More than one person has suggested that this entire endeavor is quixotic at best, distracting from real solutions at worst. Yes, I hear you, but am ignoring you. One of my usual lines when people make pronouncements is "Compared to what? Or whom?" When the accusation goes out about the evils of American interaction with oh, South America, I like to say "Compared to who? Portugal? The USSR? More recently, China? What do you mean, exactly?" So when we are looking at whether America as a whole is doing the right things about C19, it is quite natural to me to ask "Compared to who?" Especially in an election year we tend to fall into Sweden yea vs Sweden nay, or "Look how stupid Trump/Biden/Cuomo/Abbot/lockdown/opening is." I am first trying to get out of that and see if there are large tendencies related to population density, international contact, and primary strategies.
You are free to find that a ridiculous approach. I still like it.
Iceland and Switzerland are outliers, both with a lot of cases but few deaths. Switzerland’s cases are largely along its border with Italy and they have just had a resurgence, so the conclusions people were drawing two months ago are now looking premature. Iceland’s story is that they have done a level of aggressive contact tracing that likely only Scandinavians would put up with. ( Maybe Benelux as well.) While most people in all countries are happy to help with contact tracing, when it comes to doing so against their will, some will very much dislike that on principle. When Black Lives Matter or QAnon or drug dealers or pedophiles or CNN reporters refuse to give up their phones, it wouldn’t just be American libertarians who say “You can’t make them. It’s a terrible precedent. Once that seal is broken who knows what it will be used for?” There are lots of Canadians and Scots and Dutchmen who would say the same.
Still, the tradeoff on that was that Iceland did not lock down and believes they’ve got everything normal and under control at present, so maybe I’m wrong about what folks will put up with. Privacy vs having a job? Tough call. Also, it's an island, so even if we thought their approach was the bee's knees we might not be able to do it.
The other Scandinavian countries are not particularly good comps, but maybe a little something. They had much less international contact during the leadup and aren’t clamoring for more since; they have no megacities and their few large cities do not have especially dense centers; they are traditionally very cooperative with government directives. Sweden is so cooperative that they voluntarily did a lot of what everyone else had to be ordered to do. Lots of places closed on their own, but they did not close schools and government offices. Their death rate has been very high for Scandinavia, on a par with France, Spain, UK, etc. As their cases and deaths have gone very low recently (but not to zero, as is sometimes claimed), some are claiming their method worked. The hope was increased herd immunity, so maybe it will work in the long run. But at present the other Scandi countries also have low rates, without having lots of people die at the beginning, so I would say they are still in the hole. All of central Sweden has had problems, not just Stockholm.
The UK, with very high deaths per million* has a megacity and a series of cities across the Midlands, all of which have been hit hard. London has one of the highest rates of international contact in the world. France likewise has high DPM and a megacity, and international contact ,but it also has two other hotspots for other reasons: its border with Northern Italy and the area around Strasbourg, where there was an early superspreader event of 2500 people indoors for an annual religious gathering. Italy has high case rates and death rates, mostly in the northern section most similar to the rest of Europe, as opposed to southern Italy which has a more Mediterranean culture and economy. While there is some concentration of cases near those northern Italian cities, as we all remember from the early accounts, villages were also hit, and their medical services overwhelmed. Italy has large cities, but no megacity. While they technically did not have a superspreader event to kick things off, their contacts with China cannot be regarded as equivalent to more general “international contact.” A relatively small amount of contact was devastating.
Sarah Hoyt over at Instapundit assured us that nothing like Italy and Spain would happen in America because our hygiene practices were far superior to even prosperous European nations. She spoke with authority because she is Portuguese, but it doesn’t seem to have turned out that way. This is one of the reasons I skip over her posts now. Raising it as a possibility to be alert for going forward is quite different from large assertions like that. She may be right about the hygiene. I did find European bathrooms rather appalling even in England. General cultural hygiene doesn’t seem to have been the key, though.
Madrid and Barcelona do not qualify as megacities, but they are large, and Spain’s alarming number of cases do concentrate there, even on a percentage basis.
No megacities in the Netherlands, Belgium, Portugal, Germany, but they have lots of urban areas, lots of international contact, and their rates of cases and deaths are all high. Canada is very regional. Quebec has a high case rate and death rate, comparable to all but the very worst US states and the worst of western Europe, and Ontario has some moderate problems, especially around Toronto, but the rest of Canada has very few cases. Quebec’s problem is mostly, though not entirely a Montreal problem. I don’t know what’s happening there. The Canadian Maritimes mirror the northern New England states**, and Western Canada mirrors the low rates of Montana, North Dakota, etc.
What few things can we learn from the general demography, then?
1. Megacities are a large vulnerability for their entire regions, and this does not seem to be simply linear. It may be impossible to control the movement of that many people for long. Dependence on public transportation is an added vulnerability and going underground is worse.
2. Lack of population is protective, though I can’t say whether that is also nonlinear. It sure looks it. From continent maps to city maps, denser areas have more cases not only in absolute terms but per capita. The followup worry is the availability of medical care if your rural area gets the bad superspreader d20 roll of 1 and now you're screwed. While everyone else is fine and yelling "What's the problem? It's just the flu!"
3. Borders matter, but not so much as governments hope, especially in dense population areas. People must be leaking over, whatever the authorities claim. So one rule going forward would be “Don’t have a border with Italy” and “residents of big cities get out anyway.”
Additional - not really part of what I've looked at here but part of what I've picked up:
4. I thought ventilation was going to be big, but a couple of people at Chicago Boyz have put forth solid arguments that this is unlikely.
5. There are lots of co-morbidities that are a problem, and many seem to be part of Metabolic Syndrome, but obesity seems to be rising out of the pack. I thought COPD was going to be enormous, but it seems to be only moderate or even only mildly a problem. Huh. Type II Diabetes is a problem, but I don't think well-separated from the often co-occurring obesity. I have to think morbid obesity is going to even more of an issue. The others are middling.
* Deaths per million is the most useful statistic, but only in a context of other similarity. As I noted before, Andorra, Peru, New Zealand, and India’s overall numbers do not tell us anything about the US. Whatever lessons we learn from those would have to come from unexpected factors that turned up. The larger nations of Western Europe and Canada are the only real comps, and even those have limitations.
**Except for two NH counties that are partly Boston suburbs