1/E

Various southeast Asian nations suffered relatively few COVID-19 deaths per capita, especially in comparison to many "western" nations.

There& #39;s been a lot of speculation on why this is.
So this thread will examine some possible explanations.

https://archive.is/FkAho ">https://archive.is/FkAho&quo...
2/E

There are at least 3 types of explanation for what& #39;s occurring in various southeast Asian countries:

1) insufficient testing that misses many infections and/or misses many COVID-19 deaths
2) lower number of infections
3) lower proportion of infected people die of COVID-19
3/E

For explanation 1:
It& #39;s unlikely their testing misses more deaths, since their excess deaths don& #39;t outpace their reported COVID-19 deaths more than in many & #39;western& #39; countries.

https://www.nytimes.com/interactive/2020/04/21/world/coronavirus-missing-deaths.html
https://www.nytimes.com/interacti... href=" https://www.bbc.com/news/world-53073046
https://www.bbc.com/news/worl... href=" https://www.economist.com/graphic-detail/2020/07/15/tracking-covid-19-excess-deaths-across-countries

https://www.economist.com/graphic-d... href=" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7852240/">https://www.ncbi.nlm.nih.gov/pmc/artic...
4/E

Insufficient PCR testing, or antigen testing, early on might still miss past infections. Antibody testing addresses that; this will be discussed more a bit later.

https://twitter.com/AtomsksSanakan/status/1347304761415135232

https://twitter.com/AtomsksSa... href=" https://archive.is/sjUkT ">https://archive.is/sjUkT&quo...
5/E

For explanation #3:
IFR (infection fatality rate) is the proportion of SARS-CoV-2-infected people who die of COVID-19. So explanation #3 states IFR is lower in southeast Asian nations.

Some proposed reasons for why this could be:

https://twitter.com/AskeladdenTX/status/1309633580008644609">https://twitter.com/Askeladde...
6/E

The co-morbidities explanation seems less plausible, since IFR is driven more by age and sex than by co-morbidities.

IFR increases with age, as do co-morbidities, while the rate of various co-morbidities differs by sex.

https://link.springer.com/article/10.1007/s10654-020-00698-1">https://link.springer.com/article/1...
8/E

Yet South Korea& #39;s IFR is comparable to western nations in spring/summer, regardless of whether one uses antibody testing or PCR-based modeling to estimate the number of infections.

[~0.6% August IFR: https://arxiv.org/pdf/2101.11991.pdf]
https://arxiv.org/pdf/2101.... href=" https://twitter.com/AtomsksSanakan/status/1312562674656522240

https://twitter.com/AtomsksSa... href=" https://link.springer.com/article/10.1007/s10654-020-00698-1">https://link.springer.com/article/1...
10/E

So explanation #3 is likely false.

That leaves explanation #2:
As per part 4/E, antibody testing on representative samples allows one to determine the number of infected people, without the limitations of PCR + antigen testing from explanation #1 https://twitter.com/AtomsksSanakan/status/1341185258964836353">https://twitter.com/AtomsksSa...
11/E

Japan& #39;s antibody-based infection rates were ~1% or less

https://onlinelibrary.wiley.com/doi/full/10.1002/jgf2.408

https://onlinelibrary.wiley.com/doi/full/... href=" https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000121431_00132.html
https://www.mhlw.go.jp/stf/seisa... href=" https://www.fukushihoken.metro.tokyo.lg.jp/iryo/kansen/koutaikensa.html
https://www.fukushihoken.metro.tokyo.lg.jp/iryo/kans... href=" http://www.pref.osaka.lg.jp/hodo/index.php?site=fumin&pageId=39934
https://www.pref.osaka.lg.jp/hodo/inde... href=" https://www.pref.miyagi.jp/uploaded/attachment/823102.pdf
https://www.pref.miyagi.jp/uploaded/... href=" https://www.pref.aichi.jp/site/covid19-aichi/koutaikekka.html
https://www.pref.aichi.jp/site/covi... href=" https://www.pref.fukuoka.lg.jp/press-release/press-release-corona-koutai.html
https://www.pref.fukuoka.lg.jp/press-rel... href=" https://www.pref.hiroshima.lg.jp/site/2019-ncov/message20201030.html

https://www.pref.hiroshima.lg.jp/site/2019... href=" https://wwwnc.cdc.gov/eid/article/27/2/20-4088_article">https://wwwnc.cdc.gov/eid/artic...
13/E

