Why is the mortality rate. Lower in some countries singapore in kaesong stand to the many deaths well. Its exactly behind that this is inside story. Hello and welcome to the program im peter davi has covered 19 started to hit the world many of us were concerned about whether we would become infected some said its as bad as the flu others predicted worse then news about Health Systems being overwhelmed and bodies piling up started to emerge that gave us a bleak picture but its not the picture everywhere mortality rates in cattle in singapore are below 0 point one percent among the worlds lowest the gulf nations mortality rate is 0. 07 percent 12 deaths of more than 16000. 00 cases in singapore 0. 093 percent of more than 100000. 00 infections experts say testing the availability of hospital beds and population age 3 critical factors yet singapores outbreak is the biggest in Southeast Asia and cassava as the 2nd highest number of cases in the arab world although the curve is beginning to flatten out. Number of cases has gone up but thats only natural and i believe that actually its a result of our very strong testing measures so as youve seen we are testing a lot and cut that out so weve been testing approximately 40000. 00 per 1000000 so thats question if i can thats one of the highest rates of testing and that reflects a true picture of whats happening in terms of infection rate so the rates are not high theyre realistic but you will find that a lot of countries at the end of their pandemic will realize that their curve actually looks like ours the fact that we are not picking as aggressively. As we could have is because we have flattened the curve ok lets have a quick look now at 19 mortality rates in other countries just fine cats are in singapore saudi arabia and the United Arab Emirates some nations with small outbreaks such as vietnam havent suffered a single death on the flip side belgium has the highest per capita death rate in the world and in italy its estimated to be around 13 percent the us leads the world in infections and deaths with the virus killing 200. 00 people per 1000000. Ok there we are here we go lets introduce our panel today in doha dr early on bronnie a Senior Consultant in Infectious Diseases and head of research at the Communicable Disease center at the hammer medical corp from geneva we have dr Annie Sparrow professor of Population Health science and policy at mount sinai hospital also an emergency and Critical Care physician in Perth Australia we have clements professor of Infectious Diseases at Curtin University in perth welcome to you all dr amrani here in doha how have the 2 countries manage this. Im not quite sure whether youre referring specifically to the last alex if its associated with cause it has been able to maintain. I think this is largely the result of 3 things related to. Was able to handle the epidemic so far brought metal it is a bit of luck that the demographics are such that the jollity of the population are bloated younger literally healthier and with fewer comorbidities and indeed if you look at the statistics for those who had with him you would find that nearly 70 percent are between those ages of 25. 00 to 50. 00 parts of that about only one percent personal out of the 65. 00 so having a healthy younger population would certainly help and the 2nd is that qatar has been very very active in this case finding and testing very wretched proactive case finding contact they think screening activities and that means that the background numbers the denominator and call it is relatively close hopefully to the numbers and that means that when you look at proportions that the pope will come out and lower because youre a big guy and those who havent actions in the back and the 3rd i think thats also very important point is that cat heart is been able to expand its Health Capacity fairly quickly theres a lot of sex ability within the system that allows it to open close to hospitals and that it goes for the patient and more importantly he was able to more than double because that capacity which means that we can look after a large number of patients with critically and hopefully help them survive through this illness such think using those 3 so the. Key points are the main reasons why ive managed to do with this part ok dr only sparrow in geneva are the statistics reliable. Without being ever to independently verify the numbers and some countries are very good at allow an independent verification by direct evidence of others it is china when china recently revised its death rate in numbers in one hand there is actually no change in methodology so sometimes we simply dont know how good the guns are and nor do we know. Not only you know how much testing is being done in the us even trump doesnt like testing because it would put the numbers up and sample but we dont know what goes on the guess it to get so sometimes you know in syria for example the course get theres always calories for it to fail sure not the heart stopped when you die but thats different from putting code as the reason why your heart stopped so. Its its. Its a very good question and one get we always need to chase up one particular said because they get straight to the numbers always lag behind the number you can spend 3 weeks in a minute later and then die within 5 i need to become a credit cripple in india after that and some answer is of no leg. Ok professor clements there in person australia is it as simple as realizing and accepting were talking about 2 fabulous the wealthy countries singapore and cats are so as well as the