UK Edition
How and why has the approach to coronavirus differed in Asia and Europe?
Cultural, social and political differences have altered how each country has tackled the crisis thus far
To many experts, Europe adopted a worrying “wait and see” approach to coronavirus as it looked on from afar how countries including China and South Korea tackled the epidemic in its early days.
To most governments and people of Western liberal democracies, the shaky mobile phone footage of the apparatus of state ruthlessly enforcing lockdowns in Wuhan was yet more proof of how draconian the oppressive Communist regime could be.
While there is no doubt the secretive Chinese authorities have used their full force to combat the spread of the virus, the fall in infections means China is preparing now to lift some restrictions in the Hubei province, where Wuhan is located.
Meanwhile, many of China’s neighbours and countries in Southeast Asia are also reaping the rewards of introducing affordable testing kits, harnessing technology to trace and isolate the infected and enforce social distancing.
As the UK, Italy, Spain and France, among other European countries, sees coronavirus cases - and sadly deaths - rise, many leaders and their advisors are again trying to see what lessons can be learned from those who have turned the tide on virus cases.
While there are inevitable cultural, social and political differences that come into play in how each country tackles the crisis, with it now classified as a pandemic, the need to learn from others is more crucial than ever.
Lessons learned from SARS and MERS
Unlike huge swathes of Europe, some Asian countries have learned the hard lessons of coping with a highly contagious viruses, like Severe Acute Respiratory Syndrome (SARS) and even Middle East Respiratory Syndrome (MERS).
Many South Koreans, Japanese, Singaporeans and Chinese wear face masks as a matter of course (as well as practice good personal hygiene) following government campaigns in the wake of outbreaks of MERS since 2012 or SARS from 2002. Although, not every country was affected, many took precautionary steps in case viruses spread from neighbouring states.
The Chinese people’s collective memory of SARS made stockpiled face masks, disinfectants and foods commonplace. Singaporeans developed a collective responsibility and willingness to embrace distancing measures after its SARS experience.
Acute Care Beds
Those Asian countries realised how viruses like SARS and MERS, which attack the respiratory system, could severely stretch acute care units, and so boosted the number of care beds. South Korea and Japan have more than seven beds per 1,000 people (7.1 and 7.8 respectively).
It was a salutary lesson that has been ignored largely in Europe. Even France, which prides itself on having one of the best public health care systems in the world has been exposed for having surprisingly few critical care beds: 3.1 beds per 1,000 people (the UK has even fewer at 2.1 per 1,000 people).
Such EU-wide failings were highlighted by Professor Kai Zacharowski, European Society of Anaesthesiology president, recently when he said: “Governments in Europe, including the United Kingdom, have not prepared together for the unbelievable stretch on our health services being caused by this pandemic. We have not been able to organise ourselves in a way to have everything that we need, such as enough ventilators to be able to treat large numbers of patients in acute care at the same time."
Although not quite as remarkable as the Chinese building a hospital in Wuhan in just 10 days, Europe has set about transforming conference centres and stadiums into field hospitals in readiness for the anticipated increase in cases.
Testing and ‘Contact-Tracing’
When Tedros Adhanom Ghebreyesus, the director general of the World Health Organisation, declared “we are at war” with COVID-19 he declared his new mantra: “Testing, testing, testing.” Without tests, he stressed, we would be fighting the virus “blindfolded”.
But testing in Europe has not been that widespread.
South Korea, which boasts of being a democratic republic and has shunned the lockdown favoured by the Chinese, invested heavily in intensive testing programmes.
Drive through testing stations were set up and a cheap and easy kit was introduced. The infected were isolated and treated, as those whom they had contacted were tracked down.
Consequently, the country’s initial spike in cases (in part down to the spread among a secretive religious sect) was swiftly controlled.
China also introduced roadside temperature checks and, with a huge manufacturing industry, produced kits to monitor the spread (although just how open it has really been with statistics on contamination may never be known).
As soon as China reported its first case of the then mysterious virus, Singapore began screening at its borders, as laboratories bolstered their mass testing capacity and set about developing screening kits.
Those with the virus were isolated (even those who were asymptomatic), as “coronavirus detectives” contact-traced those who had come into contact with the infected.
While the UK was praised for ‘contact-tracing’ early on, the country’s supply of testing kits has remained low. President Macron in France was criticised for failing to introduce a coherent strategy for mass testing (he has pledged to ramp it up to 5,000 a day).
