Mongolia Was Putting Its Big Person Pants On In January

May 26, 2020 2:11 PM

Starting in January, Mongolia executed a perfect public health response, and they have never let up the pressure since. COVID-19 did not just leave Mongolia alone. Mongolia kicked its ass. COVID Underdogs: Mongolia by Indi Samarajiva
posted by chavenet (39 comments total)

Amazing story.

Fun with numbers: Mongolia has about 1% of the US's population. If our response had been the same, we would have 14,000 cases instead of 1.7 million, and 0 deaths instead of 100,000.
posted by zompist at 2:27 PM on May 26, 2020 [23 favorites]

For non-sovereigns, add Kerala's handling of the situation.
posted by ocschwar at 2:42 PM on May 26, 2020 [13 favorites]

Just wow.
posted by TigerMoth at 2:52 PM on May 26, 2020 [1 favorite]

Yeah, well, we're number one.
(not in a good way)
posted by mule98J at 2:55 PM on May 26, 2020 [4 favorites]

I mean, good for them, but I feel like the article, in listing the reasons that are NOT why Mongolia did so well, is ignoring the fact that there's just not that much traffic in and out of Mongolia. Chinggis Khaan International Airport (probably the coolest airport name ever) had 1.4 million passengers in 2018 on a little less than 15k movements, and a fair amount of those were domestic flights. In comparison, ATL handled 110 million passengers in 2019, with 900k movements. There's literally a hundred airports in the US more busy than the biggest airport in Mongolia.

So I guess what I'm saying is, not only did they start handling this in January, when there were far fewer cases to handle, they also inherently had a lot less to handle in general.
posted by Joakim Ziegler at 3:02 PM on May 26, 2020 [10 favorites]

You also have to take into consideration, that many countries that share a land border or are close to China had a heightened response. Whether it be more cultural (Hong Kong), or government response (South Korea), or both (Taiwan), etc. Not only did they remember SARS and various other outbreaks, they had more at risk due to the geographical connection to the original hotspots.

Whereas, you really have to see countries like US, in Europe simply dismissed it as Asia's problem. UK didn't even learn anything from the "overreaction" of swine flu and nearly dismissed COVID-19 at first. Look where that got them.
posted by xtine at 3:16 PM on May 26, 2020 [15 favorites]

Another interesting fact: today, AMZN stock exhibited a price fluctuation of 2%. At a net worth of $150B, assuming Jeff Bezos' net worth is entirely invested in AMZN, his net worth fluctuated (just today) by approximately 1/4 the GDP of Mongolia.

Also, Mongolia is the world's least densely populated country.

Full credit, of course to Mongolia, and the good judgment and policies they put into place, but the US is a different beast entirely.
posted by Maxwell_Smart at 3:17 PM on May 26, 2020 [1 favorite]

It’s true that Mongolia is the least densely populated nation on Earth. As a nation, they’re pretty socially distant by default. However, their capital Ulaanbaatar has an urban population of 1.5 million people. That’s quite enough for COVID-19 to snack on.

In fact, Ulaanbaatar (307 people per km²) has a similar density to Bergamo, Italy (400 per)— the epicenter of the outbreak in Italy; one of the worst-hit places in the world. Low density didn’t save Bergamo. On its own, it won’t save anybody.

posted by aniola at 3:21 PM on May 26, 2020 [54 favorites]

As the article says, Ulaaanbaatar is a two hour flight to Beijing, and there was a daily flight connection to Wuhan.

What Mongolia did wasn't some magic impossible to Americans. Consider: when they brought Mongolians home, they tested and quarantined them. Trump canceled travel by non-Americans, and simply did not test Americans coming back.

Differences between US state case rates seem to be linked to whether the state acted in mid or late March. Mongolia shows what could have happened if action was taken in January.
posted by zompist at 3:29 PM on May 26, 2020 [76 favorites]

The thing is, you didn't even need to start in January. Like yeah, getting your shit together in January is great if you're seeing cases but my home state of Western Australia is all but done with COVID-19 and McGowan got moving March 15th. I was worried they started too late. There are no COVID-19 patients in any of the hospitals and the only infections remaining are recently arrived from Kuwait on a live export vessel and are being quarantined in a hotel.