flexibility they have the money they can afford test kits they can afford all that they can afford to import it very quickly. Why do you think thats part of the story but i dont think thats the whole story of the flaws with st louis mortality right saying very rich European Countries for example so i think i actually agree with dr money because assessment i think there is a Great Fortune i think they the youthful population the large number of migrants by singapore and part of that are the to be young people in contrast if example entries like italy and spain where you have quite a different demographic you have a high proportion of all the people i think its also the way that. All the people who are together busy and in some of those them countries and also in the strata. If you contrast singapore where you getting large numbers of prices. With spain and inflate way getting large numbers of places that i get the saudis i think that goes out of the way to live in the. The differences in mortality right aisles i think. In European Countries what happened is that. The number of cases where you know the Tipping Point at which the Health System was not readily and so individuals went out of the getting. The no longer getting. Essential treatment that would effectively side their lives and in fact just like singapore qatar australia the Health System hasnt been there for and there will be will have been of access lets add in treatment i think those are some of the issues and then i think there are a whole bunch of other potentially more complex issues in relation to differences in you know what you will find files the regions different histories of exposure to viruses. Genetic differences in population and of course importantly such a moment differences where the general population may be more or less literate. Maybe more or less locked into. Access health care in a 20 way maybe more or less likely to. Take proper fighting behaviors so i think its a very complex that youre going to be got to boil down to one particular fact that ok any sparrow in geneva could part of it be as well that whilst were talking about a very small very wealthy country singapore and castle were also talking about a very high number of Migrant Workers whether theyre blue collar or white collar you are tested so the starting point is one of physical wellness and well being even before you get the residency permit because if you dont pass the medical you dont get the residency permit so you know the median age seeing cattle are for contracting the coronavirus i think is 30 to singapore its more like 41 or 42 but the starting point is those individuals predominantly men are quite fit and healthy anyway absolutely get to go important point because when youre testing a sick demented convictions for that reason because you need it to do or be the resident he then youre going to pick up and be a think medications did not initially done in other countries which if theyre expected to get are different stage of the epidemic theyre dealing with in europe this catastrophic record in tracks of patients has been seen in places like italy where youre going to visit people present if youre i think domestically or you dont even think youre sick or even if he might be if youre not thats it youre basically told just get home as you can so you automatically youre catching all the cases which is great to have a good idea of what the numbers at least in that cohort but also all of the asymptomatic cases put in there means of course the case the county rate is much lower. And you know what i think you know what what these things do do though is they actually detract from some of the really important issues that are behind mortality and actions related to some of these net empire we focus on your way there are different to why these countries dont but its ringback not because they have a magic bullet theres no coded magic button that doesnt exist and say that as a commission to effect its a very difficult disease and but what we do know is that right across the world desert not just age why is that where you go to get more like her but a very important gender bias sorry in dayton for example their most recent data shows is that in if youre a man then any wind up in i. C. U. More than 70 percent of those in i. C. U. And men and on those men more than 50 percent more die which is not quite different to 2 women if they actually end up as here only 43 percent its a huge difference and we see that across the across the globe crossing over every different country and thats seen that since beginning immediately thought is it healthy behavior to mean smoke or dr west the hands of whats going on but actually its really important to understand his foot and conversely why are women protected is it because they have a more robust immune system is set and something that we can then hundreds because whatever is protecting us we can use for treatment so ok ok sally im running here in doha quarantining particularly Blue Collar Workers i guess you would say that was the right thing to do at the right time as soon as the cattery or thorazine the cattery government switched on to what was really happening however the infection rate is still climbing as of 2 hours ago Johns Hopkins in the states is saying 17142 cases here mainly in doha. Yes it is quite a challenging palace and anyone who tries to tell you otherwise is problems treating it were talking about a highly infectious virus with a march pool of asymptomatic all very very. Mild some minor listened to magic individuals able to carry her virus