PLAGUE JOURNAL February 2021: What Can We Learn from Africa (again), Part 2
More ideological lunacy from the media.
[Note: All Plague Journal entries were written as events unfolded. I have edited the drafts for clarity, but the tone and content are original, reflecting what we could see at the time.]
[This is the second of a two-part story. Part one can be found here.]
Health Care in Africa
The October BBC article, “Coronavirus in Africa: Five reasons why Covid-19 has been less deadly than elsewhere,” contained the usual dogma about masks and public obedience, but what are we supposed to learn about public health in Africa? These articles imply that we have been outplayed and must change our ways. A simple search of health care systems around the world suggests that we might look elsewhere than Africa for models of public health.
A 2014 article from a website called The Richest offers a list of the “The 10 Worst Health Care Systems In The World.” (I had never heard of The Richest either, but the short article contains plenty of statistics that can be easily verified, which is more than we can say about the BBC’s data-free article about “quick action,” “public support,” and “good community health.”)
According to the article, nine of the ten world’s worst health care systems are in Africa. Let’s look at a few, and their coronavirus results. For context, consider that the U.S. fatality rate as of late February 2021 is 1,573 per million. New York State’s is 2,448 per million. Rates across much of northern Europe are similar. South Africa, the only African country with a significant region in a temperate oceanic climate, has 833 fatalities per million.
The World’s Worst Ten Health Care Systems
Here are the ten countries with the worst health care systems in the world, according to the Richest:
10: Zambia, with a life expectancy of 55, where diarrhea is a leading cause of death for children under five because of inadequate sanitization and a lack of access to potable water. Because of high birth and death rates, the median age is just 14.
COVID fatality rate: 57 per million, ranked 137th worldwide (of 221 countries).
Climate: humid subtropical. June 1st, Lusaka weather: 90% sunny with an average low of 49.
9: Lesotho, where 40% of the population lives in poverty on less than $1.25 a day, life expectancy is 49, and a quarter of the population between 15 and 49 have HIV. Lesotho is the world’s highest country, a mountainous region where the top cash crop is marijuana. The elevation and proximity to the African continent’s southeastern-most coast put much of Lesotho in a temperate climate, with relatively cool winter weather.
COVID fatality rate: 136 per million, ranked 104th worldwide.
Climate: humid subtropical and oceanic temperate. June 1st Maseru weather: 80% sunny with an average low of 33. (The coronavirus spreads most easily when lows are between 32 and 40).
8: Mozambique, where 60% live in poverty on less than $1.25 a day and life expectancy is 51.
COVID fatality rate: 19 per million, ranked 164th worldwide.
Climate: tropical savanna, humid subtropical, warm desert, and warm semi-arid. June 1st Matola weather: 91% sunny with an average low of 62.
7: Malawi, with a life expectancy of 55 and a median age of 17. Each year, 68,000 die from HIV/Aids—roughly 4,500 people per million.
COVID fatality rate: 53 per million, ranked 139th worldwide.
Climate: humid subtropical. June 1st Lilongwe weather: 86% sunny with an average low of 54.
6: Liberia, where only 4.7% of the population is over 60 and 43% is 15 or younger, and per capita GDP is just $297 (2011). In 2010, nine million malaria cases were reported, and 43% of children under five do not receive anti-malarial treatment.
COVID fatality rate: 17 per million, ranked 167th worldwide.
Climate: equatorial and monsoon. June 1st Monrovia weather: 24% sunny with a low of 76.
5: Nigeria, with 174 million people, the largest population in Africa, and a life expectancy of 52. Nigeria suffers from a mass drain of trained nurses and doctors looking for better opportunities. Twenty percent of Nigerian children die before reaching the age of 5.
COVID fatality rate: 9 per million, ranked 174th worldwide.
Climate: tropical savanna, monsoon, and warm semi-arid. June 1st Lagos weather: 17% sunny with an average low of 76.
4: The Democratic Republic Of Congo, a populous but war-torn country with widespread infectious diseases including malaria and rabies, where life expectancy is 48, and 43% of the people are under 15.
COVID fatality rate: 23 per million, ranked 155th worldwide.
Climate: tropical savanna and monsoon. June 1st Kinshasha weather: 46% sunny with an average low of 72.
3: Central African Republic, with civic strive, lawlessness, and a life expectancy of 49. Poor sanitation and a lack of access to clean water makes diarrhea a leading cause of death for children under 5.
COVID fatality rate: 13 per million, ranked 170th worldwide.
Climate: tropical savanna. June 1st Bangui weather: 31% sunny with an average low of 72.
2: Myanmar, in Southeast Asia, the only non-African country on the list. Life expectancy is 50, and Myanmar once spent the lowest amount of their GDP on health care anywhere in the world, although life expectancy and access to health care are rapidly improving.
COVID fatally rate: 59 per million, ranked 134 worldwide.
Climate: tropical savannah, monsoon, humid subtropical. June 1st Yangon weather: 9% sunny with an average low of 78.
