Why do Western countries seem to be less efficient than Asian countries in fighting against COVID-19?

Question

So far it appears that Western countries especially in Europe (e.g. Italy, Spain, UK, France, Germany) struggle to curb the spread of COVID-19. This is in contrast to most Asian countries (China, South Korea, Japan, Singapore) which were hit by the virus earlier, but managed to reduce the contagion through drastic containment measures.

While it's probably too soon to evaluate the effect of the strong measures which have been implemented in the past few days in many European countries, it looks as if Western countries have been reluctant and/or unable and/or inefficient at implementing the methods used in Asia to fight the contagion. It also looks as if Asian countries are expected to be more disciplined and/or organized than Western countries (example).

Are there any objective reasons why Western countries are less efficient than Asian countries in the fight against COVID-19?

Added: For example, are there different political choices which were made before and during the outbreak? Are there structural differences, for instance in the way governments can deploy resources in a crisis?

Answer 1

Part of it is going to be that the region (HK, Singapore, SK?, China) was hit much harder during the 2003 SARS epidemic so spent more time getting prepared.

Also, it has long been the expectation that the next epidemic would come out of China, both due to population density and proximity to livestock/wild animals, so those countries could expect another "gift" from their Chinese neighbors.

Japan? It's relatively unscathed so far, but it is an isolated island, with comparatively few foreigners which isn't on great terms with its Asian neighbors. As @bobsburner mentioned, "travel density" counts for a great deal with covid-19. For now - counting it as luck, might become skill later. Or its success might just be down to not-testing, as @steros says.

Supply chains are in Asia. This is being shown as an Achilles' heel of Western service-oriented economies: if we need to ramp production of electronic testing kits or ventilators, we are cut off from a lot of the world's manufacturing capacity.

Collectivism vs. individualism has a part to play in it as well: it's more difficult for a Western politician to push drastic measures like quarantine (let alone China's dictatorial system). Still, Italy was pretty quick to do so, because they had no choice. Still, the cultural traits leading to quick acceptance by the community of harsh limitations on individual liberties seems to be an Asian advantage at this point:

Here's a Medical Sciences Stack Exchange answer re. isolation, testing and surveillance procedures followed in Guangdong, near HK, so not Wuhan at all. An article partly covering Wuhan itself. And we've heard of the one-week hospitals. We're just not there yet, in terms of mobilization. Or coercion.

Constant deficit spending. A country like Italy is at 130%+ GDP debt. They've resisted pressure to shape up their finances, tax collection, pension payments, etc... for decades. They just don't have anything left to surge spending in emergencies. This applies to just too many European economies.

It's also really too early to say much about the final outcome. Currently South Korea and China are better at getting the disease under control, but what really counts is the long run. If a few dozen people in Wuhan spread the disease rapidly in January then we need to be ready to wait this out for a while - "social distancing & quarantines" for 3 months, then relaxing will result in restarted epidemics.

There's also, esp. at the start, plain luck. The 2003 SARS epidemic hit Canada's west coast less than Toronto, because a doctor got bad vibes about a patient with breathing problems and she isolated them, before any outbreak was known. In Toronto the same type of cases mingled with the general hospital staff and patients and the outbreak was much worse. In Italy 1 covid case was not identified as such and went to the hospital 4 times, interacting with everyone else. S. Korea had a massive cluster early on, but it was within a religious sect, which might interact less with others.

It's hard to really assign a "good vs bad" label to early spread. Past that, the quality of political leaders and their ability to balance out economic/social reality vs medical advice (which is still operating in uncertainty - witness the UK's "herd" approach) is going to be key. This is a good time to be listening to experts, and there some of the Asian technocrats are a definite better bet than some of the West's populists. I know I wouldn't be thrilled to have Duterte in the Philippines in charge, for example, and he's Asian.

Rather than competition and comparisons, it might be useful to see what has been achieved so far: to some extent S. Korea and China have shown that aggressive testing and quarantines can slow the disease, Australia was very quick to sequence the bug's genome, we got a test within weeks! and some Western countries are starting to look at and evaluate candidate vaccines. We are much better off in 2020 than if SARS had had that kind of punch in 2003.

Answer 2

It's difficult to do apples-to-apples comparisons between countries in these matters. Here's an excerpt from a recent CNN article (March 17) contrasting South Korea with Italy and delving into why the comparison (in terms of outcomes) is made difficult by confounding demographics factors:

In South Korea, the rate of testing has been quite high (3,692 tests per million people as of March 8), and its mortality among those infected quite low (about 0.6%, or 66 deaths, at last count).

By contrast, Italy tests about 826 people per million and its mortality among those with diagnosed infection is about 10 times higher, with more than 1,000 people dead from the disease. [...]

