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Pandemicia coronavirus report #63
It has been almost two months since the last Pandemicia summary. A good deal has been happening during the period, but this has been partially concealed by increasing public and media fatigue on the issue.
In this issue we look at two indicators - Deaths per capita, and Mortality - to determine policy success in dealing with Covid-19.
In this issue we look at two indicators - Deaths per capita, and Mortality - to determine policy success in dealing with Covid-19.
Epidemic
Global report
Globally, deaths are running at almost 50,000 a week, as they were doing in April 2020 and continuously for a year now. Total Covid-19 deaths will pass 5 million in early November.
Over the past month the United Kingdom has had over a million confirmed cases, the second-highest number of new infections in the world after the USA. Restrictions are to be re-introduced.
A substantial outbreak is under way in the Baltic States, the Balkans and East-Central Europe, and restrictions have been tightened.
In December, deaths in the USA will pass Pandemicia's 800,000 estimate made early last year. Most of the USA has no restrictions, but cases and especially deaths are rising.
Nearly 7 billion vaccine doses have been administered this year, but much of the world is unvaccinated.
The continuing Australia pandemic is covered in a separate report (to be completed).
Deaths per capita indicator
Total Covid deaths per capita are a primary marker of the severity of the pandemic in a constituency and the success of government policy in preventing Covid-19 deaths. At present the world average is 630 per million.In descending order of mortality by region we have South America (2700), East-Central Europe (2500) North America ( 1860) European Union (1760), Africa (460), Oceania (61)
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| Figure 1. Deaths per million, selected countries |
In the EU the worst performing country has been Bulgaria (3300 per million) and the best have been Finland (205) . In South America, the worst has been Peru (6000) and the best Guyana (1130). Iran, Sweden and South Africa have scored poorly relative to their neighbours - all around 1470.
Deaths in Peru are more than 1% of the population aged over 20. This was an initial estimate of the proportion of the world population likely to be killed by Covid-19. Official deaths are only about a third of excess deaths - more likely to be an accurate measure.
Some countries with good results are China (3.2 per million) New Zealand (5.8) Taiwan (35) Australia (63) and Pakistan (125).
Mortality indicator
Another useful indicator of the effectiveness of treatment is the mortality rate of infected people. This cannot be calculated directly so we are using smoothed daily deaths divided by smoothed daily cases, which is a reasonably robust surrogate adjusting for part of the lag between cases and deaths.
The global mortality rate is shown in Figure 2 below since July 2020. It has varied between 1.4% and 3%. In Feb 2021 it rose during the winter wave, and then in June when the Indonesian outbreak overwhelmed hospitals there.
Before the period of Figure 2, the world mortality rate fell from about 9 per cent in April 2020, when tests were not widely available and patient care was poor. In the EU it was as high as 15.8% at the peak.
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| Figure 2. Global mortality rate defined as smoothed deaths/smoothed new cases |
about 1%, as shown in Figure 3. With the assistance of vaccinations, it fell to 0.45% in early August, but since the summer outbreak topped in August, cases have been falling much more rapidly than deaths. Accordingly, the quotient indicator has been rising rapidly and is now about 2%, probably because of a decline in effectiveness of the vaccines. Social distancing has been discontinued and even deliberately curtailed across most of the USA, and now the mortality rate is no better than in late 2020. The situation is fairly serious as the country is coming into winter.
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| Figure 3. Mortality rate of new cases USA |
The mortality rate in the EU also followed the global trend as Figure 4 shows. This changed in July 2021, when widespread vaccination coupled with social distancing brought the mortality rate down to an almost negligible level (0.17%). Mortality remains low in most of Western Europe but has risen to over 1% on average across the EU, because of higher contributions from Spain, Italy, Sweden and especially from the outbreak in eastern Europe.
In Great Britain the very large number of daily cases (almost 50,000 per day) is also resulting in high deaths, despite low mortality rates. After considerable resistance from officials, Britain will be re-introducing restrictions in response to the outbreak.
