Daily death curves

April 12, 2020

The Worldometers website is the most comprehensive and up-to-date site I have found. I believe the global data they display is about as good as can be for any public database. The John Hopkins dashboard is a lot slower and not as user friendly. I find the WHO site is not as useful as the Worldometers site.

Worldometers:

We collect and process data around the clock, 24 hours a day, 7 days a week. Multiple updates per minute are performed on average by our team of analysts and researchers who validate the data from an ever-growing list of over 5,000 sources under the constant solicitation of users who alert us as soon as an official announcement is made anywhere around the world.

Sources and Methods

Our sources include Official Websites of Ministries of Health or other Government Institutions and Government authorities’ social media accounts. Because national aggregates often lag behind the regional and local health departments’ data, an important part of our work consists in monitoring thousands of daily reports released by local authorities. Our multilingual team also monitors press briefings’ live streams throughout the day. Occasionally, we can use a selection of leading and trusted news wires with a proven history of accuracy in communicating the data reported by Governments in live press conferences before it is published on the Official Websites.

I think daily death curves for each country are a better guide to the state of the pandemic than the number of infections (which are contingent on the testing policy being followed).

In the progression of the coronavirus, it would seem that Italy lies about 9 days before Spain, 13 days before the UK and 17 days before the US.


 

India has learnt not to rely on the WHO

April 10, 2020

The WHO leadership is complicit in the suppression of news about the coronavirus. Its guilt will be judged by history. It was warned by Taiwan in December but could not pay attention to anything that might upset China. But it is not always wise even with its advice.

India has learnt over the years to sidestep the WHO when necessary.

So far India has reported just over 7,000 cases with 229 deaths attributed to covid-19 (10th April, 2020). With a population of over 1.3 billion the fatality rate at present is 0.18 per million of population. It is very early days to be sure but, so far, the fatality rate is long from what was, and still is, feared.

As the Indian Express reports:

… when it comes to key aspects of COVID management, the government has politely sidestepped the periodic “advice” from the WHO and, instead, leaned on the Indian Council of Medical Research (ICMR) and the experience of several state governments — from Kerala and Uttar Pradesh to Rajasthan and Maharashtra. …

Most recently, on April 3, the government’s advisory on the use of masks while stepping out of the house was at variance with that of the WHO, which said this should be only for those who are symptomatic, health workers, or caregivers to COVID patients.

That’s not the only point where the government veered off the WHO track.

  • On January 30, WHO Director General Tedros Adhanom Ghebreyesus said that WHO did not recommend travel restrictions to China — in fact, it was opposed to such an idea. This despite the fact that the same day, the WHO’s International Health Regulations Emergency Committee raised a global alert on the need for containment, surveillance, detection, isolation, and even contact tracing. By this time, India’s first advisory on avoiding non-essential travel to China dated January 25, was already in place.
  • Three days after the WHO statement, India advised citizens to refrain from travel to China, a step up from its earlier advisory.
  • On March 16, Ghebreyesus said that the WHO’s key message is “test test test”. On March 22, ICMR head Dr Balram Bhargava said: “There will be no indiscriminate testing. Isolation, Isolation, isolation.”
  • Hours later, India went into lockdown, starting with 75 districts and then, from midnight of March 24, the whole country. The decision was based on a paper by ICMR that quarantine is a more effective way of containing the virus than even airport screening.
  • The day after the lockdown began, WHO executive director Mike Ryan said: “Without implementing the necessary measures, without putting in place those protections, it’s going to be very difficult for the country to exit (the lockdown). And when they do, they have a resurgence and I think that’s the challenge now.”
  • WHO’s clinical care guidelines clearly lay down that there is “no current evidence to recommend any specific anti-COVID-19 treatment for patients”. India, nevertheless, first included two of its undertrial antivirals — lopinavir and ritonavir — in its clinical care guidelines for patients of the novel coronavirus disease, and then revised the management guidelines to replace the antivirals with a combination of hydroxychloroquine and the antibiotic azithromycin.

All the coronavirus solutions are going to be national, not global, solutions and I am quite sure that countries with effective measures will quickly inform other countries directly. They will not rely on a pampered and ineffective WHO leadership to do that.

Mumbai lockdown 9th April 2020

India has removed the ban on exports of hydroxylchloroquine to selected countries on humanitarian grounds and has sent supplies to, at least, USA, Israel, Brazil, Sri Lanka and a few others.


 

Whether for Haiti cholera, Ebola or the coronavirus, the WHO leadership failed

April 9, 2020

The WHO has many skilled, dedicated and hard working staff.

But the WHO leadership and the organisation are not fit for purpose.