Lockdown and Self-Isolation
European countries were slow to impose lockdowns. While the UK is only now seeing police enforce the regime, France, Spain and Italy now even have military units now enforcing the policy.
China restricted the movements of hundreds of millions of people, and in keeping with its ‘Big Brother’ reputation, neighbours were encouraged to inform on those breaking rules. At its peak, only one householder was allowed out every other day to buy essentials.
Singapore, one of the world’s most densely populated places, has just made it a crime to be too close to another person.
Technology
Much has been made of how technology can help in this “war”. Those in isolation with the virus in Singapore are contacted regularly and required to send photographic evidence of their whereabouts. In Hong Kong, new arrivals have been made to wear electronic bracelets to track their movements.
South Korea has an emergency alert system which transmits details of every COVID-19 case to phones to warn if people may need to get tested after contact (names are not included, but details can include where people live or work). In China, mobile apps with green, yellow or red “health codes” determine whether someone is a contagion risk to be quarantined or free to dine out.
Culture, Demographics and Saving Face
There is no doubt every government has considered carefully how best to ensure its people will act in their own best interest. Policymakers will have considered carefully how to harness the unique characteristics of its own people for the greater good.
The French and Italians have struggled to cope with ‘social distancing’. In France where “la bise” - the habit of kissing on the cheek to greet and say farewell - is de rigueur, has meant calls to resist the temptation to kiss or shake hands have taken time to take effect. Elbow bumps replaced handshakes in the UK, before a 2m safe zone ruled such pleasantries obsolete.
However, some Asian countries - where a culture of bowing is the norm - have found it far easier to keep people at arm’s length.
Italy has faced another huge challenge due to its demographics - the nation has the second oldest population in the world. While the mean age of Covid-19 patients is 70, it has been estimated one in five such patients in intensive care beds are under 50 and have no underlying health conditions.
The government in Spain, a country consisting of folk who vehemently defend their liberties, dithered over any lockdown. It refused to cancel marches for International Women’s Day earlier this month. Hundreds of thousands of people took part. Two female cabinet ministers and the wife of Prime Minister Pedro Sanchez tested positive days after attending the Madrid event.
Now, the lockdown is stricter, with more than 100,000 fines handed out for breaches of rules (people are on board as mobile phone footage shows residents applauding from balconies as joggers are arrested). Although, it is said some are hiring out their dogs so stir-crazy neighbours can walk outside without fear of being fined.
Japan has confounded some experts because it initially had so few coronavirus cases. It was certainly slow to respond (despite the first cases being aboard the Diamond Princess cruise ship). The country consistently played down the threat, largely out of concern for the fate of its 2020 Olympic Games and Paralympics.
As soon as the decision was announced to delay it for a year, face was saved and, perhaps inevitably, there was a spike in virus cases. Tokyo has refused to lockdown due to the impact it would have on the economy.
But national government “recommendations” to avoid large gatherings have been heeded, although the cherry blossoms attracted many people to parks, and the national obsession with shopping continues unabated.
Psychology
A World Health Organisation spokesman said every government makes its own decisions based on “context and the evolution of the outbreak” to implement “the most appropriate measures adapted to the local contexts”.
Professor Leila Choukroune, director of the University of Portsmouth’s Thematic Area in Democratic Citizenship, said liberal governments were walking a “tightrope” having to balance the inherent freedoms with the need to tackle what is now a global threat.
“Governments are increasingly derogating from common law,” she said. “In the name of protecting the population, the exception becomes the norm.
“There is a real need to justify these freedom restrictions legally and convince the population of their need.”
As Mr Ghebreyesus, of the WHO, said: “Not distancing alone. Not contact-tracing alone. Not quarantine alone. Not social distancing alone. Do it all.”
Professor Jimmy Whitworth, of the London School of Hygiene and Tropical Medicine, said for some Western leaders - including Boris Johnson - imposing wide-ranging restrictions on freedoms “goes against the grain”. It is, he said, a possible reason why many European governments were slow to lockdown communities until the scale of what they were facing became abundantly clear.
“Now it is here and it’s very much a reality, I think the public is taking these public health control measures very seriously,” he added. “I think the Government here and the general public are determined to get on top of this. We are, after all, trying to minimise deaths.”