2.5 million people. They locked it all down. State borders locked down. Regions locked down. They commandeered the hotels and all arrivals and infected people spent two weeks in quarantine. Interstate flights still aren't back to normal. 9 deaths. 8 of them from the Ruby Princess fuckup c/o the conservative Australia Federal Govt being incompetent.

Massachusetts. Close to 7 million. We have more cases a day here still than WA had total. despite only 2.5x the population. It's mind boggling how much more we've screwed ourselves economically by not going in hard and fast. With an early and co-ordinated (dare I say collectivist) and fast response we could have had this shit done in 8 weeks and resumed by carefully controlling and quarantining the incoming people to the country. Now it's going to linger on for months.
posted by Your Childhood Pet Rock at 3:29 PM on May 26, 2020 [53 favorites]

Now it's going to linger on for months.

I think you misspelled years.
posted by spacewrench at 3:48 PM on May 26, 2020 [28 favorites]

Yeah, my point was that density isn't everything. While it's true that Ulaanbaatar has about the same density as Bergamo, the closest airport to Bergamo, Milan-Bergamo, has ten times the number of yearly passengers as Ulaanbaatar, and that's not even the biggest airport in that area, Milan Malpensa has twice that again yearly.

And yeah, they repatriated and tested citizens, but the first batch of students they repatriated was 31 people. I don't know how many people the US repatriated in the first round, but I'm sure it's a few orders of magnitude more.

So this feels a little like the people who get all hot and bothered about the security approach used at Israeli airports, when Ben Gurion handles 25 million passengers per year, and there are literally three international airports in the whole country.
posted by Joakim Ziegler at 4:02 PM on May 26, 2020 [1 favorite]

I also got some background from The Diplomat, and ran this draft past a Mongolian.

Two can play that game. I'd put out there that Mongolian - Chinese relations can get frosty and perhaps Mongolia has just been looking for an excuse to close the border to China, which COVID-19 provided. Which passed a check by my Mongolian colleague.
posted by Metro Gnome at 4:37 PM on May 26, 2020 [2 favorites]

The article is correct in identifying that doing things in JANUARY is a big help. And knowing what to do when you do it - that is the other important factor.

Taiwan is the other excellent example in early and correct action - about 24 million people, about 500 cases, 7 deaths. No reliance on "game changers" - just use the manual that we developed when we looked at being prepared for SARS or MERS.
posted by Barbara Spitzer at 5:01 PM on May 26, 2020 [19 favorites]

I just really like hearing stories about places that did it right.
posted by bleep at 5:15 PM on May 26, 2020 [28 favorites]

I know here in Canada, there was a psychological blindspot. We just simply did not think in January that it was going to be a problem. In February, the headlines here were about the First Nations protests. People were worried about the economic impact - not from a pandemic but from the blockades that had shut down the railways.
posted by storybored at 5:31 PM on May 26, 2020 [4 favorites]

It helps to be in a country where more than 50% of the population thinks that governments should exist.
posted by benzenedream at 5:45 PM on May 26, 2020 [40 favorites]

Also it seems extremely shitty to write this all off as natural advantage when the article goes to great lengths to explain why that's not what happened:
Three days after Hubei, the Mongolian cabinet held a special meeting, because they were taking this seriously. At this meeting, they decided to:
Close universities
Restrict vehicle crossings (not yet rail or air)
Prohibit public events
Release funds for medical equipment and personnel
Mongolia’s growth is almost completely export-driven, so they were taking a huge economic hit here, especially with zero cases. However, they were not like the dinosaurs in the west, looking at an asteroid saying “but the economy!”

Natural advantages didn't convene a meeting. Human beings making good choices decided to convene a meeting. The only thing stopping anyone else from doing this was various strains of racism layered on top of each other.
posted by bleep at 5:53 PM on May 26, 2020 [61 favorites]

My Mongolian friends tell me that this story is a little bit rose-colored in terms of who gets "dosed" back into the country. One of my friends has been stuck in Russia since it started and he said that the preference for who gets let back in is less than clear. But still, Mongolia got it right. Mongolia gets many things right, I think.
posted by frumiousb at 6:14 PM on May 26, 2020 [3 favorites]

And yeah, they repatriated and tested citizens, but the first batch of students they repatriated was 31 people. I don't know how many people the US repatriated in the first round, but I'm sure it's a few orders of magnitude more.