After the Haiti earthquake it was poorly screened UN troops who took cholera into Haiti in 2010. But the UN and the WHO leadership were more concerned with appearing politically correct and with CYA than anything else.

NY Times (Dec 2016):

After six years and 10,000 deaths, the United Nations issued a carefully worded public apology on Thursday for its role in the 2010 cholera outbreak in Haiti and the widespread suffering it has caused since then.

The mea culpa, which Secretary General Ban Ki-moon delivered before the General Assembly, avoided any mention of who brought cholera to Haiti, even though the disease was not present in the country until United Nations peacekeepers arrived from Nepal, where an outbreak was underway. ……

One of the reasons the disease spread so widely, public health experts have said, is because it was allowed to; had there been a vigorous response in the first couple of years, it would have been far easier to contain, and fewer people would have died. The death toll stands at an estimated 10,000; some say it could be higher. ………

The WHO knew about the outbreak and the causes but was incapable of taking any actions which might have political implications.

The WHO was even worse with their “egregious failure” after the Ebola outbreak of 2013.

Reuters (Nov 2015):

The World Health Organization’s failure to sound the alarm until months into West Africa’s Ebola outbreak was an “egregious failure” which added to the enormous suffering and death toll, ……

The Ebola epidemic has killed at least 11,300 people in Guinea, Sierra Leone and Liberia since it began in December 2013. The crisis brought already weak health services to their knees and caused social and economic havoc.

“The most egregious failure was by WHO in the delay in sounding the alarm,” said Ashish K. Jha, HGHI’s director and a leading member of the panel. “People at WHO were aware that there was an Ebola outbreak that was getting out of control by spring, and yet it took until August to declare a public health emergency.” …..

And now with the coronavirus outbreak, the WHO leadership has failed again. Instead of preparing for a pandemic it has wasted time on the imaginary threats of climate change, on placating China and playing nice with celebrities.

There are three charges against WHO. First, it failed to prepare the world for a pandemic, spending the years since the Sars and ebola alarms talking more about climate change, obesity and tobacco, while others, including the Wellcome Trust and the Gates foundation, actually set up a coalition for epidemic preparedness innovation, and countries like Singapore and South Korea put in place measures to cope with an outbreak like SARS in the future.

Second, once the epidemic began in China, WHO downplayed its significance, tweeting as late as January 14 that “preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission of the novel #coronavirus”, when it had already been warned by the Taiwanese health authorities among others of strong evidence for medical staff in Wuhan becoming ill.

The Chinese government at this stage had known for weeks that the virus was spreading, probably person to person, yet WHO then sycophantically praised the Chinese government. “China is actually setting a new standard for outbreak response,” said WHO’s director-general, Tedros Adhanom Ghebreyesus, a former foreign minister of Ethiopia, a country run by a repressive regime heavily dependent on China. “China is really good at keeping people alive,” echoed the assistant director-general, Bruce Aylward, on 3 March.

On 29 March, a Hong Kong-based journalist asked Aylward to comment on Taiwan’s highly-successful efforts to defeat the virus. At first Aylward ignored the question, claiming not to have heard it. When the journalist offered to repeat it, strangely he said no, he would rather move on to another question. When she pressed, the call was mysteriously cut off. When the journalist called back and asked the question again, he answered a different question, talking about China, rather than Taiwan. The background here is that China is a big funder of WHO and insists that Taiwan be excluded from the organisation since it does not recognise Taiwan’s existence as a separate country. Taiwan banned travel from China very early in the pandemic.

The third charge against WHO is that it has failed before. When the ebola outbreak in West Africa that was to kill 11,000 people began in late 2013, on its own admission WHO hindered the fight against the virus, obsessed with not letting others find out what was happening. In April 2014, the charity Medecins Sans Frontieres announced that the outbreak was out of control. They were promptly slapped down by a WHO spokesman. Others tried again in June to alert WHO. It was not until August that WHO admitted the gravity of the situation.

Later WHO admitted its “initial response was slow and insufficient, we were not aggressive in alerting the world, our surge capacity was limited, we did not work effectively in coordination with other partners, there were shortcomings in risk communication.”

All of which is true again today.

The first case was in November 2019. By December the Chinese authorities knew but were suppressing the news. By end December Taiwan and others had warned the WHO about the outbreak. The pandemic was declared on 12th March 2020. The WHO will not live down this now infamous tweet on January 14th.

The Japanese Deputy Prime Minister recently suggested that the WHO change its name to the China Health Organisation.

The WHO suppresses information, and releases cherry-picked information, to suit what its leadership considers politically correct. Multilateral organisations such as the WHO (and even those of the UN and the EU) do not necessarily level up. They all too often sink to the lowest common level set by what is often compounded among the  worst members.