East-central Europe barely participated in the initial outbreak because countries introduced early restrictions. They then failed to reintroduce controls into winter, allowing much more severe epidemics to take place in December 2020 and then in March. Although these countries have had plenty of equipment and good facilities, mortality was exacerbated by years of extensive emigration of medical staff, The mortality rate in Bulgaria, for example, rose to critical levels of 11.4% in late January, and 14% in early June, indicating system failure. In the present outbreak, mortality is 3% - still not good but shows both greater medical readiness and the effect of vaccines.
Western Europe has lifted restrictions to the extent that most businesses are open. A number of countries are requiring a 'green pass' or vaccination certificate for access to public spaces. The EU Digital Covid Certificate permits travel between countries. Some countries are now charging the unvaccinated for PCR tests.
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| Figure 4. Mortality rate of new cases, EU |
East-central Europe barely participated in the initial outbreak because countries introduced early restrictions. They then failed to reintroduce controls into winter, allowing much more severe epidemics to take place in December 2020 and then in March. Although these countries have had plenty of equipment and good facilities, mortality was exacerbated by years of extensive emigration of medical staff, The mortality rate in Bulgaria, for example, rose to critical levels of 11.4% in late January, and 14% in early June, indicating system failure. In the present outbreak, mortality is 3% - still not good but shows both greater medical readiness and the effect of vaccines.
The highest number of deaths per day in the EU at the moment are in Romania and Bulgaria. However, vaccinations are lowering mortality by three-quarters relative to the December and March waves in these countries.
Response
Vaccine
With much of the population vaccinated in the USA and in Europe during December to May, most of the focus has been on booster shots, as the vaccines appear to lose efficacy over time.
While most of those seriously ill and dying have been the unvaccinated, there have been an increasing number of "breakthrough cases. About half of those hospitalised in Israel in August 2021 were double-vaccinated, though most of these were older patients with comorbidities and already requiring care. According to Israeli estimates, the effectiveness of Pfizer vaccine against severe disease dropped from over 90% to only 55% in people over 65. Booster doses have been available to people over 60 in Israel from July, and in the USA from September.
Elsewhere, vaccine hesitancy remains a serious issue. In Palestine only 9% of the population is vaccinated, mostly because of adverse publicity surrounding the Astrazeneca vaccine, which is widely available.
While Australia was slow to begin vaccination, it will soon be the most vaccinated country in the world (after UAR) with over 90% of over 16's vaccinated. The high acceptance has been attained by mandates for all essential workers
The Australian COVAX-19 vaccine has entered Phase 3 trials in Iran after failing to gain local financial support. It is a 'protein-based' vaccine similar to Novavax and Hepatitis-B vaccine. So far, testing has been encouraging. The main ingredient is a sugar-based adjuvant turbocharger called Advax, to which is attached several parts of the spike protein as 'nanoparticles'.
Other
Restrictions have lifted across most of the USA, with only eight states currently retaining them (and all tightening). The hard-line states such as Texas and Florida banned mandates in May, preventing school districts and local governments from requiring masks .
Western Europe has lifted restrictions to the extent that most businesses are open. A number of countries are requiring a 'green pass' or vaccination certificate for access to public spaces. The EU Digital Covid Certificate permits travel between countries. Some countries are now charging the unvaccinated for PCR tests.
Australia has introduced strong mandates against unvaccinated people, limiting entry to most indoor venues, and disallowing employment in government and health services fro the unvaccinated. This has caused protest - with the most vociferous of these occurring in New York, describing Australia as dystopian - despite overwhelming support in Australia for mandates.
A range of medications for infected high-risk unvaccinated patients is coming onto the market, most notably monoclonal antibodies and the tablet molnupiravbir.
The cheap antiparasitic drug ivermectin, which has yet to be proven either effective or ineffective against Covid-19, has been attacked vigorously in mainstream media following several self-administered overdose cases,and effectively banned from use.
