Trendspotting: Developing Nations Struggle Against COVID-19

NEWSWIRE: 4/6/20

• As COVID-19 begins to spread through the developing world, countries from India to Mexico are bracing for a devastating blow. Developing countries can’t afford to shut down their economies, often have areas of extreme population density, and are short on the health care resources needed to fight the virus. (The Wall Street Journal)
• NH: The United States has the largest GDP in the world and spends the largest share of it on healthcare. Nevertheless, as COVID-19 has spread through the country, the US has found itself short of ICU beds, ventilators, and face masks. The White House is predicting that between 100,000 and 240,000 Americans will die from the virus, and some think that estimate is conservative.
• If the US is struggling, does the developing world stand a chance?
• As it turns out, there is aspect of COVID-19 deaths that actually works in favor of these countries: the age distribution of virus related-deaths. The average of of these populations tends to be young, and COVID-19 targets the very old. One of the reasons COVID-19 hit Italy so hard was because it has a large elderly population. Not so for the likes of Pakistan or Yemen. Just take Niger, for example: See the first chart below. While the virus will still spread rapidly through the population, there will probably be relatively serious illnesses but relatively more carriers who are asymptomatic or who have only mild symptoms. 
• The population density in these countries cuts both ways and is thus a mixed driver. Most of these countries have large agricultural sectors in which people are sparsely distributed in rural regions. That's good. That constitutes natural social distancing and tends to slow the virus' spread. But most of these countries also contain massive supercities in which people are squeezed into massive slums with extremely dense population distributions. Often these neighborhoods have sporadic electricity and inadequate fresh water and sewage. Here the virus will spread very rapidly. Mumbai's Dharavi neighborhood is the largest slum in Asia, housing almost 1 million people within 5-sq-kilometers. Last week the neighborhood reported its first COVID-related death and officials believe there the number will explode in the coming days.
• Low living standards are an unambiguously negative driver. Recently, I have been reporting on the history of the Spanish Flu. One thing I have stressed on my podcast is that in 1918 the US could not afford to shut down the economy. While in 2020, the US is much wealthier and can order statewide shutdowns, developing countries are a bit more like 1918 America. The informality of much of these countries' work means large swaths of the population work closely with other people and will not be supported by unemployment benefits. More than 50% of work in the Southern Hemisphere is performed in the informal sector. In Africa, the share is 76%. See second chart below. Officials fear that if they shut down their national economies, most people risk going hungry. 
• Take India, where Prime Minister Narendra Modi ordered a nationwide lockdown, which itself precipitated a national crisis. The trains in Delhi stopped running one-hour after the first announcement was given. Millions of migrant workers are now stuck in the city and have no means to go back to their rural homes. Many have started walking along the nation's highways journeying to their homes, which could be hundreds of kilometers away. For those stuck in the city without work, they can't pay their rent nor buy food. Some have called for opening the country back up and aiming for "herd immunity" rather than suppression. Many would rather take their chance with the virus than starve to death with no paycheck.
• Low living standards also translate into a woefully inadequate healthcare infrastructure. Reports from Ecuador say that the hospitals and private clinics are so full they can't take new patients. With the sick being turned back, most deaths are occurring people's homes (as happened in Wuhan), which had led to bodies lining the streets of Guayaquil.
• IMO, we should be looking carefully at East Africa. For the last month, a massive locust hatching has decimated farmlands across the Horn of Africa. While Australian and European scientists were organizing aid to kill off the bugs, new travel restrictions have cut off their access to pesticides. With the threat of starvation from farmland destruction on top of a spreading virus, the region could be decimated.

