Covid19-Comparing response and deaths across nations, over time.

[tall73]

Edit: updating to show latest data, deaths per million population

------Original Post below
There are many factors that may impact results in various nations. And there are some aspects of methodology that make it difficult as well. Some count probable deaths, while others may not.

Why No 10's Covid-19 death toll slides don't tell the whole story

The devil was in the detail: the UK’s daily figures only included deaths where the patient tested positive for Covid-19. The Belgian figures included all suspected cases regardless of whether a test was carried out.

The CDC figures for the USA started counting probable deaths as well, back on April 14, with NY adding in a number of them in one day, and then later figuring them into the daily numbers. This also makes it difficult to track the curve when methods change over time.

Yet there are still some comparisons possible. And even beyond that there are comparisons within the country over time. The below chart shows some of the developed nations with higher than average deaths per million. I didn't include all of them because I only had the historical data for some, based on earlier posts.

And this does not include those nations who are in a much better situation, such as Australia, New Zealand, South Korea, etc. The data was collected on the dates listed from Worldometers.

Some were ahead of others in the curve. But some have also managed to slow the progress of deaths per million considerably more than others.

For instance, on April 15 Canada was at 24, and Norway at 27, slightly worse off. However, since then Canada is up to 124, and Norway has climbed only to 40.

Back at the time I remember reading an article that speculated that the USA was behind places such as France, but was also behind on the curve, and would likely catch up. We do now see the USA has around tripled, and is at around the same rate France was back on April 15. Does this mean they will likely catch up to France in another several weeks? So far, it looks likely.

The UK also started behind France, but now has passed them.

Sweden with its more voluntary distancing, without full lockdown started slightly better than Switzerland, but now has shot considerably past.

Scientists will be studying things for some time. This is for discussing possible factors that may play a role for each nation, looking at lessons learned, etc.

Along with this is the question of what the goal of each country has been.

Countries such as Australia and New Zealand had the option of going for eradication due to good initial responses. My understanding is that Australia is now not staying in lockdown long enough for that to happen, but hopes to control any second wave while opening.

Some have indicated that Sweden was going for herd immunity, though they state the goal was only to slow the curve to maintain health capacity.

The UK initially considered the Sweden model then changed course.

An additional goal for some could be to limit early deaths so that therapeutics or a vaccine may be produced, which could mean prolonged lockdowns.

When is it best to change strategies? Were lockdowns helpful? For how long are they helpful?

How realistic would early travel restrictions be if a future outbreak occurred? Is there any value in such restrictions? Initially the WHO and earlier outbreaks indicated perhaps not. Though restrictions by New Zealand and Australia, etc. are part of their ongoing strategy at the moment.

Which factors matter most to results?

Early testing, contact tracing, population density, date of first case, date of community transmission, date of travel restrictions, lockdown measures, timing of lockdown measures, protecting prisons and nursing care centers, or some other factor.

 

[Tanj]

I have to wonder how many people reading this thread understand what "No 10's" means.

 

[tall73]

I have to wonder how many people reading this thread understand what "No 10's" means.

Prime Minister's Office, 10 Downing Street

 

[Occams Barber]

@tall73
As we've talked about before, there also appears to be a geographical factor to the death rates.

The table below is a side-by-side simple comparison of death rates per million for Europe and Asia taken direct from Worldometer. Both lists are in descending order.

What is immediately obvious is that the European death rates are, consistently and significantly, higher than the Asian figures. This also shows up in the averages. Europe averages 165 deaths per million while Asia is only 7. The European figures also show that the higher scores are clustered tightly around the western end of Europe.

Adding the US (242) and Canada (36) to the European group, and New Zealand (4) and Australia (4) to the Asian group, the geography is extended but the clear high/low relationship is still obvious.

One possibility is that many Asian countries are not picking up all deaths due to Covid although this is unlikely in the more developed countries like Taiwan, South Korea, Singapore, Hong Kong, Australia, New Zealand, Malaysia, Japan etc. I'd also expect to see a similar problem in some of the eastern European countries.

OB

 

[tall73]

@tall73
As we've talked about before, there also appears to be a geographical factor to the death rates.

The table below is a side-by-side simple comparison of death rates per million for Europe and Asia taken direct from Worldometer. Both lists are in descending order.

What is immediately obvious is that the European death rates are, consistently and significantly, higher than the Asian figures. This also shows up in the averages. Europe averages 165 deaths per million while Asia is only 7. The European figures also show that the higher scores are clustered tightly around the western end of Europe.

