Why is China so Dirty, and Singapore so Clean?

Note the case reports from bellwethers Taiwan, Singapore, and Hong Kong.

China Has a Way With Germs

Over the next several days and weeks, we would experience the amazing culture of China, in several different cities. But some things stood out to this germophobic American. I watched a man hock up something from his chest and spit it on the floor, right next to us, in a restaurant. No oysters for me, thanks. I’ve suddenly lost my appetite.

We visited a Hutong (inner city – where the locals live) and saw raw chickens, skinned and bleeding, just laying on the floor, waiting to be thrown on a restaurant grill…for public consumption. No FDA or USDA or food inspectors or “codes” to comply with, here. But why? This is the last purely communist country on earth. You’d think there would be red tape everywhere. What was happening here?

Then, my wife and I had to rush our newly adopted, 8-month-old daughter to the public hospital…and suddenly it all started making sense.

As we stepped in more urine, took our number from the print-out machine, walked past the line of children whining and crying from the scalp IVs in their heads, then rushed to clean up blood and mucus (left by the last patient) on the plastic table they were now laying our baby on, then waited on the ONE overworked doctor (attending to no less than three hundred people) try to round up a basic anti-biotic to administer to my daughter (right there on site – no refills) it dawned on me what I was seeing and what I had been seeing this whole time. I wasn’t watching a “backward” culture or a third-world society. These people weren’t genetically inferior to first-worlders. They weren’t “less-evolved” than I was.

I was witnessing the kind of maximum, almost brutal efficiency a society must develop when the state is the master and the individual is merely a subject. Why would a Communist country not have an effective FDA? Because who are you going to complain to if you get tainted food? The government? They don’t answer to you. The press? They are owned by the government. And again, they don’t answer to you.

So what if you don’t like the conditions in the hospital? Where else are you going to go? This hospital is the last (and only) stop. You can’t opt for another place and then just pay out of your own pocket. The government has capped financial upward mobility. There is now “income equality.” And that means nobody has the means to buy their way into a different (or better) situation. And even if you could, one doesn’t exist. The state provides it all. You’re stuck. __ Birth of a Virus

In Singapore, Things are Different

Singapore has a relative few cases of Covid 19 considering how close the ties are between the island nation and mainland China. The keys are vigilance and caution — with none of the panic that US media outlets keep trying to stoke.

Despite news photos showing long lines in Singapore supermarkets, my neighborhood markets have been calm and fully stocked. Even so, when I realized I needed a half-cup of milk to make a frittata one recent afternoon, I searched “dairy-free frittata” before deciding I had no choice but to go to the store.

I sneezed in the supermarket checkout line and instantly felt guilty.

Fear of empty shelves, by the way, seems to have driven many Singaporeans to online shopping, making online grocery delivery slots potentially a scarcer commodity than hand sanitizer.

It seems no one is holding escalator railings anymore, which is an accident waiting to happen. __ Life in Singapore

Of course, Singapore has a reputation for cleanliness. A person could once be caned for publicly chewing gum in Singapore.

We continue to monitor the case counts in Singapore, Taiwan, and Hong Kong — where the ties to mainland China are very strong, but the infection counts remain relatively low, considering.

Meanwhile in Iran, a Coronavirus Wildfire Burns

The vicious outbreaks of coronavirus in Iran, Italy, and South Korea, all have direct links to the Wuhan outbreak. But each country somehow allowed things to get out of control in specific areas, very quickly. In Iran, about a dozen government officials are infected, and one official has died.

Security forces deployed drones and water cannons across Iran on Tuesday in a bid to contain the coronavirus, a sign of the severity of the country’s outbreak.

Footage broadcast by Iranian state media showed water cannons, usually used to disperse anti-government demonstrations, spraying the streets with disinfectant. A banner on the side of one of the vehicles read: “Operation Crackdown on Corona.”

The use of these measures comes as Iran grapples with the most severe levels of contagion outside China. Iran’s Health Ministry confirmed that 77 people have now died of the disease, while there are now over 1,500 confirmed cases nationwide. Multiple reports from both within Iran and in international news agencies have challenged these statistics as significantly lower than the real numbers. This weekend, BBC Persia cited health sources claiming that at least 210 people may have already died, far above the official figure. __ Source

Vaccine Technology is Improving

Thanks to some advances in vaccine technology, we may only have to wait months instead of years for an effective vaccine to the novel coronavirus Wuhan 2019.

