On comparing national public health approaches to covid-19
Dear Editor
In their editorial to the BMJ, Majeed at al. compared the British and the South Korean public health approaches to fighting the covid-19. They have listed the very different measures the two countries have adopted in response to the crisis and their number of deaths due to the coronavirus. Since South Korea is having much fewer SARS-CoV-2 victims, the Authors suggest that the UK should adopt the South Korean Test-Trace-Isolate measures.[1]
There are, however, several flaws in that comparison.
Although the two countries are of similar population size, they have very different geographic, demographic, urban, architectural, cultural, socioeconomic, and genetic profiles. It is also likely that the system for flagging covid-19 deaths is different across the two countries. Moreover, and more importantly, the Authors aimed at proving an intervention successful by comparing countries having different interventions and different outcomes. However, from a scientific point of view, the opposite would be more appropriate: one should aim at proving an intervention unsuccessful by comparing countries having similar interventions and different outcomes (Popperian principle of falsification).
For example, countries such as the Netherlands, Belgium and Germany have a joint policy to tackle the coronavirus outbreak.[2] Moreover, they have similar geographic, demographic, urban, architectural, cultural, socioeconomic, and genetic profiles, making them more comparable. The borders between the three countries have not been closed,[3] and they can practically be considered as forming a cluster. In spite of that, at 20 May 2020, Belgium had 816 deaths per million inhabitants, Netherlands 347, Germany 103.[4] Those differences are striking.
The measures adopted by the three countries, as we said, are very similar and are those that are in place in most European countries: hand washing, social distancing, face-covering, and sanitation. It is therefore highly likely that all those measures can have very little impact on the current pandemic.
Thus far, the only evidence-based effective measures against respiratory viral outbreaks are: natural immunity; vaccine-induced immunity; and quarantine. As a matter of fact, South Korea has recently re-imposed some coronavirus restrictions (which have to be considered as mild forms of quarantine) after spike in new cases, with authorities struggling to identify transmission routes notwithstanding the TTI methods.[5]
Having said this, the examples from both Majeed et al. and I have some other limitations: they do not take into account population density, time to public health reaction, correct application of the measures, quantity of intensive care units, and have other fallacies that are typical of non-experimental comparisons made at the national level rather than at the individual one. They therefore cannot claim to produce any robust scientific evidence.
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On comparing national public health approaches to covid-19
Dear Editor
In their editorial to the BMJ, Majeed at al. compared the British and the South Korean public health approaches to fighting the covid-19. They have listed the very different measures the two countries have adopted in response to the crisis and their number of deaths due to the coronavirus. Since South Korea is having much fewer SARS-CoV-2 victims, the Authors suggest that the UK should adopt the South Korean Test-Trace-Isolate measures.[1]
There are, however, several flaws in that comparison.
Although the two countries are of similar population size, they have very different geographic, demographic, urban, architectural, cultural, socioeconomic, and genetic profiles. It is also likely that the system for flagging covid-19 deaths is different across the two countries. Moreover, and more importantly, the Authors aimed at proving an intervention successful by comparing countries having different interventions and different outcomes. However, from a scientific point of view, the opposite would be more appropriate: one should aim at proving an intervention unsuccessful by comparing countries having similar interventions and different outcomes (Popperian principle of falsification).
For example, countries such as the Netherlands, Belgium and Germany have a joint policy to tackle the coronavirus outbreak.[2] Moreover, they have similar geographic, demographic, urban, architectural, cultural, socioeconomic, and genetic profiles, making them more comparable. The borders between the three countries have not been closed,[3] and they can practically be considered as forming a cluster. In spite of that, at 20 May 2020, Belgium had 816 deaths per million inhabitants, Netherlands 347, Germany 103.[4] Those differences are striking.
The measures adopted by the three countries, as we said, are very similar and are those that are in place in most European countries: hand washing, social distancing, face-covering, and sanitation. It is therefore highly likely that all those measures can have very little impact on the current pandemic.
Thus far, the only evidence-based effective measures against respiratory viral outbreaks are: natural immunity; vaccine-induced immunity; and quarantine. As a matter of fact, South Korea has recently re-imposed some coronavirus restrictions (which have to be considered as mild forms of quarantine) after spike in new cases, with authorities struggling to identify transmission routes notwithstanding the TTI methods.[5]
Having said this, the examples from both Majeed et al. and I have some other limitations: they do not take into account population density, time to public health reaction, correct application of the measures, quantity of intensive care units, and have other fallacies that are typical of non-experimental comparisons made at the national level rather than at the individual one. They therefore cannot claim to produce any robust scientific evidence.
References
1 Majeed A, Seo Y, Heo K, et al. Can the UK emulate the South Korean approach to covid-19? BMJ 2020;369. doi:10.1136/bmj.m2084
2 Government of the Netherlands. Statement: Netherlands, Belgium and Germany on slowing down the spread of COVID-19. https://www.government.nl/latest/news/2020/05/08/statement-netherlands-b... (accessed 31 May 2020).
3 SchengenVisaInfo. Germany Decides to Keep Belgian and Dutch Borders Open Amid Coronavirus. https://www.schengenvisainfo.com/news/germany-decides-to-keep-belgian-an... (accessed 31 May 2020).
4 Worldometer. Covid-19 coronavirus pandemic. https://www.worldometers.info/coronavirus/ (accessed 31 May 2020).
5 McCurry J, Harding L, agencies. South Korea re-imposes some coronavirus restrictions after spike in new cases. The Guardian. 2020.https://www.theguardian.com/world/2020/may/28/south-korea-faces-return-t... (accessed 31 May 2020).
Competing interests: No competing interests