has, hasn't it (Victoria)?

Oh, and let's not forget Macau and Taiwan.

[alfaniner]

Originally Posted by Ulf Nereng

Perhaps something will come out of comparing with other, "similar" diseases such as flu and common cold? How prevalent are these in the countries you mention compared to other countries?

Perhaps vitamin D is a factor? Japanese eat a lot of fish and Australia has just had summer. Not sure about Canada, but maybe they add vitamins to staples like milk and butter. No idea about Hawai.

Lots and lots of sun.

[The Atheist]

Originally Posted by dann

Not a lot of hugging or touching in general, unlike Spain and Italy, for example, except for the subway. Shaking hands is probably a western habit that they've given up in this situation.

I hope everyone gives up the idiotic idea.

I've tried to get traction against the practice for decades, but nobody every bought into it.

Originally Posted by Ulf Nereng

Perhaps something will come out of comparing with other, "similar" diseases such as flu and common cold? How prevalent are these in the countries you mention compared to other countries?

Perhaps vitamin D is a factor? Japanese eat a lot of fish and Australia has just had summer. Not sure about Canada, but maybe they add vitamins to staples like milk and butter. No idea about Hawai.

As noted, a lot of vitamin D in Hawaii.

I mentioned vitamin D a couple of weeks ago as a potential reason but discounted Japan due to winter; the fish idea never occurred to me. Now I see it's a good source, you might have provided a piece of the puzzle!

Hope so - I've been ensuring the family spends as long as possible in the sun while we still have near-summer going on here. If NZ & South Africa conform to the same pattern - and they might well do, but a bit early to tell - it might well be the answer I'm looking for.

[Ulf Nereng]

If the hypothesis is correct we should expect to see better outcomes in populations that tend to eat much fish, such as Eskimos. Except I'm not really sure that they do that still. I wonder if there are databases with information about diets in various parts of the world. It could be a massive research project finding out rates of vitamin D deficiency in different populations.

Suppose that 30% of the population of country A don't get enough vit D, while only 10% of country B has that problem. I don't think that is too far-fetched even in our modern societies. Would it lead to a triple fatality rate in country A? Everything else being equal, of course.

[angrysoba]

Vitamin D? Seriously?!

That sounds rather woo-ish to me. The kind of answer that would be very convenient to the supplement industry (which is massive in places like the US, right?).

I'm not saying it can't be right.

[arthwollipot]

It's hard for me to grasp the idea of a large industry dedicated to producing and selling a substance that humans can make naturally just by going outside.

Actually scratch that. It's not hard at all.

[rjh01]

If it is related to vitamin D or winter then Australia could be in trouble in a few months. The lockdown will come off and the virus will start spreading and do so rapidly.

But in Australia's case there is a lot of testing going on. So most cases are picked up. They are stopped from spreading it by isolating themselves. But if many cases are missed and they do not isolate themselves then they will spread it far and wide.

[bruto]

Originally Posted by arthwollipot

It's hard for me to grasp the idea of a large industry dedicated to producing and selling a substance that humans can make naturally just by going outside.

Actually scratch that. It's not hard at all.

If you live in a part of the world where winter days are short, frigid and overcast, it might not be as easy to get your dose of D as it is for someone in sunny Australia.

Here in Vermont even if you go out in the winter without bundling up the extra vitamin D will be a poor tradeoff for freezing to death.

e.t.a. I also wonder, as has been suggested elsewhere, how much just depends on who has turned up where. If, as presumed, the virus was spread by Chinese travelers initially, perhaps there are some places where they just didn't get to, or at least didn't get to before social distancing reduced the spread. It might just be luck, or too soon to know.

For example, I just got back a while ago from a trip in Chile and Argentina, most of it on a ship. It was a small ship, only about 100 passengers and 70 or so crew and staff and whatnot. The trip started before there were any cases where we were and we brought none with us, so because we had no illness at the start, we had none for the while time and needed no precautions. IF one had been ill, all would have changed, as it has happened on many other ships.

[arthwollipot]

Originally Posted by bruto

If you live in a part of the world where winter days are short, frigid and overcast, it might not be as easy to get your dose of D as it is for someone in sunny Australia.

That's a stereotype. For example, in the summer past, we weren't getting much vitamin D either through the thick bushfire smoke.

[bruto]

Originally Posted by arthwollipot

That's a stereotype. For example, in the summer past, we weren't getting much vitamin D either through the thick bushfire smoke.

Of course it's a stereotype, but you are the one who seemed unable to imagine a scenario in which one might not get enough D just by going outside.

