Sunday, 22 March 2020

Most European countries are on a similar coronavirus trajectory to Italy and the projected numbers of deaths world-wide are deeply sobering

If you are in any doubt that coronavirus is a very serious problem then please read this. 

One of the striking features of the COVID-19 pandemic has been the different trajectories of spread in different countries.  

The epidemic started in China but after 81,000 cases and just over 3,200 deaths there have been no domestically acquired cases there in the last three days. The danger now for China is for the virus to come back to the country from overseas but it seems to have the virus well under control.

China’s remarkable success in controlling the virus is documented in the Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) dated 16-24 February. You can read the whole report here but there is an excellent summary here (much more detail in my previous post here).

By contrast, in Italy the number of new cases is increasing exponentially. Italy has 7,500 deaths to China’s 3,200 but on a population basis Italy has 1,230 cases per million population to China’s 56.

In fact, of the 198 countries and territories now with coronavirus, 72 of them have more cases than China when measured in cases per million population. This 72 includes most of the countries in Europe.

Eastern countries like Singapore, Taiwan, South Korea, Hong Kong and Japan are on a similar trajectory to China (see blue lines in graph below) – but most Western countries are following the pattern of Italy (see also here). The Financial Times has an illuminating series of graphs demonstrating this. 

The World Health Organisation’s top emergency expert, Mike Ryan, speaking on 22 March on the BBC’s Andrew Marr Show, said that movement restrictions and lockdowns are not enough to control spread of the virus (video here).

‘What we really need to focus on is finding those who are sick, those who have the virus, and isolate them, find their contacts and isolate them,’ Ryan told Marr (see my previous post on the importance of testing here).

Much of Europe and the US, have introduced drastic restrictions on travel for non-essential workers, many of whom are now working from home, while schools, bars, pubs and restaurants have also been closed.

However, Mr Ryan said he believed these countries need to follow the example of countries like China, Singapore and South Korea, where these restrictions had been coupled with rigorous measures to test people suspected of having the virus.

‘Once we've suppressed the transmission, we have to go after the virus. We have to take the fight to the virus,’ Mr Ryan added.

As I argued last week, the failure of countries like the US and UK, has been not having enough testing kits to identify those infected. The UK is testing about 10,000 people a day while China was producing 1.6 million testing kits per week at the height of their crisis.

Singapore, like China, has a sophisticated and extensive contact tracing programme, which follows the chain of the virus from one person to the next, identifying and isolating those people - and all their close contacts - before they can spread the virus further.

As of 26 March, Singapore had confirmed 631 cases and no deaths. For about 40% of those people, the first indication they had was the health ministry telling them they needed to be tested and isolated.

In total, 6,000 people have been contact-traced to date, using a combination of CCTV footage, police investigation and old fashioned, labour-intensive detective work - which often starts with a simple telephone call.

By contrast, in the UK, we failed to do this in the early stages allowing the virus to steal a march on us.

Now, because of the lack of resources to check anyone other than hospitalised cases, we have junior doctors being quarantined at home for two weeks simply because their child has a cold – when a simple test could clear them to go back to work.

Similarly, potentially infected healthcare staff, who haven’t been tested because we lack the resources to test them, are at risk of spreading the virus around the wards.

We also have no way of knowing (because we are not testing) just how many cases there are in the UK overall or who has it and who doesn’t. Official figures show around 9,500 but government advisor Patrick Vallance admitted last week that the real number was closer to 55,000. Given the number of deaths in the UK already it may be much higher.

The best indication we really have of the seriousness of coronavirus in any given country currently is the  number of deaths, but as death occurs on average 14 days after first symptoms (in those who die) this leaves us a long way behind the curve and means that any interventions we make may take some time to have effect.

The number of deaths so far may seem quite small - only 21,000 in total globally by 26 March - but as can be seen from the numbers opposite (source here) the number of deaths per day increased from 100 to 1,600 in sixteen days between 5 and 21 March. This amounts to a doubling of numbers every four days, or a 19% increase daily. From 21 to 26 March the average daily increase was 10%.

If this trend were to continue, and I realise this is a big if because of the large number of potentially confounding variables not least interventions by governments, then a 10% daily increase globally would result in 41,000 deaths worldwide by 31 March, 100,000 by 9 April, one million by 3 May, two million by 10 May, five million by 20 May, ten million by 27 May and 15 million by 31 May.