Western nations had much higher infection rates, with their hardest-hit regions often having rates 1 or 2 orders of magnitude more than in the three southeast Asian nations noted before

https://www.istat.it/it/files//2020/08/ReportPrimiRisultatiIndagineSiero.pdf

[https://www.istat.it/it/files/... href=" https://www.mscbs.gob.es/gabinetePrensa/notaPrensa/pdf/15.12151220163348113.pdf]
https://www.mscbs.gob.es/gabineteP... href=" https://portalcne.isciii.es/enecovid19/informes/informe_final.pdf">https://portalcne.isciii.es/enecovid1...
16/E

Similarly, this likely is not explained by cross-reactive B cells, plasma cells, and/or antibodies from prior infection with other coronaviruses.

https://twitter.com/AtomsksSanakan/status/1312654302742183936
https://twitter.com/AtomsksSa... href=" https://twitter.com/AtomsksSanakan/status/891040491214688257

https://twitter.com/AtomsksSa... href=" https://www.nature.com/articles/s41591-020-1083-1
https://www.nature.com/articles/... href=" https://www.medrxiv.org/content/10.1101/2020.06.29.20142596v1

https://www.medrxiv.org/content/1... href=" https://www.medrxiv.org/content/10.1101/2020.08.14.20173393v1">https://www.medrxiv.org/content/1...
17/E

Many of those offering these alternative explanations do so for ideological reasons and/or in bad faith, because they want to avoid an obvious answer:

Policies + behaviors in southeast Asia limited infections

20:42 - 25:52 : https://www.youtube.com/watch?v=t4yZaoA90Jk&t=1242s">https://www.youtube.com/watch...
18/E

So instead of making excuses about how southeast Asian nations have special exposure to other coronaviruses, or better immune systems, or..., we in western nations should own up to the reality that their policies + practices worked.

Deal with it.https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤷‍♂️" title="Achselzuckender Mann" aria-label="Emoji: Achselzuckender Mann">

https://twitter.com/AtomsksSanakan/status/1325442309668921351">https://twitter.com/AtomsksSa...
19/E

And h/t to @KawasakiKR11 for help in finding seroprevalence studies for Japan in part 11/E, since I only read and write in English. https://twitter.com/AtomsksSanakan/status/1364470684949299203">https://twitter.com/AtomsksSa...
20/E

Sources on infection-limiting strategies in southeast Asia:

(act early:
https://link.springer.com/article/10.1007/s10640-020-00466-5
https://link.springer.com/article/1... href=" https://academic.oup.com/cid/article/71/12/3174/5866094)

https://academic.oup.com/cid/artic... href=" https://twitter.com/AtomsksSanakan/status/1364599742257364995

https://twitter.com/AtomsksSa... href=" https://web.archive.org/web/20210224184118/https://www.mhlw.go.jp/content/10900000/000635891.pdf
https://web.archive.org/web/20210... href=" https://journals.sagepub.com/doi/full/10.1177/0275074020943707
https://journals.sagepub.com/doi/full/... href=" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7567433/
https://www.ncbi.nlm.nih.gov/pmc/artic... href=" https://www.thelancet.com/article/S0140-6736(20)32007-9/fulltext

https://www.thelancet.com/article/S... href=" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7189844/">https://www.ncbi.nlm.nih.gov/pmc/artic...
21/E