Geopolitical and Economy
The Great Resignation has been picking up speed. In the USA, over 20 million workers per month have been resigning their positions. After a long period of stagnation, wages for low-paid workers have been rising, which has encouraged many to seek better jobs.
In the OECD, about 20 million fewer people are working than before the pandemic, and 14 million have exited the labour market. As well, immigrant workers are far below the numbers pre-pandemic. There is a general shortage of skilled workers. The most glaring evidence has been in the United Kingdom where petrol prices rose and bowser queues developed because of panic buying amid a shortage of tanker truck drivers; army tankers had to be deployed to meet demand.
In the OECD, about 20 million fewer people are working than before the pandemic, and 14 million have exited the labour market. As well, immigrant workers are far below the numbers pre-pandemic. There is a general shortage of skilled workers. The most glaring evidence has been in the United Kingdom where petrol prices rose and bowser queues developed because of panic buying amid a shortage of tanker truck drivers; army tankers had to be deployed to meet demand.
Typically for crises, the well-to-do find new opportunities while the poor and vulnerable suffer. In the developing countries, the dislocations to the labour force have forced many into the informal sector, or out of the cities and back to villages where at least they can find food. About one in three workers forced to change jobs reported worse working conditions and more risk. Over two thirds of garment workers received no severance.
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Official sources in Russia have been running a strong anti-vaccination campaign. This began in March with an attempt to undermine Pfizer - in retaliation for Western attacks on the world's first vaccine, Russia's Sputnik V. As a result, there has been a tepid take-up of the vaccine with only 16% of the population inoculated. This must be seen in the context of fraught relations between citizens and the state, in which vaccination has become a casualty - 31% of citizens say they would not get vaccinated under any circumstances, and 55% are opposed to mandates.
Unfortunately there are record numbers of both cases and deaths in Russia at present - 35,000 cases a day and over 1000 deaths a day (both believed to be a significant underestimate).
Unfortunately there are record numbers of both cases and deaths in Russia at present - 35,000 cases a day and over 1000 deaths a day (both believed to be a significant underestimate).
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For Australia, the greatest casualty of the pandemic has been the 'divorce' from China. About a third of Australia's trade has been with China, making it the most China-dependent country in the developed world. China like Australia has been Covid-zero, which might have been an opportunity to open borders and renew lucrative student and trade arrangements. But rather than move closer to China, the government deliberately insulted China in favour of forming a united front with its heavily-infected traditional allies. This has inevitably led to Australia dropping its Covid-zero strategy in favour of a vaccinate-and open strategy, like the USA and Europe.
The result of the Australia-China dispute is that Australia's wine, coal, copper ore, cotton, education, rough wood, and lobster industries have been crushed. Iron ore is likely to be a casualty of the trade war before long, though at the moment China has no other source. It will take Australia a long time to find alternative trading partners, if at all.
The result of the Australia-China dispute is that Australia's wine, coal, copper ore, cotton, education, rough wood, and lobster industries have been crushed. Iron ore is likely to be a casualty of the trade war before long, though at the moment China has no other source. It will take Australia a long time to find alternative trading partners, if at all.
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The IMF is lending $250 billion to help countries with the crisis - a quarter of its lending capacity.
Summary
- Peru has been the most severely affected country in the world and has lost up to 3% of its adult population. Latin America is the most severely affected region in the world, while Oceania is the least affected. China is the least affected large country, by a very significant margin.
- Mortality (for infected people) fell almost to negligible levels in Europe following general vaccination, with many social distancing rules retained. However in the USA, where social distancing rules have been largely removed, mortality is rising and is now back at the level of late 2020. This is because new cases are falling faster than deaths.
- A severe outbreak in Eastern Europe is showing about a 75% fall in mortality over two previous waves, likely due to vaccinations. However, deaths are still the highest in Europe. This is particularly the case in Russia, where only 16% of the population is vaccinated.
- As following historical pandemics, the world's labour markets have been shocked and labour shortages have developed in some sectors. In developed countries this has been beneficial for many low-income people but in developing countries it is detrimental.
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| Burials in Peru |
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