Notice that Myanmar, the only non-African country on the list, has coronavirus results very similar to the African countries—and has a very similar climate and life expectancy.
1: Sierra Leone, war-torn, with just 0.002 physicians per 1,000 people. Sixty percent of the population lacks access to clean drinking water, and malaria is rampant. Life expectancy is 52, and 42% of the people are under 15.
COVID fatality rate: 10 per million, ranked 173 worldwide.
Climate: Monsoon. Freetown June 1st weather: 24% sunny with an average low of 77.
For comparison, South Africa, which has a far higher death rate than any of these countries—about 80 times higher than Sierra Leone—has a range of climates, including humid subtropical, humid subtropical highland, cold semi-arid, warm semi-arid, cold desert, and temperate oceanic. This last one is Koppen climate type Cfb, the same climate found across western Europe where the coronavirus ran wild in March and April. Johannesburg, the largest city, sits in the highlands at nearly 6,000 feet. Away from the coast, Johannesburg is sunny 89% of the time at the beginning of June, but low temperatures average just 39 degrees on June 1st and fall to 36 by the end of June: spreader weather.
South Africa’s second-largest city, Capetown, sits in a warm Mediterranean climate. It’s less sunny than Johannesburg, but June and July lows seldom fall below the high 40s, dropping into the 30s only a few times in June and July of 2020 (still more than almost anywhere else on the African continent). The temperate oceanic climate covers a thin strip of coast to the east of Capetown, including Port Elizabeth and East London. Port Elizabeth fell into the 30s six times in July, including a stretch of four days in the middle of the month when significant spreading probably occurred.
The town of Newcastle sits in the eastern part of South Africa between Johannesburg and the coast. Like Johannesburg, it sits in the subtropical oceanic highland climate, at about 4,000 feet of elevation. The elevation, latitude, and proximity to the coast put it in a temperate, cool, winter zone unlike anywhere else in Africa except for parts of neighboring Lesotho. June and July in Newcastle saw a whopping 33 days with lows in the 30s, with all but three remaining above freezing. The highlands region of South Africa has classic spreader weather in June and July.
The provinces of Gauteng and Kuazulu-Natal have high numbers of cases and fatalities. They also have the largest populations in South Africa, yet neither population size nor density predicts much about coronavirus outcomes. The two largest cities on the African continent, Kinshasa in the Republic of Congo (15 million people) and Lagos in Nigeria (14 million people), are in countries with very low coronavirus rates. The Congo has just 23 fatalities per million, and Nigeria has only nine per million, which means these countries have death rates of just 3% and 1% respectively of the rate in South Africa.
On the African continent, only South Africa and Lesotho have areas that experience extended periods with temperatures in the mid-30s. South Africa also has a higher life expectancy than most African countries, although lower than in most developed countries. Forty-five percent of South Africa’s COVID fatalities occur in people aged 65 or older, a demographic that is much smaller in most of Africa.
Although South Africa has by far the highest fatality rate in Africa, it has less than half the rate of the U.K.; a little more than half the rate of Spain, Portugal, and Italy; and two-thirds the rate of France (as of February 2021). Northern Europe has shorter days, less sunshine, and weeks or months longer in the 35-degree refrigerator temperatures than South Africa has, conditions that cause more serial spreading.
What Can We Learn from Africa in the West?
What can we learn from Africa about fighting the coronavirus? We won’t learn anything useful about masks, hand-washing, or distance. We can’t change the climate. What’s left? We could get rid of our hospitals, and get rid of virtually all of our restaurants and grocery stores. We could demolish every building that has heating or air-conditioning and knock out the windows in the rest. We could destroy our hand sanitizers and the other chemicals we slather on our hands and bodies: all soaps, moisturizers, shampoos, and sunscreen—especially sunscreen. We could destroy all prescription drugs and imprison our doctors. We could destabilize the government with insurgencies and coups, destroying the economy and disrupting water and food supplies. We could contaminate our wells so that half the population lacked access to clean water.
These things would bring widespread poverty, disease, and malnutrition, which would help our fight against the coronavirus by killing us from other things first.
We could close all nursing homes and other assisted living facilities. Getting rid of people older than 50 would reduce U.S. COVID fatalities by a whopping 95%. By removing our wealth, groceries, restaurants, heating, air-conditioning, escalators, automobiles, and other conveniences and comforts, we could reduce obesity, diabetes, hypertension, and other risk factors. By getting rid of medications and clean water, we reduce our at-risk populations by killing them with malaria and Aids and rabies. Children generally don’t get sick from the virus, and they don’t spread it, so if we reduce the median age of the population to somewhere in the teens we could have world-beating coronavirus outcomes.