and spread it at least 2 days we know now the one to show any symptoms so the virus is able to spread very very quickly i think the numbers in one. Concern but at the same time. Not increasing and who either one might have seen and their numbers are steadily increasing i think this is the best that you can do with such a part as with the pages that i just described if you are able to control and maintain the numbers are coming we didnt know was that the system and absorbed by things safe and appropriate isolation facilities and providing medical care. I think you could if you were able to maintain it and that calmed the level but i think that some measure or success one company has been able to or it successfully so far is though tsunami is our number its the part of beyond and care systems capacity numbers that thousands per day that system can that he be really effective ok so i think the response i think has been successful if united on that and ok lets flip that around a little bit clemmensen 1st coming back to you there wasnt a tsunami of caseys fresh infections and the mortality rate is low in singapore there was however between a tsunami of infections and 0 infections the on number coming less than one there was a spike in singapore started on april the 12th why april the 12th i mean did the authorities take their eye off the bowl everyone would i assume say no they didnt. Well singapore i guess is a little different again in that its International Travel well and also singapore in government exercise. Implemented a very Effective Response so you have all seen a constant flow people on up and so i think thats credit you need challenges and also i mean you can hear it was. We were in the shot at what was then and very quickly a limit i knew you people travelling to the country that was a little more difficult or else i got a lot smarter by the population and then once the virus got into that. And in this thread because. It was that the house together in logic routes and and transmission is still tied up so that singapore does that is a number of challenges i think that theyre right. But they need National Travel help to have a wider white population and i think its possible that i mean early days of the epidemic the virus has yet i guess in the us are its roots and. Its important not to get on top of it but then things started to get away when the virus started so that amongst them are there well ok any sparrow in geneva coming back to you i totally of course take on board what you were saying that theres no Silver Bullet here to rid the world of coronavirus its here its here for the foreseeable future it may become endemic but is there another component that we need to talk about and it might be this that when it singapore or cancel those 2 countries particularly singapore were praised by the World Health Organization for coming up with an all of government approach and thats approach works if youve got a small wealthy country city state like singapore a country like cattle but you cant apply an all of government approach to europe or to the United States and thats why i say in the us you get mixed messages coming out from different parts of the government different parts of the local government and in singapore we didnt get that and in cattle we havent had that either. Yes it does make it very difficult and to get to that in terms of its mass how time to work or whether in fact the commission is trying to discover what i get at the strategies or what i would get to probably cut strategies we all agree that we have to test test test in order to understand it no need to capture their cases to to to to be able to determine the case the county rate to be up to a state department extent tra. But also to have been there we have to complete these measures at such a distance in quarantine except that we know how to do that its clear that in order to move forward we actually have to now do what were doing it which is to put in billions of dollars now in order to save trillions because thats what its going to take to restart the Global Economy so. Without actually knowing what the population of community is we need to actually have tools in place a to go into by both protection and treatment and that then comes back to if you hear about who does the bars time get given that is done that if the boss doesnt discriminate between the with limited dates in terms of a job gender or race or ethnic it has a very different chemical outcome depending on on what a judge gender and the kind of economics of the preexisting health and economic disparities that already exist and thats why for example in states we see this exorbitant burden on the africanamerican population with their diet and 3 times faster and a right to pay 3 times higher than white population and even more than twice that of asians and hispanics whats that about net incomes back to the question as far as i can tell between singapore and tessa and the u. S. And europe you know we all have pretty much the same top 10 causes of death and those include trying to bust a disease and diabetes hypertension and obesity and being overweight and is this disease is a clear respect that and and then me so react distended to that and to do it have a disease behaves but if we dont have the same probabilities then why that were getting these very difficult outcomes met also means being very thoughtful about as 990 even i dont know the in origin of this disease tend to be that did theyve not they dont develop cuts way that women and men do and we fear trajectory in some of these which are going