But we should be clear that more testing saves lives by preventing the next infection, not by allowing doctors to catch an individual patient earlier. The "treat early" paradigm works when there is an effective drug against the disease. Give antibiotics early for sepsis, you live; wait too long, you die.

The coronavirus, though, has no specific treatment. Indeed, the syndrome of a rapidly progressing lung failure that appears to kill COVID-infected persons is a familiar clinical condition. Many infections and exposures can cause the same problem; ICU specialists have been treating it for years.

So why does Korea, the poster child of testing, have so few deaths while Italy and its late-to-the-table testing program have so many? Is it only because more testing brings mild cases into the "infected" group, diluting the statistical impact of the handful of the very ill?

Doubtful. For now, it is because of vast differences in the affected patients. Soon and increasingly, it also will be due to overwhelmed hospitals and doctors and nurses. [...]

Plenty has already been written about how the population of Italy differs from much of the world. According to a UN report in 2015, 28.6% of the Italian population was 60 years old or older (second in the world after Japan at 33%). This compares to South Korea, where 18.5% of the population is at least 60 years of age, ranking 53rd globally.

The impact of this disparity is quickly shown in the analysis of coronavirus deaths in each county. In Italy, 90% of the more than 1,000 deaths occur in those 70 or older.

By contrast, the outbreak in South Korea has occurred among much younger people. There, only 20% of cases have been diagnosed in those 60 years old and up. The largest affected group is those in their 20s, who account for almost 30% of all cases.

Then there is gender. The gender split in COVID-19 cases worldwide is about 50-50, but there are gender differences in survival. According to data from the original outbreak in China, the overall death rate is 4.7% in men versus 2.8% in women -- a whopping difference. Which is good news for South Korea, where 62% of cases occur among women.

Smoking is another factor clearly associated with poor survival. Smoking rates are about the same between the two countries: 24% for Italians and 27% for South Koreans. But gender differences among smokers are widely different: In Italy, 28% of men versus 20% of women smoke, while in Korea, it is about 50% of men and less than 5% (!) of women.

In other words, South Korea has an outbreak among youngish, non-smoking women, whereas Italy's disease is occurring among the old and the very old, many of whom are smokers. (We do not know the male-female breakdown of Italy's cases).

These basic demographic distinctions explain the difference in death rates between these two hard-hit countries -- as well as helping to explain why Seattle, with its nursing home outbreak, accounts for such a large proportion of US coronavirus deaths.

I'm not sure how much Italy and China differ in terms of lockdown-style measures implemented. See related (and insofar unanswered) question of mine here on that: How much do the Italian and Chinese Covid-19 lockdown measures resemble each other? It seems that Italy has implemented lockdowns relatively early though, and they even claim total success (locally, in terms of further infections) in the areas of those early lockdowns, claims which I am a bit skeptical about (but apparently it's not the kind of skepticism allowed on Skeptics SE, if I'm allowed to digress slightly).

Answer 3

To be honest, I doubt that your basic assumption is correct that Asian countries are handling the crisis much better than European countries. I will focus on Germany in this answer as I have first hand experience ;)

If you are watching media coverage, it indeed seems like everything is out of control. One restriction is following another and as of today everything except for the basic needs is closed. However, this does not match the numbers. For example, take the number of new infections as recorded by the Robert Koch Institut (Source)

In an uncontrolled spread of disease, there should be a huge increase day by day, reflecting an exponential increase. So far the spread resembles much more a linear spread than an exponential spread. Keep in mind as well that - due to incubation time - all reported infections of today were infected before the major restrictions were announced. Last week people were still going to bars and restaurants, going to the gym, working as normal, schools were open, etc. The conditions for an uncontroled spread were a lot better than they are now with everything closed down and people staying at home.

So far it rather looks like the spread is sufficiently contained. Also keep in mind, that one can get too successful at containing a disease. If you lock down everything, the spread may be contained for some time but there will always be some people that are still infected and undiscovered. Once the restrictions are lifted, these people will start a new wave of infection and as only few people were immunized, it will spread fast again.

Answer 4

I'm going to offer several answers, since they can all conceivably answer your question, depending on the kind of answer you're looking for.

First answer: Asian countries reacted more drastically than Western countries

You can see this in the different responses they had to people entering their countries. From China to the UK:

I live in China, where a dramatic lockdown since late January has made it clear that all residents, even those well beyond the epicenter’s outbreak in Wuhan, were in the middle of a global health crisis. The boarding process in Beijing was the final reminder: two mandatory temperature checks and an electronic health statement for which I had to provide an email address and two contact phone numbers.

