Where to Be in a Pandemic

social or economic disruption. I spoke to Bloomberg's Rachel Chang, who worked on the Resilience ranking project, about the data and the analysis that went into determining the best places for weathering the pandemic. The findings on the relative strength of health care systems around the globe and how they've succeeded or failed to manage the pandemic may surprise you. I was wondering if you might start off just explaining what this new COVID Resilience ranking does and and who

it's for. So our idea is to be able to give an accurate view, based on data of what's going on in the world right now, because what we've seen of COVID nineteen, it's it's pretty much the biggest public health crisis of a generation. And not only that, everything that we thought we knew about the world and how different countries would handle and a pandemic of this scale

has actually been proven wrong. There were many pandemic preparedness and healthcare adequacy type of rankings before the COVID nineteen pandemic, and you had countries like the US and the UK top all of those rankings, which clearly have turned out to be wrong. At the same time, this year, we've seen a lot of quite surprising success stories. We've seen developing countries really come out with unique strategies. Some of them have eliminated the entire virus from their local communities.

And so the starting point was really that COVID nineteen is going to transform has transformed the world, and Rachel, you know this, this tool has a wealth of data, um but of course we've seen a lot of questions, a lot of interrogation about whether or not COVID nineteen data can be trusted. And I was wondering if you might go into that as it relates to the resilience ranking, right. I mean, the starting point really was that we needed to have daily figures for cases and deaths, and a

lot of places have collated that. The ones where the database we're relying on is by the Johns Hopkins University. Of course, we know that cases and fatalities underreported across the board. That's just um a reality for every country. It's not something that is limited just to developing countries with porous data. It's something that we've seen repeatedly in

advanced economies as well. A big fact is just that testing was extremely inadequate in many major countries, and so there were a lot of people and I'm sure you know some who have felt that they probably were sick with COVID, but we're never able to get a test to confirm that. In terms of fatalities, a lot of people as well have died at home before being diagnosed.

That's certain countries like Russia where if somebody has a core morbidity, has another disease and then dies after contracting COVID nineteen, sometimes they mark that down as a fatality not due to COVID nineteen. So from what we know from experts, all of that data is under reported, underdetected across the board. One of the things we're looking at UM in the future, although it's not available yet, is something called access mortality, that country's record for the whole year.

So we can see in countries with pretty good overall death data by comparing what the number is to say nineteen or the average between twenty and you can see that access that will be due to COVID nineteen, and sometimes that is way more than what the official COVID nineteen fatality is. But having said all that, I think we have to go into this project with an understanding that the data is inadequate, that it probably won't be

adequate for a long, long period of time. But at the same time, it's still a valuable way for us to have a picture of what's going on right now. And I was wondering if maybe we could break down some of the data UM that you do mention and include in the resilience ranking. And one is, of course, and this is a term we've heard used a lot, is the positive test rate. Why is this particular factor important when considering and and why did you choose to

include it in the resilience ranking. So the positive test rate is something that experts do look at um to look at the situation in a country and how much undetected infection is in the community. So a very high positive test rate basically means that doctors are only testing the sickest people, people who have become so sick that they have to go to hospital very often, they are quite close to a very terrible deterioration in their disease um.

And what that means is that there is just so many cases out there in your community that haven't been detected. These are people probably moving around and infecting other people. So it's a way to tell how contain or how in control the doctors and the officials are of a

situation on the ground. So what we see, for example, is that when the infection the positive test rate falls below five percent for fourteen days, that is when the WHO says that governments should think about relaxing relaxing the lockdown restrictions. Prior to that, there's a dangerous amount of infection in the community. Now, speaking of lockdowns, actually that is another indicator you have on the ranking, the lockdown

strictness indicator. And I was wondering if you might go into what that is and and maybe continuing on from your previous discussion, why is this so important for us to understand almost from a global level. Yeah, this is a very interesting indicator because I think it's something that's really evolved over the course of the crisis. So it's

an indicator that's produced by Oxford University. They have a team of researchers which is monitoring the number and the strictness of lockdown policies that every government in the world is imposing. So and the initial phase of the crisis, what we did see is that countries that impose very strict measures very early on, so what we call that swift and up strong and early action, were very successful

at containing the virus. So the economies that are ranked in our top ten, for example New Zealand, Taiwan as well, these were places that did have a really stringent reaction early on. But what we've actually seen as the pandemic has gone on is that if a government currently has the need to impose again stract policies of lockdown, that

points to actually a failure of containing the coronavirus. The points to a failure of maintaining the gains from previous lockdowns, and so in the in our ranking, we've taken stringency as a negative thing. So the more stringent your current situation is, the lower your score in this indicator. Because I think what we've seen almost a year ender the pandemic is that that sort of disruption that lockdown's brain has been extremely economically costly, has been socially very costly

to a lot of people. That's been a huge mental health toll from isolation and disruption, and we see it as a negative to people's lives, and that's what we wanted to reflect. Now that indicator does seem to have a lot to do with with something else on the ranking, which is community mobility. But I was wondering if you might go into how how that differs how the ranking

for community mobility is slightly different from the lockdown indicator. Yeah, so the lockdown the stringency indicated from Oxford University UM is the number and strictness of government policies, and so you know, it captures the letter of what governments are trying to do, but it does not capture whether or