[arthwollipot]

Originally Posted by bruto

Of course it's a stereotype, but you are the one who seemed unable to imagine a scenario in which one might not get enough D just by going outside.

That's true. I do tend to neglect the extreme high latitudes in my thinking.

[angrysoba]

Originally Posted by bruto

e.t.a. I also wonder, as has been suggested elsewhere, how much just depends on who has turned up where. If, as presumed, the virus was spread by Chinese travelers initially, perhaps there are some places where they just didn't get to, or at least didn't get to before social distancing reduced the spread. It might just be luck, or too soon to know.

I can tell you from experience that downtown Osaka is very much NOT a place that Chinese travelers don't get to.

And that goes double for places like Kyoto which has huge numbers of tourists from China.

And Australia? And Canada? And Hawaii?

No way! Those are all popular places for Chinese tourists and those who live there part of the time.

[The Atheist]

Originally Posted by Ulf Nereng

If the hypothesis is correct we should expect to see better outcomes in populations that tend to eat much fish, such as Eskimos.

I'm looking at sunny countries, and there are a couple of others that are showing pretty flash stats:

Chile - 2449 cases, 8 dead, 14 critical
South Africa - 1300 cases, 3 dead, 7 critical

Given places like Dominican Republic with 900 cases and 42 dead, it might be a part answer.

Originally Posted by angrysoba

Vitamin D? Seriously?!

That sounds rather woo-ish to me. The kind of answer that would be very convenient to the supplement industry (which is massive in places like the US, right?).

I'm not saying it can't be right.

I think there's good evidence that you can't supplement your way out of it.

[dann]

Sunlight may play a role but for a different reason: virus in the air or on surfaces exposed to the sun. The Influence of Simulated Sunlight on the Inactivation of Influenza Virus in Aerosols (Journal of Infectious Diseases, Nov. 28, 2019). Some journalists seem to confuse this with killing virus that has already infected the body, which is impossible, of course.
Also, in the summer people people tend to go outside where the aerosols are quickly dissolved unlike indoors.
As for the eskimos: 2020 coronavirus pandemic in Greenland (Wikipedia)

[angrysoba]

Originally Posted by The Atheist

I think there's good evidence that you can't supplement your way out of it.

You can supplement your way out of a vitamin D deficiency for those who have one. I am sure you don't mean you can supplement your way out of getting the coronavirus.

And yes, that vitamin D deficiency does disproportionately affect the elderly but there are many other physical ailments that affect the elderly and it wouldn't explain why Japanese and Canadian elderly are not as badly affected.

Also, are not other groups such as pregnant women and children also susceptible to vitamin D deficiency?

ETA: Sorry, re-read your post and realize I misread it the first time. I'll leave it as it is, though, as it still includes my skepticism about vitamin D having anything to do with COVID-19. I should also say that I recently had a Zoom chat with someone I know who is allows following fad diets such as paleo and keto, who was trying to push his "immune system booster" vitamin D supplements.

[pipelineaudio]

Originally Posted by The Atheist

Japan has had the schools closed, while Australia & Hawaii have not. All three have had far weaker social distancing/shutdown rules than almost all other territories. (I'm excluding SK, HK & Singapore, as they acted differently from the start.)

Hawaii finally shut the schools last week, we were at 5 cases I think and now were at 200. Its going exponential, still mostly travel related, but not for long.

They have the locals locked down, while telling the tourists to self quarantine, and of course they aren't

[pipelineaudio]

Originally Posted by lomiller

Cultural differences could play a role with Japan.

Culturally I actually suggested that Italy and Hawaii would be the worst places of all due to how they greet each other. And days later italy went up like a roman candle but hawaii didn't. Its bizarre, but maybe it was just waiting and is about to whack us with the biggest banhammer

[Puppycow]

Originally Posted by pipelineaudio

Hawaii finally shut the schools last week, we were at 5 cases I think and now were at 200. Its going exponential, still mostly travel related, but not for long.

They have the locals locked down, while telling the tourists to self quarantine, and of course they aren't

https://i.imgur.com/1tpsFit.png

How much is the Hawaiian economy dependent on tourism? Are tourists still arriving in large numbers?

[carlosy]

Originally Posted by alfaniner

Lots and lots of sun.

Like in Italy, Spain and France?

[pipelineaudio]

Originally Posted by Puppycow

How much is the Hawaiian economy dependent on tourism? Are tourists still arriving in large numbers?