But as the plane approached London, a sense of unreality set in. The airline distributed a cheaply printed sheet that only advised us to call the usual National Health Service hotline if we felt ill. On arrival, there was no temperature check and no health statement — meaning that British officials would have had no easy way to track us if one of us came down with Covid-19. Instead, we just walked off the plane, took off our face masks and disappeared into the city.

From Europe to China (departure city Moscow, although the person had been moving around Europe before that), after the outbreak in China had been largely controlled and imported cases were a real threat:

"When the plane landed [in Beijing], people in hazmat suits took us off the plane and shuffled us to multiple health check stations. Afterwards, I took my short domestic flight to my city, Ningbo.

"When we landed we were not allowed off the plane. About 20 people, myself included, were called by seat number to exit the plane and were taken for extra health checks and to fill out more paperwork. All of us had been abroad prior to arriving in China but all from different places; France, South Africa, Ukraine. I was told that Germany was put on the high risk list in terms of the coronavirus by China the day before I arrived and I would need to be in quarantine for 14 days."

Smith was taken on an out-of-service public bus and had her own personal police officer and government official, who escorted her back to her apartment complex.

Second answer: Asian countries suffered more from SARS, and learned their lesson

When authorities in Wuhan announced on Dec. 31 that they had detected a cluster of viral pneumonia in the Chinese city, with 27 cases linked to a seafood market, they said the disease was preventable and controllable, with "no obvious signs of human-to-human transmission."

But in wealthy places on China's periphery — Hong Kong, Taiwan and South Korea — a rapid response swung into action.

One reason was that they had learned from the past.

“We were the SARS countries,” said Leong Hoe Nam, an ­infectious-disease specialist at Mount Elizabeth Hospital in Singapore who contracted severe acute respiratory syndrome during the 2002-2003 outbreak. “We were all burned very badly with SARS, but actually it turned out to be a blessing for us.”

See the rest of the source, as well as the first answer, for what they did differently.

Third answer: Asian countries are more willing to prioritize the community over the individual

There is something fascinating about reading Singapore’s government-supplied coronavirus outbreak information. The data is organized as an unfolding, public story tracing relevant details of the known cases of Covid-19 diagnosed there.

The website shares the age, sex and occupation of each person who has tested positive for the virus. It reveals where they travelled recently, and when they sought medical help. It explains when they were hospitalized and when they were discharged. There’s data on their local whereabouts, including whether they attended either of two large church services which appear to tie together two clusters of the disease.

...

The freedom to get information about the disease in Singapore, of course, comes at the cost of patient privacy. The Singapore patients aren’t named, but there’s enough information their identities might be inferred – something that would be scandalous in the United States. News reports also show that in Singapore and elsewhere in Asia, some governments are coercing citizens to disclose their movements in ways that would be unacceptable in a Western democracy.

Source, see also this article

Update June 2020: compare the scale at which China is responding to a new outbreak of a few tens of cases against what Western nations are doing. Chinese authorities are willing to lock down parts of the country & force people into quarantine in response to a small cluster, while Western authorities were not usually willing to stop people from attending BLM protests, even though they know it will further the spread of COVID-19 + they are seeing thousands of cases every day.

Answer 5

The lockdown responses have been less vigorous and slower in western countries perhaps because asian countries are simply more used to epidemics. Here I'm assuming that quarantines and lockdowns are effective in containing the virus, and I believe they are.

The last one to do anything notable in the western sphere was the Spanish flu a century ago, way past society's capacity to remember such events. And that was during war time. The 2003 SARS outbreak didn't impact western countries but it did give a serious wake-up call to east-Asian countries, and that wasn't forgotten, because it's so recent.

Western countries have a much more liberal political culture, lockdowns would be extremely unpopular and simply not followed unless the population generally accepted their necessity. Due to the previous difference in memory, most people won't see these measures as necessary until very late. For this reason, Italy was just unlucky compared to western countries which had time to see what the epidemic was doing to Italy such as Norway.

I think this also makes an interesting point about news coverage: western media in general seemed to focus on the measures taken by the PRC against the virus and not on the effects of the virus itself. Now that the virus has reached Italy, we get some images of old people dying. And that's more likely to convince someone that extreme measures may be acceptable.

PS: yes I know Iran and India are technically Asian countries but you know what I mean.

Answer 6

One measure that a lot of East Asian countries took was closing borders. This is a lot harder in Europe, both practically but also politically. Europeans are really used to spending their holidays in other parts of Europe and freedom of travel and residence is one of the pillars of the European Union. Closing intra-EU borders means you rob many people of their hard-earned vacations. On a political level, it also means a further erosion of the idea of a united Europe.