• A new analysis finds that COVID-19 is hitting the nation’s most productive areas the hardest, which is having a disproportionate impact on national income and production. The top 15 hardest-hit counties account for 26 million jobs, nearly 13% of U.S. employment, and 16% of GDP. (Brookings Institution)
• NH: I’ve seen and engaged in a lot of discussion about COVID-19’s differential impact on the economy by industry. But there’s been comparatively little analysis on how its impact varies geographically. That’s what the Brookings Institution does here.
• The outbreak will leave no state’s economy untouched. That’s clear from the soaring state unemployment numbers. But as researchers Mark Muro, Jacob Whiton, and Robert Maxim point out, it’s not true to say that its impact is being evenly distributed. The states with the highest numbers of confirmed COVID-19 cases constitute the nation’s economic center of gravity. The 50 hardest-hit counties support 60 million jobs, $7.4 trillion in economic output. That's a good 30% of employment and 36% of GDP. Narrow that down to the top 15 counties, and you’re still talking 13% of employment and 16% of GDP. Just 3 counties from this list--New York City, Los Angeles County, and Cook County--represent 17% of the nation’s economic activity. Not only are these areas densely populated, they’re at the forefront of the concentration trend that has made an ever-smaller handful of cities home to an ever-growing share of top jobs. (See “Trendspotting 1/21/20, Keyword: Metro” and “Trendspotting 3/30/20, Keyword: Tech.”) 
• To be sure, more COVID-19 cases doesn’t necessarily mean the unemployment situation in these areas is worse. Many of the people under lockdown, particularly those with higher incomes, may be working from home. Nevertheless, the outsized threat to economically vital areas illustrates the dark side of urban density. The very qualities that made these cities attractive to live and work in are the same qualities that made them the most vulnerable to the virus--and make them the most necessary, but also the most difficult, to reopen for business.

• If the current annual growth rates in Sub-Saharan Africa continue, Africa’s population will double by 2050. However, growth rates could also slow significantly due to the education of more African girls, which is already happening across large areas of the continent. (The Economist)
• NH: There are good reasons to hope, in the decades to come, for a slower-growing or stationary population on this planet. There are even better--indeed urgent--reasons to hope that this happens in Sub-Saharan Africa. The best reason is this: Absent a rapid deceleration in population growth, Nigeria and its close neighbors are on track to contain twice the population of today's Europe on barely half of Europe's habitable or arable landmass by 2060. For economies based mostly on low-productivity agriculture, this could lead directly to a Malthusian outcome--either hunger and rising mortality, misery-driven declines in fertility (Irish-style), or both. See "Trendspotting 4/15/19, Keyword: Africa."
• IMO, the dilemma is even starker than the one posed by the official UN population projections. And this is, first, because the UN projection already assumes a future downward trajectory in Sub-Saharan fertility rates--which may not happen. And, second, because of rapid declines in child mortality. These declines represent a wonderful reduction in human suffering. But they also translate into faster population growth. (See "Trendspotting 9/30/19, Keyword: Childhood Survival.")
• What to do? A favorite strategy pushed by at least three generations of western policy reformers is to facilitate or encourage or mandate birth control in the poorest and highest-fertility countries. This strategy has not been widely successful. Many less-developed governments refuse to implement it. Or there is popular resistance when they do. Or most men don't let their wives have access to it.
• Enter Wolfgang Lutz, head of the International Institute for Applied System Analysis (IIASA), a demography think tank HQed in Vienna. Lutz has argued for many years that the key to lower fertility is to increase the educational level of women by getting more girls into schools. His teams have shown that fertility declines typically follow, with a lag, rises in the educational attainment of women. Why? Because educated women become more aware of other potential futures for their lives than just being a mother. And because they are better able to stand up to their husbands.
• This Economist essay relies heavily on Lutz's research. But in practice, rolling out a school-the-girls strategy may not be much easier than the birth-control strategy. Lutz may be correct that rising female education is correlated with lower fertility. But that doesn't mean that it's causally linked to lower fertility. What actually drives a society to educate more women may be linked to many other drivers of modernity (like higher living standards, urbanization, democracy). And when these drivers aren't there, more female schooling may just not be possible. Many demographers have linked the failure of Sub-Saharan Africa's fertility rates to fall faster precisely to the unpopularity of the idea. (See also "Trendspotting 4/22/19, Keyword: Slowdown.") In many of these countries, Islamist movements like Boko Harem base their populist resistance to corrupt and dysfunctional governments precisely on their hostility to such "western" notions.
• The Economist errs as well in implying that sharp declines in fertility generate an automatic tailwind for a developing country. Yes, the "demographic dividend" proved very helpful in East Asia. But falling fertility hasn't proved nearly as helpful in other regions like Latin America. By shrinking its birth rate, Sub-Saharan Africa may avert a calamity. But much smaller families won't, by themselves, turn these nations into economic tigers.

