Covid-19 might change our world forever. This will not be the first time that our world has been fundamentally changed. Rather more dramatically, millions of years ago, a meteorite struck the Earth, creating new environmental conditions, dooming the dinosaurs and allowing mammals to emerge.

While it is not envisioned that the current pandemic will cause our extinction, there are likely to be profound political and social effects akin to other examples within the last 100 years. The Versailles peace conference in 1919-20 marked the demise of the German and Austro-Hungarian empires, the advance of democratic, representative governance in Europe, and the start of what came to be known as the transatlantic century.

A decade later came the Great Depression, the biggest worldwide economic calamity of the 20^th century. World War II marked the triumph of the liberal democracies and the Soviet Union over fascism, changing the global order. The ideological battle between the western capitalist powers and communism simmered until the peaceful fall of the Berlin Wall in 1989. The ensuing implosion of the Soviet Union triggered the collapse of Russian-backed regimes around the world, leading the US to proclaim itself the sole global superpower. And, at the turn of this century, the 9/11 attacks punctured American illusions of invulnerability and prompted a “global war on terror”.

These world-changing geopolitical events could be likened to the abrupt changes in natural environments that allow certain organisms to flourish and others to struggle, as in Darwinian evolutionary theory.

Evolution by natural selection functions by three key mechanisms: First, not all individuals are the same; there is variation among populations. Second, individuals within these variations have differing “fitness” for their environment, with some variations proving to be more successful than others. As a result, the variations that are fitter, produce disproportionately more progeny. Thirdly, the next generations having inherited these traits, continue to proliferate and compete.

In the world-changing events cited above, there were variations in the great powers. They competed in the environment of their time for scarce resources and the resource of support for their doctrines. Some were successful, others were not. The successful ones thrived at the expense of the fallen.

The effects of the Covid-19 pandemic can be regarded as similar to a fundamental change in the natural environment and countries can be compared to organisms within that changed environment. Countries differ in their capabilities (e.g. healthcare systems), their economy (e.g. central planning or market-based), and their method of governance (e.g. approach to lockdown).

These differences drive the extent of success or failure of the health, economy, and politics of that country during and after the pandemic, with Covid-19 taking a huge toll on some countries, like Italy, while other countries seem to be emerging comparatively unscathed, like China and South Korea.

The post-Covid-19 global order will be characterised by the “fitness” of these countries and the “progeny” that emerge. By “fitness” we mean the economic and political strength of a particular country and by “progeny” we refer to the trust and respect that the global community and that country’s citizens now have for the leaders of each country and that country’s governance framework.

Leaders will be judged on their responsiveness and the strategic choices they made. Just as we witnessed the demise of the Austro-Hungarian empire at Versailles, we might see dislocating shifts in the global power balance. The countries that emerge stronger (in health, economy and politics), after the pandemic, will move up in the power ranks and those emerging weaker will move down.

Is this just a hypothesis or is there evidence? One emerging piece of evidence: The US, with its far greater wealth than China, months of advanced warning of the pandemic compared to China, and one-quarter of China’s population, is predicted, as of 1 April 2020, to ultimately have 100,000 to 240,000 deaths, which would be more than 30 to 72 times the number of deaths as China, and, on a per capita basis, 126 to 305 times as many deaths.

What accounts for this difference?

Does China have a better healthcare system than the US? Disregarding the cost of the respective systems, from an operational perspective, China is clearly no better:

• child mortality rate per thousand live births: China 8.6 vs US 5.6;
• doctors per thousand people: China 1.5 vs US 2.3;
• hospital beds per thousand people: China 2.5 vs US 3.3; and
• ventilators per 100,000 people: China 3.6 vs US 34.7.

Does China have a younger demographic or a lower co-morbidity disease burden? In fact, with respect to age, China is similar to the US thanks to its former one-child policy. Hypertension is the predominant co-morbidity factor contributing to mortality in Covid-19.

China has a lower prevalence of hypertension (23%) than the US (33%). But co-morbidity prevalence doesn’t explain China’s lower mortality rate, as South Korea’s hypertension prevalence (30%) is almost the same as the US’s, yet at the time of writing (1 April 2020) has recorded 165 deaths, while the US has recorded over 4,000, which is 3.7 times more per capita.

