Thursday, October 29, 2020

Coronavirus: Haiti with Minimum Deaths?

I was sure that Haiti would be heavily impacted by COVID-19, but at the moment it looks like this thought was wrong. Haiti Times (Oct 5): reports:

Back in April, public health experts projected 1,000 deaths per day would occur by May in Haiti, whose population stands at more than 11 million. But the numbers recorded by the government have not come anywhere near these levels. 

Per Worldometer, Haiti doesn't even have 500 deaths. The article admits that there could be under-counting of deaths, but if there were 1,000 deaths per day, I'm sure I would find news articles about how graves were being dug across the country. For example, another poor country I've worried about is Yemen. And though per Worldometer there have been few official cases or deaths (actually more deaths than in Haiti), there are anecdotal evidence of significant numbers of deaths such as nearly 100 healthcare workers. 

Why exactly are there not more deaths in Haiti? One thought in the article is that it is driven by age. Once again, per Worldometer, the average age in Haiti is 24. I decided to do a check and look across the border into the Dominican Republic. Deaths in the Dominican Republic are around 10x higher than in Haiti (both countries have around the same population) and the average age is 28. Does a 4 year difference really drive 10x the deaths? But even if you argue that Haiti is under-counting deaths and are more aligned with the Dominican Republic (which might also be under-counting deaths), you'd end up at only 2,500 deaths or so. That is still a far cry from 1,000 deaths per day. 

Another interesting idea that is mentioned in the article is population density:

Despite the gradual swelling of crowded population centers in Port-au-Prince, where it is nearly impossible to maintain social distancing, the majority still live in a rural setting

Roughly 60% of Haiti’s population is rural, of which 25% is extremely rural, Campa explained, about Haiti’s population distribution.


There were a few other ideas tossed out (natural medicines, vaccinations, virus strain), but here is another one that I found interesting: Haiti has a warmer temperature than a lot of other countries, but that same idea was applied to Indonesia, as well. Admittedly, Indonesia also don't have that many cases (on a per million basis), but they also have a testing problem. And their cases have been on a steady rise (though perhaps flatlining recently) while Haiti had a quick jump in cases and then a rapid drop off. Anyways, temperature might play a role in the lack of spread, but Indonesia would seem to imply that it just slows down the spread of the virus.

My bet is that a combination of age and population density is helping to limit deaths associated with the virus. The virus is probably far more wide spread in the country due to a lack of testing. 

Finally, the economic lockdown may have limited the spread. This lockdown has resulted in financial harm for the country:

While lives have been spared, the pandemic has caused massive job loss and growing food insecurity.

In March, after Haiti recorded its first case, the government closed factories, airports and schools to limit the spread. Textile factories and airports have since reopened, while teachers and students started returning to the classroom in August. But the combined toll of last fall’s political unrest and the coronavirus ‒ both of which depressed economic activity ‒ has strained parents’ finances.

. . . “There’s been discussions by infectious disease experts around the world that this fall, we may be seeing another wave,” said Campa, who noted the recent reopening of schools and resumption of normal activities in Haiti.

This idea of a second wave is something I'll keep an eye on. As their economy re-opens, will the virus spread gain a stronger foothold in the country? We are seeing second waves in Europe. Based on the above quote, Haiti doesn't appear to be a country that could deal with another economic lockdown.

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