Adding the US (242) and Canada (36) to the European group, and New Zealand (4) and Australia (4) to the Asian group, the geography is extended but the clear high/low relationship is still obvious.

One possibility is that many Asian countries are not picking up all deaths due to Covid although this is unlikely in the more developed countries like Taiwan, South Korea, Singapore, Hong Kong, Australia, New Zealand, Malaysia, Japan etc. I'd also expect to see a similar problem in some of the eastern European countries.


View attachment 276601
OB

That is a striking comparison.

Yes, we were trying to figure out what drove that large cluster throughout Europe.

As noted in the other thread there were some reports indicating a more easily transmissible strain, though the more I see of responses to the article that is theoretical at this point. It is clear that the strain is predominating in various regions, but it is not clear from any actual experiments that it does transmit more readily.

It may also be more relaxed border security, or just that there was a lot of international traffic among those nations during the time when it was likely spreading under the surface.

 

[tall73]

Rise in German virus infections spurs concern

Berlin (AFP) - Germany's coronavirus spread appears to be picking up speed again, official data showed Sunday, just days after Chancellor Angela Merkel said the country could gradually return to normal.

The Robert Koch Institute for public health said Germany's closely watched reproduction rate (R0) had climbed to 1.1, meaning 10 people with COVID-19 infect on average 11 others.

The RKI has warned that for the infection rate to be deemed under control and slowing down, the R0 has to stay below one.

As recently as Wednesday, Germany's number stood at 0.65.

But since then the country has reported clusters of new cases at slaughterhouses and at care homes for the elderly.

 

[tall73]

Comparing the deaths per day of two nations taking very different approaches. The numbers of deaths is not the key factor as the populations are different. The shape of the curve is more of a comparison point.

Sweden

Germany

 

[Occams Barber]

Rise in German virus infections spurs concern

Berlin (AFP) - Germany's coronavirus spread appears to be picking up speed again, official data showed Sunday, just days after Chancellor Angela Merkel said the country could gradually return to normal.

The Robert Koch Institute for public health said Germany's closely watched reproduction rate (R0) had climbed to 1.1, meaning 10 people with COVID-19 infect on average 11 others.

The RKI has warned that for the infection rate to be deemed under control and slowing down, the R0 has to stay below one.

As recently as Wednesday, Germany's number stood at 0.65.

But since then the country has reported clusters of new cases at slaughterhouses and at care homes for the elderly.

Abattoirs and aged care homes seem to be the virus' favorite places. We also have a current outbreak at a meatworks and an aged care facility. While they are individually serious clusters, overall we still seem to have things under control. Phasing out lockdown has started and will slowly progress in stages over the next few weeks. Looks like international arrivals, without a mandatory 14 day quarantine, will be one of the last things we'll allow.

OB

 

[tall73]

One thing that we do not know, that could wind up being a problem for models such as Sweden, or for countries who don't intend to go for herd immunity, but are not successful in slowing the virus either, is whether there can be ADE.

My thread on the vaccine process noted the problems with SARS vaccines that when the animal was challenged again with SARS wound up with damage to organs.

It is possible this could also happen on re-infection, especially if the number of antibodies is low.

In the vaccine thread an initial study with SARSCOV2 indicated no immediate ADE, but longer term tests are still needed.

The potential danger of suboptimal antibody responses in COVID-19

Antibody-dependent enhancement

Although antibodies are generally protective and beneficial, the ADE phenomenon is documented for dengue virus and other viruses. In SARS-CoV infection, ADE is mediated by the engagement of Fc receptors (FcRs) expressed on different immune cells, including monocytes, macrophages and B cells5,6. Pre-existing SARS-CoV-specific antibodies may thus promote viral entry into FcR-expressing cells (Fig. 1b). This process is independent of ACE2 expression and endosomal pH and proteases, suggesting distinct cellular pathways of ACE2-mediated and FcR-mediated viral entry6. There is no evidence that ADE facilitates the spread of SARS-CoV in infected hosts. In fact, infection of macrophages through ADE does not result in productive viral replication and shedding7. Instead, internalization of virus–antibody immune complexes can promote inflammation and tissue injury by activating myeloid cells via FcRs5. Virus introduced into the endosome through this pathway will likely engage the RNA-sensing Toll-like receptors (TLRs) TLR3, TLR7 and TLR8 (Fig. 1c). Uptake of SARS-CoV through ADE in macrophages led to elevated production of TNF and IL-6 (ref.5). In mice infected with SARS-CoV, ADE was associated with decreased levels of the anti-inflammatory cytokines IL-10 and TGFβ and increased levels of the pro-inflammatory chemokines CCL2 and CCL3 (ref.8). Furthermore, immunization of non-human primates with a modified vaccinia Ankara (MVA) virus encoding the full-length S protein of SARS-CoV promoted activation of alveolar macrophages, leading to acute lung injury9.