Quite a bit is tourism. I think we are still having 4000 arrivals a day though many planes are coming in empty. You really aren't supposed to go out in hawaii right now, tourist or not, we have stay at home orders, it makes no sense to have these people still coming in. They are making the hotels money but all the regular tourist shops are forced closed.

It had to be extremely difficult to take any "anti-tourist" measures at all for The Missile Button Governor, and at first he allowed the infected cruise ship passengers to go cruising around our malls. But I think these are silver linings, its WAY past time Hawaii did ANYTHING else than tourism. Open any trade catalog and likely there is NOTHING at all from hawaii. maybe this can finally change that

[Pixel42]

The reasons why some countries fare better than others may well turn out to be different in each case. It's certainly worth trying to identify a common factor, but keep in mind there simply may not be one.

[Ulf Nereng]

Originally Posted by Pixel42

The reasons why some countries fare better than others may well turn out to be different in each case. It's certainly worth trying to identify a common factor, but keep in mind there simply may not be one.

I agree with this. It is likely that several factors are involved. Overall health of the population, standard of healthcare system, government response to the epidemic, cultural differences that may help or inhibit the virus, seasonal differences, and probably some others that I'm not clever enough to think of.

I looked at Worldometers life expectancy by country as that should say something about overall health in them: https://www.worldometers.info/demogr...fe-expectancy/

Italy and Spain are 6 and 7 on that list so one would think they'd have a good starting position, but that was evidently nixed by piss poor government reaction to the epidemic.

[Darat]

Originally Posted by arthwollipot

It's hard for me to grasp the idea of a large industry dedicated to producing and selling a substance that humans can make naturally just by going outside.

Actually scratch that. It's not hard at all.

It’s an issue in the UK. Government even provides vitamin D supplements for free for people on benefits. Cases of rickets have been increasing and the consensus seems to be that a healthy diet will only provide about 10% of the recommended daily amount and because kids aren’t playing out as much, especially during winter and autumn they aren’t producing enough either.

[dann]

Originally Posted by Ulf Nereng

I agree with this. It is likely that several factors are involved. Overall health of the population, standard of healthcare system, government response to the epidemic, cultural differences that may help or inhibit the virus, seasonal differences, and probably some others that I'm not clever enough to think of.

I looked at Worldometers life expectancy by country as that should say something about overall health in them: https://www.worldometers.info/demogr...fe-expectancy/

Italy and Spain are 6 and 7 on that list so one would think they'd have a good starting position, but that was evidently nixed by piss poor government reaction to the epidemic.

If we focus on Scandinavia, why does Norway appear to be doing so much better than Sweden and Denmark?
Lynoverblik: Dagens tal og vigtigste nyheder om coronavirus - yderligere 34 døde i Sverige (Sundhedspolitisk Tidsskrift, March 31, 2020)

Quote:

Denmark
Infected: 2.815
Dead: 90
Sweden
Infected: 4.028
Dead: 146
Norway
Infected: 4.494
Dead: 34
Nyeste corona-tal fra Danmark og verden: Så mange er smittede, døde og indlagte (TV2, March 31, 2020)

Does Norway test and thus find more cases than the other countries, which would make the death rate appear to be lower?
I considered if it might be related to smoking:
See "Figur 1": Her er dokumentationen for bedste forebyggelse: Cigaretter skal koste minimum 80 kroner pakken (Videnskab.dk, Sep. 20, 2019)
But then I saw this: Smoking Rates by Country 2020 (World Population Review) Fewer Danes than Norwegians and Swedes smoke, apparently.

Population density? Do fewer Norwegians live in big cities?
Public transport?
Health care?
In the case of the Scandinavian countries, I don't think that exposure to sunlight would be very different, but Norwegians might eat more fish than Swedes and Danes.
The number of ski tourists in Ischgl, Austria: Fewer Norwegians than Danes?

[JeanTate]

Originally Posted by The Atheist

This is something that's been bugging me for some time, and the subject keeps getting lost in the general thread, so I'm posting separately to try to get some help figuring out what's going on.

There are four glaring examples of places that should be knee-deep in corpses, but aren't.

Japan, Australia, Canada & Hawaii.

<snip>

Any suggestions?

My #1 suggestion: compile reliable data.

My #2 and #3 suggestions are the same.

#4: write down a testable hypothesis; try to do so without looking at any of the data. A central part of "testable" is "quantitative", even if it's just OOM (order of magnitude).

Comment: without reliable data and a testable hypothesis, you're at least half-way to woo-woo land.

