As the coronavirus crisis progressed, levels of contagion have fluctuated and restrictions proliferated. But the idea has always been present that being able to differentiate between countries that manage it well and those that cannot be used to draw conclusions.
And it is that historians of the future will surely find it difficult to know why Western European countries with similar economies have produced such drastically different results so far.
We use international comparisons constantly, of course. They are a way of measuring how governments are doing. But even comparing the simplest data can be complex.
There may be differences in how and when deaths are reported, how the causes of death are reflected on death certificates, and how long it takes from a positive test to the death of the patient to consider covid as the cause of death. All these factors will influence the results of a country at any moment in which you want to evaluate it.
So far, the differences between the two countries seem surprising.
The death rate in Germany is around 11.5 deaths per 100,000 people, while in neighboring Belgium it is 7 times higher (87 per 100,000). France is at an intermediate level, with around 48 per 100,000, while the United Kingdom is nearing the top of the European table with 63.3 per 100,000.
They are all prosperous countries with capable health systems, and all have implemented similar measures to combat the virus, with a combination of closures, social distancing and tips to improve hand hygiene. In some localities, all of this has been reinforced with curfews.
But the more you look at the data, the harder it becomes to explain the differences.
For example, Lombardy and Veneto are two neighboring regions in northern Italy, but they present striking differences. The death rate in Lombardy reaches 167 per 100,000 people, while that of Veneto is 43.
Perhaps due to this difficulty in explaining the numbers, the view in Germany about whether it is doing better than other countries is much more prudent than you might imagine. One factor, it is recognized, may be opportunity: how quickly action is taken can be just as important as what action is taken.
The prestigious German scientist Christian Drosten put it this way in the days leading up to the World Health Organization summit this month in Berlin: “There are already speeches celebrating German success, but it is not very clear what they are based on. moved with exactly the same measures as others. We haven't done anything particularly well; we just did it before. “
Germany has an extensive diagnostic testing system, a well established and staffed public screening system, and more intensive care beds than most countries.
But it may have been just as important that Chancellor Angela Merkel, one of the few world leaders with a background in science, can interpret the data herself.
Germany has a lower contagion rate than neighboring countries.
In a press conference after meeting with the heads of the governments of the federal states that make up Germany, he began one of his answers: “I am simply carrying out a calculation model.”
He then went on to talk about the mathematical logic behind the exponential growth of a pandemic, concluding with the warning that his country might need to take additional measures. He was careful to describe the situation as “urgent”, but not dramatic.
Drosten says that a population that feels well-informed will be more inclined to comply with government instructions.
“I'm reading about a level of support for the measures of 85 or 90%; it is a huge achievement. Everyone knows someone in their own circle who does not accept the measures, but you can talk to them, and it is what we should be doing. I think it's one of the biggest advantages we have in Germany. “
Professor Drosten stresses that the question is whether science meets society. In other words, it is not about the tools the government has, but how the country reacts when the government uses them.
We raised this question with Professor Yves Van Laethem, an adviser to the Belgian government, and he said that the Belgian government may have confused the public by changing their messages too quickly and too often.
“People wonder why”
Van Laethem said that sustainable and stable measures were needed as winter approaches but the willingness of Belgians to accept more changes in the rules had lowered, a phenomenon that is also detected in the United Kingdom and other countries.
“The government proposes something and immediately there is a dispute … in March and April people were so scared that they followed the rules without protesting so much. But now people see that while the cases go up, the death rate remains low and he wonders why they have to do all those things. “
Perhaps that is what explains why Belgium became one of the few countries to relax restrictions just as fears of a second wave grew in the autumn.
Since the end of July, the use of a mask in open and closed public spaces was mandatory in Belgium . You would have to carry it even if you were walking alone through a deserted park in the middle of the night.
Since October 1, those rules have been relaxed. Now they are still mandatory in shops and public transport, but in open spaces only when there are many people.
Instead, after months of resisting, their neighbors in the Netherlands began to toughen their rules, recommending the use of masks in shops and buses.
Swedish chief virologist Anders Tegnell received criticism early in the pandemic, but time seems to be proving him right.
Anders Tegnell, the chief virologist in Sweden, received criticism from those who demand coherence and sustainability from the authorities in the measures to be applied.
His advice to allow bars and restaurants to open and not force the use of the mask was questioned by many in the first phase of the pandemic, but seems increasingly supported by the evidence available in the second.
Of course, it is a myth that the Swedish government “did nothing” in response to the crisis. It has taken steps to slow down the virus, including social distancing and promoting hand hygiene. Tegnell highlights the importance of “giving a lot of influence to the population” in the design of these measures.
The quiet sense of community in Swedish political culture can make the virologist's job a little easier and raises an interesting question about the extent to which the outcome of events is determined not only by government action but by reaction to it once. have been announced.
If the Swedes and Germans can be trusted to accept their governments' orders and advice, what about societies where governments are viewed with the most skepticism, where opposition parties, trade unions, tabloids and angry local officials in the most affected areas they reject the decisions of the central power?
“It's too soon”
In France, for example the Minister of Health, Olivier Veran, announced new restrictions on the populous coastal area surrounding the city of Marseille without consulting the local authorities. The partial closure includes bars and restaurants.
The president of the regional government, doctor Renaud Muselier, described the decision as “inappropriate, unilateral and brutal”, warning that it would provoke a feeling of “revolution and revolt” among the population.
Of course, this is not just an academic debate on epidemiology. Marseille sees itself as a rival to distant Paris and it will never be difficult to find there a sense of resentment towards the central Parisian power.
But it will be interesting to see what effect, if any, the hostile local reaction to the government's decision has.
It is too early for comparisons. Maybe that is possible next year, maybe we have to wait for 2022, but not now
In short, at this stage of the pandemic, there are all kinds of difficulties in making international comparisons.
Even something as basic as social distancing is complex. France, Germany and the United Kingdom, for example, have different measures in place on this (one meter, one and a half meters, and two meters respectively). But figuring out which one is correct and how to find the balance between minimizing risk and discomfort will take months, or perhaps years of study.
The problems of making such comparisons surprised me on one occasion when I was in the Belgian Parliament with one of the country's leading politicians. That day, British scientists and politicians had praised some aspects of the Belgian response to the second wave.
He was surprised: “Honestly, every night you can see an expert in Stockholm, London or Paris say something slightly different on television. But of course, they are all experts. It's too early for comparisons. Maybe that will be possible next year, maybe we have to wait for 2022, but not now , “he told me.
Perhaps that leaves us with the only conclusion that we can safely affirm: the outcome for our health of this crisis will not depend solely on what our government tells us to do and not to do; it will depend as much, if not more, on the decisions we make about what we have been told.