Multiple factors determine whether an antibody neutralizes a virus and protects the host or causes ADE and acute inflammation. These include the specificity, concentration, affinity and isotype of the antibody.

 

[tall73]

Abattoirs and aged care homes seem to be the virus' favorite places. We also have a current outbreak at a meatworks and an aged care facility. While they are individually serious clusters, overall we still seem to have things under control. Phasing out lockdown has started and will slowly progress in stages over the next few weeks. Looks looks international arrivals, without a mandatory 14 day quarantine, will be one of the last things we'll allow.

OB

Yes, nursing homes in particular wound up driving about 50 percent of deaths in Europe, is around that number in the USA, and so far has driven 80 percent in Canada.

In the USA we are having issues with meat processing facilities etc. as well, with Trump ordering them to stay open.

 

[Tanj]

Yes, nursing homes in particular wound up driving about 50 percent of deaths in Europe, is around that number in the USA, and so far has driven 80 percent in Canada.

In the USA we are having issues with meat processing facilities etc. as well, with Trump ordering them to stay open.

Some nice graphs of what our outbreaks look like. It's quite clean due to the very low level of non outbreak cases:

Tracking the coronavirus spread: The two clusters fuelling the new case tally

(graph numbers 3 & 4 on that page)
3 outbreaks, 3 different patterns. Note the Cedar Meats one reported 1 case today.

Australia has a semi regular trickle of people repatriating in from other countries. It's noteworthy that on many days >= 50% of our cases are people from overseas (fortunately in mandatory quarantine). Today 4 of the 7 Victorian cases were from recent arrivals.

 

[Occams Barber]

Some nice graphs of what our outbreaks look like. It's quite clean due to the very low level of non outbreak cases:

Tracking the coronavirus spread: The two clusters fuelling the new case tally

(graph numbers 3 & 4 on that page)
3 outbreaks, 3 different patterns. Note the Cedar Meats one reported 1 case today.

Australia has a semi regular trickle of people repatriating in from other countries. It's noteworthy that on many days >= 50% of our cases are people from overseas (fortunately in mandatory quarantine). Today 4 of the 7 Victorian cases were from recent arrivals.

Thanks @Tanj. Apart from the outbreaks we seem to be doing OK.

In post #4 I set out a very basic comparison of death rates for European and Asian countries based on Worldometer data. It appears to be showing a huge-across-the-board difference between European and Asian deaths per million.

Do you have any thoughts on what might be the cause of the difference?

OB

 

[Tanj]

Thanks @Tanj. Apart from the outbreaks we seem to be doing OK.

In post #4 I set out a very basic comparison of death rates for European and Asian countries based on Worldometer data. It appears to be showing a huge-across-the-board difference between European and Asian deaths per million.

Do you have any thoughts on what might be the cause of the difference?

OB

Differences in testing and assignment of cause: Generally speaking the less developed countries are in Asia, and are likely to have lower levels of testing and accurate diagnosis/reporting. THe reason Belgium ranks #2 is they count just about everything as COVID related (which might well be accurate).

General country demographics: especially age distribution and population density.

Social attitude: by and large Asian cultures are more obedient to central authority.

Environment: I think this virus does less well in conditions where people live in hot/humid conditions

A decent response to the epidemic: South Korea, Taiwan, Hong Kong.

 

[Occams Barber]

Differences in testing and assignment of cause: Generally speaking the less developed countries are in Asia, and are likely to have lower levels of testing and accurate diagnosis/reporting. THe reason Belgium ranks #2 is they count just about everything as COVID related (which might well be accurate).

General country demographics: especially age distribution and population density.

Social attitude: by and large Asian cultures are more obedient to central authority.

Environment: I think this virus does less well in conditions where people live in hot/humid conditions

A decent response to the epidemic: South Korea, Taiwan, Hong Kong.

Thanks. I was hoping we could find the whizz-bang single factor that solved the whole problem but, unfortunately, real life ain't that simple.

The annoying thing is that we have loads of data on this virus but we have yet to really establish what, if anything, it can actually tell us.

OB

 

[Tanj]

Thanks. I was hoping we could find the whizz-bang single factor that solved the whole problem but, unfortunately, real life ain't that simple.

