The globally reported COVID-19 data[1], published online by the medical journal The Lancet on Feb 19, 2020, tells part of the story of this incredible pandemic.
Other parts of the story are less obvious as the reported numbers need to be put in context. What follows is an exploration of what some of the numbers might mean and what the implication might be.
Countries with reported infections
The data tells us that 185 countries have reported infections. How many countries haven’t? That depends on how many countries there are. And that number is surprisingly hard to pinpoint—it depends on whom you’re asking. The United Nations (UN) recognizes 195 (193 + the Holy Sea + Palestine) countries. The CIA mentions 267 world entities and 228 countries, some of which include disputed territories, such as Kosovo, Somaliland, and Western Sahara.
With that in mind, the percentage of countries in the world without reported cases to date lies between 5% and 9%.
That leaves us with at least ten countries that have not reported any cases, yet[2]. These include North Korea, Tajikistan, Turkmenistan, and Yemen in Asia; Comoros and Lesotho in Africa; and a handful of Pacific Island Nations, including Kiribati, Nauru, Palau, Samoa, Solomon Islands, Tonga, Tuvalu, Vanuatu.
This brings the country or territory-count to more than 195. If we use the CIA number, we have 228 countries minus 185 with reported infections, which leaves us with 43 that haven’t reported cases, out of which we just identified 14. I’ve no idea who or what the other 29 might be, likely more disputed territories such as Hong Kong, Nepal, Turkish Cyprus, etc. It would be interesting to know what number Johns Hopkins uses.
One thing we do know is, some countries still haven’t reported any active cases. Are they so isolated, they truly have not had any infections? Or are they unable to test? Or are they lying? Depending on the country, the likely answer is ‘yes’.
North Korea is among the most politically isolated countries in the world. Few people come or go, so there is less risk from exposure and transmission. The border to China was closed in January[3] and all foreign travel prohibited. North Korea is also one of the most secretive, tightly controlled countries, so it’s difficult to know what is really going on inside. Any information is sparingly distributed by the government and nothing in the way of personal communications or a free press.
Turkmenistan is just as tightly controlled but farther from China, with little international travel to begin with.
Geographic isolation may also play a role in the low infection rate among Pacific Island nations. According to Al Jazeera[4], that might change soon, however, due to weak health care systems, and high rates of diabetes and obesity.
So, who’ll be the last nation to catch this horrible bug? Maybe Nauru, the “least visited place on Earth[5]”, maybe Kiribati, maybe someplace else. Only time will tell. The one sure thing is that no country will remain unaffected, regardless of what officially reported numbers may claim.
How does COVID-19 compare to the common flu?
The CDC estimates that between 12,000 and 61,000 die every year from the common flu in the US and 290,000 to 650,000 die worldwide. We know the coronavirus that causes COVID-19 is far more contagious than the common flu. Contrast that with the fatality rate due to COVID-19, which lies around 18,000 in the US and 100,000 worldwide, as of today.
And yet, the global health care system has become so overwhelmed that doctors are forced to make unthinkable choices. The current numbers clearly don’t match the realities at the front lines.
COVID-19 hasn’t run its course, by a long shot. We need a better system to track the numbers to estimate and project infection rates and to plan strategically and intentionally, going forward.
Fatality Rates among the top ten countries with confirmed cases
How do the top ten countries with confirmed cases compare in terms of fatality rates? The countries with the highest rates to date are Italy, the UK, Belgium, France, and Spain (12.8%, 12%, 11.3%, 10.5%, and 10.2% respectively).
So, Italy, Spain, the US, and France have the most deaths, but Italy, UK, Belgium, and France have the most deaths per capita, i.e. the highest chance of dying from COVID-19 after contracting the virus.
We can see that the US now leads the world with 492,240 currently confirmed, active cases (up from 466,396 this morning) and the second-highest death toll with 18,350 (up from 16,703 this morning).
The US may be amongst those with the highest number of deaths to date, but this number needs to also be understood in the context of the total population. While the US has suffered more losses than most, the actual fatality rate is among the lowest. More than 18 thousand people have died but that is 3.7% of those who’ve been confirmed to have the virus. In Italy, more than 18 thousand have died but the population is much smaller than that of the US and their death rate translates to 12.8%. So, a comparable number of people have died, but the chances of dying in either country are far from similar.
The upside
Overall, the countries with the lowest fatality rates are Turkey, Germany, the US, and China (2.1%, 2.3%, 3.7%, and 4% respectively). At least according to their own accounting. On paper, China seems to have dealt best with the pandemic and keeping the confirmed numbers exceptionally low but China’s otherwise shoddy track record when it comes to recognizing human rights and freedom of speech might make that assertion less likely to be accurate. There is no point in speculating by how much, though.
While Turkey and China are amongst those countries where information (and the population) is tightly controlled, the US and Germany are arguably less secretive and more open in terms of information sharing, so their numbers may be more factual.
The numbers are all based on incomplete and therefore less than accurate data. For example, the people who died yesterday became infected days or weeks ago. A more accurate way to calculate the fatality rates would be to calculate yesterday’s deaths with the confirmed case numbers from when the victims started showing symptoms or tested positive[6]. Unfortunately, we can’t track that sort of data.
