The last term of my Master's was completed virtually during a pandemic. Ironically, I was studying 'International Health Management', which makes for a great story, but also meant that I actually incorporated the pandemic into my studies and wrote my dissertation on the spread of COVID-19.
Although much of the research will now seem obvious, I wrote this at a time when research was very limited and new advancements were being made daily in the study of COVID-19. This posts aims to discuss six of the most important social structures and policies that affected the initial spread of COVID-19.
1) Age Structure
Although age structure doesn't actually affect the spread of COVID-19 directly, it does impact the severity of the outbreak; those aged over 60 are more likely to be severely affected by the virus and hospitalised (Amariles et al., 2020; Felbermayr et al., 2020), meaning that countries with ageing populations are more likely to suffer more fatalities and overwhelm healthcare systems. This also means that certain policies, such as closing schools, could force vulnerable grandparents to care for children whilst parents are working, thus increasing their susceptibility to the virus.
In Italian culture, intergenerational co-residence very common (Dowd et al., 2020), meaning that asymptomatic younger people are more likely to infect elderly relatives compared to in the UK where co-residence is less common. Although one could argue that high-income countries (HICs) are more likely to have ageing populations and thus, could be more severely affected, low- and middle-income countries (LMICs) actually account for 69% of people aged 60+ globally (Wilkinson, 2020) and this, alongside weaker healthcare systems, represents significant vulnerability in LMICs.
2) Healthcare Systems
It goes without saying that certain countries, including Germany and South Korea, handled the first-wave of COVID-19 extremely well and promptly, leading to less stress on their healthcare systems and fewer fatalities than most.
In countries such as Venezuela, where only 15% of essential medication is available (Suarez et al., 2018) and access to healthcare is very limited, a high COVID-19 rate would be devastating. Additionally, healthcare systems in countries with other ongoing outbreaks are already overwhelmed, with 87% of African countries having experienced at least one epidemic in the last decade (Otu et al., 2020).
The spread of COVID-19 can be reduced through increased testing and tracing, which South Korea understood and implemented early. By 18 March 2020, South Korea had carried out 286,716 tests, compared to Italy's 148,657 and Colombia's 2,571. Governments in countries such as Japan and Hong Kong quickly coordinated with their high-performing health systems to provide funding and ensure increased testing and treatment, reducing the overall spread.
Worryingly, during epidemics, often it's those with other diseases that suffer greatly, including cancer and hypertension (Anderson et al., 2020). In the US, native Hawaiians and other Pacific Islanders (NHPIs) are the highest risk group for co-morbidities (Kaholokula et al., 2020), and the US' private healthcare system means that many won't seek treatment or get tested for fear of hefty medical bills (Ahmed et al., 2020).
3) Inequalities & Infrastructure
Pandemics rarely affect everyone equally; the Black Death affected poorer populations more, and densely-populated areas allowed the bubonic plague to thrive (Ahmed et al., 2020).
This pandemic has forced many citizens to remain home-bound in order to slow the spread, which is hard enough in the global North, however for certain populations in the global South, it is almost inconceivable. Almost 1 billion people live in informal settlements (Corburn et al., 2020), with dense populations and where sanitation and water are lacking. This makes it very hard to follow the World Health Organisation's (WHO) guidelines, such as social distancing and frequently washing hands. Many of those living in informal settlements are also informal workers, meaning that they rely on daily wages for food and working from home is impossible. One survey found that 72% of Brazil's 13 million favela residents (Burki, 2020) would run out of money after only one week of social isolation (UNIC Rio, 2020).
Furthermore, countries such as Brazil are riddled with severe inequality, meaning that certain populations (for example, its native population) are neglected by the government and at higher risk of being infected by COVID-19 than other populations. Brazil's prison system also operates at 166% capacity (Calmon, 2020), which makes it impossible to socially distance and facilitates spread, putting prisoners (who are disproportionately black) at increased risk of infection.
4) Connectivity
This factor includes technological connectivity, as well as physical connectivity. Harris (2020) found that New York's subway system facilitated the spread of COVID-19 initially, and given that pooper communities are more likely to use public transport systems, they're more likely to be infected. Nonetheless, technology is advanced and ubiquitous in New York, at least offering some residents the possibility of working and socialising remotely. Compare this to a country such as Ecuador, where technology is lacking (Torres & Sacoto, 2020) and thus, neither learning nor working can be carried out virtually for the majority of citizens.
A major factor for the spread of COVID-19 is globalisation; in fact, the initial infections in many countries were thought to come from wealthy travellers (Kirby, 2020). In March 2020, international travel bans were rife and affected 90% of the world population, rendering tourism impossible. For countries that depend on tourism such as Samoa, these restrictions will force many people into poverty and affect the economy severely (Hevia & Neumeyer, 2020; Gössling et al., 2020; Olayemi et al., 2020).
