WEBVTT - Where to Be in a Pandemic (Rebroadcast) 0:00:01.280 --> 0:00:06.440 Welcome to Prognosis. I'm Laura Carlson. It's day three, ten 0:00:06.800 --> 0:00:11.840 since coronavirus was declared a global pandemic. Today's episode was 0:00:11.920 --> 0:00:15.040 first aired in November, so we won't be sharing today's 0:00:15.120 --> 0:00:19.920 virus news now. For our main story, everyone is fighting 0:00:19.960 --> 0:00:23.400 the same coronavirus, but nearly a year into the pandemic, 0:00:23.680 --> 0:00:27.880 quality of life and control of the pathogens spread look 0:00:28.000 --> 0:00:33.320 vastly different across the world. Bloomberg's COVID Resilience Ranking scores 0:00:33.400 --> 0:00:37.680 the largest fifty three economies on their success at containing 0:00:37.720 --> 0:00:42.120 the virus with the least amount of social and economic disruption. 0:00:42.920 --> 0:00:46.520 Back in November, I spoke to Bloomberg's Rachel Chang, who 0:00:46.520 --> 0:00:49.760 worked on the Resilience ranking project. I spoke to her 0:00:49.800 --> 0:00:53.000 about the data and the analysis that went into determining 0:00:53.159 --> 0:00:58.120 the best places for weathering the pandemic. The findings on 0:00:58.200 --> 0:01:01.960 the relative strength of healthcare systems around the globe and 0:01:02.280 --> 0:01:06.840 how they've succeeded or failed to manage the pandemic may 0:01:06.880 --> 0:01:15.720 surprise you. I was wondering if you might start off 0:01:15.760 --> 0:01:20.800 just explaining what this new COVID Resilience ranking does and 0:01:20.800 --> 0:01:24.480 and who it's for. So our idea is to be 0:01:24.600 --> 0:01:29.360 able to give an accurate view based on data of 0:01:29.480 --> 0:01:32.000 what's going on in the world right now, because what 0:01:32.040 --> 0:01:34.600 we've seen of COVID nineteen, it's it's pretty much the 0:01:34.640 --> 0:01:39.560 biggest public health crisis of a generation. And not only that, 0:01:39.800 --> 0:01:42.280 everything that we thought we knew about the world and 0:01:42.319 --> 0:01:45.640 how different countries would handle and pandemic of this scale 0:01:45.800 --> 0:01:49.880 has actually been proven wrong. There were many pandemic preparedness 0:01:49.960 --> 0:01:55.040 and healthcare adequacy type of rankings before the COVID nineteen pandemic, 0:01:55.360 --> 0:01:57.880 and you had countries like the US and the UK 0:01:58.520 --> 0:02:01.280 top all of those rankings, which clearly have turned out 0:02:01.520 --> 0:02:04.440 to be wrong. At the same time, this year, we've 0:02:04.480 --> 0:02:07.920 seen a lot of quite surprising success stories. We've seen 0:02:08.360 --> 0:02:11.920 developing countries really come out with unique strategies. Some of 0:02:11.960 --> 0:02:15.600 them have eliminated the entire virus from their local communities. 0:02:16.560 --> 0:02:19.760 And so the starting point was really that COVID nineteen 0:02:19.840 --> 0:02:23.760 is going to transform has transformed the world, and Rachel, 0:02:23.919 --> 0:02:28.600 you know this, this tool has a wealth of data, 0:02:28.880 --> 0:02:32.359 um but of course we've seen a lot of questions, 0:02:32.680 --> 0:02:36.720 a lot of interrogation about whether or not COVID nineteen 0:02:36.800 --> 0:02:38.799 data can be trusted, and I was wondering if you 0:02:38.880 --> 0:02:43.520 might go into that as it relates to the resilience ranking, right. 0:02:43.560 --> 0:02:46.600 I mean, the starting point really was that we needed 0:02:46.639 --> 0:02:50.720 to have daily figures for cases and deaths, and a 0:02:50.760 --> 0:02:53.959 lot of places have collated that. The ones where the 0:02:54.320 --> 0:02:57.760 database we're relying on is by the Johns Hopkins University. 