And so we may never know the actual numbers for any country. Still, the US and Germany seem to be on the right track in terms of preventing infections and treating those who’ve taken ill. This should bring a modicum of relief to those living in the US or Germany who are overcome with worry and are unsure if we’re doing the right thing.
Rates of recovery among the top ten countries with confirmed cases
The reported numbers of recovery directly relate to the number of those still sick. In the US, we can subtract fatalities (18,350) and recoveries (28,790) from the confirmed cases (492,240), and we get a “still sick” number of 445,100, which is about 90% of those who fell sick at some point. In other words, 3.7% died and 5.8% recovered.
This is yet another statistic that should raise a red flag. It would mean that many of those who’ve contracted the virus and who’ve fallen ill must have been sick for months. (The first case in the US was recorded on January 21 in Washington State. That is 80 days or 11 weeks ago.) Clearly, nobody is acutely sick that long, which means cases of recovery are also severely underreported and we don’t really know how many people are currently sick and/or where exactly the sick are located in terms of geography.
How cases are reported in the US
Counties and states are tasked with reporting confirmed cases of COVID-19 and confirmed deaths from COVID-19 to the CDC (Center for Disease Control and Prevention) for record-keeping. At the same time, doctors, nurses, and other medical staff across the US are increasingly speaking out about a lack of auditing, a lack of testing the dead, and a general lack of oversight according to a number of online news outlets such as Buzzfeed[7], CNN[8], Washington Post[9], Kaiser Health News[10], etc.
The main reason for severely underreported numbers may be the ongoing, well-documented (disputed by the White House but obvious to those on the frontlines) lack of tests and reliable testing. This includes the early, unreliable test kits, the lack of general testing that could identify those who have the virus (and spread it) but aren’t symptomatic, the contradicting testing guidelines randomly issued by federal and state authorities, the lack of testing guidelines for COVID-19 deaths that occur outside the health care system, and on and on.
Secondarily, our under-supported and overwhelmed health care workers have more pressing priorities than diligently jotting down numbers and filling out the usual reams of paperwork required by our massive financial-interest-driven health insurance system.
How does that affect the reliability and therefore the utility of the current stats? The rate of infections, rather than the amount, is disturbing enough, without the probability of being skewed towards the low end. And we desperately need accurate numbers. We need them to properly respond to the current health disaster–from tracking outbreak hot-spots to efficiently allocating resources. We also need them to effectively plan and prepare for similar, highly probable, future events.
The current numbers aren’t useful, and they don’t tell the whole story. Far from it.
One way to get better numbers eventually (at least in the US) may be to hold another CENSUS a year or so from now to count household members who died (confirmed by testing) or may have died due to complications from a COVID-19 infection (according to symptoms). Or maybe some sort of non-government, community-driven survey[11] can get a better statistic than the current one. We won’t be able to get any closer to the truth, short of digging up and testing the dead.
Two more numbers
I don’t know how to put this last observation in any meaningful context, but the realization was so startling, I have to share it: 1,650 people died in the US from COVID-19 in the time it took me to research and write this article. 4,936 people died worldwide. (I spent about 12 hours on this–from initial concept to final draft.)
Final thoughts
Social distancing is the only vaccine we have right now and it’s free. Don’t be that person who spreads the virus to family, friends, and neighbors for no reason other than boredom or willful ignorance.
We need to keep new infection rates in check until we’ve got a viable pharmacological vaccine. That means we’ll need to continue the current measures for far longer than anyone will be comfortable with. If it goes on too long, however, civil unrest will be inevitable. This pandemic is going to test our resilience, our humanity, and our democracy.
While I have plenty of gripes any day of the week, I’m also trying to look at the bigger picture: I’m grateful for my privilege living in the Florida Keys and I will continue to do my part to support my community and keep everyone safe to the best of my ability.
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[1] Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real-time. Lancet Infect Dis; published online Feb 19. https://doi.org/10.1016/S1473-3099(20)30120-1. Retrieved 10 April 2020.
[2] https://cdn.statcdn.com/Infographic/images/normal/21279.jpeg Retrieved 10 April 2020.
[3] https://www.japantimes.co.jp/news/2020/01/22/asia-pacific/science-health-asia-pacific/north-korea-closes-borders-all-foreign-tourists-coronavirus-china/#.XpCuby-z0WoRetrieved 10 April 2020.
[4] https://www.aljazeera.com/news/2020/04/remote-pacific-islands-prepare-worst-coronavirus-looms-200403045004961.html Retrieved 10 April 2020.
[5] https://www.youngpioneertours.com/nauru/ Retrieved 10 April 2020.
[6] https://www.medrxiv.org/content/10.1101/2020.03.14.20036178v2.full.pdf
[7] https://www.buzzfeednews.com/article/nidhiprakash/coronavirus-update-dead-covid19-doctors-hospitals
[8] https://www.cnn.com/2020/04/04/health/recovery-coronavirus-tracking-data-explainer/index.html
[11] https://hosted-washpost.submissionplatform.com/sub/hosted/5e7bd9faf362630035018215
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