5) Government Response & Culture
Although many governments enacted similar policies, such as wearing masks in public (Avery et al., 2020) and banning non-essential travel (Shukman, 2020; Hopman et al., 2020; Anderson et al., 2020), international bodies such as the European Union didn't enact many transnational policies, meaning that individual countries were left to respond as they saw fit, and experts learnt about the effectiveness of different measures in real-time (Hale et al., 2020).
Needless to say, the UK failed considerably in reducing spread, leaving the NHS overwhelmed and producing one of the highest global fatality rates at the time of writing (Horton, 2020; Anderson et al., 2020; Avery et al., 2020). New Zealand, on the other hand, proved exemplar and even eliminated new cases for a couple of weeks, by enforcing a strict national lockdown prior to any fatalities (Cousins, 2020). Contrarily, Brazil's president went so far as to discourage social distancing (Burki, 2020), and undermined the threat of COVID-19, leading to Brazil having the highest infection rate in May (The Lancet, 2020).
Countries that enforced early detection and implemented more stringent lockdown measures given their risk, such as South Korea and Singapore (Dowd et al., 2020; Frey et al., 2020; Hale et al., 2020), suffered fewer infections and fatalities than countries that did the contrary.
Adherence to government interventions directly affected infection rates. Interestingly, citizens' trust in their government affected compliance with government measures, with Japanese citizens feeling protected by their government (Imai, 2020), compared to those in Hong Kong (Legido-Quigley et al., 2020). Furthermore, countries with collectivist cultures, such as Japan, experienced much more adherence to new regulations and policies (Baldetti, 2020) compared to countries with individualist cultures, such as the US, where citizens even protested against wearing face coverings (Frey et al., 2020).
6) Media
Lastly, the media largely affected the spread of COVID-19. The absence of information can lead to exaggerated perceptions of the threat (Garfin et al., 2020), so in order to avoid people acting irresponsibly or panicking due to misinformation, it's essential to provide timely, accurate information to the public (Legido-Quigley et al., 2020; Wilkinson, 2020); this also gains public trust, which leads to greater compliance with new regulations.
This is why Bolsonaro and Trump's responses to the pandemic, including calling it a "little flu" (Calmon, 2020), and discouraging the use of masks was potentially detrimental. Similarly, Russia's government distributed propaganda via fake social media accounts, blogs, and news outlets blaming the West for COVID-19 (Sukhankin, 2020). Nonetheless, other countries' governments, including China and Spain, used social media alongside mainstream media to provide daily briefings and debunk rumours (Legido-Quigley et al., 2020; Depoux et al., 2020), which reduced infection rates.
This is a very brief overview of six social structures and policies that affect the spread of COVID-19, and was accurate at the time of writing (June 2020). The references below offer a more in-depth look at the spread of COVID-19 and how different countries have been affected, and I am also happy to share my dissertation in full if solicited.
References
Ahmed, F., Ahmed, N., Pissarides, C., & Stiglitz, J. (2020). Why inequality could spread COVID-19. The Lancet. 5(5), e240. https://doi.org/10.1016/S2468-2667(20)30085-2
Anderson, R.M., Heesterbeek, H., Klinkenberg, D., & Hollingsworth, T.D. (2020). How will country- based mitigation measures influence the course of the COVID-19 epidemic? The Lancet. 395: 931-934. https://doi.org/10.1016/S01406736(20)305675
Amariles, P., Granados, J., Ceballos, M., & Montoya, C.J. (2020). COVID-19 in Colombia endpoints. Are we different, like Europe? Research in Social and Administrative Pharmacy. ISSN 1551-7411. https://doi.org/10.1016/j.sapharm.2020.03.013
Avery, C., Bossert, W., Clark, A., Ellison, G., & Ellison, S.F. (2020). Policy Implications of Models of the Spread of Coronavirus: Perspectives and Opportunities for Economists. NBER Working Paper Series. Available at: http://www.nber.org/papers/w27007. [Accessed 30 June 2020]
Baldetti, S. (2020). First observations on law, religion and COVID-19 in Japan. Between the "Confucian style" lockdown and religious response to pandemic. Diresom. Available at: https://diresomnet.files.wordpress.com/2020/04/baldetti_diresom-papers-inglese-2.pdf [Accessed 30 June 2020]