0:02:57.800 --> 0:03:02.040 Of course, we know that case us and fatalities are 0:03:02.120 --> 0:03:07.240 underreported across the board. That's just um a reality for 0:03:07.560 --> 0:03:10.519 every country. It's not something that is limited just to 0:03:10.720 --> 0:03:14.680 developing countries with porus data. It's something that we've seen 0:03:14.760 --> 0:03:19.000 repeatedly in advanced economies as well. A big fact is 0:03:19.040 --> 0:03:22.720 just that testing was extremely inadequate in many major countries, 0:03:22.760 --> 0:03:24.359 and so there were a lot of people and I'm 0:03:24.400 --> 0:03:27.040 sure you know some who have felt that they probably 0:03:27.040 --> 0:03:29.280 were sick with COVID, but we're never able to get 0:03:29.280 --> 0:03:32.280 a test to confirm that. In terms of fatalities, a 0:03:32.280 --> 0:03:34.680 lot of people as well have died at home before 0:03:34.720 --> 0:03:39.200 being diagnosed. There's certain countries like Russia where if somebody 0:03:39.200 --> 0:03:42.400 has a core morbidity, has another disease and then dies 0:03:42.880 --> 0:03:46.360 after contracting COVID nineteen, sometimes they mark that down as 0:03:47.200 --> 0:03:50.040 a fatality not due to COVID nineteen. So from what 0:03:50.080 --> 0:03:53.600 we know from experts, all of that data is underreported, 0:03:53.680 --> 0:03:56.680 underdetected across the board. One of the things we're looking 0:03:56.720 --> 0:03:59.520 at UM in the future, although it's not available yet, 0:03:59.720 --> 0:04:03.320 it's a thing called access mortality that country's record for 0:04:03.360 --> 0:04:06.640 the whole year. So we can see in countries with 0:04:06.720 --> 0:04:11.080 pretty good overall death data by comparing what the number 0:04:11.240 --> 0:04:14.720 is to say, twenty nineteen or the average between twenty fifteen, 0:04:14.760 --> 0:04:18.720 and you can see that access that will we do 0:04:18.839 --> 0:04:21.120 to COVID nineteen, and sometimes that is way more than 0:04:21.160 --> 0:04:24.880 what the official COVID nineteen fatality is. But having said 0:04:24.880 --> 0:04:26.640 all that, I think we have to go into this 0:04:26.680 --> 0:04:30.640 project with an understanding that the data is inadequate, that 0:04:30.720 --> 0:04:33.320 it probably won't be adequate for a long long period 0:04:33.360 --> 0:04:35.479 of time. But at the same time, it's still a 0:04:35.560 --> 0:04:37.840 valuable way for us to have a picture of what's 0:04:37.839 --> 0:04:41.000 going on right now. And I was wondering if maybe 0:04:41.040 --> 0:04:44.719 we could break down some of the data UM that 0:04:44.760 --> 0:04:48.680 you do mention and include in the resilience ranking. And 0:04:48.800 --> 0:04:51.800 one is, of course, and this is a term we've 0:04:51.800 --> 0:04:55.760 heard used a lot, is the positive test rate. Why 0:04:55.800 --> 0:04:59.240 is this particular factor important when considering and and why 0:04:59.240 --> 0:05:02.120 did you choose to included in the resilience ranking. So 0:05:02.279 --> 0:05:05.880 the positive test rate is something that experts do look 0:05:05.920 --> 0:05:08.159 at um to look at the situation in the country 0:05:08.200 --> 0:05:11.960 and how much undetected infection is in the community. So 0:05:12.000 --> 0:05:15.520 a very high positive test rate basically means that doctors 0:05:15.520 --> 0:05:18.880 are only testing the sickest people, people who have become 0:05:18.920 --> 0:05:21.520 so sick that they have to go to hospital very 0:05:21.520 --> 0:05:24.279 often they are quite close to a very terrible deterioration 0:05:24.320 --> 0:05:27.279 in their disease um. And what that means is that 0:05:27.279 --> 0:05:29.280 there is just so many cases out there in your 0:05:29.320 --> 0:05:32.679 community that haven't been detected. These are people probably moving 0:05:32.720 --> 0:05:36.159 around and infecting other people. So it's a way to 0:05:36.240 --> 0:05:41.040 tell how contain or how in control the doctors and 0:05:41.080 --> 0:05:44.480 the officials are of a situation on the ground. So 0:05:44.560 --> 0:05:48.960 what we see, for example, is that when the infection 0:05:49.040 --> 0:05:53.239 the positive test rate falls below five percent for fourteen days, 0:05:53.760 --> 0:05:55.960 that is when the w h O says that governments 0:05:56.000 --> 0:06:00.479 should think about relaxing relaxing the lockdown restrictions. Prior to 0:06:00.600 --> 0:06:04.600 that there's a