We have environments here in the U.S. that partially mimic such conditions. Our homeless are robust when it comes to the coronavirus. They live outdoors, with poor sanitation and nutrition. They have almost no illness and vanishingly few deaths from coronavirus, although plenty of misery from other things, including drug abuse, violence, malnutrition, and problems stemming from mental illness. Lessons from around the world show us that hot weather, poverty, and societal dysfunction provide the greatest protection against coronavirus illness and death. Wealthy, stable countries in gray, temperate climates are the most vulnerable. The young journalists full of ideological fire and little education believe (or pretend to believe) that there are lessons to be learned from the savannah. But they don’t look at the data about weather and demographics, and the lessons they report are pure fiction.
The New York Times Joins the Chorus
After I wrote the above, the New York Times “The Morning” email arrived with a me-too Africa story called “An epidemiological whodunit” (3/8/2021) asking, “Why has the death toll been relatively low across much of Africa and Asia?” A graph of per capita fatality rates in the 25 most populous countries illustrates something we have known all along: wealthy countries are hit hardest. The graph shows very low rates in Thailand, Vietnam, Bangladesh, Pakistan, and many African countries.
When I glance at it, the other correlation that jumps out is latitude: hot-weather countries near the Equator have lower rates than cool countries in high latitudes. The five wealthiest countries rank in the top seven for coronavirus fatalities per capita. The top three are Great Britain, Italy, and the U.S.; France and Germany are fifth and seventh.
The only anomalies on the list are the ones we already know about: Japan is wealthy yet has low coronavirus rates. The Japanese prize physical health, especially in older people. Just 0.9% of Japanese men and 2.3% of Japanese women are obese. Japanese have much higher levels of vitamin D than we have in the U.S. or in the gray countries or northwest Europe. South Korea—though not on the Times chart—has a similar culture of health, with low obesity and a low coronavirus fatality rate.
The Times writer, David Leonhardt, doesn’t see the world as it is. He begins with some predictable ideology, telling us that health emergencies “tend to inflict their worst damage in poorer places, which is indeed what’s happening within the U.S., where the toll has been higher in many minority and low-income communities.” The story of race has been wildly distorted, as there are only a handful of states with black-white racial disparities, which should be studied for the outliers they are, not as representative of the U.S. overall. And it’s unclear why Leonhardt even mentions race, when the point he was making was about “poor places.” He must think minority and poor are synonyms. Which minorities? People of Chinese descent, or Indian, or Nigerian, or countless other categories, however defined? We know he wants us to reflexively substitute “black and brown.” Are all black people poor, according to the New York Times?
The press told us from the beginning that poor and minority “essential” workers were going to get sick, but the data never supported the story, with its broad categories that had nothing to do with the spread of our virus. Restaurant workers and grocery workers aren’t getting sick, although people in meat plants are. The most at-risk, of course, don’t work at all: people in nursing homes.
Leonhardt’s sweeping statement ignores a glaring reality about U.S. wealth and health, which is that the U.S. has an epidemic of obesity, diabetes, vitamin-D deficiency, and other modern illnesses. Instead of spreading fear and telling us about the heightened risks faced by “people of color,” the press should have engaged in a public-awareness campaign to improve health. In the hundreds of millions of words published in the last year, I’ve not heard any reporters or health officials mention the importance of exercise, weight loss, or vitamin D. They prefer stories of race and gender, which help no one.
We know that Leonhardt’s story won’t include much that is true, and we can predict the usual propaganda about masks and hand-washing. Age is also hard to miss when looking at Africa. Leonhardt hits all these, though his view of outdoor spreading is laughable. In a paragraph with the heading, “Fresh air helps,” he writes: “Daily life tends to better [sic] ventilated in warmer, lower-income countries. People spend more time outdoors, and windows are often open. Covid spreads less easily in these settings than it does in poorly ventilated indoor spaces.”
Less easily? He and his fellow spreaders of fear will try to keep every threat alive, granting differences of degree only. (But—we don’t know. We will never know. Stay safe.)
Six percent of South African homes have air conditioning, the highest in Africa. (The U.S. figure is 91%.) South Africa has by far the highest rate of coronavirus fatalities in Africa, roughly 100 times greater than Nigeria, Tanzania, and the Republic of Congo (all of these countries appear in the Times chart). Air-conditioning and longer life expectancy both contribute to the higher death rate in South Africa, although South Africa’s temperate European climate is the main cause.
Naturally, Leonhardt praises “policy,” telling us that “Rwanda quickly and aggressively enforced social distancing, mask-wearing, contact tracing and mass testing.” Of course they did. Policy and obedience (flavored with some race and gender) is the only story the press knows how to tell.
Leonhardt concludes by throwing up his hands, writing, “The full answer to this mystery surely involves multiple explanations.” He notes that while “hundreds of thousands of people across Africa and Asia have died” of COVID, “many others are alive today for reasons that are both unclear and marvelous.” The ideology of a New York Times journalist is so distorting that he chooses the word marvelous to describe the rampant disease, malnutrition, and dysfunction that kill Africans before they reach an age—or weight—to be at risk from coronavirus, and he completely misses the effect that climate has on the spread.
[This is the second of a two-part story. Part one can be found here.]