not there is enforcement and compliance on the ground. And what we're seeing is that you know, there are a lot of places where governments are imposing all of these intense rules, but there's no enforcement, people are not following

it um. And then there are also places where governments don't have to really impose any kind of rules, but because of a high level of social compliance and high level of population ownership of the problem, people kind of decide for themselves that they don't want to be as mobile as before and they stay home or when here that they are more cases. So that's two sides of

the same coin of disruption. And so at this point we look at mobility as the higher mobility is to the pre pandemic baseline, the better situation on economy is in right now. One indicator that you do include on this ranking is going to be more and more relevant as we go forward in time, and certainly with the news from say Visor and bioin tech, something that we're all very optimistic about, and that is of course the

vaccine access indicator. I was wondering if you might maybe unpack a little bit about what people can understand from from this data point. Yeah, this is a really exciting indicator and one that we put a lot of effort into piecing together. Going off on a database that was originally put together by some deep researchers. But you know,

this is such a shifting thing. Countries are announcing new agreements every day, vaccines themselves are making so much progress every day, So it's something we've really had to keep

on top of. But we think it's a really valuable way of uh, you know, not just revealing something that's, as you said, is is the most important thing that everybody is thinking about right now, but it's also a way to take that ranking and kind of pivoted towards the future because the biggest beneficiary of this indicator being included countries where in the US is the number one example of this, have really lost control of the epidemic,

and the US well, the administration of the outgoing President Donald Trump has said openly that they don't want to contain the coronavirus. They want to use treatments and vaccines

to solve the crisis. And we've seen them. We've seen the US poll almost twenty billion dollars into funding some of this res such and indeed, it's now in a situation where it has five separate vaccine agreements with five different Phase three candidates, and as we know vaccines like the FISO one has proven extraordinarily effective, and we know that that approval is going to come just in a couple of weeks, So it could very much be a game changer for countries who otherwise have lost control of

their situations. I was wondering if you might just go through some of the other variables that are measured in the resilience ranking and and perhaps just very briefly the

rationale and including some of these variables. So some of the other things that we've included pre pandemic measures, like, for example, the Universal Healthcare Coverage Indicator, which looks at twenty three different aspects of in the economies healthcare system, ranging from very basic stuff like basic childhood vaccines to

something like cancer care. And what that indicator was shown, although it was the atabase was put together before COVID nineteen, was that it was really give an idea of the strength of the country's healthcare system, which we think makes a big difference in how patients are helped. The other thing that that does reflect is the ability of a place to continue providing non COVID nineteen healthcare even through

the pandemic. And we've seen that that's quite an important facet for maintaining a normal life for a lot of people. Um another thing as well, We've included the United Nations Human Development Index, which is quite widely known and widely used as a measure of a country's well being. It's

made up of three components. One of that is life expectancy, the second one is wealth per capita, and the third one is expected years of schooling, which we think can act as a proxy for populations trust in science, which has really emerged as something that makes a difference in terms of whether people are following public health guidance like mask wearing, handwashing. These times, small things can really make a big difference. How are you hoping a user of

this tool can can apply this information? What can they take away from this resilience ranking? I think I think the main thing that people can take away, first of all, is that the coronavirus is not something that cannot be controlled. The economies that have placed really high on the ranking, a lot of the people in these places are living lives pretty much the pre pandemic life, you know, before

COVID nineteen was even a thing. Decisive and United action has really helped some of these places control the coronavirus. I mean, Taiwan has gone two d days without a local case. Uh. You know, there's live music, social events, mass social events in New Zealand. What the ranking really provides is um an idea of where the look for some of these strategies. Right some of these countries have

pioneered some of the best strategies to fight something like this. Secondly, I think what the virus really helps to do is to put things in past active for people, because I think it's pretty much a once in a lifetime thing where there is a single event that has affected people around the world in the same magnitude. And I think it's very important to have a perspective on, you know, a situation for example, like in Japan, which now is entering a winter wave and the capital of Tokyo just

raised its alert to the highest level last week. But Japan is in a situation where there are thirty eight people in serious condition from COVID nineteen right now, which is an extraordinarily low amount by the standards of other places. And finally, I think it is a ranking that aims to kind of dispel some of the myths that people have to kind of change people's minds and show them that you know, the world is not that's not um exists accounting to some of these old ideas that we

had that kind of ruled the world for so many years. Right, Like, the best healthcare systems are not necessarily where we think they are, the strongest scions let leadership, and not necessarily

in the places that we think they are. And I think one of things that emerged that has emerged is that Asia as a region has been extremely effective at controlling a coronavirus because of very strong public health systems, because of contact traces on the ground, because of publicly funded nurses, because of free health coverage, and these are all things that we want to show people are very important in the coronavirus era. That was Rachel Chang and

that's it for our show. To day. For coverage of the outbreak from one twenty bureaus around the world, visit Bloomberg dot com slash coronavirus and if you like the show, please leave us a review and a rating on Apple Podcasts or Spotify. It's the best way to help more listeners find our global reporting. The Prognosis Daily edition is produced by Tophor foreheads in Gaspore, Magnus Hendrickson, and Nie Laura Carlson. Today's main story was reported by Rachel Chang

with help from Emma O'Brien. Original music by Leo Sidrin. Our editors are Rick Shine and Francesco Levi. Francesco Levi is Bloomberg's head of podcasts. Thanks for listening.