Why East Asia Succeeded and America Failed

A tale of two very different coronavirus responses

East Asian countries all have very different coronavirus responses, but they have one thing in common. Experience. Hard-won, hard-fought experience. They’re fast now because they suffered before, with SARS, MERS and other epidemics.

All of these countries have built a national immune system, and that’s what enables them to fight COVID-19 so well. The US had an immune system as well, before Trump destroyed it. In fighting any novel pathogen, it is this experience more than any particular tactic that makes the difference.

How Countries Build Immunity

If your body gets sick once, it learns the disease and it builds antibodies. That’s how a vaccine works, it gives your body that information without actually giving you the disease. When a disease hits a vaccinated human, the immune system doesn’t think about it, it just recognizes and automatically whips into place.

The immune system will recognize the antigens immediately and attack aggressively well before the pathogen can spread and cause sickness. (publichealth.org)

In the same way, East Asian countries have been sick before. They’ve been hit with SARS, MERS, H1N1. This painful experience has given them physical antibodies. Taiwan built a command center and passed legislation. Hong Kong’s citizens knew about masking and distancing. China built a failsafe reporting system (which failed).

When coronavirus hit they didn’t spend time running computer models or debating whether this was serious or not, they just acted. Their national immune systems were primed and they whipped into place. This wasn’t about whether they had authoritarian governments or democracies, it was just down to experience.

Each country learned different lessons, but the number one lesson was this. Act fast. Without speed, all actions mean nothing.

For China that meant lockdowns and fever clinics, for Singapore it was rapid contact tracing, for Hong Kong it was grassroots masking and distancing. You can debate the specific tactics, but that’s beside the point. The strategy is to hit fast and hit hard. If you spend even a week debating tactics you’re already dead.

The key lesson is that any epidemic response has to be automatic— like an immune system. And the only way an immune system really learns is by getting sick. People had to die of SARS and MERS to ‘immunize’ these countries. That’s what made them strong enough to fight COVID-19.

How Countries Destroy Immunity

Sadly, there’s also a cautionary tale. After swine flu and Ebola, US President Barack Obama built an immune system for America. Out of the bureaucratic cacophony that Ebola exposed, he appointed an epidemic czar, one bureaucrat to rule them all.

Building on the Ebola experience, the Obama administration set up a permanent epidemic monitoring and command group inside the White House National Security Council (NSC) and another in the Department of Homeland Security (DHS) — both of which followed the scientific and public health leads of the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) and the diplomatic advice of the State Department. (Foreign Policy)

This all sounds very dull, but this is what a national immune system looks like. It’s bureaucrats and org-charts, this is the bone marrow of public health.

The next President — Donald Trump — out of spite for everything Obama, destroyed all of this. He ripped out the country’s immune system.

In May 2018, Trump ordered the NSC’s entire global health security unit shut down, calling for reassignment of Rear Adm. Timothy Ziemer and the dissolution of his team inside the agency. The month before, then-White House National Security Advisor John Bolton pressured Ziemer’s DHS counterpart, Tom Bossert, to resign along with his team. Neither the NSC nor DHS epidemic teams have been replaced. The global health section of the CDC was so drastically cut in 2018 that much of its staff was laid off and the number of countries it was working in was reduced from 49 to merely 10. (Foreign Policy)

When coronavirus hit, America was completely unprepared, not just because its President was an idiot, but because he had ripped out the country's spleen, lymph nodes, and bone marrow years earlier.

When COVID-19 hit, the US reacted like a patient with no immunity at all, which is to say, badly. That more even than the President’s current idiocy is why their outbreak is the worst in the world. It wasn’t what he did, but what he didn’t allow the country’s immune system to do.

Lessons Learned

Since we’re all in the soup now, what do we learn?

The number one lesson is one you cannot just be told. You must suffer. All of the East Asian countries have suffered. People died, economies contracted, hospitals broke and failed. Great wisdom is borne of great suffering and this is no different. East Asia only had an immune system because they’d been sick before. They’re only living because they died.

In terms of specific tactics, there are some clear lessons. Command centers, stockpiles of PPE, and the basics of testing, contact tracing, and quarantine. However, they all did this in different ways. In China, they had aggressive lockdowns while they rolled out fever clinics. In Singapore, they remained open but had vigorous monitoring and rapid contact tracing.

Each country had evolved a different immune system, but the vital thing is that they had one. And they funded it and tended it and didn’t abandon it when times were good. Then, when the time came, they listened to their immune systems and whipped into action fast.

This is a lesson the whole world is learning now, painfully. If we’re smart we should just copy East Asia now, without wasting precious time on modeling and debate, but to some degree, we just have to learn through pain. The lesson is not authoritarianism vs democracy, or Asian culture vs western, it’s just experience vs inexperience. And that’s not something anyone can tell you. You just have to suffer.

Some countries have learned this, some countries have forgotten, but we’re all getting a crash course right now. For your health and mine, I pray that your country learns. This isn’t over, and this isn’t our last pandemic. We need to learn from East Asia and from the failure of America and build and preserve our immune systems now.

This more than Britain’s insane definition is herd immunity, and it’s not biological. It’s political, social and bureaucratic. The herd is protected not by frail human flesh, but by office buildings, words on paper, and above all the collective memory of people that have suffered, learned and come back stronger.