dangerous amount of infection in the community. Now, 0:06:04.640 --> 0:06:08.520 speaking of lockdowns, actually that is another indicator you have 0:06:08.720 --> 0:06:12.120 on the ranking, the lockdown strictness indicator, And I was 0:06:12.160 --> 0:06:14.960 wondering if you might go into what that is and 0:06:14.960 --> 0:06:18.520 and maybe continuing on from your previous discussion, why is 0:06:18.560 --> 0:06:21.039 this so important for us to understand almost from a 0:06:21.040 --> 0:06:24.320 global level. Yeah, this is a very interesting indicator because 0:06:24.360 --> 0:06:27.160 I think it's something that's really evolved over the course 0:06:27.240 --> 0:06:30.120 of the crisis. So it's an indicator that's produced by 0:06:30.160 --> 0:06:33.520 Oxford University. They have a team of researchers which is 0:06:33.560 --> 0:06:37.719 monitoring the number and the strictness of lockdown policies that 0:06:37.760 --> 0:06:41.080 every government in the world is imposing. So and the 0:06:41.160 --> 0:06:44.080 initial phase of the crisis, what we did see is 0:06:44.160 --> 0:06:48.440 that countries that impose very strict measures very early on, 0:06:48.640 --> 0:06:52.520 so what we call that swift and strong and early action, 0:06:53.440 --> 0:06:57.159 were very successful at containing the virus. So the economies 0:06:57.200 --> 0:07:00.560 that are ranked in our top ten, for example New Zealand, 0:07:01.040 --> 0:07:04.719 Taiwan as well, these were places that did have a 0:07:04.760 --> 0:07:08.799 really stringent reaction early on. But what we've actually seen 0:07:09.080 --> 0:07:12.640 as the pandemic has gone on is that if a 0:07:12.680 --> 0:07:17.360 government currently has the need to impose again straight policies 0:07:17.400 --> 0:07:20.720 of lockdown, that points to actually a failure of containing 0:07:20.720 --> 0:07:24.200 the coronavirus AP points to a failure of maintaining the 0:07:24.320 --> 0:07:28.239 gains from previous lockdowns, and so in the in our ranking, 0:07:28.320 --> 0:07:32.400 we've taken stringency as a negative thing. So the more 0:07:32.480 --> 0:07:35.840 stringent your current situation is, the lower your score in 0:07:35.880 --> 0:07:38.640 this indicator. Because I think what we've seen almost a 0:07:38.720 --> 0:07:41.760 year end the pandemic is that that sort of disruption 0:07:41.840 --> 0:07:46.400 that lockdown's brain has been extremely economically costly, has been 0:07:46.440 --> 0:07:49.240 socially very costly to a lot of people. That's been 0:07:50.040 --> 0:07:54.080 a huge mental health toll from isolation and disruption, and 0:07:54.120 --> 0:07:56.240 we see it as a negative to people's lives, and 0:07:56.240 --> 0:08:00.360 that's what we wanted to reflect. Now that indicator seem 0:08:00.360 --> 0:08:02.320 to have a lot to do with with something else 0:08:02.440 --> 0:08:05.280 on the ranking, which is community mobility. But I was 0:08:05.280 --> 0:08:08.800 wondering if you might go into how how that differs 0:08:08.840 --> 0:08:13.560 how the ranking for community mobility is slightly different from 0:08:13.560 --> 0:08:17.560 the lockdown indicator. Yeah, so the lockdown the stringency indicated 0:08:17.600 --> 0:08:24.240 from Oxford University is the number and strictness of government policies, 0:08:24.240 --> 0:08:26.120 and so you know, it captures the letter of what 0:08:26.240 --> 0:08:29.360 governments are trying to do, but it does not capture 0:08:29.400 --> 0:08:33.760 whether or not there is enforcement and compliance on the ground. 