• In a new Pew survey, 44% of Americans say that their lives have changed “in a major way” due to COVID-19. It offers a wide-ranging portrait of how our daily behaviors are different now: We’re working from home, watching kids at home, going out much less, and praying more. (Pew Research Center)
• NH: Not surprisingly, Pew’s surveys about the outbreak have reflected steadily deepening concern among Americans and a widening net of effects over time. Now we’re starting to see how these effects are playing out differently among different groups. Fully 40% of working-age Americans say, for example, that they’ve worked from home as a result of the outbreak. But you’re far more likely to be working from home if you have a postgraduate degree (73%) or a bachelor’s degree (62%). The share drops significantly among those with some college education (35%) or a high school diploma or less (22%). These are the people who are most likely to have lost their jobs or are working the in-person service jobs that are still operating. Similarly, upper-income earners are a lot more likely to be working from home than lower-income earners (61% vs. 27%).
• Conversely, though, it’s upper-income earners who are finding it the most difficult to take care of kids who are home from school. Here, the sweet spot is in the middle: Middle-income earners are the most likely to say it’s been at least somewhat easy for them to handle child care responsibilities (70%) due to the outbreak, followed by lower-income (63%) and then upper income earners (58%). Why the gap? Upper-income earners are the most likely to be at home, but they’re also probably accustomed to outsourcing their child care; lower-income earners, meanwhile, have the least flexible jobs.

• As school moves online and public spaces close their doors, inequities in student internet access are becoming a major issue. Tens of millions of Americans can’t access or can’t afford a reliable connection, leaving educators scrambling to provide alternatives like printed worksheets and portable wi-fi hotspots. (USA Today)
• NH: There has always been a wide gap between students who have home internet and those who don't. A 2015 study found that 39% of kids age 3-18 did not have access to internet at their home. And while some students might have internet, there is no saying if it is fast; a Microsoft study found that 168.2 million Americans are not using internet "at broadband speeds."
• Previously, many students relied on free WIFI provided by a "third space." Howard Schultz, the CEO of Starbucks, popularized the term as a place other than the home or the work office for Americans to spend their time. Many students in rural areas have relied on a "third place" like the local Starbucks or McDonalds to do schoolwork through the free internet. But with many of these places closing because of the pandemic or only offering takeout, students can no longer get the WIFI they once used.  
• Sure, some districts have tried to provide internet access to kids. But often without much success. Some schools have given students free WIFI hotspots, but not every school district can afford that. And while both the president and the Democrats called for school aid in the CARES Act, no such money made it into the bill.
• Some students who lack internet do have access to a smartphone with 3 or 4G services. Studies show that by middle school, 53% of kids have their own smartphone. But that doesn't help the youngest students, nor does it address the impracticality of learning the periodic table on a 5.5" screen.

• As China has emerged from lockdown, the number of divorce filings in several cities has jumped to record highs. This trend is an ominous warning of what the U.S. and other countries may be headed for; already, domestic violence reports are seeing a nationwide surge. (Bloomberg Businessweek)
• NH: Already the reports are pouring in: With the COVID-19 lockdown, local governments around the world are seeing more instances of domestic violence and suicide. And now this story about how China is seeing a rush of divorce filings now that the lockdown has eased and courts are functioning again.
• IMO, most of the evidence to date is scattered or anecdotal. We'll have to wait until we have more evidence before coming to conclusions.
• Yes, there does seem to be some rise in domestic violence calls. But the rise may be no more than proportional to the rise in the amount of time that couples who fight are forced to spend together. And, on the flip side, it may be linked to a simultaneous decline in the incidence of violent crime as people spend a lot less time "on the street." As a general rule--to paraphrase Leo Tolstoy--lockdowns may tend to improve happy marriages and push unhappy marriages to the breaking point.
• There is evidence that more people are now calling counselors to talk about their anxiety or loneliness. But there is no evidence yet that the suicide rate is rising. In fact, serious national crises often coincide with suicide-rate declines, perhaps because society feels itself "pulling together" (as in World War II) at a time of challenge. Historically, it is true that rising unemployment does probably trigger rising suicides. On the other hand, it is also true that mortality rates overall tend to fall during recessions. (The rise in suicides is more than compensated by falling auto accidents, falling homicides, and improved health due to more sleep and less work-related stress.)
• The NYT has recently argued both sides of this one. When President Donald Trump said he feared a wave of suicides if the economy were shut down, the newspaper issued a brutal factchecker rebuttal. More recently, it explained that the shutdown would indeed lead to an avalanche to mental health problems, including more suicides.
• And what about China? We'll see. At the height of the February shutdown, the CCP optimistically (if unromantically) suggested to couples that this might be a good time to help remedy China's birth decline. Well, in about nine months, we'll see about that one too.