Burki, T. (2020). COVID-19 in Latin America. The Lancet. 20(5): 547-548. https://doi.org/10.1016/S1473-3099(20)30303-0
Calmon, M. (2020). Considerations of coronavirus (COVID-19) impact and the management of the dead in Brazil. Forensic Science International: Reports. 100110. https://doi.org/10.1016/j.fsir.2020.100110
Corburn, J., Vlahov, D., Mberu, B., Riley, L., Caiaffa, W.T., Rashid, S.F., Ko, A., Patel, S., Jukur, S., Martínez-Herrera, E., Jayasinghe, S., Agarwal, S., Nguendo-Yongsi, B., Wera, J., Ouma, S., Edmundo, K., Oni, T., & Ayad, H. (2020). Slum Health: Arresting COVID-19 and Improving Well- Being in Urban Informal Settlements. Journal of Urban Health. 97: 348–357. https://doi.org/10.1007/s11524-020-00438-6
Cousins, S. (2020). New Zealand eliminates COVID-19. The Lancet. 395(10235): 1474. https://doi.org/10.1016/S0140-6736(20)31097-7
Depoux, A., Martin, S., Karafillakis, E., Preet, R., Wilder-Smith, A., & Larson, H. (2020). The pandemic of social media panic travels faster than the COVID-19 outbreak. Journal of Travel Medicine. 27(3): taaa031. https://doi.org/10.1093/jtm/taaa031
Dowd, J.B., Andriano, L., Brazel, D.M., Rotondi, V., Block, P., Ding, X., Liu, Y., & Mills, M.C. (2020). Demographic science aids in understanding the spread and fatality rates of COVID-19. PNAS. 117(18): 9696-9698. https://doi.org/10.1073/pnas.2004911117
Felbermayr, G., Hinz, J., & Chowdhry, S. (2020). Après-ski: The Spread of Coronavirus from Ischgl through Germany. IFW KIEL. Available at: https://www.ifw-kiel.de/fileadmin/Dateiverwaltung/IfW- Publications/Gabriel_Felbermayr/Apres- ski__The_Spread_of_Coronavirus_from_Ischgl_through_Germany/coronavirus_from_ischgl.pdf [Accessed 30 June 2020]
Frey, C.B., Chen, C., & Presidente, G. (2020). Democracy, Culture, and Contagion: Political Regimes and Countries Resposiveness to COVID-19. Oxford Martin School. Available at: https:// www.oxfordmartin.ox.ac.uk/downloads/academic/Democracy-Culture-and-Contagion_May13.pdf [Accessed 30 June 2020]
Garfin, D.R., Silver, R.C., & Holman, E.A. (2020). The Novel Coronavirus (COVID-2019) Outbreak: Amplification of Public Health Consequences by Media Exposure. Health Psychology. 39(5): 355-357. http://dx.doi.org/10.1037/hea0000875
Gössling, S., Scott, D., & Hall, C.M. (2020). Pandemics, tourism and global change: a rapid assessment of COVID-19. Journal of Sustainable Tourism. 1. https://doi.org/10.1080/09669582.2020.1758708
Hale, T., Angrist, N., Kira, B., Petherick, A., Phillips, T., & Webster, S. (2020). Variation in Government Responses to COVID-19. Blavatnik School of Government Working Paper. Available at: https://www.bsg.ox.ac.uk/sites/default/files/2020-05/BSG-WP-2020-032-v6.0.pdf [Accessed 30 June 2020]
Harris, J.E. (2020). The Subways Seeded The Massive Coronavirus Epidemic In New York City. NBER Working Paper Series. Available at: https://www.nber.org/papers/w27021.pdf [Accessed 30 June 2020]
Hevia, C., & Neumeyer, P.A. (2020). A perfect storm: COVID-19 in emerging economies. VOX. Available at: https://voxeu.org/article/perfect-storm-COVID-19-emerging-economies. [Accessed 30 June 2020]
Hopman, J., Allegranzi, B., & Mehtar, S. (2020). Managing COVID-19 in Low- and Middle-Income Countries. JAMA. 323(16):1549–1550. https://doi.org/10.1001/jama.2020.4169
Horton, R. (2020). Offline: COVID-19 and the NHS - “a national scandal”. Lancet. 395(10229): 1022. https://doi.org/10.1016/S0140-6736(20)30727-3
Imai, H. (2020). Trust is a key factor in the willingness of health professionals to work during the COVID-19 outbreak: Experience from the H1N1 pandemic in Japan 2009. Psychiatry and Clinical Neurosciences. 74(5): 329–330. https://doi.org/10.1111/pcn.12995
Kaholokula, J.K., Samoa, R.A., Miyamoto, R., Palafox, N., & Daniels, S.A. (2020). COVID-19 Special Column: COVID-19 Hits Native Hawaiian and Pacific Islander Communities the Hardest. Hawai'i Journal of Health & Social Welfare. 79(5): 144–146.
Kirby, T. (2020). South America prepares for the impact of COVID-19. The Lancet. 8(6): 551-552. https://doi.org/10.1016/S2213-2600(20)30218-6
Legido-Quigley, H., Asgari, N., Teo, Y.Y., Leung, G.M., Oshitani, H., Fukuda, K., Cook, A.R., Hsu, L.Y., Shibuya, K., & Heymann, D. (2020). Are high-performing health systems resilient against the COVID-19 epidemic? The Lancet. 395(10227): 848-850. https://doi.org/10.1016/S0140-6736(20)30551-1
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