So it is May when the increase will really kick in if we fail to stop it. The increases beyond this do not bear thinking about. I have put the figures in a chart below. 

These numbers will of course be mitigated by preventive measures like rigorous testing, tracing and isolation - or by social distancing and lockdown - but this dramatic increase in numbers over time is the frightening effect of a 10% increase in daily death rates on the total number of deaths globally.

This is not scaremongering. This is simply what the maths shows – and is what happens when a virus that is as contagious as Ebola and 30 times more deadly than the flu (with a mortality rate of 3.0-3.4% according to the WHO – detail here) is allowed to establish itself in a population.

Unless curbed this will simply overwhelm our health systems with far more patients requiring oxygen and ventilators than we have capacity for.

This is why it is so crucial that we all play our part – for our leaders to get the policy right and resources right and for all of us to help make it work. But we are also going to need some supernatural help to beat this – more on that later.

The table below is based on a 10% daily increase in global deaths. The actual increase from 5 to 21 March was 19% daily and 10% daily from 21 to 26 March.

Date Daily deaths at 10% daily increase Total deaths at 10% daily increase  Actual Daily deaths Actual total deaths 
21/03/2020 1,600 13,000 1,634 13,013
22/03/2020 1,760 14,760 1,626 14,647
23/03/2020 1,936 16,696 1,873 16,154
24/03/2020 2,130 18,826 2,381 18,894
25/03/2020 2,343 21,168 2,390 21,284
26/03/2020 2,577 23,745 2,791 24,073
27/03/2020 2,834 26,579 3,217 27,344
28/03/2020 3,118 29,697 3,518 30,862
29/03/2020 3,430 33,127 3,105 33,966
30/03/2020 3,773 36,900 3,723 37,788
31/03/2020 4,150 41,050 4,535 42,309
01/04/2020 4,565 45,615    
02/04/2020 5,021 50,636    
03/04/2020 5,524 56,160    
04/04/2020 6,076 62,236    
05/04/2020 6,684 68,920    
06/04/2020 7,352 76,272    
07/04/2020 8,087 84,359    
08/04/2020 8,896 93,255    
09/04/2020 9,785 103,040    
10/04/2020 10,764 113,804    
11/04/2020 11,840 125,644    
12/04/2020 13,024 138,669    
13/04/2020 14,327 152,996    
14/04/2020 15,760 168,755    
15/04/2020 17,336 186,091    
16/04/2020 19,069 205,160    
17/04/2020 20,976 226,136    
18/04/2020 23,074 249,209    
19/04/2020 25,381 274,590    
20/04/2020 27,919 302,509    
21/04/2020 30,711 333,220    
22/04/2020 33,782 367,002    
23/04/2020 37,160 404,163    
24/04/2020 40,876 445,039    
25/04/2020 44,964 490,003    
26/04/2020 49,460 539,463    
27/04/2020 54,406 593,869    
28/04/2020 59,847 653,716    
29/04/2020 65,832 719,548    
30/04/2020 72,415 791,963    
01/05/2020 79,656 871,619    
02/05/2020 87,622 959,241    
03/05/2020 96,384 1,055,625    
04/05/2020 106,023 1,161,648    
05/05/2020 116,625 1,278,273    
06/05/2020 128,287 1,406,560    
07/05/2020 141,116 1,547,676    
08/05/2020 155,228 1,702,903    
09/05/2020 170,750 1,873,654    
10/05/2020 187,825 2,061,479    
11/05/2020 206,608 2,268,087    
12/05/2020 227,269 2,495,356    
13/05/2020 249,996 2,745,351    
14/05/2020 274,995 3,020,346    
15/05/2020 302,495 3,322,841    
16/05/2020 332,744 3,655,585    
17/05/2020 366,018 4,021,603    
18/05/2020 402,620 4,424,224    
19/05/2020 442,882 4,867,106    
20/05/2020 487,171 5,354,277    
21/05/2020 535,888 5,890,165    
22/05/2020 589,476 6,479,641    
23/05/2020 648,424 7,128,065    
24/05/2020 713,267 7,841,332    
25/05/2020 784,593 8,625,925    
26/05/2020 863,052 9,488,977    
27/05/2020 949,358 10,438,335    
28/05/2020 1,044,293 11,482,628    
29/05/2020 1,148,723 12,631,351    
30/05/2020 1,263,595 13,894,946    
31/05/2020 1,389,955 15,284,901    


  1. I think you should watch this 9 min interview with a German specialist so as not to be accused of fueling economic and societal collapse

    God bless

    1. I've watched it. Not impressed I'm afraid. He is of course correct that the elderly and infirm are most vulnerable to COVID-19.

