Europeans in general and Dutch in particular still seem to believe that the Covid-19 is barely more serious than a flu and hardly poses a threat to the continuity of regular social and economic life. Their governments have so far only undertaken soft measures and their citizens have not adjusted their merry lifestyles. A hard look at a number of key facts and figures and experiences in Asia should have taught them otherwise. In spite of cultural differences and contested information, it is imperative that they and their governments draw lessons from elsewhere, wake up and act quickly to avoid long-term disruption and damage.
The beauty of contested information
For an academic, especially one trained in public policy, the appearance of conflicting views of reality, contested pieces of information, incomplete data or contradictory policy recommendations is a fascinating one. It makes for a colorful topic of analysis and a rich, ambiguous interpretation of ‘truth’. That applies, at least, as long as there is no private involvement in the subject at hand. Just over a month ago, when seen from Europe the outbreak of the latest coronavirus was a dramatic event happening in another world. Sufficiently important to hit the national news, but not significant enough for most to justify a quest for fact-finding in epidemiological phenomena and administrative responses to the emerging crisis. What happened in China mattered to China, South Korea and other places in Asia, but how different countries in Asia reacted to the spread of the virus outside China and what the relative effectiveness was of measures undertaken to contain the spread was not a point of reflection. Those who did study it found contradictory standpoints in Asia and Europe on the usefulness of surgical masks. Did they protect efficiently or not? If so, which types and to what extent? Should they be reserved for medical staff or for everybody? Were the reported infection numbers correct or incorrect, results of an honest attempt to count or a dishonest attempt to disguise? Could news reports be trusted? Did contagion only happen when patients had symptoms or also before? Were infectious droplets airborne or not and if they were, at what possible distances? Should authorities keep everyone at home or just potentially affected individuals? Were tough constraining measures preferable for a prosperous recovery of economic activity or should action be postponed as much as possible to honor personal freedom or to acquiesce to the demands of lobby groups? By and large, the picture was that Asian countries preferred caution in interpersonal interaction and stricture in their administrative response to the crisis, even those considered liberal-democratic and/or progressive, while Europeans did not. In Asia, surgical masks and panic were ubiquitous. People sat at home, day after day, shivering with fear and/or bored for not being able or allowed to maneuver outside. And the numbers kept rising, exponentially or incrementally depending on geographic circumstances and government response.
The ominousness of contested information
The meaning of contested information and its relative attraction obviously changes once there are consequences for one’s personal life. Such is now also the case for any study of Covid-19, which has evolved into a pandemic by any standard except in its official qualification. For any European carefully following developments over the past week, intellectual excitement is bound to mingle with private worries. Any search for clarity and truth is fraught with profound questioning, disconcerted discussion and intense debate with family, friends and colleagues.
So in the end the virus did come to Europe, exactly as predicted by most pundits. All of a sudden there was drama in the country of drama. And from Italy on, it gradually began to reach all corners of Europe with the furthest corners generally reached last. Those weeks and days of rising infection numbers, I spent in the Netherlands. As soon as it became obvious that the situation was serious enough in China (as discussed in my previous blog ‘The shadow of a black swan in China’) and might be transferred across its borders, I decided to avoid any flights and all international train-rides except one to France, planned in late February which I was truly unable to resist. All this period long, it struck me that most fellow Dutch were remarkably carefree during the initially slow but sure expansion in Europe. Nobody wore surgical masks, and those who did were ridiculed. Everybody stood close to one another on public transport, talking and laughing, and merry life went on as usual. As far as I can tell, the attitude in the rest of Northern Europe was much the same. To mention Europe and a public health crisis seemed to be a surreal combination, in fact almost a contradiction in terms. It could simply never happen. Dangerous epidemics belong in territories where governments are corrupt, administrative response is unprofessional, decent infrastructure is lacking, medical care is basic, quality of life is low and people are uneducated. Oh my, if only the virus reaches Africa, Latin America and South (East) Asia — then a catastrophe will happen of a size that dwarfs even the one in China.
Europe and Holland in particular, meanwhile, were celebrating. Our cabinet is honest and well-prepared. Hospitals are clean and well-equipped. Universities and schools are alert to any signals from administrative authorities and scientific experts. The vast majority of people are healthy, well-nourished and smart. With a death-rate of 2% globally the world and 0.2% for all individuals under 50 years of age outside China, what could possibly go wrong? Perhaps Covid-19 is not exactly a flu, but its seriousness was at the same level. All those funny foreign scholars and students from China, Iran and other countries who were scared and panicked felt the urge to hide this in public. They should be happy to be in Holland or Europe, which is so much safer than their home country! Ironically, however, they were not feeling safe. How could they be so irrational, emotional or downright silly to give in to the media craze? Stick to the facts, I proudly thought like my sturdy fellow nationals. Be strong and healthy. Regular life should continue untrammeled.