0:08:34.120 --> 0:08:36.040 And what we're seeing is that, you know, there are 0:08:36.080 --> 0:08:39.040 a lot of places where governments are imposing all of 0:08:39.080 --> 0:08:41.840 these intense rules, but there's no enforcement, people are not 0:08:41.880 --> 0:08:45.200 following it um. And then there are also places where 0:08:45.640 --> 0:08:49.240 governments don't have to really impose any kind of rules, 0:08:49.280 --> 0:08:52.319 but because of a high level of social compliance and 0:08:52.400 --> 0:08:57.520 high level of population ownership of the problem, people kind 0:08:57.559 --> 0:08:59.480 of decide for themselves that they don't want to be 0:08:59.520 --> 0:09:01.880 as mobile as before, and they stay home more when 0:09:01.880 --> 0:09:04.640 they hear that they are more cases. So that's two 0:09:05.080 --> 0:09:09.280 sides of the same coin of disruption. And so at 0:09:09.320 --> 0:09:13.440 this point we look at mobility as the higher mobility 0:09:13.480 --> 0:09:18.320 is to the pre pandemic baseline, the better situation economy 0:09:18.400 --> 0:09:33.800 is in. Right now, one indicator that you do include 0:09:33.800 --> 0:09:37.520 on this ranking is going to be more and more 0:09:37.840 --> 0:09:40.600 relevant as we go forward, and that is, of course, 0:09:40.720 --> 0:09:44.200 the vaccine access indicator. I was wondering if you might 0:09:44.320 --> 0:09:47.520 maybe unpack a little bit about what people can understand 0:09:47.600 --> 0:09:50.040 from from this data point. Yeah, this is a really 0:09:50.080 --> 0:09:53.320 exciting indicator and one that we put a lot of 0:09:53.400 --> 0:09:57.640 effort into piecing together. Going off on a database that 0:09:57.720 --> 0:10:01.040 was originally put together by some Duke researchers. But you know, 0:10:01.080 --> 0:10:04.760 this is such a shifting thing. Countries are announcing new 0:10:04.800 --> 0:10:08.319 agreements every day, vaccines themselves are making so much progress 0:10:08.320 --> 0:10:10.079 every day, So it's something we've really had to keep 0:10:10.080 --> 0:10:12.800 on top of. But we think it's a really valuable 0:10:12.800 --> 0:10:16.079 way of uh, you know, not just revealing something that's 0:10:16.240 --> 0:10:17.920 as you said, is is the most important thing that 0:10:17.960 --> 0:10:20.040 everybody is thinking about right now, but it's also a 0:10:20.080 --> 0:10:23.400 way to take that ranking and kind of pivoted towards 0:10:23.440 --> 0:10:27.880 the future because the biggest beneficiary of this indicator being 0:10:28.000 --> 0:10:32.600 included countries where in the US is the number one 0:10:32.640 --> 0:10:36.000 example of this, countries who otherwise have lost control of 0:10:36.080 --> 0:10:40.160 their situations. I was wondering if you might just go 0:10:40.240 --> 0:10:43.360 through some of the other variables that are measured in 0:10:43.679 --> 0:10:47.040 the resilience ranking and and perhaps just very briefly the 0:10:47.120 --> 0:10:51.160 rationale and including some of these variables. So some of 0:10:51.200 --> 0:10:55.160 the other things that we've included pre pandemic measures, like, 0:10:55.559 --> 0:10:59.719 for example, the Universal Healthcare Coverage Indicator, which looks at 0:11:00.000 --> 0:11:04.720 twenty three different aspects of in economies healthcare system, ranging 0:11:04.720 --> 0:11:08.000 from very basic stuff like basic childhood vaccines to something 0:11:08.040 --> 0:11:11.360 like cancer care. And what that indicator was shown, although 0:11:11.400 --> 0:11:14.079 it was the database was put together before COVID nineteen, 0:11:14.600 --> 0:11:16.000 was that it was really give an idea of the 0:11:16.000 --> 0:11:18.960 strength of the country's healthcare system, which we think makes 0:11:18.960 --> 0:11:22.720 a big difference in how patients are helped. The other 0:11:22.800 --> 0:11:24.920 thing that that does reflect is the ability of a 0:11:25.000 --> 0:11:29.400 place to continue providing non COVID nineteen healthcare even through 0:11:29.440 --> 0:11:32.240 the pandemic, and we've seen that that's quite an important 0:11:32.280 --> 0:11:35.880 facet for maintaining a normal life for a lot of people. 