The annoying thing is that we have loads of data on this virus but we have yet to really establish what, if anything, it can actually tell us.

OB

It's a head scratcher.

 

[sfs]

A decent response to the epidemic: South Korea, Taiwan, Hong Kong.

All places that took SARS seriously as a dry run.

 

[rambot]

Note; I am very certain asian countries do not have old age homes. Certainly many...

 

[Bob Crowley]

Australia and New Zealand have the advantage of being geographically isolated, although quick reaction do doubt had a bearing. I don't know the actual percentages, but in Australia a considerable number of cases came from cruise ships or overseas travellers, particularly in the early stages.

The virus has obviously moved into the community, but lock-downs and social distancing have reduced its mobility. There have been some clusters of infection eg. some aged care homes and abattoirs in the main.

Interstate travel has been restricted, but we've got the advantage of only having seven states, whereas the USA for example has fifty, a much higher population, more roads and bypasses no doubt to cross borders, and in a given period of time it would have many times the number of flights and ships arriving from overseas.

If I understood some data correctly there were a bit over 1 billion passenger flights within or arriving or departing the USA in 2018, with 120 million passangers arriving by air in 2018. That's over 2 million a week. Allow a week or two for the virus to actually make its presence unmistakably known, and it's easy to see why it was able to spread so quickly before active measures could be taken to contain it.

For Australia with considerably lower numbers to contend with, it's been "easier" to control. But it's had a significant economic impact. Virgin Australia, Australia's second largest airline, has gone into voluntary administration for example, and a lot of people have lost their jobs, with many businesses facing an uncertain future.

Some restrictions have started being lifted. We had "Mother's Day" yesterday and families were allowed to gather in groups of ten in any one place. Last week some restrictions on travel were lifted, and schools are starting to resume. In the state of Queensland anyway - states are dong their own thing following general guidelines from the federal government, based on their own data.

The downside is that we won't develop herd immunity, so that if it does break out again, it will take off like wildfire. Hopefully by that time a vaccine will have been delivered, although immunising 25 million people would take some doing.

We've had nearly 7000 diagnosed cases, with 97 deaths, which is a pittance compared to some other less fortunate nations.

 

[Occams Barber]

Australia and New Zealand have the advantage of being geographically isolated, although quick reaction do doubt had a bearing. I don't know the actual percentages, but in Australia a considerable number of cases came from cruise ships or overseas travellers, particularly in the early stages.

The virus has obviously moved into the community, but lock-downs and social distancing have reduced its mobility. There have been some clusters of infection eg. some aged care homes and abattoirs in the main.

Interstate travel has been restricted, but we've got the advantage of only having seven states, whereas the USA for example has fifty, a much higher population, more roads and bypasses no doubt to cross borders, and in a given period of time it would have many times the number of flights and ships arriving from overseas.

If I understood some data correctly there were a bit over 1 billion passenger flights within or arriving or departing the USA in 2018, with 120 million passangers arriving by air in 2018. That's over 2 million a week. Allow a week or two for the virus to actually make its presence unmistakably known, and it's easy to see why it was able to spread so quickly before active measures could be taken to contain it.

For Australia with considerably lower numbers to contend with, it's been "easier" to control. But it's had a significant economic impact. Virgin Australia, Australia's second largest airline, has gone into voluntary administration for example, and a lot of people have lost their jobs, with many businesses facing an uncertain future.

Some restrictions have started being lifted. We had "Mother's Day" yesterday and families were allowed to gather in groups of ten in any one place. Last week some restrictions on travel were lifted, and schools are starting to resume. In the state of Queensland anyway - states are dong their own thing following general guidelines from the federal government, based on their own data.

The downside is that we won't develop herd immunity, so that if it does break out again, it will take off like wildfire. Hopefully by that time a vaccine will have been delivered, although immunising 25 million people would take some doing.

We've had nearly 7000 diagnosed cases, with 97 deaths, which is a pittance compared to some other less fortunate nations.

Nice summary Bob.

OB

 

[Occams Barber]

Australia and New Zealand have the advantage of being geographically isolated, although quick reaction do doubt had a bearing. I don't know the actual percentages, but in Australia a considerable number of cases came from cruise ships or overseas travellers, particularly in the early stages.

The chart below shows the % of infections from overseas and local sources as at 12 May. It comes from the ABC's running summary of the virus, as it applies to Australia, linked by @Tanj in post #11.
Tracking the coronavirus spread: The two clusters fuelling the new case tally

OB