“How East beat West on Covid-19”. So ran the headline. I’ve seen a number of such articles hailing the triumph of Asian nations, applauding regional case numbers like World Cup football scores. Some even extolled Asian cultures, crediting Confucianism. One article lauding Malaysia quoted a Singapore academic: “Ethnic Malay cultures ... promote banding together against common threats.” Erm, really? That’s how Malaysia beat the virus?
Covid-19 is complex, so comparisons and generalisations are problematic. There’s more behind the case numbers.
I don’t mean to diminish the stellar job in pandemic response from some Asian nations, including Malaysia. But that’s just not the whole story. East and West have different risks – can we compare when the playing fields aren’t level?
Key risk factors causing severe Covid-19 include age, male sex, obesity and underlying disease. Crowded cities accelerate viral spread – highly densely-packed New York City battled explosive spread.
Age is the strongest predictor of severe disease and death. In Asia, populations are young. For example, in Vietnam, 40% of the population is younger than 25 years while only 7% is older than 65 years. Malaysia has similar numbers.
In Italy, 22% of people are in the 65+ age group, triple Vietnam’s figure. This is a group at high risk – they made up 88% of deaths in late August in the European Region, the World Health Organisation (WHO) said. Thus, just by age, you’d expect far more Covid-19 deaths in Italy than Vietnam.
The average age of Italians who died from the virus was 80. Covid-19 is extremely dangerous for people aged 80 and older. US data from August showed deaths in the 85+ age group were 630 times higher than in young adults (18 to 29 years); for those aged 65-74 years, it was 90 times higher.
But how come Japan, with its large elderly population, was not hit hard? Obesity significantly increases the risk of severe Covid-19 – even in younger people. And Japan has one of the world’s lowest obesity rates, as do South Korea and Vietnam, while the United States has one of the highest, with 40% of adults obese.
Obesity rates are also very high in Britain and Mexico, which have suffered high Covid-19 deaths.
Since the pandemic began, studies have reported that many of the sickest patients have been obese. Obese patients fill US coronavirus wards – one US study found 77% of patients overweight or obese.
Also common in Covid-19 wards are patients with noncommunicable diseases (NCDs) such as heart disease, hypertension and diabetes (which are linked to obesity). NCDs are a major global problem, but are particularly bad in Europe and the United States – Covid-19 has highlighted this.
A WHO survey found that among people dying of Covid-19 in Italy, 68% had hypertension and 31% diabetes, while in Spain, 43% of people with severe Covid-19 had heart disease, as did one in five health workers who died.
Experts describe this deadly mix as a “syndemic”, a synergistic aggregation of NCDs and Covid-19.
Interestingly, the region with the lowest Covid-19 deaths is sub-Saharan Africa – it also has the lowest NCD burden and youngest populations with some countries having two-thirds of their populations under 25 years.
Of Covid-19 deaths in Malaysia, 80% had an NCD such as heart disease, diabetes or high blood pressure, Health director-general Tan Sri Dr Noor Hisham Abdullah said in April.
Malaysia has relatively high rates of NCDs and obesity – we were once ignomiously described as the “fattest nation in Asia” by the WHO.
A 2019 national survey found half of adults have abdominal obesity (the worst type of fat), while nearly one in five adults had diabetes. They are at high risk of developing severe Covid-19 if infected.
Disease outcomes also depend on factors such as available healthcare – especially intensive care beds and nursing care. Many died in Madrid and New York City because overwhelmed hospitals could not provide the care needed. In New York City, survival rates were very poor in the public hospital Elmhurst, partly due to a lack of nursing care – patients were found dead in rooms. In Mexico, 80% of those who died from Covid-19 were not intubated or put on a ventilator because of supply shortages.
Public health resources, including testing to track the epidemic, and contact tracing are also key. Many Western nations did not have the resources for extensive contact tracing. In China, Wuhan had a phenomenal 1,800 teams, each with five people.
Some factors are intangible, such as trust between people and the government. Public trust has been a huge issue in the United States, and also in Madrid, where corruption is said to be rife, whereas the public were far more cooperative in Canada, Germany, New Zealand and Scandinavia. Despite political crises and changing governments, this was not an issue in Malaysia as the public rallied behind a “trusted face”, Dr Noor Hisham.
Covid-19 has highlighted the need to protect seniors and to address obesity and NCDs. Measures are needed to improve diets and enable physical activity, such as regulating the food industry and ensuring more people can access more parks easily. For people with obesity, know that even losing a little weight can have a big impact on metabolic health.
Human Writes columnist Mangai Balasegaram writes mostly on health but also delves into anything on being human. She has worked with international public health bodies and has a Masters in public health. Write to her at firstname.lastname@example.org. The views expressed here are entirely the writer's own.