Covid-19 second wave – a winter surge: Things likely to get worse before they get better

Covid-19 deaths worldwide recently crossed the 1.5 million mark. The expectation is that by the time the winter is over these will top 2 million—the estimated death count during the Asian flu pandemic of 1957-58. This will make Covid-19 the worst pandemic in over a century, exceeded only by the estimated 40-70 million deaths during the Spanish flu pandemic of 1918-19.

News regarding the emergence of a new viral disease in China started filtering in as early as in December 2019. The Covid-19 pandemic arguably started sometime around early March 2020, when there were few Covid-19 deaths outside China. It then spread rapidly, first to Europe, and then across the Atlantic to the Americas.

The number of Covid-19 infections and deaths are the two variables most commonly used to compare the incidence of Covid-19 across space and time. The reliability of both sets of data varies considerably from country to country. Counting the number of infections in each country, and then making cross-country comparisons, is more problematic because the incidence and criteria of testing varies enormously. In contrast, howsoever flawed, reported Covid-19 mortality remains the single most reliable criteria to make cross-country comparisons.

Covid-19 mortality in deaths per million (to control for population differences) has been aggregated through snapshots taken at six-week intervals beginning March 6, 2020, to track the spread and intensity of the pandemic across space and time (see table). Data for 27 major countries has been classified into the East Atlantic, West Atlantic and South and East Asia—these countries together account for 68% of the global population and 83% of all Covid-19 deaths.

The last six-week interval saw the largest number of Covid-19 deaths per million (52) globally. This rate has risen in each successive six-week interval, except that ending July 21, when it appeared that the pandemic might be receding. It is now clear that the pandemic is still in the expanding mode. The significance of the breakthrough in Covid-19 vaccines must be seen against this backdrop. Help might be on its way, but things are likely to get worse before they get better.

The winter second wave is still basically a European phenomenon. Covid-19 mortality in Europe showed a sharp fall during the last few intervals, before the resurgence in the six weeks beginning September 5, and a further acceleration over the last six weeks. The table indicates that Covid-19 mortality in Europe during the second wave is significantly higher than during the first phase. The Americas, on the other hand, have shown a consistently high mortality of above 150 in each of the last five intervals. Overall mortality in the Americas is still much higher than in Europe. Covid-19 deaths have declined in Asia during the last six weeks.

The pandemic so far is primarily a transatlantic phenomenon. The Americas and Europe together account for 77% of deaths globally, even though they hold just 23% of the global population. Covid-19 mortality in these regions currently averages 550-750 per million, compared to 65 in Asia and 40 in Africa.

Asia’s figures are inflated by the relatively higher mortality in West Asia, and in India, and Africa’s by the high mortality in South Africa. India accounts for over 75% of Covid-19 deaths in South and East Asia taken together, and its Covid-19 mortality of 100 per million is twice that of any other country in this region. It is also the only country outside the Americas (the US, Brazil and Mexico) where Covid-19 deaths exceed 100,000. The good news, however, is that Indian Covid-19 mortality during the last six weeks was at half the level of the preceding six weeks.

If India is excluded, Asia’s death rate falls to 50 and Africa’s to 25. Asia’s death rate would fall further if only South and East Asia were considered, as Covid-19 mortality in West and Central Asia that adjoin Europe and the Atlantic system is much higher—although still lower than European levels. Asia’s death rate would then be comparable to Africa’s.

China’s official Covid-19 mortality figures are puzzling. Following the initial high mortality, the number has remained frozen at 4,634 since April 2020, which is difficult to believe. But China’s economic recovery is nothing short of remarkable. It is the only major economy that will not shrink in 2020. It is also on track to recoup all the output lost on account of Covid-19, with its GDP next year expected to be at the level forecast before the Pandemic. A V-shaped recovery can only occur if conditions are back to near-normal.

The sharp difference in Covid-19 mortality, by a factor of over 10, between the transatlantic region and Africa and Asia is even more startling when one considers that the transatlantic region is on the whole more advanced technologically, richer, and with better healthcare systems. The G7 countries, the most advanced, best governed and prosperous globally, with half of global GDP at nominal prices, and one-third at purchasing power parity, have just 10% of the global population. However, they account for a third of all Covid-19 deaths.

In these circumstances, the finger of suspicion points to genetic differences as a major determinant of mortality. Is the Darwinian logic of natural selection at work? This can also explain the relatively higher mortality in India, which lies at the junction between the West and the East as it were, and has a greater intermingling of races than in other parts of Asia.

Since Covid-19 mortality is higher amongst the elderly, the higher median age in richer countries could also be a factor in greater mortality in Europe and the Americas. However, Japan, an aged and rich Asian country, has very low levels of Covid-19 mortality. Also, mortality in poorer and younger countries like Mexico in North America, and in South America, is very high. Median age can, therefore, at best, be a contributory rather than a determining factor.

Within the same region, differences in governance could also be a contributory factor. Populist leaders who discount science and do not adjust policies on the basis of fast-growing evidence and knowledge about Covid-19 transmission and prevention have generally fared badly. The US, under the whimsical President Donald Trump, and Brazil under the populist Jair Bolsonaro have fared poorly in the transatlantic. In Asia, countries like India and Iran have floundered. India’s Covid-19 mortality and economic growth are out of sync with surrounding Asian levels. The collapse in growth is closer to Latin American levels where Covid-19 mortality is several times higher.

On the other hand, Germany has fared well by European standards. Indeed, several advanced countries with women leaders, such as New Zealand, Norway, Switzerland, Denmark, Finland, Germany, Iceland, Taiwan and Scotland, have done better than those governed by male leaders. They tend to be more empathetic and guided by science, and focus more on good housekeeping in governance rather adopt a populist or muscular stance. The pandemic would hopefully assist women leaders to break a critical glass ceiling and take the world back to a semblance of normalcy.

The author is RBI Chair Professor, ICRIER