Covid-19 Pandemic; observations thus far.

There have been more than 10 million cases and more than 500,000 deaths worldwide due to Covid-19 as of today. It is nearly impossible from the new cases and death numbers that are presented even by respectable sites for someone to reach a conclusion on how Covid-19 pandemic compares those in the past.  The cultural differences among people and the enormous variation of lockdowns, from very strict to light to mini make comparisons very difficult.  The examples below provide us with information on how four distinct populations fared due to their unique characteristics.

On the cruise vessel Diamond Princess 3,618 tests were performed on 3,711 people (2,666 passengers and 1,045 crew).  712 of the tests or 19% were positive. Half of those tested had symptoms while half were asymptomatic. There were 14 deaths.  The death rate of the entire cohort (crew + passengers) was 0.37% while the death rate among those who tested positive, who were likely elderly, it was 2%.  In a brief report has been published in the Journal of Emerging Infectious Diseases, the interested reader, can find epidemiological information regarding Covid-19 in a group of people who were isolated in close proximity within the confines of a vessel. The passengers and crew were quarantined in Yokohama, Japan and the lockdown was total. 

In the State of Ohio 787,929 tests were performed, of which 52,419 or 6.7% of which were positive. There were 2,890 deaths.  The death rate for the 10 million inhabitants is 0.03%.  The death rate is 6% among those who tested positive.  Ohio enacted what I consider a light lockdown.

In Greece a total of 308,392 tests were performed of which 3,409 or 1.11% were positive.  There were 192 deaths.  The death rate from Covid-19 among the 10 million inhabitants is 0.002%.  The death rate is 6% among those who tested positive.  Greece enacted a strict lockdown. 

In Sweden a total of 444,600 tests were performed and 68,451 or 15 % were positive.  There were 5,333 deaths.  The death rate from Covid-19 among the 10 million inhabitants is 0.05% while it is 8% among those who tested positive.  Sweden enacted a mini lockdown allowing its inhabitants to continue their lives as in the past forbidding only gatherings of more than 50 people.

The cultural differences among people and the enormous variation of lockdowns from very strict to light to minimal make comparisons near impossible.  Also, the way different societies care of their elders and those at risk varies not only between countries but also between big cities and small villages within the same country.  The three above mentioned countries have near identical populations (10 million) but fewer than 10,000 elderly are housed in nursing homes in Greece a country in which the elderly are cared at home.  Approximately 30,000 elderly are in nursing homes in Sweden to more than 100,000 in Ohio.  Also, the number of people incarcerated differs as well, from approximately 6,000 in Sweden to 10,000 in Greece to 50,000 in Ohio.  Finally, risk factors such as smoking is more prevalent in Greece while obesity is more prevalent in Ohio. 

In the past 6 months we have learned that certain practices such as social distancing, avoidance of crowded places and wearing masks, the practice of respiratory etiquette and other hygienic practices such as washing hands are effective.  Intense early testing and contact tracing in the early phase of the epidemic have been employed successfully by several Asian countries such as Singapore, S. Korea and Taiwan.   We also learned that strict infection control measures at hospitals, nursing homes, meat processing facilities, prisons and cruise ships are necessary. 

We now know that locking down entire countries adversely impacts economies.  McKinsey's researchers estimate that government deficits could reach $30 trillion by 2023.  Stanford University's epidemiologist John Ioannidis believes that the infection fatality rate (IFR) of Covid-19 can vary from less than that of Influenza to ten times more.  It all depends on case mix, how patients are treated and what age group is infected.  It is known that almost 80% of the deaths are individuals over the age of 80 or those with poor health due to risk factors.  Since several countries  such as Taiwan, Singapore, S. Korea and Japan have dealt successfully with the viral epidemic, hopefully the rest of the countries can decrease their fatality rate if a second or more waves take place. (In the picture the US daily fatality rate as depicted in a NYT article)