to guide our way forward many ways ok. Just to force you there any sparrow because we are heading towards the end of the Program Early on ronny here in doha when you talking to other clinicians other people involved in this fight and some of this why do cats are not go for a full lock from the get go because talking about the coronavirus uncovered 19 a lot here on inside story its clear to me that if you close a country done for 3 weeks you can beat the virus into so everything here in council has been a strong recommendation it hasnt been go home stay home you get one trip out the front door per day why do they not do that. I personally think that when youre trying to ask people to do things that are valid and today norms things that are different and im not easy to maintain i think maintaining any reasonable middle ground between forcing people to do things that are completely in total really very very difficult to comply with in the long term and may well lead to some kind of a backlash versus allowing people to do anything without any control i think of what midline very very well reminding a lot of education alternation citizens and militants of the country as to what they should do and infection and try to come to the efforts to control it and i dissent times to limit access to certain things but payment for example and alarming censure shoppin abstention and our i think with that part of that that you want like the people i and read. And youre more among the to be more effective than if you were reports can be knocked down at some point you cant do that not now and when you do then maybe a 2nd or 3rd rate it may really be hard. Clements on the point of a 2nd wave how do these 2 countries find shewn what theyre doing if they feel the need to go beyond what theyve already done if theres a 2nd wave. Well i think its really critical that. The countries that were talking about take a risk by the action of a phased approach and that russians are coming out. And they do it in a strange way as a monitor the impact of changes. And see whether they result in i mean every sentence cases and communication making the population aware that it has come back that. Social distancing of the lockdown measures would need to be back in place you made a point earlier about the differences in century medical systems and federal systems and i do think that that runs the risk of. Giving us a simplistic impression of how different systems out function are and how successful they are in managing pandemics i live in australia which has a federal system so much of the United States and theyve been incredibly effective in tackling the pandemic the reason that is because we have very strong. Leadership and government set up a National Cabinet where the heads of all different jurisdictions around most of the people where i want to come together and manage it manage the endemic or the epidemic and i dont nationalize i think thats really where the family is in the United States and europe and that is around the lack of collaborative and government politicization of 000 of the pandemic politicization of the response its not just about the level or governance system of the country its how that that system is used. To manage the endemic and ok so to put the last question to any sparrow in geneva poked me for interrupting you arent you clemens clearly any sparrow countries around the world are not as wealthy as cattle in singapore flexibility was something that we talked about at the top of the program whats the takeaway for you from other countries what can they learn from whats happened here and in singapore. Reason we try to you had to feel that in the period is because it buys at the time to be able to manage these patients. And not overwhelm our hospitals give the catastrophic extend that weve seen in italy and its pain not just our hospitals i Health Care Workers because were on the front line and the greater the burden on them and if they dont we havent got the people in place to protect them then theyre the ones you can get addicted and then use both the Human Resources and the physical doses to actually look after our patients so it is incredibly important to actually eat everything in case this very things and to allow that to be done more actually and it also says look at the demographics where the most vulnerable cases if you have a are in an Elderly Population then figure out how to focus on you know sometimes fast food joints family farm as we didnt care and that there is this huge mortality rate in Nursing Homes because we have retained change in the were so busy thinking about what goes on in the i. C. U. Ok we have to leave it there thank you so much to our guests they were dr early on ronny dr Annie Sparrow and professor Archie Clements and thank you too for watching you can see the show again any time for the website aljazeera dot com and for further discussion go to our Facebook Page thats facebook dot com forward slash a. J. Inside story can also join the conversation on twitter at a. J. Inside story im at it itll be one for me its a doggy and the team here in doha thanks for watching i will see you very soon for the moment of. I heard. What impact would call did 19 on the drop in the oil price have on the race to the white house can donald trump survive these historic setbacks and does the job only have what it takes to beat. The special coverage ill just get. Expelled from their base in jordan in lebannon left in the political wilderness rebellion was rising in the ranks of the p. L. O. 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