Bloomberg, one of the largest global market information organizations, recently published a league table they term “the Covid resilience ranking” of the best places to be living in, in the coronavirus era, indicating the effectiveness of the handling of the virus combined with the least amount of disruption to business and society.
They considered some 10 key metrics to score 53 economies with more than $200 billion, and the metrics included, among others, the viral caseload, mortality rate, effectiveness of trace, treat, and isolate strategy, the capacity of the health care system, the impact of lockdowns, freedom of movement of the population, and vaccine supply arrangement.
They found that many a wealthy economy regarded as the most prepared for a pandemic may have been overwhelmed by repeated surges in coronavirus infection, necessitating recurrent lockdowns with adverse impact on their economies, and causing disruption in freedom of movement of their citizens. In contrast, many other economies -- both developed and developing -- may have defied expectation and done well, occupying elite positions in the league table.
In May 2020, I wrote about the leaders who have championed the genuine concerns of the populations they lead with their honest compassion and pragmatism. I mentioned the names of a few: Angela Merkel, Katrín Jakobsdóttir, Moon Jae-in, Tsai Ing-wen, Jacinda Ardern.
Not surprisingly, New Zealand led by the dynamic and extremely popular Prime Minister Jacinda Ardern tops the Bloomberg league table with the highest achieved score of 85.4. This was followed by Japan, Taiwan, South Korea, and Finland. India, with a resilience score of 58.1, was placed in 34th position, Pakistan, with a score of 61.7, has performed better than India, and was ranked 27th, whereas Bangladesh, with a score of 64.2, was placed at the 24th position. Vietnam with a score of 74.3 was placed in 10th position.
Given the positions of countries in the league table, I would emphasize that though doubtful, the table may give an overall impression, as comparisons can be attempted only if the variables used are known, accurate, and comparable. I remember in my days during our War of Liberation as a recruiting aide, the courage of young people demonstrated was mostly exemplary, startling, and often unexpected and unforeseen. The valour unleashed could often be out of character, though conclusions on their ability to perform as a freedom fighter could not have been drawn, as much was unknown.
When data is unknown, as well as unreliable and dissimilar, it is impossible to compare objectively. Scientists such as Sir David Spiegelhalter from the University of Cambridge is of the opinion that trying to rank different countries in the pandemic is a “completely fatuous exercise” and there is danger that such a table can adroitly be adopted by authoritative regimes as a thoroughfare to disaster for a population, if used for deception and deceit.
Confirmation of Covid-infection can only be arrived at by investigative tests, and it is obvious that if a country carries out extensive tests, their yield of caseloads would be higher than the ones who conducted fewer tests. Many recorded the number of people tested in the country, in contrast to others who have documented the total number of tests carried out, signifying diverse connotation and as such, the number of tests may not spell out uniform significance, as many may have tested more than once. The timing of tests, and place of test done, may have impacted the caseload.
Similar disparity may be observed in calculating the number of deaths. Some recorded deaths only in the hospital, others both in hospitals and care homes, and some initially only in hospitals and then combined hospitals and care homes. In many a country, there is hardly any provision of care homes, care is usually carried out in their own homes. This is further complicated by the absence of international standards of definition and/or cause of death. Some countries would calculate death from the pandemic only if the dead person had a positive test for coronavirus before their death, others may record death due to coronavirus if the doctor had suspected infection by coronavirus before the death of the person.
The death rate related to coronavirus has attracted great debate. Again, there is marked discrepancy in the definition of death rate, one being the ratio of deaths to confirmed cases. If the death rate is calculated from testing people when ill enough to be admitted to hospital, the death rate would be unusually high and different from the rate arrived at by calculating test positive patients who are asymptomatic as well as patients not ill-enough to require hospital admission. Complicating further is the mention (or not) of coronavirus in the death certificate.
Population characteristics exert significant leverage on the virus, influencing the ramifications consequent on the transmission, infectivity, severity of illness, organ failure, and death. The success of primary health care was also influenced by the demographic dividend -- the high concentration of the young population in Bangladesh is a major contributor in keeping the pandemic at bay to a significant extent. The other significant factor is that the source of national wealth -- remittance -- not only never declined during the pandemic, but moved upward, thanks to the patriotism of the millions of Bangladeshi expatriates overseas.
To close today’s Surgeon’s Note, let me seek the kind allowance from my readers, sanctioning me to conclude that since the validity of the league table is inherently and scrupulously linked to the data used, the authenticity of data published by authorities from countries with tightly controlled political systems is at best questionable, and at worst erroneous -- making the comparison dubious and potentially invalidated.
Dr Raqibul Mohammad Anwar is Specialist Surgeon, Global Health Policy and Planning Expert, and Retired Colonel, Royal Army Medical Corps, UK Armed Forces.