[Ulf Nereng]

The number of tests performed in Norway at the time of writing this is 90242. Norway is obviously less densely populated than Denmark, and we see that most cases of coronavirus are concentrated in Oslo and Viken (region around Oslo), and the larger cities on the west coast.

Public transport is still running, but with far fewer passengers, making it possible to "social distance" when riding them.

Thanks for the link to that smoking statistic! I'll take a closer look at that later.

[dann]

The number of tests in Norway, 90,242, is amazing! Denmark: 23,763. (For the rest of you: Norway: 5.368 million inhabitants, Denmark: 5.823 million)

They understood much too late that proper testing of as many as possible helps immensely against spreading the virus. They also didn't have the tools for testing more than a very limited number of people. I'm not even sure that they have the tests now. The number of infected will rise significantly when they get them.


ETA: France, Italy and Spain, in partcular, have a higher percentage of smokers than Scandinavia.

[Ulf Nereng]

This is the webpage I go to to see information from Folkehelseinstituttet (loosely translated to english as "People's Health Institute"): https://www.fhi.no/sv/smittsomme-sykdommer/corona/

The numbers are lagging about 24 hours behind, though. The graphs still give a good picture of what's going on. The best are in "Dags- og ukesrapporter" (Dayly and weekly reports).

[dann]

The number of Norwegians tested positive, 4,447 (of 90,242 tests), is probably much closer to the actual number of people infected than the Danish number, 2,860 (of 24,175).

[bruto]

It will be interesting to see how it all develops, as I seem to recall that a favorite winter destination of Norwegians is Spain.

I still wonder if some of this is just a matter of the oddities of distribution, which can change quickly with time. If the vectors of spread don't happen to happen in a certain place, spread won't. One chance change can change a lot in a hurry.

I wonder if there's a version of Conway's "Game of Life" that mimics the spread of this virus.

[dann]

Originally Posted by bruto

It will be interesting to see how it all develops, as I seem to recall that a favorite winter destination of Norwegians is Spain.

I still wonder if some of this is just a matter of the oddities of distribution, which can change quickly with time. If the vectors of spread don't happen to happen in a certain place, spread won't. One chance change can change a lot in a hurry.

I wonder if there's a version of Conway's "Game of Life" that mimics the spread of this virus.

Of Danes, too. I was in the Canaries, Lanzarote, Dec-Jan this year. I think that's where most Scandinavians go in the winter, but the Canaries didn't seem to have been infected until an Italian tourist brought the virus to Tenerife in late February. (I had considered going back for a week or two when this case came to my attention.) At this point, the Canaries have many cases, but tourism has stopped almost entirely, at least from Scandinavia.
Madrid and Barcelona have the most cases and deaths.
El mapa del coronavirus en España: 8.269 muertos y más de 94.400 casos

[lomiller]

WRT Australia they have performed 9600 tests per million people vs 3100 per million people in the US

[lomiller]

Originally Posted by dann

If we focus on Scandinavia, why does Norway appear to be doing so much better than Sweden and Denmark?
Lynoverblik: Dagens tal og vigtigste nyheder om coronavirus - yderligere 34 døde i Sverige (Sundhedspolitisk Tidsskrift, March 31, 2020)



Does Norway test and thus find more cases than the other countries, which would make the death rate appear to be lower?
I considered if it might be related to smoking:
See "Figur 1": Her er dokumentationen for bedste forebyggelse: Cigaretter skal koste minimum 80 kroner pakken (Videnskab.dk, Sep. 20, 2019)
But then I saw this: Smoking Rates by Country 2020 (World Population Review) Fewer Danes than Norwegians and Swedes smoke, apparently.

Population density? Do fewer Norwegians live in big cities?
Public transport?
Health care?
In the case of the Scandinavian countries, I don't think that exposure to sunlight would be very different, but Norwegians might eat more fish than Swedes and Danes.
The number of ski tourists in Ischgl, Austria: Fewer Norwegians than Danes?

Tests per million people
Denmark 4800
Norway 15800
Sweden 2900

[angrysoba]

Originally Posted by JeanTate

My #1 suggestion: compile reliable data.

My #2 and #3 suggestions are the same.

#4: write down a testable hypothesis; try to do so without looking at any of the data. A central part of "testable" is "quantitative", even if it's just OOM (order of magnitude).

Comment: without reliable data and a testable hypothesis, you're at least half-way to woo-woo land.

Thanks for that! For some reason, that one thing you said suddenly helped me understand a concept I had heard but not really understood which is "overfitting".