      But he then argues that mortality rates are high in Italy because the Italians have high levels of air pollution and because there are lots of Chinese people there.

      He then goes on to say that those succumbing to the virus would have died anyway and that no more than 30 people a day in Germany are going to die.

      He also argues that none of the measures being put into place around the world to contain the spread of the virus are necessary.

      He is I'm afraid out of touch with reality on this.

      As I say above this virus is as contagious as Ebola and 30 times more deadly than the flu (with a mortality rate of 3.0-3.4% according to the WHO).

      He needs to take a visit to hospitals in Italy and Spain and observe first-hand how health services are being overwhelmed there.

  2. Thanks for the response. However surely what the professor says is that n italy is THE China of Europe NOT that Chinese are living in N Italy? I checked out his claim and, indeed, N Italy has some of the worst pollution in Europe. Maybe you could help me with something? Why has the government downgraded C-19
    from highly infectious YET instituted a lockdown?

    1. I really don't see how higher air pollution would account for the figures in Italy especially given that the US and Spain are now rapidly following the same trajectory. The daily deaths are now rising in Germany - over 40 yesterday - so his prediction of 30 deaths daily for 100 days is already looking dodgy. But if you are still convinced by him then just watch what happens over the next two weeks. Since I originally wrote this on 22 March total deaths have gone from 13,000 to 21,000 in just four days.

    2. The lockdown is because of the predicted increase in cases swamping the capacity of the NHS. I'm not sure I would have called coronavirus highly infectious. It is thankfully much less infectious (easy to catch) than chickenpox or measles.

    3. You can follow German deaths here -

      You will see that they are already increasing exponentially on a daily basis far above the professor's prediction.

  3. I forgot to say how much I respect you for all your efforts in the cause of Christ. I saw you in Wales at a Christian holiday camp 9? Years ago and all of us were impressed by you. We were with a PhD Cambridge zoologist at the time and she distinctly gave voice to all of us calling you a "hero"

    1. Thank you but I'm not sure I have ever been to a Christian holiday camp in Wales.

  4. Prof Walter Ricciardi claims that Italy's death rates from covid-19 have been inflated by 88%!!

    1. That makes him sound even more like a conspiracy theorist. What does he think about Spain and the US I wonder.

  5. I originally wrote this article using figures based on a 19% daily increase of global deaths as this was the daily increase between 5 and 21 March.

    From 21 to 25 March the average daily increase of deaths fell from 19% to 10%. This makes a massive difference to projections but with this modified rate there would still be 15 million deaths globally by the end of May.

    Of course this is also speculative as we do not know yet what will happen to the daily increase as widespread social distancing, quarantining and the tracing of contacts takes place.

  6. On 27 March there were 3,271 new deaths making a total of 27,344 deaths globally. This is ahead of our figures above and represents a 12% daily increase in global deaths since 21 March.

    If this rate continues we would expect to hit 100,000 total global deaths by 7 April not 9 April.

    1. Do you believe confining the entire British pop under indefinitely house arrest is a grave infringement of civil liberties when (a) it is not a hiid and therefore has no high fatality rate (b) Lord Sumption calls it a gross infringement on liberties (c) 2/3 of those who die from c-19 would have died this year from other causes (Prof Ferguson?) anyway? How do measure the cost in business closure, unployment, lost education, homeless Ness, lonely elderly people, etc.

      Thanks for previous replies. God bless

  7. Have you read the NHS Prof John Lee article in the Spectator online: evidence on covid 19 is not as clear as we think? He also questions the fatality rates etc

  8. I should clarify and be more precise. Uk government says as of March C-19 not high case infectious disease. There fore not easily spread in community, health care settings and no high case fatality rate!! Yet lockdown and economic catastrophe??!!

  9. The daily increase in deaths and the total number still fit with a 10% daily increase after ten days from 21 to 31 April. So we are still on course for 100,000 deaths by 9 April, one million by 3 May, two million by 10 May, five million by 20 May, ten million by 27 May and 15 million by 31 May. Of course the current measures to flatten the curve may well have a big effect on this.

  10. The daily increase in deaths globally is now definitely beginning to taper off. Lockdown measures are working in curbing the rate of spread of the infection.

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