Yes, it's a global pandemic

As I was googling who our visitor @EricMH was, I came upon his article here that I would like to discuss with folks:

But, is it really a global pandemic? If you’ve been watching the news, you might notice that some areas of the world are oddly absent from the reporting.

This is true. I live in Southern Mexico. The only way I can get COVID-19 news about the place where I live is informal Facebook and WhatsApp reports. The reason? No one pays reporters to report on things here. If you want to know what is going on, you have to tune into the mayor’s Facebook live press conference and know people who are in the know.

Is COVID-19 vulnerable to heat? It is worth asking whether that explains the lower mortality rate near the equator and in the southern hemisphere. At any rate, given how little we know about COVID-19, we should acknowledge the unknown unknowns before drawing firm conclusions on the subject.

I know development workers all over the world and in most developing countries, nobody trusts the government’s official stats. My friends in Africa and India are saying similar things to what I am saying here. In most places in Mexico, you cannot get an official test unless your symptoms merit hospitalization. Private doctors who have obtained their own tests and are testing patients say the government won’t include those positive tests in the official counts because they weren’t done at official hospitals.

There are five official reported cases and one death in the town of 6,000 where I am right now. But one of my colleagues has been home sick with COVID for a month now. She cannot get a test because she can still breathe. I know of about ten people who are sick right now, presumably with the virus, and no one has been counted because they haven’t been tested. (Just like Trump says, if you don’t test, you have fewer cases!)

I am evacuated from the place where I normally work because it is unstable and run by drug cartels. Things are much worse there, but people refuse to go to the hospital because if you test positive, you can’t have a normal funeral, which is a fate worse than death for many people. Hundreds of people in the city where it has been 90-100F for the last two months are officially sick.

The social distancing lockdown has been far stricter here than many places in the US. No one is allowed into the town where we are who doesn’t live here or have an official pass like the FedEX and DHL guys. But my husband had to meet the UPS delivery guy on the outskirts of town to get our replacement credit card because he didn’t have his stuff in order to come into the town. All cars are stopped going in and out for temperature checks and to have the interiors sprayed with disinfectant (not sure what good that does, other than psychologically impress upon people that we are in a crisis.) Masks are required in all public spaces and only one person per family is allowed in stores. In Walmart in the state capital, all the aisles deemed non-essential merchandise have been roped off for months. I went to Office Depot to buy art supplies for my daughter taking a summer online class and I had to tell a police officer what I wanted and once it was deemed essential enough, an employee escorted me to the aisle and the cash register. Only one customer was allowed in the store at a time. Everything but grocery, pharmacy, and takeout has been closed since late March. My kids’ orthodontist meets us in the parking garage and opens up the office to keep my kids braces on track. I think this might not be totally legit because he won’t even turn the lights on in the front of the office that is visible to the shopping mall security. People are definitely still getting infected. It is definitely a real pandemic.

All this to say that the conclusions about COVID-19s effect on the global South are only as good as the data and I suspect the data coming out of the majority world is mostly garbage and shouldn’t be used to draw any conclusions about whether the virus spreads in hot climates. Looks like it’s doing just fine despite pretty draconian efforts to stem the tide.

The one thing that I think may be different in poorer, warmer countries is that there is no climate control. The virus spread like crazy in NY, and the Midwest when it was cold and people were indoors with circulated air. It is now spreading like crazy in Texas, Florida, and Arizona where it is really hot and people are in AC with circulated air. Here most public gathering spaces are not enclosed like that, and are essentially outdoors. Many churches and markets and eating places are outside under canopies or in wall-less structures called palapas, not in enclosed buildings, and the enclosed buildings don’t have ventilation systems circulating the air; they have open windows. Whatever advantage this gives the countries is probably offset by the number of people who rely on crowded public transport systems. Public transportation has been significantly restricted here, with temperature checks, and mandatory masks and maximum occupancy at 1/3. In a one hour trip into the capital you will be stopped at three police checkpoints.

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Yes, indeed it’s a global pandemic. “Global pandemic” is from the department of redundancy department.

