This week Fred Goldstein and I discuss how the pandemic has affected other countries and look into why their data sometimes seems quite different to the United States. We dive into the data form Bangladesh and India to understand why their death rates and rates of infection are lower than what we would expect based on experience here.
Despite a low rate of vaccination in Bangladesh they have a lower rate of reported deaths from COVID19, this despite having a higher density population. There are multiple contributory factors but some we discuss
🔒Rigorous Lockdowns
😷Mask Wearing
🧪Variable testing access
💽Quality of Data Reported
🧑⚕️Strong Public Health Programs
You can read more details on the Mask study from Bangladesh here Finally, A Randomized Trial of Mask Wearing
Raw Transcript
Nick van Terheyden
Hi, this is Dr. Nick on the incrementalist here with incremental insights for better business better health.
Fred Goldstein
And this is Fred Goldstein with accountable health here helping employers and other companies with their population health programs. So Nick, we’ve talked about a lot of different countries around the world, but mostly focused on the United States. But it’s really interesting what we can learn that is being done elsewhere, or perhaps some data that comes out of other places. And one of them of interest recently is Bangladesh. So why don’t we start there?
Nick van Terheyden
Yeah, so a question came up in some discussions with colleagues, friends, as to why when we look at these countries, we don’t see the same incidence, you know, yet. In Bangladesh, as an example, you have a very high density population in a limited geography or space. Irrespective of anything else, living in close quarters tends to be challenging, different socio economic, we see this in, you know, lots of other continents and countries. Yet, when you compare it in our world and data, which is a great website for doing comparisons, you look at the incidence as a percentage. You just don’t see it, what’s going on for it?
Fred Goldstein
Well, it’s it’s fascinating to think about that, because, you know, what are the infection rates, the death rates, obviously, it’s been really difficult, and the world has not done a good job of getting vaccines out to these countries, so that they can help protect themselves. I think the most recent I saw for Bangladesh was about 10% of the population is vaccinated. And obviously, there’s an effort, but you’ve got to get the vaccine to them to help them out. And so it would be good to see that go up. But it’s interesting to see what are potentially lower death rates, lower infection rates, and I’m wondering, you know,
Nick van Terheyden
I just resistant to COVID-19.
Fred Goldstein
You’re the you’re the medical physician here. And I got perspective, I would not assume so people are people are people. So
Nick van Terheyden
I think we see this worldwide. So let’s talk about some other countries and some of the experiences. So India is a great place to sort of focus on because there was a whole period of time, we’ve seen some different periods in their particular history with this disease. So first of all, worldwide disease, any idea that you can come up, isolate, you know, do due deference to New Zealand and Australia who have done a reasonable job, but there are, you know, significant Island, and they’re limiting people coming in. But in the case of the other places, it’s essentially running through your population. So in the case of India, what we saw was, they locked down the country completely, I mean, that you, if you looked at the videos, you saw them, this was you are confined, and there was challenges with, you know, a population that has very limited resources, there was very little in the way of doordash, or any kind of services for food. And I’m laughing, and I don’t mean, you know, it’s not wasn’t humorous for them, but, you know, huge challenges, but they enforced it very, very rigorously. And they saw almost, I don’t want to say negligible, but a very, very low rate compared to other countries that had what I would call a softer lockdown. And I think we saw the same thing in Bangladesh, right?
Fred Goldstein
Yeah, my understanding is they did some serious lockdown to mean you weren’t allowed out of your house for extended periods of time. My understanding is also there was a fascinating study done that said, in essence, when you call the lockdown, don’t allow the people to disperse back to their homes, you know, they may be in a central city or something, because that apparently allowed for the spread to get out as you locked down. And so I understand they did a number of lockdowns and reopen, they had their schools closed for about 18 months, as I understand. And you I also wonder, if when you see data that says this was in people who were more well off, were infected, or had higher death rates, if in countries with really severe socio economic issues, if it’s just a vast underreporting of the individuals who who were not in those groups, and so they’re not getting tested, maybe they’re not even getting access to the hospital. As I noted in one of the articles I read, the reported 30 something deaths for the day in Bangladesh, and every death was in the hospital was a hospital patient. So I assume there were some that were outside of the hospital.
Nick van Terheyden
And I think we can safely say that deaths are occurring outside of the hospital. So a are they being reported, you know, don’t have detailed data on that. But even if they are being reported, are they being classified accordingly? Or are they even getting tested to link them back and say that this was COVID-19 is a disease and you make an important point, accessibility to testing, if you don’t test her, I mean, this reminds me a lot of very famous book in the medical profession, you know, still around today and it, you know, don’t measure the temperature if you don’t want to find high temperature or pyrexia, as we call it in the medical profession. You know, same thing with testing. And I know there’s a lot of myths and disinformation around that. And that’s why you don’t see this and that. But in this case, you know, it appears that there is a low proportion of testing very low vaccination rate, which clearly needs to be fixed. I think it’s not solid data that can be relied upon. Not that there’s any discrepancy or, you know, attempt to conceal, but there’s just not the capacity. And the other thing that you and I both noticed was that the I think the largest study right on Mars squaring was carried out in Bangladesh. That’s extraordinary to me, why is it that that country, so were they able to impose or create an environment where people followed it, we see this in Africa, where you have a very strong public health policy that is focused on the community, they don’t have the same hospital infrastructure, we saw much less transmission, because everything was focused on communication and public health. And part of that was, you know, wearing wearing a face covering. So they’ve done a good job, it would appear, but there’s also some questions of data and how much it’s representative, what’s actually going on.
Fred Goldstein
And I think it should be pointed out that that mask study showed that masks do work. And what would be fascinating to get out of that is what were the communication methodologies that they use in those communities to create that high level of mask wearing, so we can take some of that and bring it back here and potentially apply it in our communities as well.
Nick van Terheyden
Gonna be some of that culture, I suspect, and you know, the willingness and compliance we see that as a difference. But yeah, there’s maybe some communication tactics and capabilities that, you know, we can always learn from other countries.
Fred Goldstein
Absolutely. There’s a lot of really good stuff going on. And I would hope that over the next few months, we and other countries come together to help not only get the more vaccines, but also the testing, as you pointed out, because if you could get rapid tests, you consider the percent of that population that does need to leave their house every day just to support themselves, to get food to earn an income. And if you could put rapid tests out in that community, you could obviously open it up much quicker. So once again, and fantastic week. Thanks so much for joining us, Nick. And this is Fred Goldstein with the Campbell health. If you’ve got any more questions, please go to accountable health. llc.com
Nick van Terheyden
and this is Dr. Nick, I’m the incrementalist here with incremental insights for better business, better health.