It's not like the actions Mongolia took wouldn't at worst scale linearly with population. Sure the first wave was 31 people but look at the difference between an effective quarantine by Mongolia and what the US did which, for one example, was basically to let suspect (not even random) cruise ship passengers just disperse into a military base in San Diego. Where they had procedures more appropriate for broken legs than a novel virus. And naturally things exploded from that point as the base workers travelled back and forth from home with minimal precautions. This at a time things were already taking off in Europe.

Or how instead of having a coordinated single government response the jack ass in charge ignored the problem and then not only did he not coordinate the response when he finally acted; he set up 50+ internal governments to compete with the Federal response and each other. To the point where state governments were using secrecy and state militias to protect PPE shipments from their own Federal government. (Also in a display of how incompetent the Federal Government is under Trump the states were able to keep massive international PPE shipments secret from the grifters in charge).

A federal government that intentionally kneecapped it's own response to global pandemics two years earlier because the guy who implemented the plan was black.

A government that is actively pushing reopening the country at a time when the virus is not in check, and testing isn't available at a level that would allow reopening even if it was.

Make no mistake: Trump's actions have already resulted in at least 35K more deaths than even a normally partisan US government would have incurred with any moderately effective president in power. Shit even a bubbling fool who wasn't trying to shove loyal but useless people into every executive position would have had a better response. The Trump government actively made the pandemic response worse because they a) didn't have trying to make it better as an even top five goal and b) because they actively prevented competent staff from doing their thing. The guy in charge continues to advocate for a drug regiment that is both ineffective and actively harmful both individually and from a public heath perspective! His backup wouldn't wear a mask in an isolation ward because it hides his face. The president still refuses to wear a mask. He wants to defund the WHO during an actual global pandemic! This list could continue for hundreds of items big and small.

Relative to Mongolia Canada is barely better than the USA but at least the Trudeau Federal government acted like a federal government focused on minimizing the impact once they finally started responding rather than being focused on getting good stock market numbers and fucking TV ratings. And thank $Deity that immoral Trump-lite "small government" fool Shear wasn't in charge.

Mongolia acted early, decisively and consistently and their results are because of that and not any special environmental setup, physical location, or accident of demographics. Some of those things make taking appropriate action easier but you still have to take the effective action and frankly western governments didn't do so early enough nor consistently enough; many still aren't. Mongolia also apparently wasn't afraid of being perceived as having over-reacted. The US actively shot themselves in the foot on multiple occasions. I'm glad someone did have an effective response so that books on the subject will have a good, practical example to point to rather than a stack of hypotheticals.
posted by Mitheral at 6:14 PM on May 26, 2020 [38 favorites]

I liked these articles from the same writer more:

Fighting COVID Isn’t A Mystery, The West Was Just Dumb

The Strength Of Shithole Countries
posted by Borborygmus at 6:27 PM on May 26, 2020 [20 favorites]

I have been linked to some of the author's other articles before - an excellent corrective for the Westerner.
posted by save alive nothing that breatheth at 7:11 PM on May 26, 2020 [5 favorites]

This was very interesting, thanks.
posted by medusa at 8:37 PM on May 26, 2020 [1 favorite]

ignoring the fact that there's just not that much traffic in and out of Mongolia

This shifts the exponential curve left or right along the time axis; it doesn't alter the shape of the growth. Mongolia had cases. If they hadn't reshaped the curve, these would have fed into the status-quo doubling time. They reshaped the curve.
posted by away for regrooving at 12:51 AM on May 27, 2020 [16 favorites]

I still check on the virus tracker on a regular basis, and the trends are unmistakable:

Six of the top 10 countries with highest number of sick people are virus deniers
1 USA 1,725,278
2 Brazil 394,507
3 Russia 370,680
5 UK 265,227
9 Turkey 158,762
10 India 151,876

Same goes for the countries with most new cases today:

1 Russia 370,680 +8,338
2 Mexico 74,560 +3,455
3 Brazil 394,507 +2,147
posted by growabrain at 2:23 AM on May 27, 2020 [5 favorites]

If you read the fucking article you would see that they returned 31 students only on purpose because they repatriated citizens in small batches to manage the process.