Examples of what I critiqued from those using a Tokyo study w/ non-representative sampling [ https://www.twitter.com/AtomsksSanakan/status/1365177417023774720]:

https://www.twitter.com/AtomsksSa... href=" https://www.twitter.com/carlheneghan/status/1309558504307544064
https://www.twitter.com/carlheneg... href=" https://www.twitter.com/MonicaGandhi9/status/1335747616148127745
https://www.twitter.com/MonicaGan... href=" https://www.twitter.com/dwallacewells/status/1308855749821554689
https://www.twitter.com/dwallacew... href=" https://www.twitter.com/AlexBerenson/status/1308798932097658881
https://www.twitter.com/AlexBeren... href=" https://www.twitter.com/MLevitt_NP2013/status/1308979101215096834

Nic">https://www.twitter.com/MLevitt_N... Lewis:
https://judithcurry.com/2020/10/14/t-cell-cross-reactivity-and-the-herd-immunity-threshold/">https://judithcurry.com/2020/10/1...
22/E

Further context on why prior infection with other coronaviruses does not adequately explain low COVID-19 deaths per capita in southeast Asian countries, especially in light of low seroprevalence:

https://twitter.com/AtomsksSanakan/status/1364660714342932487
https://twitter.com/AtomsksSa... href=" https://twitter.com/AtomsksSanakan/status/1364664008830246913

https://twitter.com/AtomsksSa... href=" https://twitter.com/AtomsksSanakan/status/1365870324861067266">https://twitter.com/AtomsksSa...
24/E

Re: "Ioannidis defends a failed version of explanation #3 [...]. He under-estimated IFR in southeast Asia"

Update on Asian seroprevalence studies:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00238-5/fulltext
https://www.thelancet.com/journals/... href=" https://www.mhlw.go.jp/content/000761671.pdf
https://www.mhlw.go.jp/content/0... href=" https://twitter.com/KawasakiKR11/status/1379530595148181507

He& #39;s">https://twitter.com/KawasakiK... still doing it:
https://twitter.com/AtomsksSanakan/status/1376029923903672322">https://twitter.com/AtomsksSa...
25/E

Ioannidis, March 2021:
"I& #39;m not talking about [New Zealand, Vietnam, Taiwan] that did a wonderful job and did exactly what I was saying a year ago. Test, test, test. That& #39;s what the WHO was saying. And then isolate, then contact trace"

31:35 - 31:47 https://www.youtube.com/watch?v=HBd5Q8NpvoI&t=1895s">https://www.youtube.com/watch...
26/E

Basic summary of the thread:

Southeast Asian countries successfully limited COVID-19 deaths predominately by pursuing policies + behaviors that prevented infections.
It& #39;s not a matter of them having better immune systems, special pre-exposure to other viruses, etc.
27/E

Based on this thread, one would predict that Malaysia& #39;s NHMS results (likely to be released in May/June) would show <2% of people infected, with an IFR of ≥0.4%.

http://iku.moh.gov.my/nhms 
https://iku.moh.gov.my/nhms"... href=" https://twitter.com/AtomsksSanakan/status/1360114634662019073

https://twitter.com/AtomsksSa... href=" https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&pickerSort=asc&pickerMetric=location&Metric=Confirmed+deaths&Interval=Cumulative&Relative+to+Population=true&Align+outbreaks=false&country=KOR~JPN~CHN~VNM~SGP~PHL~EuropeanUnion~AUS~NZL~THA~MYS">https://ourworldindata.org/explorers...
28/E

https://twitter.com/AtomsksSanakan/status/1379865372740960259

Ioannidis& #39;">https://twitter.com/AtomsksSa... debate opponent, June:
"restrictions cannot safely be lifted without the capacity for massive testing, contact tracing, and adequate protection for high risk populations"
https://bmj.com/content/369/bmj.m1924

Ioannidis,">https://bmj.com/content/3... July:
#selection-921.0-947.146">https://archive.is/VVxam #selection-921.0-947.146">https://archive.is/VVxam...
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