Because people from collectivist cultures are more likely than those from individualistic cultures to emphasize the importance of others’ well-being, place high value on cooperation with others, and see taking care of and staying together with family members as highly important, we predicted that death rates from COVID-19 would be significantly lower in collectivist countries than in individualistic countries. Our results were consistent with our predictions: the DPM rate was significantly—in fact, more than 50%—lower in collectivist countries. The effect remained significant when we analyzed the data with median age as a covariate; thus, the difference could not be explained by the fact that the median age in collectivist countries was lower than the median age in individualistic countries. There is evidence to suggest that this difference is a product of both longstanding differences in how the two types of societies tend to organize their affairs and differences in their immediate reactions to the pandemic. Of course, there are exceptions to the rule that collectivist countries have lower death rates than individualistic countries, because there are many factors involved in determining how viruses spread, but the general pattern is unmistakable, and there appear to be several reasons for it.
Implications for Nursing Homes and Long-term Care Facilities
First, as discussed above, a very large share of COVID-19 deaths in individualistic countries such as the US, Canada, and many Western European countries have occurred in nursing homes and long-term care facilities, whose typically elderly residents are much more vulnerable than younger people to developing severe illness if infected with COVID-19. When coronavirus is inadvertently introduced into these densely populated facilities, the elderly population is ravaged by COVID-19. This has not happened in collectivist countries,[1] because even very frail elderly individuals tend to live in family homes with their children and extended families. Because the overwhelming tendency in collectivist countries is for the elderly to be cared for by their families rather than living in densely populated nursing homes, they are less likely to be exposed to coronavirus, contract COVID-19, and die; collectivist cultures do not throw their elderly away.
Implications in Terms of Government Policy
A second likely reason for the difference in death rates is differences in the nature and timeliness of governments’ responses to the pandemic in collectivist and individualistic countries. Within less than three weeks of identification of the virus in Wuhan, China, where it originated, the city—and soon the entire province of Hubei—were locked down. All mass transit was halted, travel to and from the province was shut down, all non-essential businesses were shut down, citizens were required to stay at home except for essential needs such as grocery shopping and urgent medical care, and anyone venturing out was required to wear a mask (Wikipedia, 2020). A massive contact tracing and testing program was implemented, special hospitals solely for COVID patients were built within weeks, and quarantine housing was set up for individuals who tested positive but did not require hospitalization.
Similarly, rapid and sweeping public health measures measures—not in every case involving the extensive lockdown measures taken in Wuhan, but comprehensive nonetheless—were taken in many collectivist countries—Taiwan (Farr & Gao, 2020), Cuba (Morris & Kelman, 2020), Vietnam (Dabla-Norris et al., 2020), Thailand (United Nations, 2020), etc. A study of when different countries implemented mask-wearing requirements or adopted near-universal mask-wearing identified 41 countries that adopted mask requirements or strong recommendations to wear masks within 20-30 days of their first case (Leffler et al., 2020); all except the Czech Republic and Slovakia were collectivist countries. Certainly, there are exceptions to the rule that collectivist countries’ governments reacted more effectively. Among the individualistic countries, New Zealand rapidly implemented a sweeping lockdown and temporarily wiped out COVID within the country in less than two months (Kam & Reynolds, 2020), and still has fewer than 25 deaths to date (Coronavirus Cases, 2020), while several collectivist countries in Latin America, such as Brazil (Barberia & Gomez, 2020; Diario, 2020), Peru (Saavedra, 2020), and Chile (Beaubien, 2020), had very ineffective governmental responses to COVID and have among the highest death rates in the world. But in general, effective governmental responses to COVID have been very much the exception among individualistic countries, and common in collectivist countries.