“Mongolia didn’t negotiate with the virus, offering up their grandparents. They just told the virus to fuck off and saved everybody. Yes, their economy was hammered, but this was unavoidable. They saved as much of their economy as possible. They lived to fight another day. This is textbook public health.”

What happened and did not happen in Mongolia was on purpose. There was a plan. The country asked for advice from the WHO early on and followed the advice. I don’t understand why it’s difficult to grasp that idea. The leaders were smart about this; many other countries were not, including Sweden. It will be years before we know if Sweden’s choices were better or worse or much better or much worse than that of other nations. But with Mongolia, it’s pretty easy to look at it and say, yes, good job. Which is almost impossible to say about other nations and the way they handled Covid-19.

The nation may not deserve kudos about anything else, but it seems like they tackled this in an effective way. Moreover, they did it without all of the resources that first world nations have.
posted by Bella Donna at 5:50 AM on May 27, 2020 [23 favorites]

Big ups to Mongolia. Saving its people first.
See also Vietnam
posted by adamvasco at 6:25 AM on May 27, 2020 [11 favorites]

... and Taiwan. And New Zealand. And Germany. US deaths were a choice Trump and the GOP made.

There was a plan. They tore it up.

There are long-standing (and long-chosen) health and economic disparities and racist policies and a preference for individualism over the common good that would certainly have made any response challenging in the US, but we could have avoided so much death and pain.

Good for Mongolia. The world can use less arrogant US exceptionalism.
posted by zenzenobia at 7:21 AM on May 27, 2020 [7 favorites]

Mongolia: zero points given their low population density.
Vietnam: zero points given their high population density.

Westerners, to each other: Our leadership is incompetent!
Westerners, on outsiders: There is nothing our leadership could have done, we have more airports!

[not all Westerners, of course. But seriously, I hope that someday we can have fewer reflexive comments on how we are not like them – wishful thinking!]
posted by romanb at 7:27 AM on May 27, 2020 [22 favorites]

romanb, what's the high population density argument?
posted by Nancy Lebovitz at 7:40 AM on May 27, 2020 [1 favorite]

And yeah, they repatriated and tested citizens, but the first batch of students they repatriated was 31 people. I don't know how many people the US repatriated in the first round, but I'm sure it's a few orders of magnitude more.


I don't understand how people keep saying stuff like with a straight face as if it was this thing that would've been impossible to control in the United States because of magnitude. Like this would've been persuasive if they tried to do ANYTHING and failed because of magnitude, but really, we didn't do ANYTHING. This isn't a failure of magnitude, it's a failure of leadership.

If we can cobble together and spend 2 TRILLION DOLLARS in a week in what purports to be the greatest country in the world, I am absolutely certain with competent leadership that listened and followed the preexisting pandemic playbook they could have implemented something similar.
posted by Karaage at 7:53 AM on May 27, 2020 [11 favorites]

Canada also trotted along in denial and while I'm happy with some aspects of how Canada is handling this, I don't think our public health response has been at all robust enough in Ontario and Quebec, we didn't act fast enough, etc. etc. The two links in this comment are a really interesting way to think about it - many countries taking a naive, adolescent-like approach waivering on 'how bad could it be." Thank you for the links and the discussion.
posted by warriorqueen at 8:11 AM on May 27, 2020 [3 favorites]

That is a fascinating article about a fascinating country. I don't presume to know how/if other countries could have/should have emulated Mongolia's approach - but it really is an interesting article. Thank you.
posted by davidmsc at 10:28 AM on May 27, 2020 [2 favorites]

Trump canceled travel by non-Americans, and simply did not test Americans coming back.

Oh it was worse than that. The U.S customs people funneled them all into a hall and kept them there for about 6 to 8 hours all in order to not even do any real screening or quarantining. There was a kid who flew into O'Hare and reported symptoms to the customs officials and was just waved right on through who tested positive 2 days later.