Numbers never lie
Still, I was subject to a nagging anxiety that fluctuated over time. What if it was serious? I have young children at home. What if it is not just a flu but something worse? What if those emotional foreigners are right and the bold Dutch are wrong? This concern was kept alive by an unfortunate appetite I have for numbers. Numbers do not lie, do they? Yes, we know very well that they do, but still. The latest source of international statistics on infection rates, death rates and recovery rates shown in tabular breakdown for all nations and updated at frequent intervals was therefore an intriguing source of inspiration.
The name of the beast was worldometers.info, maintained by John Hopkins University. I feel incompetent to judge the usefulness of surgical masks, I am not an expert in assessing the differential danger of various subspecies within Covid-19 or its relative pros and cons vis-a-vis other viruses, but simple numbers I can read and analyze. And that is what I did. I saw how high the numbers were for China, South Korea, Italy and Iran. I saw that of all inpatient cases, 94% led to recovery and 6% to death. I noticed that the figures for the poor captives on board the Diamond Princess were disheartening. I recognized that the increases in Hong Kong, Singapore, Taiwan and other territories in Asia were generally moderate, increasing only by a few cases each day. I noticed that beyond Italy, the spread in Europe took off in Switzerland, Germany, France, Spain and some Nordic countries. The numbers rose by a few per day initially, but then went into the dozens per day and for the larger countries eventually the hundreds per day. Remarkably high numbers were noted for San Marino and Iceland, given their populations. The Netherlands and Belgium were latecomers on the stage, but when they were hit the same pattern appeared there. At the time of writing, the epidemic is beginning in Eastern Europe. What transpired was a gap between small daily increments in Asia (+1, +3, +4, +6, +9) and large ones in Europe (+12, +28, +46, +91, +244). If South Korea, Italy and Iran were seen to be in deep crisis – because they had cases numbering in the thousands, the origins of infections could no longer be established and their medical systems were flooded with demand they could not handle – then Germany, France and Spain which had already crossed the 500-600 case threshold were perhaps imperceptibly but irrevocably heading in the same direction. The Netherlands and Belgium ended Friday, March 6th with 128 (+46) and 109 (+59) cases respectively. But the boys and girls on the train kept partying.
State of denial
There was something wrong here, so I gathered myself and decided to act. When Chinese and Iranian colleagues turned to me, asking how on earth it was possible that passengers from China Eastern and Iran Air could enjoy unproblematic landings at Schiphol airport – left totally unchecked at customs to freely go anywhere they liked – I phoned a variety of public agencies, including the Dutch advisory for public health made responsible for handling the coronavirus outbreak in the Netherlands (RIVM), the regional health authorities (GGD), Schiphol airport, the Ministry of Transport and Infrastructures and Royal Dutch Customs (Koninklijke Marechaussee). I asked them why flights from such risky locations were still allowed to land in the Netherlands and how on earth it could be that the passengers were not only not checked, but also received no instructions whatsoever. I realized these were sensitive questions so I tried to be as diplomatic as I could. The response was generally along the lines of: ‘we fully understand your concerns, but we cannot say anything substantial on this matter.’ They kindly recommended me to contact any of the other agencies and parties mentioned above. I followed up by asking if I could speak to any policymaker present, to establish what policy or protocol was in place for such situations and whether they would be willing to listen to the ideas and advice of concerned citizens. They would reply: ‘Sorry sir, we are not in a position to do this; let us transfer you to the public relations office.’
It transpired that only airlines themselves decide where they fly (as long as they have a slot at the airport), but neither government nor airport authorities impose any restrictions nor have any intentions of doing so. I discovered that Royal Dutch Customs have no protocol in place to check individuals who land if they do not report feeling unwell or request any counselling or advice. They would only have such a thing in place if it were enacted by GGD, but it is not. Taking responsibility is not a sexy thing for public agencies. Is Holland a living medical lab? Yes, it is. But not just Holland; Finland is in exactly the same situation. It has roughly the same (absence of) regulations in place and people seem to find it normal, according to a Finnish colleague of mine. Some other countries in Europe like Belgium are somewhat more cautious, asking people to self-quarantine, but not by very much. Personal freedom, strong economic lobbies, lack of initiative to regulate and general disbelief that things can go wrong prevail. Is Europe really well-prepared for crisis? There is ample evidence of local GGDs sending people back home because they do not have sufficient capacity to examine potential patients. In addition, there are a number of stories, some of which were relayed to me in person and one mentioned in a question of a Dutch MP in the Second Chamber of Parliament, suggesting that they were asked to keep their problems secret to avoid arousing public concern. Are the reported Dutch numbers on www.worldometers.info even reliable?
Food for thought and action
There may not be an imminent threat to life for many when the average death-rate is 2% (or is 6%?), but it is still sad if grandmother dies before her time. Infection rates are possibly still moderate at this point and the healthcare systems can still handle the pressure (or can they?), but it is very likely they will be unable to cope with people flooding in when Germany, France and Spain cross the 2,000 case number and the Netherlands, Belgium, Switzerland and Sweden break 500. We could learn lessons from Wuhan, Daegu, Qom and Milan. Why don’t we?
Europe, wake up. Wake up!