• Between January 2019 and January 2020, Hungary’s birth rate rose an impressive 9.4%. The country also saw gains in the fertility rate and the number of marriages, which suggests that its “baby bonus” strategies are making an impact. (MercatorNet)
• NH: Last week I wrote about how the western media loves to lambaste Victor Orban's pronatalism policies. Not only do they think the policies are discriminatory, but they think they won't work. See "Trendspotting 3/30/20, Keyword: Hungary" But I cautioned over making premature judgments, and now the numbers from the Hungarian Central Statistical Office (KSH) show that Hungary's birth rate and fertile rate are indeed both on the rise.
• In January of 2019, Hungary's birthrate was 8.9 children per 1,000 people. By January 2020, it rose to 9.7. And while the KSH hasn't yet updated the figures for 2019, one can see a similar rise in fertility rates for 2018. In 2011 Hungary's total fertility rate was 1.23. In 2018, it rose to 1.49. Oh, another noteworthy statistic, In 2004, abortions in Hungary peaked at 52,539. By 2018, it had fallen to 26,941. That's more than a 50% drop.
• The west might not like Hungary's methods, but they can't say they aren't working.

• Gay couples are more likely to live in big cities than in Middle America, but those who live in Middle America are more likely to have families. In California, for instance, 16% of gay couples have children—but in Wyoming, that share rises to 25%. (The Economist)
• NH: Well, this is partly because all married couples in rural states have on average more children than married couples in coastal urban states. That's because, in rural states, the cost of raising kids is lower and the culture generally expects couples to have children.
• But there's another reason as well. Most children with same-sex households were originally children of heterosexual relationships--before one parent moved out to live with someone of the same sex. That means that these gay parents and their children already have ties to the community. Gays who are childless, on the other hand-- and especially gays who are young and childless--may tend to relocate to more cosmopolitan towns in coastal urban states. That would not only explain why gays in coastal urban states have fewer kids, but also why, per capita, a lot more out-of-closet gays live in these states. (See chart below.)

• In the age of social distancing and self-isolation, slow courtship is making a comeback. Those looking for love are now making connections through phone calls and video chats, with some apps jumping in to help by offering virtual date ideas. (The Economist)
• NH: You might have seen some articles encouraging the use of the phrase “physical distancing” over “social distancing.” We might be physically isolated, the thinking goes, but we’re still free to maintain and create social connections. Nowhere is this clearer than in the world of online dating, which now looks a lot like dating did 30 (or 50) years ago. Before people ever get to meeting in person, all they can do is talk. And talk. And talk. And talk some more.
• What's happening on the new hit Netflix show "Love in Blind" is happening in real life.
• And it turns out that daters are okay with that. With lots of young people bored at home and looking for something to do, users are reporting that they’re getting more matches than ever, not fewer--confirming that apparently nothing, not even a global pandemic, can stop online dating. Bumble has seen a 93% increase in video chat and voice call usage since March 13. Fully 70% of Hinge users have said they’re interested in trying digital dating. Tinder, meanwhile, has seen a 10 to 15% increase in daily messages. There’s even a new dating app on the scene: Quarantine Together, which texts users daily reminders to wash their hands and physically distance, and once they confirm they’re doing so, sends them a new match daily. Since its launch in mid-March, the number of users signing up has been growing by 50% every day. Ah, young love.

DID YOU KNOW?

Home Alone. All signs indicate that COVID-19 has us headed toward a global economic recession. But for those who live alone, there’s another incoming threat the nation also needs to watch out for: a “social recession.” Researchers from MIT just released a preliminary report showing that social isolation produces signals in the brain akin to hunger pangs; in other words, that our need to connect is as fundamental as our need to eat. Social distancing measures are helping to protect us from the virus, but they’re exacerbating our loneliness. And according to a new survey from the Kaiser Family Foundation, Americans’ mental health is suffering in other ways, too: Fully 45% of adults say that worry and stress related to coronavirus has negatively affected their mental health, up from 32% in early March. The causes of the stress are multiple and varied, with large shares worried about getting sick, the economy, local businesses, affordability of treatment, and the impact on health care workers.