When looking at the current spread of Covid-19, new cases and death rates, it is worth noting that Europe currently has 7 out of the top 10 worst-affected countries (including Russia and Turkey), while Asia only has one – Iran.1 With the pandemic originating in Wuhan, China it is interesting to see that bordering countries are not displaying higher numbers of cases. This article will look at reasons as to why this might be.
China is currently the 11th worst-hit country in the world having reported 82,919 COVID-19 cases with deaths standing at 4,633 (as of 13th May).2 COVID-19 cases per million in China are at 58 whereas in the USA, the worst affected country, this number stands at 4,256 raising doubts that China has been reporting incorrect figures. According to academic research undertaken at Hong Kong University’s School of Public Health, published in the Lancet, the true number is estimated to be up to four times higher if the current definition of a COVID-19 case was used from the outset.3 China is not the only country to have potentially underestimated COVID-19 cases and due to differing methodology when counting cases, the UK for example originally only counted deaths recorded in hospitals and were forced to add thousands to the death toll after taking into account cares home deaths and deaths in the community.4
Wuhan became the epicentre of the COVID-19 outbreak in December 2019 and was put into lockdown on January 23rd, 2020. However, this decision to implement a lockdown may have been premature, especially considering that China has the largest amount of international students worldwide and over 120,000 in the UK alone.5 The beginnings of the outbreak coincided with the start of the new university term, seeing many students returning from China to their respective university. European universities have proved popular for Chinese students to attend due to the increased job prospects and cultural enrichment that comes with it.6 There is a reasonable probability that the migration of students from Asia to Europe for final term and exams would likely have been a contributing factor for the virus arriving in Europe as the influence of population mobility has been recorded to play a role in global health.7
It would be a disservice to countries who have been able to control the outbreaks not to detail how this was managed. Singapore, South Korea, Hong Kong and Taiwan were among the first countries to be hit, and although not bordering China (apart from arguably Hong Kong), all have close trade and tourism links with China and the rest of the Western world, presenting the likelihood of increased exposure and the virus.8 Lessons learned from previous epidemics such as SARS in China, Taiwan and Singapore in 2002-2003, and MERS in South Korea in 2015 has meant that these countries were better prepared to respond to COVID-19 – it is also arguably a factor in why the burgeoning COVID-19 was taken seriously at its very early stages.9 These lessons are easily identified when viewing country responses to the COVID-19 outbreak, Taiwan, for example, stopped the exporting of protective masks when the first reports of a new coronavirus began to appear, ensuring that they would have a large enough stockpile for the local population. Temperature checks and quarantines were also swiftly introduced to reduce the spread of the disease.10 The willingness to close borders and introduce measures to interrupt human-to-human transmission were further learned during the SARS and MERS epidemics and have been reflected in the sweeping restrictions to public amenities and quarantine measures seen in Hong Kong, Taiwan, China and South Korea.11 12 South Korea, in particular, have been lauded for their COVID-19 response, the success of which has been realised through rigorous testing to identify and monitor cases. In the early stages, South Korea had the highest number of cases outside of China, but due to extensive testing were able to control the spread.13 The use of technology has also played a part in reducing the spread of the virus with South Korea, Singapore, China and Hong Kong using digital tracking technology, including smartphone location data, credit card transactions and CCTV footage, to track and trace those who have contracted COVID-19.14
Political factors also come into play, not just in the earlier admissions of incorrect figures. Traditions of Confucianism in countries such as South Korea, China and Singapore have helped. According to Sung-Yoon Lee, an international relations professor at The Fletcher School at Tufts University, “In the Confucian civilisation … respect for authority, social stability, conformity, the good of the society and nation above individualism … are an ameliorating factor in a time of national crisis.” 15 When rules are laid out by those in authority, the population follows and few complain. Vietnam has a “culture of surveillance” and Singapore “a nanny state”, both Governments being centralised and unified with their populations accustomed to this obtrusiveness. In comparison, in the Western world, as has been seen in the UK and USA, many have ignored the lockdowns and protest in groups.16 Even in Italy, more than 40,000 people had charges against them for violating the lockdown imposed to contain the virus spread between March 11th and March 17th.17 It should also be noted, the West has a much more tactile society, with hugs, kisses and handshakes, in comparison to the traditionally more formal East. As such, the virus has a greater chance to spread from person to person, contributing to the introduction of the two-metre social distancing rule.18 Due to the traditionally more formal aspect of Asian culture, the opportunity for person-to-person infection is reduced and measures imposed to prevent the spread of the virus has been more easily integrated.
In conclusion, it is not a case of how hard each respective continent has been hit but how quickly and efficiently each has responded to the virus. Countries surrounding China have been able to respond efficiently mainly due to the historic trauma created by the SARS and MERS pandemics enabling those effected to both understand the gravity of the situation, as well as the ability to draw on past lessons, avoiding many of the mistakes seen in Europe’s response to this pandemic. Political and cultural influences have also enabled the quick response to this outbreak with the local populace more open to the use of tracking and tracing, in addition to the differing societal norms which makes day-to-day physical contact less of an occurrence.