Figure 1. Pandemic numbers COVID-19 to 9/15/2020 for the 50 most affected countries.

Six months after the World Health Organization (WHO) declared the COVID-19 pandemic that probably started at the city of Wuhan, China, several personal reflections that can be madeto this point.

In the first place, this viral disease is causing an unprecedented health and economic crisis around the world. Most RACI readers and CACI members have never seen anything like this in their lifetime before and the only reference we have on global crises like this comes from history books such as the Second World War.

When one reads the daily reports on infections, mortality, and lethality (table 1, figure 1) we can see how the different countries of the world have been affected by the pandemic from the most economically viable onesto those still in their early stages of development.

It is surprising to read thecoronavirus in the world website and see how the world’s leading economies rank first in the number of contagions and mortality per 1 million population.

Among the 214 countries reporting their results—and arbitrarily excluding a few countries due toquestionable (in my personal opinion) data reporting—it is interesting to see that the world’s strongest economy with over 6,500,000 infections ranks first in the number of infections.This may be explained, in part, by the dynamics of this country’s economic policy based onconsumer economy. Nonetheless, the 589 deaths/million population reported is surprising and maybe due to the well-known deficiencies of this country’s public and private healthcare system.

A total of 15 countries (including Mexico, and Brazil) out of the 20 counties with the highest number of deaths per million population are developed economies.

In the opposite side of the spectrum we have the world’s third and fourth economies—China, Germany, and Japan—with death rates/millionpopulation that rank#171 (3 deaths/million population), #57 (112deaths/million population), and#138 (11deaths/million population), respectively. Actually, the death rate per million population of Asian countries is extremely low: Vietnam 11deaths/million population, Taiwan, 21deaths/million population;New Zealand, 5deaths/million population, and South Korea, 7deaths/million population. In our region, Uruguay (13deaths/million population) and Cuba (9deaths/million)are among the lowest deaths rates reported per million population.

Considering that I arbitrarily excluded counties whose data I am hesitant about, I believe that the numbers presented above can be explained beyond the mere analysis of each country’s GDP.

As I mentionedone of the reasons that may explain the number of infections reported may have to do with the characteristics of economy that happens to beheavily influenced by consumer economydriven by private initiative. The importance given bythe governments of each of these countries to the management of the pandemic may have played a role too. Nonetheless, the social, cultural, rational, and even racial characteristics of the population and the interest shownby the leaders of each country in the management of this pandemic could explain why countries with a very low GDP have had such an effective sanitary response.

Thesometimes conflictingresult analysis in the number of infections, mortality and lethality reported by, on the one hand,the so-called leading countries, andon the other hand, Uruguay, Taiwan, Singapore, Cuba, and New Zealand, among othersmay have different explanations. However, the characteristics of each population, the decisions made at central government level, the citizens’ observance of the protective measures implemented to avoid contagion, and solid public and private healthcare systems are the most plausible explanations to these findings.

In our repeated visits to China and Japanwe saw that the use of face masks is mandatory in these countries.

By September 8th, Argentina had the sad privilege of being among the top 10 countries with the highest numbers of infections. However, it ranks #30 in the death rate/million population.Although this speaks of a civilized behavior as a nation that has been courageous for centuries,it actually shows that, while I am writing these lines, our public and private healthcare systemsstill hold tothe highest standards of quality.

Finally, we should not forget that the approval of a vaccine will require the completion of three long stages as part of clinical research. So, until the necessary data on efficacy and safety become available by regulatory bodies, I strongly recommend to all of you that you take care of yourselves.

Alfredo E. Rodríguez MD, PhD, FACC, FSCAI
Editor-in-chief of RevistaArgentina de Cardioangiología Intervencionista (RACI)

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Lessons learned from the SARS COVID-19 pandemic

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