Covid-19, the Territory Anomaly

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?

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.

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.

lomiller said:

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.

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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.

lomiller said:

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

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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.

lomiller said:

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.

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Horatius said:

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

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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.

The Atheist said:

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.

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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.

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)

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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.

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.

Ulf Nereng said:

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.

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Lots and lots of sun.

dann said:

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.

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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.

Ulf Nereng said:

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.

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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.

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.

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.

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 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.

arthwollipot said:

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.

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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.

bruto said:

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.

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

arthwollipot said:

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

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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.

bruto said:

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.

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

bruto said:

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.

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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.

Ulf Nereng said:

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

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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.

angrysoba said:

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.

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

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)