The new technologies that are being harnessed are what are known as vaccine platform technologies. Vaccine platforms, as my colleagues and I wrote in a report assessing their promise, offer a means to use the same building blocks to make more than one vaccine. To slightly oversimply, a vaccine platform confers the ability to switch out the pathogen being targeted very rapidly, akin to changing a video game cartridge. Indeed, the recently FDA-licensed Ebola vaccine uses another virus as a platform with the requisite Ebola protein inserted.

Because of this rapid availability to utilize platforms for a variety of different targets, the initial development process can be significantly shortened. This is especially true for vaccines utilizing the genetic material of the target alone. These DNA and RNA vaccines basically can be “printed” once the genetic sequence of the target is known.

Off Topic: How is aging similar to climate change?

Answer: Climate is always changing, and you are always aging.

As gerontologists Sean Leng and Brian Kennedy put it, “Aging is the climate change of health care.”

… In 2013, a team of international researchers identified nine “hallmarks of aging”: disrupted communication between cells, genome mutations (associated with cancer), telomere shortening, changes in DNA’s chemical structure (apart from the genetic code), degradation of cellular proteins, diminished cellular ability to identify and adjust to nutrient levels, impaired mitochondrial functioning, cellular senescence (when cells stop dividing and growing due to age), and nonrenewal of stem cells. While each hallmark has symptoms, “there are no biomarkers to describe aging overall,” according to Chuck Dinerstein, senior medical fellow at the American Council on Science and Health. These hallmarks occur in every human, and because many of them occur simultaneously, it’s difficult to tease out each individual process or to identify causal relationships. We know that the net effect is aging, but there’s a lot scientists don’t yet know about the processes that causes these hallmarks. Hayflick has argued that differentiating between aging and age-associated diseases is crucial, and that the lack of distinction between them “is the most serious impediment to our understanding of the aging process.” __ Source

Achieving effective treatment for aging is likely to help in achieving effective treatment for many diseases — both degenerative types of diseases as well as infectious diseases. The current global outbreak of novel coronavirus appears to be most lethal for the elderly, which is also the case for many endemic infectious diseases such as seasonal flu.

As we suggested a few days ago, you may find it educational to continue to monitor cumulative case counts for Singapore, Taiwan, and Hong Kong, all kept updated by the South China Morning Post.

We continue to see conventions and trade shows being cancelled around the world. The wisdom of governments that instituted early travel restrictions on travelers from infected regions of China, continues to be supported by the worldwide infection counts.


Case Fatality Rates: Flu vs. Coronavirus 2019

Of those who are infected by novel coronavirus 2019, how many can be expected to succumb to the infection? Here is one take on the question:

The WHO said in a press conference Monday that in Wuhan, China, the city where the virus emerged, the mortality rate ranged from 2% to 4%. Officials said that in the rest of China, outside of Wuhan, the mortality rate of coronavirus is 0.7%.

Mike Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said the mortality rate in China has since risen to 0.9%.

… Christopher Mores, a global health professor at George Washington University, helped make sense of some figures. He calculated the average, 10-year mortality rate for flu using CDC data and found it was 0.1%. That 0.1% rate is frequently cited among experts, including Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

… __ https://khn.org/news/fact-check-coronavirus-homeland-security-chief-flu-mortality-rate/

More numbers:

Another recent study, considered the largest on COVID-19 cases to date, researchers from the Chinese Center for Disease Control and Protection, analyzed 44,672 confirmed cases in China between Dec. 31, 09 and Feb. 11, 2020. Of those cases, 80.9% (or 36,160 cases) were considered mild, 13.8% (6,168 cases) severe and 4.7% (2,087) critical. “Critical cases were those that exhibited respiratory failure, septic shock, and/or multiple organ dysfunction/failure,” the researchers wrote in the paper published in China CDC Weekly. __ https://www.livescience.com/new-coronavirus-compare-with-flu.html

The calculation is fairly simple, but getting accurate numbers to plug into the formula can be next to impossible sometimes.