What is striking is that the global problem of the coronovirus has to find national – not globalised – solutions.


 

Swedish coronavirus policy least successful of the Nordic countries

April 8, 2020

Much as I admire Anders Tegnell (Sweden’s Chief epidemiologist) he appeared, at today’s press conference, to be brushing aside the differences between the Nordic countries a little too lightly. I am sure the health services have done a fantastic job. But, for whatever the reason, Sweden’s policy has so far resulted in many more fatalities (actual and per capita) than in the surrounding Nordic countries. The fatality rate is almost twice that of the next nearest Nordic country (Denmark). There is most likely a lapse of policy, rather than lack of equipment or failure of care, which lies behind this reality.

The reason is probably not unconnected with the overwhelming representation of the over-70’s (88% of all deaths in Sweden) among the fatalities.  (They are not particularly over-represented in the number of cases registered). It seems as if many of these older people were a “captive and doomed” population, stuck helplessly within their care homes – not protected in time from infection by the developing policy.

 


Note for reference:

In the Nordic countries the crude mortality rate (all causes) is between 7,000  and 8,000 per million of population every year. Sweden would normally see about 70,000 -80,000 deaths every year (all causes) compared to the 687 attributed so far to covid-19.

In Italy with a population of 60 million, there would be about 450,000 deaths due to all causes every year. The deaths attributed to covid-19 are currently about 17,500.


 

Have the old been sacrificed in Sweden?

April 8, 2020

We can never know what might have been.

But the aged in their care-homes did not go out and bring in the virus. They were infected by others. As of 7th April, 7,693 cases have been registered in Sweden and 591 deaths have been attributed to the coronavirus. Of these 2,807 cases (36% of total cases) and 519  deaths (88% of all deaths) were of people over 70 years old. Just in Stockholm’s care homes, 159 deaths have been registered. The major difference in deaths per capita between Sweden and the other Nordic countries is the much higher number of deaths among the old in Sweden.

It may well be that those infected mildly and showing no symptoms have been the main carriers of the virus. In one department at a major hospital more than half of all the employees were without symptoms but were infected with Covid-19.

Of course, there is a youth obsession in Sweden. Of course, those who are labeled “retired” have a lower value. Of course, the care-homes are a place for the old to be tucked away out of sight. Of course, there is a formal perception that with a lower “expected remaining life”, the old have a lower value to society and get a lower priority for care. It could have been worse, of course.

It may not have been intentional but the numbers say that in the fight against the coronavirus, the old have been sacrificed in Sweden.

As of 7th April 2020


Related:

When healthy and young has priority over sick and old


 

Coronavirus deaths per capita paint a different picture

April 7, 2020

UPDATE!

The figures below are as of March 30th. There have been more deaths in the eight days since and the per capita fatality rates keep increasing. For example the rate in Sweden after the latest figures announced today, is almost 59 deaths per million of population compared to the 10.8 it was a week ago. Many of the deaths reported today are from earlier days which had gone previously unrecorded. So the numbers have changed though the shape of the curves has not. It would seem that many European countries are at, close to, or have just passed, a peak (hopefully the only peak).


The numbers being reported by countries as “infected” is a function of the testing strategy being followed and is not really a sound measure of the spread of the coronavirus. The number of deaths being reported as due to the coronavirus are probably a better measure though even this number is distorted by

  • political considereations (for example N Korea denies any deaths and West Bengal in India reports them as deaths by other causes),
  • overestimates due to deaths by other causes being attributed to the coronavirus, and
  • underestimates in countries where coronavirus testing is lacking or haphazard,
  • variations in quality of care in different countries.

Nevertheless, the number of deaths per million of population paints a somewhat different picture than that based on number infected.

deaths per million of population

The highest fatality rates in Europe are in Italy (178), Spain, Netherlands, France Belgium and Switzerland (35). Sweden comes in at 10.8 while Germany is an outlier in Europe with a fatality rate of only 6.5 per million. By this measure, China comes in at a very low 2.38. However there is a suggestion that China has under-reported deaths by a factor of 10 (with, in some reports from the crematoriums, just Wuhan suffering some 40,000 fatalities). If true it would take China up to a death rate in the twenties per million of population.

Japan and Indonesia have fatality rates of 0.43 per million while India currently is showing a fatality rate of 0.02 per million.

The variation across the EU countries and how they correlate with different lock-down policies will be something to study when the infection wave is over. The geographical spread, or lack of spread, will also be of great interest. I would not be surprised, at first glance, if latitude and prevailing weather has had some effect. I note also that in India, anecdotal evidence is that chloroquine has been widely used as a prophylactic.