0:11:36.679 --> 0:11:39.760 Another thing as well, we've included the United Nations Human 0:11:39.760 --> 0:11:43.840 Development Index, which is quite widely known and widely used 0:11:43.880 --> 0:11:48.800 as a measure of a country's well being. It's made 0:11:48.840 --> 0:11:51.839 up of three components. One of that is life expectancy, 0:11:52.360 --> 0:11:55.199 the second one is wealth per capita, and the third 0:11:55.200 --> 0:11:58.679 one is expected years of schooling, which we think can 0:11:58.720 --> 0:12:02.320 act as a proxy for populations trust in science, which 0:12:02.360 --> 0:12:04.920 has really emerged as something that makes a difference in 0:12:05.000 --> 0:12:09.920 terms of whether people are following public health guidance like 0:12:10.000 --> 0:12:12.960 mask wearing, handwashing, These types of small things can really 0:12:12.960 --> 0:12:16.240 make a big difference. How are you hoping a user 0:12:16.480 --> 0:12:20.240 of this tool can can apply this information. What can 0:12:20.520 --> 0:12:23.400 they take away from this resilience ranking? I think I 0:12:23.400 --> 0:12:26.600 think the main thing that people can take away, first 0:12:26.600 --> 0:12:30.200 of all is that the coronavirus is not something that 0:12:30.280 --> 0:12:33.440 cannot be controlled. The economies that have placed really high 0:12:33.520 --> 0:12:36.240 on the ranking, a lot of the people in these 0:12:36.240 --> 0:12:41.000 places are living lives pretty much the pre pandemic life, 0:12:41.040 --> 0:12:43.920 you know, before COVID nineteen was even a thing. Decisive 0:12:44.320 --> 0:12:47.840 and united action has really helped some of these places. 0:12:48.400 --> 0:12:51.520 What the ranking really provides is um an idea of 0:12:51.520 --> 0:12:53.600 where the look for some of these strategies. Right, some 0:12:53.640 --> 0:12:56.560 of these countries have pioneered some of the best strategies 0:12:56.880 --> 0:12:59.680 to fight something like this. Secondly, I think what the 0:13:00.240 --> 0:13:02.880 really helps to do is to put things in perspective 0:13:03.360 --> 0:13:05.559 for people, because I think it's pretty much a once 0:13:05.559 --> 0:13:07.680 in a lifetime thing where there is a single event 0:13:07.760 --> 0:13:12.400 that has affected people around the world in the same magnitude. 0:13:13.040 --> 0:13:16.800 And Finally, I think it is a ranking that aims 0:13:16.880 --> 0:13:20.319 to kind of dispel some of the myths that people 0:13:20.360 --> 0:13:23.520 have to kind of change people's minds and show them 0:13:23.600 --> 0:13:27.200 that you know, the world is not does not um exists. 0:13:27.200 --> 0:13:29.440 Accounting to some of these old ideas that we had 0:13:29.480 --> 0:13:31.920 that kind of ruled the world for so many years, right, Like, 0:13:32.000 --> 0:13:34.520 the best healthcare systems are not necessarily where we think 0:13:34.600 --> 0:13:38.960 they are, the strongest science led leadership, and not necessarily 0:13:38.960 --> 0:13:41.120 in the places that we think they are. And I 0:13:41.120 --> 0:13:43.360 think one of things that emerged that has emerged is 0:13:43.400 --> 0:13:47.959 that Asia as a region has been extremely effective at 0:13:47.960 --> 0:13:52.439 controlling the coronavirus because of very strong public health systems, 0:13:52.480 --> 0:13:55.439 because of contact traces on the ground, because of publicly 0:13:55.559 --> 0:13:59.960 funded nurses, because of free health coverage, and these are 0:14:00.000 --> 0:14:03.240 all things that we want to show people a very 0:14:03.280 --> 0:14:11.360 important in the coronavirus era. That was Rachel Chang, and 0:14:11.440 --> 0:14:13.559 that's it for our show today. For coverage of the 0:14:13.600 --> 0:14:16.760 outbreak from one and twenty bureaus around the world, visit 0:14:16.760 --> 0:14:21.400 Bloomberg dot com slash coronavirus and if you like the show, 0:14:21.720 --> 0:14:24.040 please leave us a review and a rating on Apple 0:14:24.080 --> 0:14:27.360 Podcasts or Spotify. It's the best way to help more 0:14:27.440 --> 0:14:31.880 listeners find our global reporting. The Prognosis Daily edition is 0:14:31.920 --> 0:14:36.480 produced by to for foreheads Magnus Hendrickson and me Laura Carlson. 0:14:37.120 --> 0:14:41.320 Today's main story was reported by Rachel Chang. Original music 0:14:41.360 --> 0:14:45.360 by Leo Sidrin. Our editors are Rick Shine and Francesco Levi. 0:14:45.920 --> 0:14:50.480 Francesco Levi is Bloomberg's head of podcasts. Thanks for listening, 0:15:00.760 --> 0:15:01.160 he Lef