Coronavirus: Why some countries have been hit worse by COVID-19

The world has now recorded more than 10 million cases of coronavirus and documented more than half a million deaths as a result of the pandemic.

It started in China, possibly back as far as November, but then spread rapidly to Europe and other countries in Asia before working its way into the Americas.

But the way in which countries around the world have been affected has not been equal.

Worst for deaths

The country with the highest number of deaths is the US, which has seen more than 125,000 people die from COVID-19 related symptoms, according to data compiled by the Johns Hopkins University in Baltimore.

But that doesn’t make it the hardest hit.

In Belgium, 85.2 people out of every 100,000 have died – more than double the rate of the US (38.5/100,000).

In terms of COVID-19 deaths, all the worst hit countries are European ones. After Belgium, the UK, Spain, Italy, Sweden and France have the highest death rate per head.

All these are countries that were hit by a first wave earlier than most of the rest of the world (apart from China), so have been living with the virus for longer.

However, the statistics for death rates do not tell the whole story.

The number of COVID-related deaths is very likely to be under-reported everywhere, as only people who have tested positive or who were identified as potential COVID cases and then die will have been recorded as having died from the disease.

In many countries, differences in record keeping may mean that there is no way for COVID-19 to be registered as a factor in death – that’s if a doctor was even consulted in the first place.

A better way to assess the number who may have died from the impact of coronavirus is to look at excess mortality. That is how many more deaths above the average a country has recorded. If the number dying is above the seasonal norm, it may indicate people are dying from the impact of a disease like coronavirus.

The true death rate is not expected to be known for some time, possibly many years, until researchers have had a chance to look at how many people in communities all around the world have really died from coronavirus-related symptoms.

Worst for cases

The country with the highest number of cases is, again, the US. More than 2.5 million people have tested positive for coronavirus across the country.

But, as with deaths, it is not the country with the highest number of cases that has been the worst affected.

This is where things get tricky.

The reason why is because the extent to which a country records positive cases is entirely dependent on the scale of its testing operation.

To confirm its number of cases, the US carries out 1,650 tests a day per million people, according to OurWorldInData. By contrast, India, which has recorded around 548,000 cases, carries out fewer than a tenth of that number of tests each day – just 147 tests/million.

And of course, the fewer tests a nation carries out per head, the fewer positive tests they will find.

Not all countries publicise how many tests they carry out. The figures for many African countries, for example, are unknown.

It makes it very hard to know exactly how widespread coronavirus is in a community.

Chile and Peru have recorded hundreds of thousands of cases and have rates of infection, in the case of Chile, many times that of the UK. But Chile has relatively high rates of testing and Peru has a relatively low rate, so it can be difficult to work out which is reporting the most accurate figures.

Many African countries are have so far reported lower levels of infection than the rest of the world but considering the levels of testing are likely to be low, the accuracy of their figures is also hard to gauge.

Which countries are getting worse now

The best way to look at which countries are getting worse and which are getting better is to look at the numbers testing positive in the last two weeks.

But even this can be skewed by the numbers being tested. If a country suddenly increases its testing, it is likely to see a jump in cases unless the level of infection is dropping to the same degree.

Nonetheless, some clear trends are apparent, with India, Ivory Coast, Honduras, Argentina, Colombia, South Africa, Morocco and Bolivia all seeing large rises in the numbers of people infected.

Other countries have also recorded sharp rises but in some of those cases the numbers testing positive are so small, compared to the populations, that they may not be statistically significant to be regarded as safe.

It is not until the level of testing in parts of Africa, for example, starts to rise that statisticians are likely to feel confident that accurate figures are being recorded.

The countries that appear to be seeing the biggest drops in cases – the UK, Ireland, France, Italy and Canada for example – are among those which were hit by the outbreak earlier.

But it is not known if there is going to be a second wave around the world. There are signs in the US and in Iran, for example, that this has already occurred, with a surge in cases after initial lockdowns began to be lifted.

Lockdowns work but so does test and trace

The countries that have fared best in terms of deaths are all those which employed an effective test and trace system or a muscular lockdown, or both.

China has seen one of the lowest death rates in the world, after being the original epicentre of the outbreak.

While the Chinese authorities have been criticised for the slowness of their response, as soon as it was apparent that the disease was spreading rapidly in the Wuhan region movement was banned and citizens ordered to stay indoors.

They then set about monitoring the movements of everyone who they viewed could allow the virus to spread.

Authorities in Singapore, South Korea and Iceland were not so draconian but early on imposed a test and trace system that allowed them to quickly close down any clusters and to isolate and treat those who needed it.

All four countries have seen fewer than 1 in 200,000 of their citizens die.

In contrast, countries like the US and Brazil were slow to accept the need to take positive action to control the virus. Both countries also have decentralised health systems, which make coordination of a national response harder.

They have gone on to be the two countries with the highest number of COVID-19 patients in the world.

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