We can track global cases here; Coronavirus Map: Tracking the Global Outbreak

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But that’s my point. How reliable do you think those numbers are? The situation on the ground is undoubtedly much worse. Many countries lack the medical infrastructure to test and report and many poor people don’t trust the medical establishment and would rather just die at home.

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And even in nations like the U.S. which are supposed to have more reliable reporting … when some are estimating the true numbers of infected people may be up to ten times the known infected, even our numbers are failing to tell the whole story. But one hopes that death rates and hospitals filling with people - those numbers, delayed as they are, give us something to work with.

Were the imposed measures in place first, or were people in your area of Mexico already self-quarantining and distancing of their own fear first? I.e. … are attitudes pretty much in line with what is being asked of the public?

No, they weren’t doing anything (other than some people wearing masks) until the police began enforcing closures and questioning people why they were out, telling people they could not walk in groups and that kind of thing. Most people live on money they make from day to day. Food insecurity is a big problem now.

Schools were closed in the whole country at the beginning of March two weeks early for Easter vacation, and they haven’t gone back. The federal government downplayed things initially, but state and local governments did their own thing. Where we are, the mayor banned gatherings of more than 10, church services, town meetings, and all sports leagues when the schools closed, before there were any cases in the state. On March 25, when a few cases started to show up in the state, they closed the weekly open air markets, and the archaeological site that attracts tourists. At that point there were just over 400 reported cases in the whole country and 5 reported deaths. The state governor issued similar shutdowns statewide two days later.

Every week we get notices about how “this is the critical week” and even more stringent measures are imposed. As of two weeks ago, taxis and buses in and out of town stopped operating. Many of the more rural indigenous towns have put up roadblocks on the highway and aren’t letting anyone into their towns, so nobody really knows what is going on there.

A month ago my husband and daughter went back to our house in Guerrero because we needed documents that will be necessary to renew our kids’ visas whenever immigration opens again. Lots of roads in there were closed to traffic and there were police checkpoints going in and out.

About every four weeks or so we take my younger two into the city to see the orthodondist and we get groceries. So except for about three trips into the city and one trip into town to get eggs, I have not left the pretty much abandoned campus of the linguistics center where we are staying in temporary housing since late March. (There are four other individuals in different apartments who also came out from there language areas because there is less threat of civil unrest here.) There is a family that used to have a fruit and vegetable stand, and if you send them an order on Saturday morning, they will deliver a crate of produce. So we don’t need to shop much. Most of what I know is just what is reported by local people on WhatsApp or what we see on our infrequent forays into the city. Like we heard that the prison a few kilometers down that road has twelve official cases in really bad shape.

Things are not nearly as politicized here. People do what they are told to the extent that they can and the extent that it is enforced, which has been a lot. I think part of that is because if you get sick, you can’t really buy privileged care and there isn’t much the healthcare system can do for you. There aren’t emergency rooms. There are only a couple places doctors are allowed to refer COVID patients and everyone is in the same boat as far as what is available. You can probably get albuterol and oxygen. They do not seem to be using ventilators much, both because they don’t have them and the outcomes aren’t even that good.

I heard the average hospital stay before someone dies is 2 days. In the US it is several weeks, so that is part of the reason that the hospitals are not overflowing. That and the fact that people would rather just stay with their families and be able to maybe get a priest to do last rites. In several states reports are that they are near capacity.

This is a NYT article from the beginning of May. Not much has changed as far as I know with regard to the federal government’s messaging or the availability of testing.

(Edited to remove some things I probably should not have said on a searchable public forum.)

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Geez, should you try to leave and if you wanted to return to the U.S. is there even a way to do it? Frankly if they’re working to enforce masks and social distancing you’re probably better off where you are. We don’t seem to have elected many adults in this country.

The window for leaving is kind of over at this point. You can, you just have to travel by bus to Mexico City, fly to Tijuana, and then rent a car and drive to California to get a domestic flight. But I heard there are now sometimes problems at the border. And no one wants to take a bus. We’re okay with the choice to stay, it was made with full knowledge of what the medical options were. And yes, from an international perspective, the US is not looking much like the promised land. Things are not better where we have family and connections in Chicago.