More importantly, South Korea appears to have Covid-19 under control with new cases per day of less than 200 for the last three weeks. The US is currently recording more than 20,000 new cases per day (and this number is steadily increasing), which is already 16 times more per day on a per capita basis.

Did China follow a different approach to lockdown? This is clearly so, as despite being the first country affected by the virus, China executed a rapid, draconian lockdown, enabled by surveillance technology. China is being lauded by many for its response, but is not without fault, specifically the government’s denial in the early days.

A second emerging piece of evidence for China assuming a more assertive foreign policy, is its demonstration of “soft power”, by sending doctors and medical equipment to other countries now that its own epidemic has been controlled, while the US withdraws from the global stage.

Contrasting the US and China’s response is a stunning illustration of a functional autocracy versus a dysfunctional democracy. But of course, this is not just about the US versus China. South Korea represents a third alternative to the dictatorial, but effective approach of China and the until now laissez-faire, but ineffective approach of the US.

Coincidentally, South Korea and the US identified their first Covid-19 positive patients on the same day. South Korea’s high-tech, transparent solutions have allowed the country to not only “flatten the curve,” but also do it in a less extreme, authoritarian way than can be seen elsewhere. Key to South Korea’s success has been the thoroughness of its testing, while the US has struggled to roll out widespread testing.

From our local context here in Cape Town, South Africa, we are proud of the quick and decisive action taken by our government. With barely a few cases recorded, a national state of disaster was declared and our schools were shut down, and a week later, before the first Covid-19 death and with less than 1,000 confirmed cases, the nation was forced into lockdown with police and military enforcement.

Just as countries with experience dealing with the Sars epidemic of 2002 primed them for the measures to be taken in dealing with the new coronavirus epidemic, so South Africa, with its experience in tracking, and tracing TB patients and contacts may have an advantage. In addition, our doctors are used to dealing with infectious disease in a low-resource environment. Our population has a significantly smaller elderly proportion compared to China, Europe and the US.

It is too early to tell with certainty how South Africa will fare. The early actions have been encouraging, but we have challenging conditions in dense, urban shantytowns and a high disease burden of HIV and TB. South Africa has demonstrated a favourable humanitarian approach, but at what cost to an already fragile economy?

Looking forward to a post-Covid-19 world, we wonder how the global geopolitical paradigm will change.

What can we learn that will allow us to deal better with the next pandemic (yes, there will be another), and for our other simmering, inevitable, disruptive event, namely climate change?

How will the global world order change? Will the US continue as the supreme superpower or will China topple the US and take first place? What will become of our global economy? In what form will our global, connected economy re-emerge? Will nationalistic tendencies dominate, creating new barriers? Or, will we see new, innovative approaches to global trade?

The debate regarding the cost to our privacy versus effective measures to curb the spread of the virus rages on. Will Covid-19 be a tipping point for us to voluntarily cede our privacy and freedom to our governments in exchange for our protection? Again, South Korea offers a benchmark of a democratic system exercising rapid and effective intervention. Will attitudes change regarding the merits of a free-market economy as many people recognise the importance of well-functioning government services?

We reference an extract of Ronald Reagan’s speech to the United Nations in 1987: “I occasionally think how quickly our differences worldwide would vanish if we were facing an alien threat from outside of this world.”

Sars-CoV-2, the virus that gives rise to the Covid-19 disease, is novel, but not alien. Nevertheless, it presents as a common enemy to all of us the world over. While this pandemic could drive an isolationist, nationalist response, it could also integrate the nations of this world against a common enemy.

Covid-19 has the potential to cause disruptive evolutionary pressure on geopolitics, resulting in a changed global order. Will it produce a high road of greater connectedness, trust and cooperation, along with strengthened international institutions like the United Nations and the World Health Organisation?

Or will it produce a low road where international institutions are undermined, and countries become isolationist, protectionist, populist and nationalist?

For the sake of our little country at the southern tip of Africa, we hope and strive for the high road. DM

Wayne Borchardt is an independent strategist and lectures on strategic decision making at UCT’s Graduate School of Business.

Dr Gary Kroukamp is an ENT Specialist and a self-confessed history nerd.