 

Cured and discharged – a 100 day epidemic in each country

April 6, 2020

The number of those infected, hospitalised, and now cured and discharged is just beginning its steep rise.

Global data including China (Worldometers)

It seems as if Italy and Spain, after China, are showing a downturn in the number infected. Other countries, including the US, should reach their peaks in the next two or three weeks. India and Africa are more uncertain.

It does look like the global pandemic may take another 6 – 8 weeks to be on the downturn everywhere. However the epidemic in each country seems to be taking about 100 days to reach its peak.


 

Knowing what you don’t know: Ambushed by the coronavirus

April 2, 2020

Ambushed by the coronavirus, 15.5 billion km ago.

10 year old: So the earth moves around the sun and we move with it?

Dad: Yes.

10 year old: And in one hour we have moved 107,000 km along with the earth?

Dad: Yes.

10 year old: And the sun moves around the centre of the galaxy?

Dad: Yes, the sun and the entire solar system orbit the centre of the Milky Way Galaxy.

10 year old: And in one hour the sun has moved 828,000 km?

Dad: Yes.

10 year old: So in one hour I have travelled 935,000 km around the galaxy?

Dad: Yes.

10 year old: And does the galaxy move?

Dad: Yes, It is thought that the galaxy moves 2,160,000 km relative to other galaxies in an hour.

10 year old: So where did the coronavirus come from?

Dad: We don’t know.

10 year old: And it came in November last year?

Dad: Yes.

10 year old: And we have travelled 15.5 billion km since last November?

Dad: Aaaah, Yes. About that.

10 year old: So we could have been ambushed by coronaviruses lying in wait for us there?

Dad: No.

10 year old: But you don’t know where it comes from.

Dad: We don’t know where it came from, but we know it didn’t come from space.

10 year old: So you do know what you don’t know.



				

Sweden: Flattening the curve (update 1)

March 31, 2020

The time-series of new Covid-19 cases detected every day might suggest that a peak has been passed.

However, it is very difficult on the exponential growth section to be able to tell when the curve begins to flatten off. The growth of Covid-19 cases is better looked at, I think, in terms of new cases against the cumulative number of cases rather than just the traditional time-series. A caveat is that the number of positive cases depends upon the testing strategy. Nevertheless plotting the daily new cases against the cumulative cases on logarithmic scales is a better guide as to whether exponential growth is still occurring.

There are indications that the growth may just be getting off the exponential growth rate but it is not clear yet.

In any event I prefer this plot to the simple time-series.


Sweden’s voluntary lock-down may be able to flatten the curve


 

Strange: In the EU, Covid-19 deaths have not yet changed the all-causes mortality

March 29, 2020

The “European monitoring of excess mortality for public health action” (Euromomo) publishes weekly mortality statistics across 24 countries of the EU.

“Some wonder why no increased mortality is observed in the reported mortality figures for the COVID-19 affected countries”.

European mortality bulletin week 12, 2020

Pooled estimates of all-cause mortality show, overall, normal expected levels in the participating countries; however, increased excess mortality is notable in Italy.

Data from 24 participating countries or regions were included in this week’s pooled analysis of all-cause mortality in Europe.

The number of deaths in the recent weeks should be interpreted with caution as adjustments for delayed registrations may be imprecise. Furthermore, results of pooled analyses may vary depending on countries included in the weekly analyses. Pooled analyses are adjusted for variation between the included countries and for differences in the local delay in reporting.

Note concerning COVID-19 related mortality as part of the all-cause mortality figures reported by EuroMOMO

Over the past few days, the EuroMOMO hub has received many questions about the weekly all-cause mortality data and the possible contribution of any COVID-19 related mortality. Some wonder why no increased mortality is observed in the reported mortality figures for the COVID-19 affected countries.

The answer is that increased mortality that may occur primarily at subnational level or within smaller focal areas, and/or concentrated within smaller age groups, may not be detectable at the national level, even more so not in the pooled analysis at European level, given the large total population denominator. Furthermore, there is always a few weeks of delay in death registration and reporting. Hence, the EuroMOMO mortality figures for the most recent weeks must be interpreted with some caution.

Therefore, although increased mortality may not be immediately observable in the EuroMOMO figures, this does not mean that increased mortality does not occur in some areas or in some age groups, including mortality related to COVID-19.

source: Euromomo Bulletin week 12

As of now Euromomo does not have any explanation. The data does not yet show that Covid-19 has contributed any significant increase to the total, all-causes deaths which may even be showing a small decrease.

It could be that the lockdowns are preventing other more usual viral infections and other deaths from occurring.


First seen at Roy Spencer’s blog.


 


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