Our local elected officials actually seem more responsible than the local,population. I think the rugged individualism culture is really killing people. As to the article, it does seem like the northern hemisphere is more greatly effected, though Brazil is certainly an exception. However, the areas most affected have the most population. It is said 90% of the worlds population is in the northern hemisphere, so you would expect the vast majority of disease to be there also. One would have to correlate disease to population density to really get a good idea of the effect of latitude on the coronavirus attitude.

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Well I hope you’re safe down there and that things get better up here. We just Zoomed today with a couple of physicists in Chicago who had gone to Cal with Lia. They’re in their 70’s and he at least is still teaching at the university. Seems like the charm of using Zoom wears thin for everyone who does a lot of it in their work (as he does in teaching his classes online). I caught a two hour lecture from England on Wednesday on biodiversity in gardens from Great Dixter in Sussex. Not at all interactive but really interesting.

On an up note I’m seeing many more people wearing masks in my neighborhood but it is nothing like what you describe with enforcement. But I ran into a couple of women this evening putting up posters they’d printed up with a photo of a person in a mask and large text that read: My mask protects you; Your mask protects me. I thanked them.

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Reminds me of the funny quote @LM77 shared about the two biggest factors in the spread of the disease. Our rugged individualism contributes to one of the senses in which density plays a role.

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Yeah … you wouldn’t be any better here in regard to hospital access. I think the vast majority of the population (including many people of means) would opt for nearly anything before hospitals at this point … considering hospitals a place of last resort. Though I did go into a local clinic for a simple (but necessary for me) procedure just a week ago. The place was empty - including the waiting room (and not just because they were forcing people to wait outside … I was literally the only patient there). I just wait in my car till they come out to get me and then I had the entire staff to myself. Not a bad time to get things done. But that’s privilege talking. I’m not in the highest risk groups (though not in the lowest either courtesy of age), so I have the luxury - at least psychologically - of shunting aside worry for myself, anyway.

Communities where people must sell their goods on the local market to eke out their living … I don’t imagine they have much of any kind of economic safety net. And when churches shut down where you are, they probably can’t just do an online alternative, which would make their deprivation of community that much more severe. Our prayers go out for the communities there as well as here.

I think that the spread of the virusfrom one country to another is initially because the number or flights and people involved. The greater connectivity between one country and another, business and pleasure, meant a greater chance of initial spread in the “north” . Once it enters a country, depending on those initial conditions, it then spreads through the populations. It could end up getting worse in poorer “global south” countries because of higher numbers of people, poorer santitation and health care, and could do so long after the “north” has recovered. There is also less news from the south abiut any spread.

I think the idea that the pandemic targets the Northern Hemisphere is contradicted by the spread in Brazil.

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I thought I was agreeing with you???

The sum total of his argument seems to rely on this graph:
image

The only problem is that 90% of the world’s population lives in the Northern Hemisphere:

In short, COVID-19 appears to target the Northern Hemisphere because that’s where most people live.

Ah, yes, agreeing it is a global pandemic. You’re right that even the reported numbers show that. It’s just very probable that those reported numbers on your link represent only a fraction of the real situation.

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People are more tech savvy then Americans give them credit for. Lots of people have smart phones. At least one of the churches in town (there are only like 30 members), a Methodist one, has been live streaming. There is a whole contingent of merchants who have a WhatsApp group and have moved their business to home delivery. You just text them what you want. The hard part has been that the artisan community depends on tourism and there is none of that for the foreseeable future. One guy who makes these cool journals covered in local textiles that I like to buy as gifts has set up an Amazon marketplace shop. People adapt. But local churches are always collecting for food distribution efforts.

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It should be but (often) isn’t. As defined by the WHO and CDC, a pandemic ‘refers to an epidemic that has spread over several countries or continents, usually affecting a large number of people’, and thus need not be global. So chalk this one up to the department of dumb definitions.

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But in popular usage…

Doesn’t really belong here but since I mentioned these posters above I figured I’d share it here. I thought they were really positive in putting out the message.

What I like about it is that it speaks to that dismissive attitude that we should go ahead if we feel we need protection. Our masks do us far less good than they do others. That’s why we all need to mask up if we’re ever going to put this behind us and open as soon as safely possible. It’s also why going without one isn’t just about expressing ones sense of power; it’s also about being an inconsiderate jerk.

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