Still More: As increasing numbers of people see the wisdom in working remotely from home, this novel method of connecting biological neurons with artificial neurons may someday prove useful. If an accurate coder-decoder intermediary between the biological and the micro-electronic worlds can be perfected, better means of telepresence can help to slow a pandemic down.

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6 Responses to Why is China so Dirty, and Singapore so Clean?

  1. Gavin Longmuir says:

    If I understand correctly (and I am not sure I do), “case fatality rates” could potentially be quite misleading and not easy to compare between regions or countries. Case fatality is the number of deaths divided by the number of “cases” — which means people who were diagnosed as having the virus (generally because they exhibited symptoms and were evaluated in a hospital).

    It is quite plausible that in Wuhan hospitals were overloaded and many people decided it was safer to stay away from hospitals. The one who ended up as “cases” were generally those with more severe symptoms who got involved in the medical system — and 2 to 4% of them died. In other parts of China where the hospitals were not so overloaded, more people were evaluated by medical professionals, increasing the denominator in the case mortality figure, and only 0.7% died.

    The figure that is really of interest is the “population mortality” figure, which will be much lower if (as has been reported) only about 20% of those exposed to the virus actually catch the disease. Of course, the tough question is — What is the population? If we use the Diamond Princess cruise ship as a relatively well defined statistical sample, there have been something like 7 deaths out of the 3,760 or so passengers and crew confined to the contaminated ship — a 0.2% fatality rate among the sample population. And that could be a high-side number, since everyone was given higher exposure to the virus than one would expect under normal circumstances, and the most susceptible individuals (the aged & infirm) are notoriously over-represented among cruise ship passengers.

    If we extrapolate from the cruise ship sample to a lower 0.1% population mortality rate among the approximately 350 Million US residents, that would still amount to about 350,000 deaths — far above the 60,000 or so who die each year from ordinary flu. But there would presumably be a lot of overlap between those 350,000 people and the 2,800.000 people who die each year in the US, mostly from the problems of advancing age and declining health. The net “additional deaths” would likely be significantly lower.

    Bottom line is that the virus is serious — but are we in danger of making things worse by over-reacting?

    • alfin2101 says:

      Yes, in lieu of perfect data a lot of assumptions are made. Many cases and deaths in Hunan are thought to have been lost to accounting, having died outside of the system and cremated with a convenient diagnosis having nothing to do with coronavirus. Both cases and deaths were probably under-counted, but no one knows by how much for either.

      The death toll from the Princess Diamond is far from complete. The correct calculation for case fatality rate would be to divide the 7 known deaths by the 700 or so known to be ill. This would give a roughly 1% CFR. The real numbers are seldom perfect out there in the world.

      Different populations are more likely to die from the virus than others. As you say, the CFRs will vary between populations, and should not be considered as one fixed number.

    • alfin2101 says:

      You seem to be suggesting the use of a different estimate of risk of death from the virus, such as attributable risk or the standardized mortality ratio.

      In the epidemic setting, such approaches can conflate infectivity with virulence, which in the case of covid19 may be distinct. It is easy to catch (respiratory, feces, urine . . .) but only a small portion will become seriously ill, and fewer yet will die.

      CFR is crude but it is timely and can be quickly modified as data accumulates. It can help guide public health measures in real time. And if the virus mutates to a less lethal strain, epidemiologic data may suggest what is happening before the genomic assays pick up the change.

  2. Will Brown says:

    Short answer to your titular question; China is a face culture, Singapore is not.

    It could be argued that Singapore is an overly “rule of law” country and culture, but anyone who forgets the fundamental, all-encompassing nature of Chinese public reputation based culture will always fail in their dealings with the Chinese.

    • alfin2101 says:


      I might suggest that such persons will “always fail in their dealings with the Chinese” unless they crush them utterly, leading to yet another collapse of dynasties.

      • Will Brown says:

        A) If they crush them utterly, demonstrably they didn’t forget the fundamental nature of Chinese culture. 🙂

        B) It isn’t really necessary to “crush them utterly”, only to so damage the public reputation (face) of Chinese political and cultural elites that the majority of Chinese come to regard them as having lost the Mandate of Heaven. No Chinese political construct has ever survived once this change in public opinion occurs.

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