Implications in Terms of Citizen Conduct
A third possible difference between collectivist and individualistic countries that could account for the difference in median DPM rates is the responses of individual citizens to the pandemic. After all, government mandates to stay at home and to socially distance and wear masks when out in public would do little good if citizens did not obey them. To take the example of mask-wearing, it is well-known that East Asian countries had very high rates of mask-wearing (typically above 90%) among the public from very early on in the pandemic, whereas in the vast majority of European countries and in North America, mask-wearing rates were much lower (Donaghy, 2020). Latin American countries also have high rates of mask-wearing outside the home compared to, for instance, the United States (Moloney, 2020). Italy is an exception among the individualistic countries, having had a high rate of public mask-wearing since April (Donaghy, 2020), but adoption did not become widespread until after it had been hard-hit by the pandemic (He & Laurent, 2020). In contrast, as we discussed previously, residents of Hong Kong spontaneously adopted a high rate of mask-wearing very early on in the pandemic despite the existence of a government ban on wearing masks at the time! Meanwhile, at the opposite end of Eurasia, thousands of protesters recently gathered in the streets of Berlin ((Cohen, 2020) and London (Turnnidge, 2020) to loudly protest against the government’s infringement on their “right” to gather in public without masks or social distancing and declare the pandemic a “hoax” or propagate conspiracy theories about it, and across the ocean, hundreds of thousands of motorcyclists gathered in South Dakota, USA for an annual festival, with little in the way of masks or social distancing evident, spreading new COVID infections far and wide (O’Kane, 2020). It may as well be on another planet. Mass resistance to sound public health policy simply does not occur in collectivist countries.
In short, there is evidence suggesting that the substantial differences in death rates from COVID-19 between collectivist and individualistic countries that we have identified may be a product of three factors: 1) higher rates of nursing home residence in individualistic countries, 2) more rapid and effective government action to control the spread of COVID, and 3) differences in citizens’ actions that protect themselves and others (e.g., a high rate of mask-wearing), or put themselves and others at greater risk (e.g., attend mass gatherings without social distancing). However, future research needs to undertake a more thorough examination of evidence about these differences. In addition, we noted a number of major exceptions to the rule that collectivist countries have lower DPM rates—some individualistic countries also have low COVID death rates, and some collectivist countries have very high death rates. What factors might account for these exceptions to the rule? Certainly, one plausible explanation is the nature of their current governments. New Zealand, a low-DPM individualistic country, currently has a self-described progressive social democrat, Jacinda Ardern of the Labour Party, as its Prime Minister (Wikipedia, 2020). Brazil, in contrast, currently has a far-right President, Jair Bolsonaro, who formerly served as an officer in Brazil’s military dictatorship (Wikipedia, 2020), and has been openly disdainful of the recommendations of the country’s health experts and of the seriousness of the threat posed by COVID-19 (Barberia & Gomez, 2020). Future research needs to systematically examine the possible reasons for such exceptions to the rule that collectivist countries have lower death rates from COVID-19 than individualistic countries.
Implications for Decisions About Reopening Schools
A major practical concern about countries’ approach to the pandemic that we have not yet discussed is whether schools should be reopened while the pandemic is still ongoing and, if so, how that should proceed. Several individualistic countries, such as the United States and Canada, are proceeding to do so (at least partially) while they still have high infection rates, because there is immense pressure for workers with children to go back to work if they have not done so already. We believe that this is a recipe for disaster.
First, without proper physical distancing and mask use, there is an increased likelihood of contracting COVID-19. Given that we currently have no good estimates of true COVID-19 infection rates (Sinclair, 2020a; Sinclair, 2020b; Sinclair, 2020c; Sinclair, 2020d; Sinclair & Kumar, 2020; Sinclair & Singh, 2020) or the percentage of the population that is asymptomatic and walking around shedding the virus, and given that students are in close quarters (much like the elderly), students may become infected and, during the 14 day incubation period in which they may have few (if any) symptoms, unwittingly infect their families. This becomes an exponential function of infection as infected family members proceed about their daily business and shed the virus. Eventually, the virus will re-emerge in nursing homes and long-term care facilities and, at every step along the way, deaths will occur (especially among the elderly).
We suggest the following approach to reopening schools:
- Continue online education.
- If our first suggestion is not adopted, double the number of buses so that physical distancing can be maintained.
- Lengthen the school day so that half of the class is taught in the morning and the other half is taught in the afternoon. This way, physical distancing can be maintained in the classroom.
- When one half of the class is being taught in the classroom, the other half of the class engages in physical distancing in the gymnasium and/or auditorium and, under strict supervision, watches educational films.
- Universal mask use must be implemented in schools.
- Mask use will be difficult for children from kindergarten to about 3rd grade so we do our best and, at least, have the ability to maintain physical distancing.
