The Overwhelming Importance of Geography in Explaining Covid Mortality

I’ve written before about the World Mortality Database, compiled by researchers Ariel Karlinsky and Dmitry Kobak. It provides estimates of excess mortality for all the countries around the world in which reliable figures are available.

These estimates aren’t as good as the age-adjusted excess mortality estimates that the ONS has computed for European countries, but they’re the best we’ve got for making international comparisons. (The reason they aren’t as good is that they’re based on all-cause deaths, rather than age-standardised mortality rates.)

At the present time, estimates are available for 117 countries, comprising a large share of the world’s population. What do they reveal about which countries have done well and which haven’t, during the pandemic?

All the countries with high levels of excess mortality are in Latin America and Central Asia. And the top three – with exceptionally high levels of excess mortality – are all Latin American countries with large indigenous populations, suggesting that such populations might be particularly susceptible to Covid.  

More illustrative, though, is the bottom of the chart. And here one thing really stands out: of the 15 countries with zero or negative excess mortality, no less than 14 are islands (the other being Brunei).

And of the 18 countries with 1% excess mortality or less, fully 17 have either one or zero land borders. The Dominican Republic only borders Haiti; and Brunei only borders Malaysia. (The exception is Malaysia, which borders Thailand, Brunei and Indonesia.)

After two years of lockdowns, mask mandates, and vaccine passports, it seems the best strategy for dealing with Covid is… be a small country with few land borders.

Much has been made of Australia and New Zealand’s success in containing the virus – up until December of 2021. But clearly this owes much more to their geography than to the specific policies they imposed. After all, almost all the countries at the top of the chart imposed stringent lockdowns as well.

A fair summary of the evidence in the chart above would be: Lockdowns can work to contain the virus, at least for a time, if you combine them with strict border controls. But once the virus gets a foothold in your country, they make very little difference.

Another thing to notice is that the East Asian countries are still concentrated at the bottom of the chart, strongly suggesting that some cultural or biological factor – perhaps greater prior immunity – explains the success of that region.

What lessons are there for the next coronavirus or influenza pandemic? Containment may be viable strategy for small islands and peripheral states with few land borders. But for the vast majority of countries, it isn’t worth pursuing. Instead, those countries should plan for focused protection.

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December 2022
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