If the U.S. government were to plot to deliberately infect Americans they probably wouldn't have come up with as effective system as the international arrivals situation at the airports post Euro-travel embargo. Customs for those arrivals were ideal incubators - prolonged crowded indoor exposure - and that the people on those flights then got on connecting flights to all over America was just insane.

I wonder how many people who returned from Europe had relatives get infected and get really ill or even die shortly after their return and are now going to be thinking "Am I the asshole?" for the rest of their lives.
posted by srboisvert at 12:11 PM on May 28, 2020 [4 favorites]

When I lived in Ottawa I tutored the wife of the Mongolian ambassador to Canada for her English as a second language course for about 15 minutes. It was supposed to be an hour but I just ended up saying "Your English is already better than mine." She was just amazing and had really elegant handwriting and I consider that to be the closest I have ever come aristocratic greatness.

She also had no false modesty and made no effort to salve my ego. So if she was representative of their leadership I am not at all surprised that they pursued the correct course with zero hesitation or qualms.
posted by srboisvert at 12:23 PM on May 28, 2020 [4 favorites]

Oh it was worse than that.

Don't forget that the Cheeto initially announced in his press conference that Americans would not be permitted to return to the US and he announced the closure a couple days before it took effect guaranteeing a mass panic as Americans who had any interest in coming home scrambled to travel before the deadline or get locked out of the country for the duration. Even though quickly "clarified" the writing was on the wall that if you want to go home you'd better do it now 'cause who knows when a Trump tantrum will seal the border tight against you.

Mongolia negotiated returns in batches their system could handle. They enforced inbound quarantines (not just "self-isolate for a couple weeks" with no monitoring) and extended those to entire passenger lists and the districts travelled through when it was discovered a case slipped through precautions.

But most importantly they did this well ahead of the curve of community transmission. Even if other countries had taken their weak actions in January instead of waiting till an exponential curve was already becoming apparent we'd have way fewer deaths. If enforced quarantines had been put in place for all travellers entering January 18 when Trump was first notified of the upcoming pandemic by Health and Human Services Secretary Azar; or even heck on January 24th when senators started shorting the stock market; the death toll would be at least a magnitude of order lower if not two or three. The US would have missed the zero infection target because of citizens returning from Wuhan but they might of been able to prevent or stop community spread. Instead 101K+ graves and a push to let underprivileged people sacrifice their health and lives so the DOW doesn't drop.

In one way the Mongolian results are disheartening because they prove we could have stopped a pandemic that is on pace to kill at least half a million people when only a few thousand had died. Collectively we knew what to do, we knew how to do it and we knew when to do it while it could still be done. Instead 5.76M infected, some significant percentage of those hospitalized and/or suffering from long term/permanent effects, and 358K+ people dead and counting.
posted by Mitheral at 3:43 PM on May 28, 2020 [5 favorites]

One of Obama's health care people, Andy Slavitt who is doing some great covid-19 blogging/tweeting, calls the situation a reverse-Karenina - All the covid-19 failures are the same but all the successes are unique (from "All happy families are alike, but every unhappy family is unhappy in its own way" (Leo Tolstoy, Anna Karenina)
posted by srboisvert at 4:49 AM on May 29, 2020 [4 favorites]

Almost as if all you had to do was act like you thought death was a bad thing and you'd be able to handle it.
posted by bleep at 8:21 AM on May 29, 2020 [2 favorites]

Oh it was worse than that. The U.S customs people funneled them all into a hall and kept them there for about 6 to 8 hours all in order to not even do any real screening or quarantining. There was a kid who flew into O'Hare and reported symptoms to the customs officials and was just waved right on through who tested positive 2 days later.

If the U.S. government were to plot to deliberately infect Americans they probably wouldn't have come up with as effective system as the international arrivals situation at the airports post Euro-travel embargo. Customs for those arrivals were ideal incubators - prolonged crowded indoor exposure - and that the people on those flights then got on connecting flights to all over America was just insane.

First item of business for a Democratic president should be to deal with the Customs and Border Patrol. Not a single person in the CBP stepped forward to implement any change to procedure at O'Hare that day.

Not one.

Every single person in the CPB needs to be fired. Every. Last. One.
posted by ocschwar at 7:02 PM on May 29, 2020 [3 favorites]