- Extracurricular activities and socializing can still occur but with mask use and physical distancing strictly enforced.
This approach, while not perfect, certainly helps to alleviate the potential nightmare scenario that we described above. Furthermore, it reduces the stress on parents with respect to daycare because students are in school for the entire day. This affords parents the opportunity to return to their dual-income jobs, increases purchasing power, and benefits the economy, in general. The ill-planned and haphazard approaches being used in various states and provinces in the US and Canada, respectively, we argue are dangerous and, potentially, disastrous.
Implications in Terms of Misperceptions of Safety When Reopening the Economy
Furthermore, the move to reopen the economy in the West might provide a false sense of security and a gross overestimate of the control over coronavirus as well as an underestimate of the likelihood of contracting COVID-19. Consider the research addressing the availability heuristic (Tversky & Kahneman, 1973; Kahneman, 2011). The reopening of the economy being pushed in the West is, upon superficial consideration, simply a return to the state of affairs people overwhelmingly remember as normal and without significant risk of serious illness and death. Thus, when politicians and others promote doing so and do not present it as a risky choice—particularly given the significant lag between increased risk of exposure upon reopening and the actual development of serious illness from COVID-19—people are likely to overestimate their safety and underestimate the danger associated with the potential of contracting COVID-19 and let their guard down. This is extremely problematic, because a return to “business as usual” in the economy with insufficient social distancing will likely lead to spikes in infections and deaths in the same manner as reopening schools. Indeed, reopening schools may also contribute to the false sense of security through the availability heuristic.
The Importance of Random Sample Testing
Recently, epidemiologists and other scientists have been making predictions about potential “herd immunity.” Their inferences are highly speculative at this point because, as Sinclair and Kumar (2020) point out, there is no objective data regarding true COVID-19 infection rates. Indeed, the epidemiological models and “curves” appear to be based on flawed data and invalid assumptions. They use number of positive cases as a proxy measure for infection rates. This is based on a biased sample of the population because, generally, people displaying symptoms and who are likely to test positive, frontline workers who are more likely, we believe, to contract the virus, and the types of people who want to be tested form the basis of the sample: This sample does not represent the population and, thus, no valid inferences about true infection rates can be made.
Random sample testing, on the other hand, provides an unbiased sample and is representative of the population (i.e., the sample is unbiased). Through public opinion polling, we can predict the outcome of a US presidential election within three percentage points 19 times out of 20 with a random sample of about 350 Americans. The error variance in the predictability of these polls occurs because some people change their minds between the time of the poll and the election. Of course, predictive validity increases as the time between the poll and the election decreases (see, e.g., Fishbein & Ajzen, 1975; Steel & Ovalle, 1984).
The error variance in COVID-19 tests is extremely low, and we would prefer a bias toward false positives than false negatives during a pandemic situation: COVID-19 does not change its mind in the way that people do; a person tests positive at one point in time or they do not. No health agency in the world including the CDC, WHO, Health Canada, etc., has collected the correct data. Had we been collecting (or start collecting now) random sample COVID-19 tests from the beginning of the pandemic, we would know, exactly, the infection rate as well as the percentage of the population that is asymptomatic and shedding the disease: Testing each week would provide exact information regarding our success at battling the virus (Sinclair & Kumar, 2020).
In the present study, we relied on DPM in order to assess culture-based differences in relation to COVID-19 because DPM is the most objective measure that we have to date. Finally, we argue that to be able to progress further in our battle with the virus, understand cultural differences, and make judgments about potential herd immunity, reopening the economy, and reopening schools, we must shift from the guesswork of scientists who are using biased samples to estimate infection rates to random sample testing which leads to truth.
[1] We reanalyzed the European long-term care facility death rate data from Gandal et al. (2020), who showed differences in long-term care facility COVID-19 deaths as a function of country, and obtained results consistent with this argument. We categorized the countries as collectivist (n = 11) or individualistic (n = 21; there are more individualistic countries in Europe, whereas there are more collectivist countries in the world). A 2-sample t-test showed that there were significantly fewer nursing home deaths in collectivist (M = 41.45, s = 51.22) than individualistic (M = 209.62, s = 222.63) countries, t (30) = 2.45, p < .03.